Using the Environmental Health Disparities Framework to understand Black and Latino perspectives of a local fertilizer plant fire

Zimmer et al. BMC Public Health (2024) 24:2817 https://doi.org/10.1186/s12889-024-20235-z

RESEARCH

BMC Public Health

Open Access

Using the Environmental Health Disparities Framework to understand Black and Latino perspectives of a local fertilizer plant fire

Rachel Zimmer1*, Ashley Strahley2, Aylin Aguilar2, Kimberly Montez3,4, Deepak Palakshappa3,4,5,
Amresh Hanchate6, Camila A. Pulgar7, Mia Yang8, Justin B. Moore1,4, Rowie Kirby-Straker9, Crystal Dixon10 and Callie L. Brown3,4

Abstract

In February 2022, a fertilizer plant fire burned for four days and displaced thousands of residents, who were mainly low-income and Black or Latino, from their homes in Winston Salem, NC. In partnership with Black and Latino resi- dents and nonprofit organizations, we sought to understand Black and Latino resident perceptions of the chronic and acute health risks, as well as the emotional and financial effects that resulted from the fire, which included
the release of nitrous dioxide. We used the Environmental Health Disparities Framework to guide this community- engaged research study, capturing through semi-structured interviews: 1) how residents perceived their commu- nity before and after the fire, 2) how the fire impacted physical and mental health, and 3) how individuals coped
with stress. We used thematic analysis to analyze the data and identified seven major themes. Participants: 1) per- ceived their neighborhood positively, 2) were unaware of the potential dangers of the fertilizer plant before the fire, 3) experienced adverse health and financial effects from the fire, 4) took action to protect themselves from the impacts of the fire, 5) raised concerns about the environmental impacts of the fire, 6) raised concerns about the city’s response to the fire, and 7) provided recommendations for future city response.

Keywords Community-based participatory research, Older adults, Children, Health disparities, Environmental justice, Environmental crisis, Air pollution

 

*Correspondence:
Rachel Zimmer
r.zimmer@wakehealth.edu
1 Department of Implementation Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC 27101, USA

2 Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston Salem, NC, USA
3 Department of Pediatrics, Section of General Academic Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC, USA

4 Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
5 Department of Internal Medicine, Section of General Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA

6 Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC, USA
7 Department of Family Medicine, Wake Forest University School

of Medicine, Winston-Salem, NC, USA
8 Department of Internal Medicine, Section of Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
9 Department of Communication, Wake Forest University, Winston-Salem, NC, USA
10 Department of Health and Exercise Science, Wake Forest University, Winston Salem, NC, USA

© The Author(s) 2024. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.

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Background

Racial and ethnic minority communities in the United States (US) often bear a disproportionate burden of envi- ronmental hazards that impact health, a phenomenon rooted in public policy, zoning practices, and land-use decisions [1–3]. Across the US, racial and ethnic minor- ity communities live near industrial zones and facilities handling hazardous materials, subjecting residents to heightened health risks associated with pollution expo- sure and possible environmental disasters [3, 4]. Chemi- cal explosions, particularly those caused by ammonium nitrate (AN), have resulted in significant human and infrastructure loss [5, 6].

Nitrous dioxide (NO2) is a chemical released while burning ammonium nitrate, and its odor warns of acute exposure. NO2can damage the lungs by altering mac- rophage and immune function and can cause symp- toms of abdominal pain, nausea, headache, coughing, and fatigue [7]. In addition, toxic dust from a chemical fire can settle on surfaces and the ground in surround- ing and downwind areas. Since 1916, precipitating fac- tors that led to ammonium nitrate (AN) blasts included storage techniques (e.g., confinement, piling), absence of adequate ventilation, humidity, exposure to an igni- tion source (e.g., fire), and mixtures with other chemicals [5–9] . Urban storage of AN in any facility in proximity to residential areas greatly increases the risk of death and injury to the surrounding communities [10].

