Community Cancer Prevention in Knights Landing
By Benjamin Sipes
Agricultural landscapes surround the rural community of Knights Landing, located just northwest of Sacramento, California. Dust laden with pesticides drifts from the agricultural fields into the town, and water from the fields, which contains pesticides and other chemicals, seeps into the ground water. Residents of Knights Landing are noticing peculiarly high instances of cancer, which may be a result of exposure to these agricultural chemicals. Several of the roughly 1,000 people that live there work on the surrounding farms, which certainly puts them at higher risks for these exposures, but it is not just the field workers who seem to be affected.
Concerns have been building in the community, but because of their relatively small size and status as an unincorporated community, the Knights Landing lacks the resources and political power for action. They seek support from the state government to investigate the high prevalence of cancer and to provide Knights Landing with the resources to prevent exposure to carcinogens. Seeking answers, they contacted Dr. Deeb-Sossa, an associate professor in the Chicana/o studies department at the University of California, Davis. They expressed that their community has not received attention for their increasingly grave plight, and urged someone to step in.
When Skye Kelty, a graduate student working on her Ph.D. in toxicology and pharmacology, heard about Knights Landing in her Community-Based Participatory Research (CBPR) class, she was immediately interested. And so began the series of events that has led Skye and her colleague Alfonso Aranda, a graduate student in health and medical geography, to investigate the potential environmental risks contributing to the prevalence of cancer in Knights Landing.
What makes Skye different from many other environmental health researchers is her commitment to a community-engaged project: while many toxicologists study certain chemicals in the confines of a laboratory, Skye also works actively with the community to answer the questions that they need answered. Her research focuses on the chemical naphthalene, a volatile organic compound produced from combustion (cars and cigarettes, for example) with numerous negative health effects, one of which may be cancer. But Skye’s question goes deeper—if naphthalene produces these health risks alone, what happens when arsenic, pesticides, and nitrates are present as well?
By building their scientific method around the community’s experience, Skye Kelty and her team have developed a project that not only investigates how precise combinations of harmful chemicals influence the occurrence of cancer and other diseases, but also aims to empower project participants and ultimately improve the health and well-being of the Knights Landing community.
Environmental health has been a concern for Skye since she was a kid growing up by the beach in Los Angeles. She regularly enjoyed going to the ocean to swim but found herself often distressed by the trash that ended up there. “I started to realize that anything that we put out as humans into the environment all ends up at my beach at some point,” she says. Even at her early age, Skye began organizing people to help her pick up trash on the streets and by the ocean, hoping to make the water a safer place for everyone to enjoy.
As she grew up, Skye’s concern with environmental health hazards continued, and she became increasingly troubled by the prevalence of cancer. Instead of investing herself in looking for a cure, however, she decided to study the environmental conditions that cause cancer in hopes to prevent them. Attending Rice University in Houston, Texas, she studied a variety of disciplines including chemistry, environmental science, cellular biology, atmospheric science, and cancer biology. Her goal was to use a broad understanding of many disciplines to aid her research into cancer prevention.
But Skye did much more in Texas than just study. She also became actively involved first in cancer advocacy, and subsequently in environmental advocacy. “I worked with groups in the Houston Ship Channel, specifically TEJAS, the Texas Environmental Justice Advocacy Services,” she says, “They really showed me how to work with communities and I had some amazing advisors.” It was this experience that stimulated her interest in the community-science dialogue.
When the time came to look at graduate programs, she hoped to synthesize her interdisciplinary education at Rice with her community advocacy work with TEJAS. “I was able to find this awesome lab [working with Dr. Laura Van Winkle at UC Davis],” Skye says, “which allowed me to bring in my knowledge of environmental issues to look at small scale cellular biology.” Skye has started her Ph.D. at UC Davis, and she has chosen Knights Landing as her dissertation's focus.
To thoroughly investigate the environmental health conditions in Knights Landing, Skye must utilize a broad array of research methodologies, including some outside her own discipline. Accordingly, she and Alfonso have gathered a team of academic advisors to help them. “We have public health students involved, undergraduates from different disciplines, we have Chicana/o studies advisors, Human Development professors, community members, yolo county health officials and Epidemiology professors are advising us as well,” she says. This team was especially important when Skye faced unforeseen issues with her multidisciplinary approach. “Building that advising team has been a rough process. Luckily, Davis has amazing faculty who are happy to help with these problems.”
