Community Science as Resistance to Neoliberal Scientific Praxis.

Background: Flint is a site of resistance to neoliberalism specifically because of the actions of Flint residents. The impacts of this organizing are due, in part, to sustained efforts to reimagine how communities can contribute to scientific knowledge production. We argue that Flint residents' efforts to advance a community-driven research (CDR) agenda represent an important and successful resistance to neoliberal scientific regulatory practices. Methods: We present Flint as a case study in CDR as a form of resistance. This article uses participatory observation within community-based research and draws from the personal experiences of the research team as long-term and lifelong residents of Flint who were actively involved in different aspects of community mobilizing during the water crisis. Case Study: We highlight Flint's rich and sustained community-based participatory research history, resident-led data collection efforts to assess the environmental and health conditions, a resident-led effort to tell the story of the water crisis from the residents' perspective, and recent efforts to develop and advance a CDR model. Discussion: Community-led research efforts in Flint follow Leitner et al.'s typology of contesting neoliberalism through opting in to neoliberal science to advance community needs, collecting data to support direct opposition through protest and mobilization, creating alternative knowledge frames, and using CDR to disengage from the traditional scientific model. Conclusions: Through CDR, Flint residents work in direct resistance to the tacit integration of neoliberal values into science and alternatively advance community organizing as a key aspect of science toward environmental justice.

Advancing Du Bois's Legacy Through Emancipatory Environmental Sociology.

Environmental sociology, while dedicating significant scholarship to issues of environmental racism and environmental justice, remains a predominately white subdiscipline that has not enjoyed general relevance across sociology. One of the drivers of the dominance of white perspectives in the subdiscipline is the lack of a core theoretical pillar that anchors the importance of racism to structuring inequitable environments. W.E.B. Du Bois not only offered a foundational approach to sociological inquiry, but also a deeply material perspective on the maintenance of racial inequities. Du Bois's approach to sociology lays the path for a liberatory approach that documents the scope of a problem, interrogates its drivers, and works with affected communities and allied resources to develop alternative models with transformative outcomes. This paper argues that an environmental understanding was original to Du Bois's methodology as demonstrated through his concept of the total environment. He connected inequitable environments to the legacy of racial capitalism, which he saw as driven by anti-Blackness. His solution was to advance Black solidarity and community cooperatives through Pan-Africanism. Du Bois' framework establishes an approach to conducting emancipatory environmental sociology that provides theoretical and methodological legitimacy for engaging in partnership with marginalized communities to advance their goals towards liberation.

Troubling heroes: Reframing the environmental justice contributions of the Flint water crisis.

While the story of the Flint water crisis has been shared widely, the popular narrative-described in multiple documentaries and as evidenced by accolades heaped upon a limited few number of actors involved with Flint-largely leaves out the broad experiences and actions of Flint residents in responding to the crisis, raising awareness, and advocating for change. Academic literature has contributed to reinforcing an abbreviated and disempowered version of the narrative where Flint residents needed rescue. In this article, we present an extended description of the Flint water crisis leading up to the water switch in April 2014, including descriptions of community mobilization efforts to call government actions into account and produce investigations that validated the concerns of the residents. We offer a review of prominent academic literature demonstrating patterns of erasure that suggest Flint residents were disempowered. In response, we offer three examples which demonstrate how Flint resident mobilizations have broad historical context, national reach, and individual actions that contradict the narrative that Flint residents lack agency and power. In our analysis, rather than viewing Flint residents as in need of rescue by science, we argue that the community mobilization in Flint is indicative of a highly successful implementation of popular epidemiology with profound effects on national conversations about lead in water, drinking water infrastructure management, and environmental justice.

Understanding the Intrinsic and Extrinsic Motivations Associated with Community Gardening to Improve Environmental Public Health Prevention and Intervention.

Considering that community members continue to garden in and near environments impacted by pollutants known to negatively impact human health, this paper seeks to characterize the intrinsic and extrinsic motivations of a gardener and elucidate their perception of soil quality and environmental responsibility, awareness of past land use, and gardening behavior. Via semi-structured interviews with community gardeners in the Boston area (N = 17), multifactorial motivations associated with gardening as well as ongoing environmental health challenges were reported. Gardeners are knowledgeable about their garden's historical past and are concerned with soil quality, theft, trash maintenance, animal waste, and loss of produce from foraging animals. Study findings directly inform the field of environmental health exposure assessments by reporting gardening duration, activities that can lead to incidental soil ingestion, and consumption patterns of locally grown produce. This information combined with an understanding of a gardener's intrinsic and extrinsic motivations can be used to develop urban agricultural infrastructure and management strategies, educational programming, and place-based environmental public health interventions.