On January 31st, 2022, a large fire occurred at the Winston Weaver Company fertilizer plant, which stored approximately 600 tons of ammonium nitrate in Win- ston-Salem, North Carolina [11–13]. Comparatively, in 2016, the West Waco fertilizer plant, which held 40–60 tons of AN, exploded and caused a 2.1 magnitude earth- quake; in 2020, a warehouse holding 2,750 tons of AN exploded in Beirut (Lebanon), claiming the lives of 220 people and injuring 6,500 others [8, 14, 15]. The Weaver fertilizer plant fire occurred within city limits and was adjacent to a residential area with over 6,000 community members. The fire raised many environmental concerns, highlighting several hazards of residing near industrial facilities [12, 16].

Although research has emphasized the intersectional relationship between income, race, and environmen- tal hazards, gaps remain in understanding the impacts specific to AN-related disasters, including perceptions of chronic and acute health risks and the emotional and financial effects [17]. Through mixed methodol- ogy, including qualitative inquiry, our research aimed to explore the multilevel impacts of the Weaver fertilizer plant fire on Black and Latino residents with children or older adults in the household who lived within a two- mile radius of the Weaver fertilizer plant during the fire,

assessing 1) how affected residents perceived their com- munity before and after the fire, 2) how the fire impacted residents’ physical and mental health, and 3) individual experiences coping with stress.

Methods

Theoretical framework

This study is anchored in the socio-ecological perspective offered by the Environmental Health Disparities (EHD) Framework [18]. The EHD is a theoretical lens through which researchers can better understand and analyze health disparities, including the multilevel connections between race, environment, and health. The EHD Frame- work emphasizes the complex interplay between various levels of influence, including community-specific stress- ors, individual-level stressors, coping mechanisms, and environmental disasters. It highlights how historical inequities, such as discrimatory zoning policies, exac- erbates risks faced by marginalized communities in the context of environmental disasters like chemical fires [18].

Using this framework, our study delves into the inter- section of environmental and psychological stressors and their cumulative impact on health outcomes. Unlike traditional models that often simplify the relationship between exposure and disease, the EHD Framework offers a more nuanced approach. It highlights how factors such as community resources, pollution levels, individ- ual stressors, coping strategies, and even environmental disasters, like the Weaver fertilizer plant fire, are inter- connected and contribute to health disparities within communities [18].

The EHD framework goes beyond conventional models by considering the cumulative impact of multiple levels of influence on health, including structural inequalities, environmental policies, and community resilience. This approach ensures that research captures the direct health effects of the fire and the broader societal and systemic factors that contribute to disparities [3, 19, 20].

Study overview

Setting and participants

Constructed in 1939, the Winston Weaver Company fer- tilizer plant adhered to the building codes from 1936, which lacked specific provisions for storing hazardous materials or fire mitigation strategies, such as a sprinkler system [11]. At the time of the fire, adjacent rail cars were reported to hold 100 of the total 600 tons of AN [11]. Modern building codes forbid the outside placement of rail cars containing such materials and require fire miti- gation strategies. However, the Weaver fertilizer plant was grandfathered based on the 1936 building codes. Although it had successfully met contemporary fire and

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safety inspection criteria, it was not required to comply with modern building codes [21].

The fire took place in a community in which 80% of the individuals living within a two-mile radius were racial and ethnic minority groups, with over 70% classified as low-income [12]. During the fire, the fire department ini- tiated a voluntary evacuation covering a one-mile radius due to the potential explosion hazard, diverting residents to a community shelter [22]. After the fire was resolved, the city contracted with a local non-profit organization to reimburse displaced community members or those who incurred expenses during the fire. To qualify for reimbursement, residents had to live within one mile of the fertilizer plant and have financial impacts, includ- ing expenses related to food or shelter [23]. Receipts and documentation were required for residents to be reimbursed for up to $1,000 per family; families without receipts were guaranteed an affidavit of up to $300 [23]. Of the 6,500 evacuated community members, 656 fami- lies received reimbursement funds [23]. A review of pay- ments found that only about $240,000 of the 1 million allocated for displaced community members has been spent after two years [23].