Concerns have been building in the community, but because of their relatively small size and status as an unincorporated community, the Knights Landing lacks the resources and political power for action. They seek support from the state government to investigate the high prevalence of cancer and to provide Knights Landing with the resources to prevent exposure to carcinogens. Seeking answers, they contacted Dr. Deeb-Sossa, an associate professor in the Chicana/o studies department at the University of California, Davis. They expressed that their community has not received attention for their increasingly grave plight, and urged someone to step in.
When Skye Kelty, a graduate student working on her Ph.D. in toxicology and pharmacology, heard about Knights Landing in her Community-Based Participatory Research (CBPR) class, she was immediately interested. And so began the series of events that has led Skye and her colleague Alfonso Aranda, a graduate student in health and medical geography, to investigate the potential environmental risks contributing to the prevalence of cancer in Knights Landing.
What makes Skye different from many other environmental health researchers is her commitment to a community-engaged project: while many toxicologists study certain chemicals in the confines of a laboratory, Skye also works actively with the community to answer the questions that they need answered. Her research focuses on the chemical naphthalene, a volatile organic compound produced from combustion (cars and cigarettes, for example) with numerous negative health effects, one of which may be cancer. But Skye’s question goes deeper—if naphthalene produces these health risks alone, what happens when arsenic, pesticides, and nitrates are present as well?
By building their scientific method around the community’s experience, Skye Kelty and her team have developed a project that not only investigates how precise combinations of harmful chemicals influence the occurrence of cancer and other diseases, but also aims to empower project participants and ultimately improve the health and well-being of the Knights Landing community.
Environmental health has been a concern for Skye since she was a kid growing up by the beach in Los Angeles. She regularly enjoyed going to the ocean to swim but found herself often distressed by the trash that ended up there. “I started to realize that anything that we put out as humans into the environment all ends up at my beach at some point,” she says. Even at her early age, Skye began organizing people to help her pick up trash on the streets and by the ocean, hoping to make the water a safer place for everyone to enjoy.
As she grew up, Skye’s concern with environmental health hazards continued, and she became increasingly troubled by the prevalence of cancer. Instead of investing herself in looking for a cure, however, she decided to study the environmental conditions that cause cancer in hopes to prevent them. Attending Rice University in Houston, Texas, she studied a variety of disciplines including chemistry, environmental science, cellular biology, atmospheric science, and cancer biology. Her goal was to use a broad understanding of many disciplines to aid her research into cancer prevention.
But Skye did much more in Texas than just study. She also became actively involved first in cancer advocacy, and subsequently in environmental advocacy. “I worked with groups in the Houston Ship Channel, specifically TEJAS, the Texas Environmental Justice Advocacy Services,” she says, “They really showed me how to work with communities and I had some amazing advisors.” It was this experience that stimulated her interest in the community-science dialogue.
When the time came to look at graduate programs, she hoped to synthesize her interdisciplinary education at Rice with her community advocacy work with TEJAS. “I was able to find this awesome lab [working with Dr. Laura Van Winkle at UC Davis],” Skye says, “which allowed me to bring in my knowledge of environmental issues to look at small scale cellular biology.” Skye has started her Ph.D. at UC Davis, and she has chosen Knights Landing as her dissertation's focus.
To thoroughly investigate the environmental health conditions in Knights Landing, Skye must utilize a broad array of research methodologies, including some outside her own discipline. Accordingly, she and Alfonso have gathered a team of academic advisors to help them. “We have public health students involved, undergraduates from different disciplines, we have Chicana/o studies advisors, Human Development professors, community members, yolo county health officials and Epidemiology professors are advising us as well,” she says. This team was especially important when Skye faced unforeseen issues with her multidisciplinary approach. “Building that advising team has been a rough process. Luckily, Davis has amazing faculty who are happy to help with these problems.”
Unlike many other studies investigating environmental health, the community also constitutes an integral part of the expertise that Skye and Alfonso's team requires. Community health advocates called promotoras have proved to be an indispensible asset to Skye’s project by acting as the community experts on the team. Promotoras are lay community health workers who usually live and work in the target community, and therefore have the cultural knowledge and social ties necessary to develop culturally appropriate health interventions. As a result, promotora-led projects often have more sustainable outcomes, and have been increasingly recognized for their capacity to improve access to healthcare resources among marginalized groups.
