The methods for conducting the pilot research study are described elsewhere (Haynes et al. 2010). The CAB was strongly instrumental in the conduct of the pilot research study. CAB members helped iden­ tify potential locations for the study and recruitment methods, thereby building on the strengths and resources of the commu­ nity in a collaborative research process. Their involvement resulted in the development of the Community Profile Survey (CPS), used to identify potential study participants. As described by Haynes et al. (2010), the CPS collected demographic information includ­ ing age, years lived in Marietta, number of children, occupation, former residential addresses, and length of time lived at those former residences. The CAB members also distributed the CPS throughout the commu­ nity. Given the NCA director’s high profile within the community, potential participants also called her home to inquire about the research study and complete the CPS over the phone. During the pilot, interest about the study spread through the community by word of mouth, and potential participants arrived during the studyt­esting days. These walki­ns completed the CPS and were screened for eligibility. All participants signed a UC IRB approved consent or assent form before data collection. The results of the pilot study have been reported previously (Haynes et al. 2010; Standridge et al. 2008). Results of the Community-wide Survey The survey was completed by 271 respondents. We excluded individuals who returned a sur­ vey and reported living outside of Washington County (n = 42). Thus, 229 respondent results were analyzed. Community concern about local air quality. The overwhelming majority of survey respondents were “very concerned” to “con­ cerned” about the quality of the air (91%), quality of the water (85%), and quality of the soil (74%) as opposed to reporting “slight con­ cern” to “no concern” about air quality (5%), water quality (7%), and soil quality (5%; Table 1). A high percentage of survey respon­ dents were also “concerned” to “very con­ cerned” about the odor in the local air (75%) Table 1. Respondents’ concern about local environ­ ment, odor, and Mn exposure (n = 227–229). Local environmental concern Air Water Soil Odor (smell) in air Mn exposure Very concerned to concerned Slightly to not Neutral concerned 209 (91) 193 (85) 168 (74) 172 (75) 175 (77) 8 (3) 19 (8) 33 (15) 30 (13) 25 (11) 12 (5) 15 (7) 25 (5) 26 (12) 27 (12) Data represent number of respondents (%). compared with only 12% who were reportedly “slightly concerned” to “not concerned” about the odor in the community’s air. Additionally, 77% (n = 175) were “concerned” to “very con­ cerned” about Mn exposure in their commu­ nity as opposed to only 27 respondents (12%) who were not concerned. Risk perception. The community respon­ dents perceived air quality to influence their health (93%) and the health of their chil­ dren (94%; Table 2). They also perceived the amount of Mn to affect their health (71%) and the health of their children (73%). In addition, they also reported an association of symptoms with the quality of air (Figure 1). We asked them if they thought particular health symptoms or conditions became worse when the quality of air became worse. The vast majority (≥ 75%) perceived health symp­ toms (asthma, throat irritation, headaches, difficulty breathing, stuffy nose, shortness of breath, sore throat, cough, eye irritation, and cancer) became worse when the quality of air became worse (Figure 1). Other symptoms strongly perceived to be related to air quality included mood/depression, fatigue, decreased school performance in children, and decreased work performance (Figure 1). The community was predominantly “not sure” if falls, hand Table 2. Air quality risk perception and willingness to participate in a research study (n = 189–229). Respondents’ perception of risk Air quality affects your health Amount of Mn in the air affects your health Likelihood of participating in a research study Air quality affects your child’s health Amount of Mn in the air affects your child’s health Likelihood of allowing your child to participate in a research study Data represent number of respondents (%). Academic–community partnership in Appalachia tremor, and kidney damage were related to air pollution. When asked if Mn specifically contributed to health symptoms, > 57% of all respondents were “unsure” if the amount of Mn in the air affected their health or their children’s health (data not shown). Survey participants were asked to rate their level of understanding of Mn exposure in their community. Only 11% reported “a lot,” whereas 22% reported “no” understand­ ing. When asked if they wanted to learn more about their potential exposure to Mn, 87% reported “yes,” nine (4%) reported “no,” and 8% reported “don’t know” (data not shown). Barriers to improving air quality. The survey participants were asked to identify the barriers they believed their community faced to improve their local air quality. They could select all options that applied or respond “other.” On average, each respondent selected four of the options. The leading barriers per­ ceived in the community included “fear of impact on economy” (88%, 197 of 224), lack of enforcement from federal government (77%, 173 of 224), lack of research related to quality of air and health (63%, 142 of 224), and lack of enforcement from local government (59%, 132 of 224; data not shown). Twentyt­wo per ­ cent (50 of 224) responded “other,” some of Extremely likely to likely Unlikely to Not sure extremely unlikely 212 (93) 163 (71) 175 (77) 214 (94) 167 (73) 120 (63) 7 (3) 55 (24) 41 (18) 5 (3) 52 (23) 41 (22) 10 (4) 11 (4) 12 (5) 9 (4) 10 (4) 28 (15) 100 90 80 s tne 70 d pon 60 s e fro 50 e tag 40 n e rc 30 e P 20 10 0 No Don’t know Yes tshaAm iiittrryoanEe iiitttrrraonaohT secaheadH guohC ilittfryhangucﬁbeD tftrrsseaenhoobhS tffysnoeuS ttrrhoaoeS itFague llFsa trreoandHm irsseondodoepM iilttyobA ttranecocne racneC rkow cena Figure 1. Health symptoms or conditions perceived to become worse when the quality of air is worse (percentage of survey respondents indicating each symptom or condition). e looh ecn g iyaaeddnKm rsscedaeceD frraoepm rsedceaeD frropem Environmental Health Perspectives • volume 119 | number 10 | October 2011 1367