We included English or Spanish-speaking Black or Latino residents who had either children or older adults living in the home and who lived within two miles of the Weaver fertilizer plant at the time of the fire. This approach aimed to focus on the unique experiences of these racial and ethnic groups, who comprise most of the population in this neighborhood and are often dis- proportionately affected by environmental disasters due to longstanding social and environmental inequities. We also focused on households with children or older adults, who experience greater health and social effects from ecological disasters and are often under-represented in research [24, 25]. Specifically, children are of shorter stature, have a higher respiratory rate, and have a lower body mass than adults, which puts them at greater risk for toxic absorption and inhalation of heavy gases. Addi- tionally, prior studies have shown that older adults are at increased risk for morbidity from disasters [24, 25].

Data collection

Our team co-developed a semi-structured interview guide based on the EHD with community advisors, stake- holders for individual, in-person, and phone interviews [18]. Compared to focus groups, individual interviews were most conducive to enabling participants to share and describe their experiences due to questions explor- ing personal physical and mental health (see Supplemen- tary File 1). Due to convenience, we included one dyad interview, which included a mother and son who lived in the same household. We co-designed questions in

partnership with community leaders, non-profit organi- zations, and residents from the affected area, using the EHD framework as a conceptual basis for the guide. The interview guide was reviewed and modified through an iterative process for this study. We also engaged with Black and Latino-led community-based partners using community-based participatory research (CBPR) guided principles to help recruit participants from the commu- nity around the Weaver fertilizer plant [26]. Our research team and community partners recruited a convenience sample of participants by sending flyers and newsletters through local community organization listservs, canvass- ing neighborhoods, and talking about the study at local community meetings. Participants elected to participate in the study by self-selecting after reviewing a community flyer and calling our research team to set up an interview or agreeing to an interview when approached within the community by our study team. Study coordinators con- firmed that participants lived within a two-mile radius of the Weaver fertilizer plant during the fire.

We trained six expert community members as a part of the study team to recruit, obtain consent, and inter- view participants. The community interviewers received training through the Wake Forest Baptist Comprehen- sive Cancer Clinic’s Qualitative and Patient Reported Outcomes (QPR-O) shared resource, a professional qualitative research service. They conducted two prac- tice interviews with two co-investigators to review and refine the interview guide. Expert community interview- ers with concordant ethnic and language backgrounds conducted interviews with participants to help facilitate trust. Another study co-investigator interviewed three Black participants.

After verbal consent, the interviews, conducted between August 2022 and June 2023, ranged from 8 to 49 min, averaging 21 min. The interviews took place via phone, in a private community-based setting, or the participant’s home with the interviewer. While we rec- ognize community expertise has a considerably higher value, participants were compensated with a $50 gift card for participating in the interviews via mail if completed by phone or immediately after the in-person interview. The interviews were audio recorded and transcribed verbatim. Certified translators translated Spanish-lan- guage interviews into English, and a bilingual Q-PRO researcher reviewed the translation for accuracy. The Wake Forest School of Medicine Institutional Review Board approved the study.

Data analysis

Two research team members, AA and AS, reviewed the transcripts and developed a codebook to capture concepts found in the textual data using a combined

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inductive-deductive approach. First, deductive codes were created to align with a priori domains of interest, including concepts from the EHD framework, and then open coding was conducted on a subset of transcripts to identify additional, emergent codes inductively.

Data were managed with ATLAS.ti software [27]. AA and AS independently coded the transcripts in groups of 4–6 transcripts and met to compare after each group was coded. The codebook was modified iteratively based on discussions of code meanings and applications. Dis- crepancies in coding were discussed and resolved by con- sensus. Researchers reviewed text segments separately by participant demographic group (Black and Latino) to maintain language integrity and then summarized text segments by code. Summaries were synthesized into themes using the principles of reflexive thematic analy- sis [28]. Summaries were compared by participant demo- graphic group to identify common and unique themes and capture unique experiences per demographic group (see Fig. 1).