Given their especially engaged role in the community and health advocacy training, promotoras are well equipped to facilitate the communicatory link between community members and Skye’s academic research team. “They are just normal people who live in this community, and they are really active about community health. So, they have joined our project and are helping design the project, do recruitment and execute a lot of the research outreach,” says Skye.
The first phase of Skye’s project aims to understand the problem from the community’s perspective, and promotoras play a critical role in this process. Each subset of experts therefore can learn from each other: while Skye and her undergraduate assistants are training the promotoras to understand research methods and basic cancer biology, the promotoras use their expertise to organize groups of community members into focus groups that hone in on residents’ problems. Promotoras will also be intimately involved in designing the health survey that the Environmental Health Sciences Center (EHSC) is funding Skye and her team to create. The survey’s goal is to assess qualitatively which chemicals the community finds most concerning.
Skye’s and Alfonso's understanding of the community’s experience goes beyond just surveying them. Alfonso is using a method of CBPR known as “photovoice” to enhance the quality of their qualitative study. Photovoice as a method allows community members to capture elements of their daily life that they believe pose environmental risks, thus giving them a “voice” through the pictures they take. Alfonso will give 20 community members from the focus groups cameras and train them to photograph aspects of their lives that will be helpful in assessing real environmental threats. “In a rural area, we have no idea what kind of exposures are out there, so they are really the experts,” Skye says.
The next phase in Skye’s study is to collect biological and environmental samples from Knights Landing. Those who work in the fields are certainly exposed to pesticides, but how much of those pesticides end up in family homes? Dust actively accumulates pesticides, so Skye’s project will sample the dust in many Knights Landing homes. Similarly, the project will sample well water from homes in Knights Landing to test for heavy metals and pesticides. Lastly, Skye will test blood and urine samples from a subsample of community members to measure which toxic chemicals are entering their system.
Collecting these data will propel Skye and her team into the last phase of their project—chemical tests in a basic laboratory. Once she analyzes the composition and concentration of toxins found in community members, the final step is to model those same level of exposures in laboratory animals and measure their effects. “[We will] expose my lab system to realistic exposures and realistic combinations of exposures to see if there are any effects we can detect that might be linked to some of the diseases in the community.”
Many studies investigating environmental health hazards focus on a single toxicant’s effects. However, a variety of toxins influence each other in often unpredictable ways. While Skye’s dissertation specifically focuses on naphthalene, not pesticides, she is using this opportunity to meld together her chemical of interest with the community’s to assess their influence on each other.
Skye believes this integration gives her work more validity, because results obtained from testing naphthalene on only healthy animals is unrealistic to real life exposure. “It is not just super healthy cells or super healthy model systems,” Skye explains, “these people have diabetes, they are exposed to pesticides and water quality issues. So [my work] is really trying to contextualize not just what is happening in a healthy adult, but also what is happening in people that might be more susceptible.”
Ultimately, Skye wants to have a project that is both scientifically valid and helps the community understand many of the problems they face. The relationship between Skye and the community is reciprocal; she helps answer questions about pesticide exposure and water quality, while they help her understand the context of naphthalene in a community. Furthermore, having community members inform her where to sample for potential environmental hazards makes her sampling more specific to their precise concerns and more accurate to the exposure source.
The One Health Clinic that UC Davis runs in Knights Landing helps facilitate Skye’s ability to give back to the community. Once a year, the clinic hosts what they call their “One Health Festival” that offers healthcare and health advice to the greater population of Knights Landing. This festival is where Skye’s team will present the findings from their study, thus answering questions that the people helped generate. “I want to be sure that the work I am doing really is benefiting that community,” she says.
But Skye is not satisfied with just informing the community; she wants to help enact change. “My goal for the whole project,” says Skye, “is to pick five actionable things that we can go into CAL EPA, the Environmental Justice Department, or the Yolo County Health officials.” This information could lead to changes that help to prevent cancer in Knights Landing.
This project represents more than just improving the community of Knights Landing. It is using a method different from how researchers conventionally conduct environmental health research. Skye may not yet have her Ph.D., but she is helping to revolutionize a new way of producing science. By making the community engaged in asking the research questions, designing the research methodology, and interpreting the results, they will obtain results more relevant to that community than through any other form of study. “We really hope we can set an example for how folks can actually do this.”