Research altruism as motivation for participation in community-centered environmental health research.

Protection of human subjects in research typically focuses on extrinsic rather than intrinsic motivations for participation in research. Recent sociological literature on altruism suggests that multiple kinds of altruism exist and are grounded in a sense of connection to common humanity. We interviewed participants in eight community-centered research studies that sampled for endocrine disrupting compounds and that shared research findings with participants. The results of our analysis of participation in these studies indicate that altruistic motivations were commonly held. We found that these sentiments were tied to feeling a sense of connection to society broadly, a sense of connection to science, or a sense of connection with the community partner organization. We develop a new concept of banal altruism to address mundane practices that work towards promoting social benefits. Further, we offer that research altruism is a specific type of banal altruism that is a multi-faceted and important reason for which individuals choose to participate in community-centered research.

Factors affecting weight counseling attitudes and behaviors among U.S. medical students.

PURPOSE: To identify the factors associated with perceived relevance and reported frequency of weight counseling among medical students. METHOD: The authors surveyed all medical students in the Class of 2003 at 16 U.S. medical schools during first-year orientation (1999), orientation to wards (2000-2001), and fourth year (2002-2003). RESULTS: Across the three time points, response rates were, respectively, 89% (1,846/2,080), 82% (1,630/1,982), and 77% (1,469/1,901); a total of 2,316 medical students participated. More than half of the students felt that weight counseling was highly relevant to their intended practice (respectively, 63% [1,149/1,812], 70% [1,050/1,509], and 54% [717/1,329]). Among fourth-year students, 25% (350/1,393) reported that they "usually-always" provided weight counseling to general medicine patients. Perceived relevance peaked at orientation to wards (odds ratio [OR]=1.88), then declined to initial levels.Greater school support for health promotion was positively associated with high counseling frequency (OR=1.06). Students interested in non-primary-care specialties were less likely than others to consider weight counseling highly relevant (OR=0.59) or, in their fourth year, to provide it to patients (OR=0.50). Finally, higher personal fruit/vegetable consumption and confidence that this intake would increase were positively associated with high perceived relevance (both OR=1.07) and frequency of weight counseling (OR=1.09 and 1.16, respectively). CONCLUSIONS: The majority of medical students consider weight counseling relevant to their intended careers. Promoting healthy personal behaviors and encouraging acquisition of skills in weight management across all specialties would likely improve clinical practice.

Predictors of US medical students' prevention counseling practices.

OBJECTIVE: To understand predictors of medical students' prevention counseling practices. METHODS: We surveyed medical students (n=2316 individuals) in the Class of 2003 at freshman orientation, and again at entrance to wards and senior year in a nationally representative sample of 16 US medical schools (response rate=80.3%). MAIN OUTCOME MEASURES: Perceived relevance of prevention counseling and seniors' frequency of prevention counseling. RESULTS: Healthier personal practices (p<0.0001), intention to become a primary care practitioner (p=0.0007), and attending a medical school that encouraged healthy personal practices (p=0.002) significantly predicted the frequency with which seniors reported currently counseling patients about preventive interventions (using a validated measure). Perceived counseling relevance was also significantly predicted by intention to become a primary care practitioner (p<0.0001), attending a school that encouraged healthy personal practices (p=0.0007), being earlier in one's training (p<0.0001), more interested in prevention (p<0.0001), female (p<0.0001), non-White (p=0.007), and by having healthy personal practices (p=0.008). CONCLUSIONS: Several of the variables predicting physician counseling also predict US medical students' reporting counseling (especially personal health practices and specialty type). In addition, the avidity with which medical schools encourage students to be healthy significantly influences their reported patient counseling. These findings can give a fresh, evidence-based direction to help create physicians who counsel patients about prevention.

Basic demographics, health practices, and health status of U.S. medical students.