Using I‐Poems for validation

We invited Black and Latino community members to a member-checking event, presenting data as I-poems [29]. I-Poems are a tool to highlight participant voices and promote researcher reflexivity [30]. To create the I-Poems, three researchers (RZ, AA, AS) read through each interview transcript and identified all “I” or “We” statements. We organized the statements by thematic area and iteratively constructed stanzas that commu- nicated the most salient themes and best represented the entire dataset (see Fig. 2) [30]. We presented the

I-poems to community members who attended the event (n = 4 Black participants, no Latino participants), allowing them to reflect on the findings in a way that elevated community member voices and fostered heal- ing in the community. We also partnered with local nonprofits, Authoring Action, and the Piedmont Envi- ronmental Alliance to participate in and lead itera- tive creative writing exercises, allowing participants to write out and read aloud their writings together to help the participants process data and express and discuss their emotions safely.

Research team reflexivity

The research team members are all current residents of the city where the Weaver Fertilizer Plant fire occurred and resided in the town at the time of the fire. There- fore, we were exposed to media coverage surrounding the fire and its aftermath. However, unlike the com- munity participants, none of the researchers or com- munity interviewers resided in the area affected by the fire, nor had their home, family, health, or employment directly impacted. The Latino community interviewers worked with organizations connected to the commu- nities affected by the fire, which helped to foster trust with the Latino study participants. One of the Black community interviewers was a community member who was the executive director of a service-oriented community-based organization serving the local com- munity affected by the fire. The other interviewers were community members and academic researchers unknown to the study participants.

Fig. 1 Flow diagram of methods

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Fig. 2 Weaver fire community I Poem (English version)

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Results

Participants

We interviewed 18 Latino and 21 Black participants; however, one interview with a Black study participant was excluded as no audio recording was available due to faulty recording equipment, resulting in a final sample of 20 Black participants. Most participants in both demo- graphic groups were female (Table 1). About half of the Black and Latino participants were over 50. Most Black participants had resided in their neighborhood for 15 or more years, whereas most Latino participants had lived there for five or fewer years.

Qualitative themes

We identified seven major themes within the domains of the EHD framework (Gee & Payne-Sturges, 2004). Par- ticipants: 1) perceived their neighborhoods positively, 2) were unaware of the potential dangers of the Weaver fer- tilizer plant, 3) experienced adverse health and financial effects from the fire, 4) took action to protect themselves from the impacts of the fire, 5) raised concerns about the environmental impacts of the fire, 6) raised concerns about the city’s response to the fire, and 7) provided recommendations for future city response. We provide

representative quotes below, with additional quotations mapped to the EHD framework in Table 2.

Perceived their neighborhoods positively

Participants of both groups described generally posi- tive experiences living in their communities before the fire. Many participants described their neighborhood as quiet, with peaceful and friendly neighbors who “all look out [for] one another” (Black participant (BP), 13). Some Black participants also mentioned how they appreciated the neighborhood’s proximity to local stores.

Despite generally positive perceptions about their neighborhood, both groups expressed concerns about crime and disrespectful behavior, such as littering, loud noise, people driving too fast, firearm violence, and prop- erty destruction. A few Black participants explained that they felt their neighborhood had been abandoned and divested both before and after the fire. Specifically, they were concerned about the poor quality of local schools and the resulting diminishment of local educa- tional opportunities for children. One Black participant noted that the city had stopped maintaining their local neighborhood park or roads over the past few years. She explained that the park used to be a place for kids to play, and now there are “trees, weeds, and one rusty broken- down sliding board” (BP, 10).

Were unaware of the potential dangers of the Weaver fertilizer plant
Most participants were unaware of the potential hazards of the Weaver fertilizer plant, and some did not know that the fertilizer plant existed. One participant pointed out that they thought the fertilizer stacks on site were “cement sacks” (Latino participant (LP), 03). One Black participant expressed surprise, stating, “I knew Weaver was in our neighborhood, but…I never knew a fertilizer company could be that dangerous” (07). Another par- ticipant admitted to initially dismissing evacuation calls, thinking it was a prank due to the lack of awareness about the plant (BP, 01).

After the fire, community awareness of potential haz- ards increased. Both Black and Latino participants acknowledged a heightened sense of vigilance, with some describing the fire as a “wake-up call” that made them more “alert” and “cautious” about their surroundings.

