The three core public health functions (assessment, policy, and assurance) rest upon the foundation of the public health sciences of epidemiology and biostatistics. Well-constructed epidemiologic studies provide information about environmental risks and inform interventions and public health policies. Large, long-term cohort studies focusing on chronic diseases are often the best method to identify excess risk due to specific environmental exposures. One strength of a cohort study is the ability to characterize exposures and risk factors before disease onset, eliminating a bias that may be present with other study designs. Long-term cohort studies, however, require considerable resources and a strong commitment by community members participating in the study. Creating partnerships with the community is a critical step in designing successful epidemiologic research efforts that inform both interventions and policies. Community context is also vital to understanding appropriate and targeted recruitment and data collection methods for a selected community.
This pilot study was part of a planning process to develop a long-term epidemiologic cohort study that would examine exposures and risk factors for chronic diseases in rural communities throughout New Mexico. The state has a unique and diverse population that is approximately 47% Hispanic, 40% non-Hispanic white, 10% American Indian, and 3% other race/ethnicity (U.S. Census Bureau, n. d.). Although New Mexico is culturally rich, it is consistently ranked as one of the 10 poorest states in the U.S. About 30% of residents live in rural areas (U.S. Census Bureau, 1995), often with limited healthcare facilities. Chronic health conditions in New Mexico, such as diabetes, obesity, heart disease, and certain cancers vary widely among racial and ethnic groups. For those with these chronic conditions, racial and ethnic groups other than non-Hispanic whites often have higher mortality (New Mexico Department of Health, 2013).
The purpose of this pilot project was to examine the attitudes, beliefs, and concerns of rural-dwelling adults towards participating in a longitudinal cohort study, and to assess factors that contribute to willingness to participate. Focus groups were held in the Grants Mining District to discuss the possibility of implementing a long-term cohort study with blood samples to study chronic diseases in rural communities throughout New Mexico. The Grants Mining District was chosen for this pilot study because of its rural nature, cultural diversity, and local availability of healthcare providers and facilities, as well as the considerable historical uranium mining activity (Figure 1). Using this community-engaged approach, the research team hoped to gain important information to maximize acceptance of and participation in a future long-term research cohort study.
Context: Grants Mining District, New Mexico
The Grants Mining District (also referred to as the Grants Mineral Belt) is primarily in Cibola and McKinley Counties, but also includes portions of Sandoval and Bernalillo Counties, as well as tribal land, and is located off Interstate 40 between Albuquerque and Gallup. The Grants Mining District was the primary focus of uranium extraction and production activities in New Mexico from the 1950s until the late 1990s. With the decline and eventual end in mining came a rise in unemployment and a decline in the population as many miners and their families left.
There are 97 legacy uranium mines in the Grants Mining District (U.S. Environmental Protection Agency [U.S. EPA], 2011) and a number of mill sites where chemicals were used to extract uranium and make "yellowcake," a powder that can be processed into fuel for nuclear reactors. By-products of milling include a sandy waste containing heavy metals and radioactive radium (U.S. Nuclear Regulatory Commission, 2015). The Jack-pile-Paguate mine on the Pueblo of Laguna was once the world's largest open pit uranium mine (Figure 1), and it was placed on the National Priorities List of Superfund sites in December 2013. Assessment of health and environmental impacts of uranium...