Review Developing a Bidirectional Academic–Com munity Partnership with an Appalachian-American Com munity for Environmental Health Research and Risk Com munication Erin N. Haynes,1 Caroline Beidler,2 Richard Wittberg,2,3 Lisa Meloncon,4 Megan Parin,1 Elizabeth J. Kopras,1 Paul Succop,1 and Kim N. Dietrich1 1Department of Environmental Health, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA; 2Neighbors for Clean Air, Marietta, Ohio, USA; 3Mid-Ohio Valley Health Department, Parkersburg, West Virginia, USA; 4Department of English and Comparative Literature, College of Arts and Sciences, University of Cincinnati, Cincinnati, Ohio, USA Background : Marietta, Ohio, is an Appalachian-American community whose residents have long struggled with understanding their exposure to airborne manganese (Mn). Although community engagement in research is strongly endorsed by the National Institutes of Health and the National Institute of Environmental Health Sciences in particular, little has been documented demonstrat- ing how an academic–community partnership that implements the community-based participatory research (CBPR) principles can be created and mobilized for research. o Bjectivs : We created a bidirectional, academic–community partnership with an Appalachian- American community to a) identify the community’s thoughts and perceptions about local air qual- ity, its effect on health, and the perception of risk communication sources and b) jointly develop and conduct environmental health research. Methods : We formed a community advisory board (CAB), jointly conducted pilot research stud- ies, and used the results to develop a community-driven research agenda. r esult : Persons in the community were “very concerned” to “concerned” about local air quality (91%) and perceived the air quality to have a direct impact on their health and on their children’s health (93% and 94%, respectively). The CAB identified the primary research question: “Does Mn affect the cognition and behavior of children?” Although the community members perceived research scientists as the most trusted and knowledgeable regarding risks from industrial emissions, they received very little risk information from research scientists. words c onclusi : Engaging a community in environmental health research from its onset enhanced the quality and relevance of the research investigation. hTe CBPR principles were a useful frame - work in building a strong academic–community partnership. Because of the current disconnect between communities and research scientists, academic researchers should consider working collaboratively with community-based risk communication sources. k ey : academic–community partnership, air quality, Appalachian American, community advisory board, community-based participatory research, manganese, risk perception. Environ Health Perspect 119:1364–1372 (2011). http://dx.doi.org/10.1289/ehp.1003164 [Online 16 June 2011] a partnership between an academic institu­ tion and a concerned community group in an Appalachian­ American community. Here we describe how the partnership developed into a large­scale epidemiologic investiga ­ tion that was driven by the concerns of the Appalachian community. We begin from the perspective of the community partner. Perspective from the community part- ner. It’s 2:00 in the morning, and the second author (C.B.) is awakened by a bitter metallic taste in her mouth. She and her husband just completed construction of their dream home on a hilltop that overlooks the scenic Mid­ Ohio River Valley in Marietta, Ohio. The bitter taste in her mouth was but one recur­ ring symptom that she would experience, and Caroline was not alone. Other residents also experienced headaches, burning eyes, fatigue, muscle aches, tremors, and nose bleeds. The Mid­ Ohio River Valley is also home to an industrial corridor, including a ferromanga­ nese refinery—Eramet Marietta Industries Inc. (EMI; Marietta, OH). Until recently it was the only ferromanganese refinery in the United States, and it has released thousands of pounds of manganese (Mn) into the Marietta airshed [U.S. Environmental Protection Agency (EPA) 2009]. The > 50y­earo­ld c om­ pany leads the nation in fugitive airborne Mn emissions. When driving past the refinery, the smell would force community members to roll up their windows, and they immediately turned on their windshield wipers to clear away the “toxic mist.” Concerned about air pollution, community members formed Neighbors for Clean Air (NCA), a nonprofit citizen action group. NCA mobilized to track smells by Address correspondence to E. Haynes, University of Cincinnati Medical Center, P.O. Box 670056, Cincinnati, OH 45267­ 0056 USA. Telephone: (513) 558­ 5427. Fax: (513) 558­ 4838. E­ mail: Erin. Haynes@uc.edu We thank P. Kuhnell for his assistance in con­ structing the figures. This study was supported by grants from the National Institute of Environmental Health Sciences (1R21ES013524­ 02, 5T32ES10957, R01ES016531, R03 HD059615­ 01, and P30­ES06096 ). C.B. and R.W. are members of Neighbors for Clean Air. The other authors declare they have no actual or potential competing financial interests. Received 3 November 2010; accepted 16 June 2011. ovlume 119 | number 10 | October 2011 • Environmental Health Perspectives Environmental health issues are prevalent and persistent in numerous communities across the United States, and particularly in dis­ advantaged communities. Participation by communities throughout the research process has been encouraged by the National Institute of Environmental Health Sciences (NIEHS), which recently initiated the Partnerships for Environmental Public Health (PEPH) umbrella program (Birnbaum 2009). The pro­ gram goal of the PEPH is to engage commu­ nities in all stages of research, outreach, and educational activities to prevent, reduce, or eliminate environmental exposures that may lead to adverse health outcomes with particu­ lar emphasis on populations at highest risk. The program was founded based on the earlier reports from the NIEHS (O’Fallon and Dearry 2001; O’Fallon et al. 2003) that emphasized its role in supporting communitye­ngaged envi ­ ronmental health research through community­ based participatory research (CBPR) (Israel et al. 2001; Minkler and Wallerstein 2003; O’Fallon and Dearry 2002). CBPR is defined as “a methodology that promotes active 1364 community involvement in the processes that shape research and intervention strategies, as well as in the conduct of the research studies” (O’Fallon et al. 2000). The NIEHS endorses six guiding principles of CBPR: a) promote active collaboration and participation at every stage of research, b) foster colearning, c) ensure projects are community driven, d) ensure research and intervention strategies are cultur­ ally appropriate, e) define community as a unit of identity, and f ) disseminate results in useful terms (O’Fallon and Dearry 2002). The recognition that environmental health science research is enhanced through the implementation of the CBPR principles is gaining momentum (Brody et al. 2009; Brown et al. 2006; Minkler et al. 2008; Olden 1998; Quandt et al. 2001; Vásquez et al 2006; Wing et al. 2008); however, there remains a gap in the literature describing the implementation of CBPR principles in the process of devel­ oping a bidirectional academic–community partnership. The purpose of this article is to document how the CBPR principles were used to build