Experienced adverse health and financial impacts
because of the fire
During the fire, community members experienced intense emotions such as panic, terror, shock, and fear of potential explosions and for the safety of their homes. One mother expressed concern about the pos- sibility of chemicals reaching their area, “They were

Table 1

Sex

Female

Male

Age

18–25 26–30 31–40 41–50 51- 60 61–70 71–80 80+

Time in Community

1–5 years 6–10 years 10–15 years 15 + years

Distance
< .5 mile

< 1 mile 1 mile

Demographics of participants

  

Black Participants (N = 20)

15 (75%) 5 (25%)

1 (5%) 1 (5%) 2 (10%) 2 (10%) 8 (40%) 4 (20%) 1 (5%) 1 (5%)

2 (10%) 2 (10%) 1 (5%) 15 (75%)

5 (25%) 9 (45%) 6 (30%)

Latino Participants (N=18)

14 (78%) 4 (22%)

0
1 (6%) 4 (22%) 4 (22%) 3 (17%) 4 (22%) 2 (11%) 0

11 (61%) 4 (22%) 1 (6%)
2 (11%)

7 (39%) 1 (6%) 10 (56%)

   

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Table 2 Findings mapped to environmental health disparities framework

EHD Domain

Theme

Subtheme

Impactful Quotes

Community Level Vulnerability

Neighborhood Resources

• Perceived their neighborhoods posi- tively and were unaware of the potential dangers of the Weaver Fertilizer plant

• Generally positive experiences living in their neighborhoods

• I feel pretty safe now that the plant
is gone.” (PB20)
• I still love where I live, but I’m glad
that company is not in business anymore.” (PB07)

Community Stressors

• Concerns about crime and disrespect- ful behavior
• Felt that neighborhood had been abandoned and divested by the city

• “One thing I don’t like about the traffic. People coming through, driving too fast.” (PB16)
• “…this neighborhood has been abandoned, so just the quality of life

Structural Factors

• Most were unaware of the potential dangers of the Weaver Fertilizer Plant • Since the fire, there has been
an increased awareness of potential dangers in the community

• “I knew Weaver Fire was in our neigh- borhood, but…I never knew a fertilizer company could be that dangerous.”
• “I was afraid because there’s a gas sta- tion nearby. I thought “if that gas station explodes. Something that could burst because there’s gas… in the depths

• Everybody been out here like 50-plus years…It’s good.” (PB14)
• We all get along…look out for one another.” (PB13)

has changed over the years…” (PB05)
• “The noise…That’s the only thing I don’t like as much” (PL14)
• “I received a stray bullet through the win- dow…Well, what can you do?” (PL07)

of the earth.” (PL01)
• “We could hear everything. We knew there was a fire… but we didn’t know what had exploded…we didn’t know it was chemicals and that we were being exposed to that.” (PL11)
• “My daughter told me ’Mommy, some- thing fell down behind the trailer, there was even a tremor. ’Oh, don’t exaggerate’ I told her. I never imagined it was some- thing so serious.” (PL04)

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Table 2 (continued) EHD Domain

Theme

Subtheme

Impactful Quotes

Individual Level Vulnerability

Individual Coping

Took action to protect themselves from the impacts of the fire

• Evacuated self and/or family to another location
• Prayed to a higher power
• Adjusted home environments for safety

• “My family decided to go to a hotel b/c I was doing really bad, my chest. My son has asthma and allergies, so we couldn’t stay in the apt.” (PL11)

Environmental Hazards and Pollution

• Raised concerns about the environ- mental impacts of the fire
• Raised concerns about the city’s response to the fire

• Concerns about smoke and water pol- lution after the fire
• Distrust of city’s clean-up efforts
after the fire

• “..there were some environmental issues (before) but none life threatening.” (PB11) • “As long as the smoke was in the air… The coughing was just ridiculous. I couldn’t sit outside.” (PB20)

• Mainly negative experiences
with the process of the fire evacuation

• The water smells like sewer. I’d rather buy bottles of water to cook..than to actually use the water…You can taste the differ- ence.” (PB12)

•..it smelled like acid…it made your nose hurt” (PL12)
• I’ve noticed that the trees don’t look
as beautiful as before.” (PL09)

• “I don’t think it’ll ever be cleaned
up properly…I understand when you dig something or cover something up, it don’t go away and putting dirt on it can’t fix it. (PB11)