BACKGROUND: There has never been a nationally representative survey of medical students' personal health-related practices, although they are inherently of interest and may affect students' patient-counseling practices. METHODS: To determine basic health practices and status, a survey was conducted of medical students (n =2316 individuals responding to > or =1 survey) in the Class of 2003 at freshman orientation, entrance to wards, and senior year in a nationally representative sample of 16 medical schools (response rate=80.3%). RESULTS: Most medical students (84%) reported never having smoked cigarettes, and both genders typically drank two drinks per drinking episode (with bingeing more common among men). Students exercised a median of at least 4 hours per week, and preferred strenuous exercise. Medical students across all years and both genders reported a median of 7 hours of sleep per night. Nearly all (97%) reported their health to be at least good, typically with 1 or fewer days of poor physical or mental health in the past month. Both genders (particularly women) were unlikely to be overweight or obese. Reported rates of any chronic condition were < or =2% except for hypertension among men, and obesity, dyslipidemia, and depression in both genders. Unlike their other relatively positive behaviors compared with their peers, medical students had variable rates of preventive screening. CONCLUSIONS: Medical students in the United States were healthy, and reported many good health behaviors when compared with other young U.S. adults. However, for some, health behaviors and personal health practices either did not meet national goals or placed students at risk.

Experiences of belittlement and harassment and their correlates among medical students in the United States: longitudinal survey.

OBJECTIVE: To determine medical students' perceptions of having been harassed or belittled and their correlates, for the purposes of reducing such abuses. DESIGN: Longitudinal survey. SETTING: 16 nationally representative US medical schools. PARTICIPANTS: 2884 students from class of 2003. MAIN OUTCOME MEASURES: Experiences of harassment and belittlement at freshman orientation, at entry to wards, and in senior year by other students, by residents or fellows, by preclinical professors, by clinical professors or attendings, or by patients. RESULTS: 2316 students provided data (response rate 80.3%). Among seniors, 42% (581/1387) reported having experienced harassment and 84% (1166/1393) belittlement during medical school. These types of abuse were caused by other students (11% (158/1389) and 32% (443/1390) of students experienced such harassment or belittlement, respectively). Harassment and belittlement was also caused by residents (27% (374/1387) and 71% (993/1393)), preclinical professors (9% (131/1386) and 29% (398/1385)), clinical professors (21% (285/1386) and 63% (878/1390)), and patients (25% (352/1387) and 43% (592/1388)). Only 13% (181/1385) of students classified any of these experiences as severe. Medical students who reported having been harassed or belittled did not differ significantly from those not reporting such experiences by sex, ethnicity, political orientation, or religion. They did differ significantly by chosen specialty and were significantly more likely to be stressed, depressed, and suicidal, to drink alcohol or to binge drink, and to state that their faculty did not care about medical students. They were also significantly less likely to be glad they trained to become a doctor. CONCLUSION: Most medical students in the United States report having been harassed or belittled during their training. Although few students characterised the harassment or belittlement as severe, poor mental health and low career satisfaction were significantly correlated with these experiences.

Female genital cutting and reproductive experience in Minya, Egypt.

In African populations practicing female genital cutting (FGC), beliefs exist that these procedures enhance reproduction and that their medicalization may diminish adverse effects, yet available findings are mixed in part for methodological reasons. We use data from a representative sample of ever-married women aged 17-55 years in Minya, Egypt, to examine the effects of type of FGC and type of circumciser on a woman's risks of primary infertility and pregnancy loss. Contrary to previous studies in Egypt, neither type of circumcision nor type of circumciser is associated with adverse fertility outcomes among circumcised women in Minya.

Firearm-related personal and clinical characteristics of US medical students.

BACKGROUND: Firearm injuries are the second leading cause of fatal injury in the US, and several medical specialty societies encourage patient counseling about firearm injury prevention. Because personal choices. influence physicians' willingness to counsel, it would be valuable to know how frequently guns are kept in the homes of physicians-in-training, as well as their perceptions and current rates of counseling about firearm injury prevention. METHODS: At a nationally representative sample of 16 medical schools, we surveyed the class of 2003 at freshman orientation, entrance to wards, and during senior year. RESULTS: A total of 2,316 students provided data (response rate = 80.3%). Among freshmen, 16% reported living in a home with a firearm, 13% did so at entry to wards, as did 14% of seniors (14% overall, women = 9%, men = 19%). Only 34% of seniors reported counseling their patients more often than "never/rarely" about firearm possession and storage. CONCLUSIONS: US medical students reported substantially lower rates of household gun ownership than the general population, but their participation in firearm-related counseling is also low.