Given their especially engaged role in the community and health advocacy training, promotoras are well equipped to facilitate the communicatory link between community members and Skye’s academic research team. “They are just normal people who live in this community, and they are really active about community health. So, they have joined our project and are helping design the project, do recruitment and execute a lot of the research outreach,” says Skye.
The first phase of Skye’s project aims to understand the problem from the community’s perspective, and promotoras play a critical role in this process. Each subset of experts therefore can learn from each other: while Skye and her undergraduate assistants are training the promotoras to understand research methods and basic cancer biology, the promotoras use their expertise to organize groups of community members into focus groups that hone in on residents’ problems. Promotoras will also be intimately involved in designing the health survey that the Environmental Health Sciences Center (EHSC) is funding Skye and her team to create. The survey’s goal is to assess qualitatively which chemicals the community finds most concerning.
Skye’s and Alfonso's understanding of the community’s experience goes beyond just surveying them. Alfonso is using a method of CBPR known as “photovoice” to enhance the quality of their qualitative study. Photovoice as a method allows community members to capture elements of their daily life that they believe pose environmental risks, thus giving them a “voice” through the pictures they take. Alfonso will give 20 community members from the focus groups cameras and train them to photograph aspects of their lives that will be helpful in assessing real environmental threats. “In a rural area, we have no idea what kind of exposures are out there, so they are really the experts,” Skye says.
The next phase in Skye’s study is to collect biological and environmental samples from Knights Landing. Those who work in the fields are certainly exposed to pesticides, but how much of those pesticides end up in family homes? Dust actively accumulates pesticides, so Skye’s project will sample the dust in many Knights Landing homes. Similarly, the project will sample well water from homes in Knights Landing to test for heavy metals and pesticides. Lastly, Skye will test blood and urine samples from a subsample of community members to measure which toxic chemicals are entering their system.
Collecting these data will propel Skye and her team into the last phase of their project—chemical tests in a basic laboratory. Once she analyzes the composition and concentration of toxins found in community members, the final step is to model those same level of exposures in laboratory animals and measure their effects. “[We will] expose my lab system to realistic exposures and realistic combinations of exposures to see if there are any effects we can detect that might be linked to some of the diseases in the community.”
Many studies investigating environmental health hazards focus on a single toxicant’s effects. However, a variety of toxins influence each other in often unpredictable ways. While Skye’s dissertation specifically focuses on naphthalene, not pesticides, she is using this opportunity to meld together her chemical of interest with the community’s to assess their influence on each other.
Skye believes this integration gives her work more validity, because results obtained from testing naphthalene on only healthy animals is unrealistic to real life exposure. “It is not just super healthy cells or super healthy model systems,” Skye explains, “these people have diabetes, they are exposed to pesticides and water quality issues. So [my work] is really trying to contextualize not just what is happening in a healthy adult, but also what is happening in people that might be more susceptible.”
Ultimately, Skye wants to have a project that is both scientifically valid and helps the community understand many of the problems they face. The relationship between Skye and the community is reciprocal; she helps answer questions about pesticide exposure and water quality, while they help her understand the context of naphthalene in a community. Furthermore, having community members inform her where to sample for potential environmental hazards makes her sampling more specific to their precise concerns and more accurate to the exposure source.
The One Health Clinic that UC Davis runs in Knights Landing helps facilitate Skye’s ability to give back to the community. Once a year, the clinic hosts what they call their “One Health Festival” that offers healthcare and health advice to the greater population of Knights Landing. This festival is where Skye’s team will present the findings from their study, thus answering questions that the people helped generate. “I want to be sure that the work I am doing really is benefiting that community,” she says.
But Skye is not satisfied with just informing the community; she wants to help enact change. “My goal for the whole project,” says Skye, “is to pick five actionable things that we can go into CAL EPA, the Environmental Justice Department, or the Yolo County Health officials.” This information could lead to changes that help to prevent cancer in Knights Landing.
This project represents more than just improving the community of Knights Landing. It is using a method different from how researchers conventionally conduct environmental health research. Skye may not yet have her Ph.D., but she is helping to revolutionize a new way of producing science. By making the community engaged in asking the research questions, designing the research methodology, and interpreting the results, they will obtain results more relevant to that community than through any other form of study. “We really hope we can set an example for how folks can actually do this.”