• “My mama said she wasn’t goin’ nowhere. I had to stay home with her.” (PB15)
• “My mom helped feed us while we
was there ’cause we didn’t have no food” (PB13)
• We did not go out…unless it
was an emergency.” (PB15)
• “I just prayed to God…I prayed that he would enlighten us so this would be solved.” (PL18)

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Table 2 (continued) EHD Domain

Theme

Subtheme

Impactful Quotes

Health Effects of Stressors

• Experienced adverse health and finan- cial effects from the fire

• Many experienced adverse mental and physical health effects
• Financial impacts were widespread and varied

• “I thought, ’Well, maybe I need to change the type of filter, because I had my son tested for allergies to figure out what
was causing him to have reactions…He had to go on a nebulizer” (PB06)

• “I feel that we’re (neighbors) closer now…there’s more communication. We’re more united.” (PL14)
• “Prior to Weaver fire, it was more like sea- sonal allergies in the spring. After…I noticed he (son) had to go on a nebulizer because he couldn’t breathe. He would cough a lot.” (PB06)
• “I feel nervous, desperate–anxious, sometimes I feel like I want to start run- ning away and disappear. Doctors ask me, do you feel this? I say no, because they don’t really care, but I do. I feel desperate sometimes.” (PL13)
• “You no longer sleep well”. (PL13)
• “…I’m not the same now.” (PL17)
• “Headaches. It’s like almost every day” (PB12)
• “We started seeing neighbors go
to the hospital…it was a back-to-back thing” (PB12)

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saying that an explosion could reach several kilom- eters away. I worried because we are very close. If the chemicals exploded, the distance they were giving went beyond the area where we live. I got very worried for my girls” (LP, 14). Several Black participants expressed concern for older neighbors, with some unable to evac- uate, prompting worries about their well-being. “Some people couldn’t leave because of the elderly, so I think about all my elderly people who lived here who could not or did not have access to leave” (BP, 20).

After the fire, participants reported various new health issues, particularly respiratory problems. Many Latino and some Black participants had trouble breath- ing, coughing, congestion, frequent headaches, dizzi- ness, body pain, and nausea. One mother described, “My son has some respiratory concerns. Before the Weaver fire, it was more like spring seasonal allergies. After the Weaver fire…I noticed that he had to go on a nebulizer and was given albuterol because he couldn’t breathe. He would cough a lot.” (PB 06) Skin irritation and allergy symptoms, such as itchy or watery eyes, were also common. Some noted worsened asthma due to smoke exposure. Concerns about long-term health effects from the fire were widespread among partici- pants. Many Black and Latino participants reported enduring negative mental health effects, including anxi- ety, stress, and sleep disturbances. Some Latino partici- pants described feeling traumatized or desperate, while others experienced depression and flashbacks when passing the site of the fire.

The financial impacts of fire were widespread and varied. Participants from both groups highlighted the financial strain caused by medical expenses and medica- tion needed due to the fire’s health effects. Specifically, Latino participants mentioned the economic burden of increased medical appointments necessitated by post-fire symptoms, adversely affecting their financial well-being. One explained, “It affected me a lot. I got an infection that clogged my nasal cavities. From the fire in January until July, when the doctor saw me since I don’t have insurance, it’s pricey. They referred me to the hospital. I had [nasal] surgery” (LP, 17). Some participants described the cost as a barrier to receiving healthcare, and they did not access healthcare for themselves or their families due to cost.

Nearly all Latinos and about half of the Black par- ticipants reported some economic impact from the fire, mostly losing income from being unable to work for one or more days. One Latino participant lost his job, eventu- ally finding another job that paid him less. “I lost that job because I didn’t go for a week. They were paying me 15 an hour… [Now,] I’m only making 13 dollars an hour” (04). Participants who evacuated faced additional expenses,

including food, housing, and replacement of perishable groceries left behind.

Took action to protect themselves from the impacts of the fire

Participants employed various evacuation and home modification strategies for protection during the fire. Most Black and Latino participants evacuated, with nearly all Latino participants staying with family or friends. Those who evacuated remained away from their homes for up to two weeks.

Some participants near the Weaver fertilizer plant could not evacuate due to financial constraints or physi- cal limitations and opted to stay indoors. They discussed taking protective measures in their homes, such as seal- ing doors and windows, wearing face masks, and drink- ing bottled water. Some participants also replaced air filters and expressed that they relied on their faith, with one participant mentioning prayer as a protective meas- ure, noting that she prayed, “Lord, just watch out for me” (BP, 15).

Several Latino participants treated their respiratory problems with natural remedies, including lemon, ginger, cinnamon, and herbal teas, to help with coughing and congestion. Some “gargled with lemon and vinegar,” and others used “ginger and lemon tea” (09 and 15). Others sought medication treatment through health care provid- ers or purchased inhalers, nasal sprays, and allergy medi- cation to alleviate their symptoms.

Raised concerns about the fire’s environmental impacts, including smoke and water pollution
Most participants identified smoke clouds and the smell of smoke as the primary source of pollution during the fire. Some described the odor as rotten or chemi- cal, reaching two miles away and lingering for weeks to months. One participant mentioned it took about a month to remove the “rotten smell” from their home; they explained that their home “smelled like chemicals” (BP, 05). Another participant noted changes in air quality, stating, “I feel like, after the fire, the air was different” (BP, 06).

Some noticed differences in the tap water’s taste after the fire. They expressed concern about the safety of the water and began drinking bottled water instead of water from the tap. “The water smells like sewer. I would rather buy bottles of water to cook than to use the [tap] water… You can taste the difference” (BP, 12). Another Latino participant noted, “The trees don’t look as beautiful. I don’t know if it was all the smoke because it was there for many days and wouldn’t go away. I don’t know if it affected the trees that much. It’s not the same now” (09).

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Raised concerns about the city’s response to the fire

Participants described mainly negative experiences and feelings of injustice associated with the fire evacua- tion process and reimbursement methods. One person explained, “We’re human beings. We’re not just a num- ber. How’s that [fire] going to affect my children or any of these children?” (PB, 05).

Both Black and Latino participants expressed dissat- isfaction with evacuation procedures, citing issues such as lack of resources and confusion. Many described feel- ing stressed due to not knowing where to evacuate or confused about what happened during the evacuation. Few participants went to a shelter organized by the city for evacuees, but those who did found it ill-equipped and chose to sleep in their car or return home instead of staying there. One person explained, “When you got to the Coliseum [shelter], they didn’t even have cots. They didn’t have anything for us. We just went up there, and there was nowhere to sit. There was nowhere to lie. My husband and I just sat in our car.” (PB 05).

They emphasized the need for a more inclusive evacu- ation plan, particularly for older adults and people with disabilities. A couple of participants noted, “Some people just couldn’t leave because of the elderly, so I think about all of my elderly people that live over here that could not leave or did not have access to leave.” (BP, 20); “Our neighbors were elderly, and no one supported getting them out of their property during the fire. Ultimately, they remained in the home, and that was very dangerous for them.” (BP, 19) Some Latino participants mentioned that they did not understand the English language evac- uation orders. They described hearing the fire depart- ment’s evacuation orders over a loudspeaker or seeing emergency services personnel in their neighborhood but not comprehending what was being communicated. One Latino participant recounted, “I don’t speak English, but I imagine they were evacuating people. Now, I realize they were evacuating people” (07).

Participants shared varying experiences with the city’s reimbursementprocess.Someheardaboutthepossibility of being financially reimbursed from community meet- ings, friends, neighbors, or through television advertise- ments. Barriers to applying for reimbursement included a lack of process awareness, fear of immigration status exposure, fragmented communication, lack of response or follow-up, and limited reimbursement amounts or explanations about the reimbursement process. One participant explained, “I went to the meetings, but they just didn’t explain everything to us as well as we wanted it to be explained to us…They said that they would reim- burse us, and we never heard anything back from them” (BP, 20). Another participant reported a significant finan- cial impact and explained that their family could not be reimbursed for their expenses because they exceeded the $1000 per household limit.

Latino participants described additional challenges with reimbursement processes due to language barriers or the need for guidance on asking for reimbursement. One Latino participant stated that they paid taxes but must “settle” and cannot make “demands” due to legal status. They expressed frustration with not being reim- bursed, “I paid my taxes for ten years…but we can’t ask for much because we don’t have papers…and that’s why we keep quiet. That’s why we put up with everything that happens to us until we’re just resigned to it. That’s not freedom” (LP, 10).

Raised recommendations for future city response

Study participants had several recommendations for future city and community responses. (see Table 3).

Discussion

Our study qualitatively investigated the aftermath of the Weaver fertilizer plant fire in Winston-Salem, North Carolina, and revealed significant health and social impacts on Black and Latino participants. Key themes

Table 3 Participant recommendations
Participant Recommendations for Emergency Management

Provide a diverse strategic notification process, including Spanish-speaking resources, during disasters to ensure timely and effective communication

Implement evacuation procedures that prioritize the needs of individuals with disabilities and older adults and ensure their safety and well-being

Improve the availability of shelter and lodging options in evacuation scenarios, catering to diverse needs and circumstances facing community members affected by disasters

Address the economic impact of the disaster on affected individuals and families and pro- vide additional avenues for reimbursement or compensation. Barriers to application processes should be removed

Provide comprehensive information regarding the health and environmental implications of the fire, empowering residents to make informed decisions about their safety and well- being

  

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we identified included: generally positive perceptions of neighborhoods before and after the fire, a lack of aware- ness about the potential dangers of the plant, adverse health and financial effects, proactive actions taken to protect against fire’s impacts, concerns about the envi- ronmental impacts of the fire, dissatisfaction with the city’s response to the fire, and recommendations for future disaster responses.

Importantly, our study focuses on families with chil- dren and older adults, populations that are dispro- portionally impacted by disasters [24]. Children are emotionally and psychologically vulnerable, relying on caregivers for safety, which heightens the trauma expe- rienced during a disaster [24]. Similarly, numerous stud- ies have shown that older adults are at increased risk for morbidity during public health emergencies, particu- larly those with chronic health conditions or functional disabilities [25]. Additionally, social isolation or limited support networks may hinder older adults from safely evacuating during emergencies [25].

Participant recommendations highlight the need for a more inclusive disaster response strategy that addresses the diverse needs of affected communities. For instance, implementing a notification system, that includes Span- ish-language resources, would ensure timely and effective communication during future disasters. Tailoring evacu- ation procedures to prioritize the needs of people with cognitive or functional disabilities can help ensure the safe evacuation of vulnerable populations and provide support during and after a crisis. Further, participants suggested that shelters must be equipped with acces- sible facilities, cots, and essential amenities to accom- modate individuals with health or mobility limitations. Addressing the financial burden of disasters through expanded reimbursement programs and streamlined application processes would alleviate economic stress on affected families. Additionally, clearer communication about potential health risks, environmental contamina- tion, and protective measures taken during an environ- mental disaster is vital for fostering community trust and safety. Incorporating these strategic recommendations into disaster response plans could significantly improve the resilience and well-being of communities, especially historically marginalized and underserved populations. These findings contribute to the broader literature on dis- aster preparedness, emphasizing the importance of inclu- sive, equitable, and community-centered approaches in mitigating the impacts of environmental disasters.

Our study also mirrors findings from previous environ- mental disaster research. Ecological disasters, such as the Hurricane Katrina aftermath, disproportionately affected marginalized communities, and exposed stark disparities in disaster preparedness, response, and recovery efforts

[31–33]. Similar to the experiences documented in our study, the Flint water crisis revealed systemic environ- mental neglect, with predominantly Black residents bear- ing the brunt of the consequences [34]. These disasters underscore the complex interplay of race, socioeconomic status, and ecological vulnerability, highlighting how preexisting inequities exacerbate the impact of environ- mental hazards on minority communities [31, 35]. An underlying challenge mitigating and addressing impacts of disasters is public perception of health, which tends to focus on individual medical treatment and can obscure the role of environmental health. This lack of recogni- tion can influence political decision-making and impede efforts to prioritize environmental health concerns [36].

The findings from this study indicate a need for policy interventions that address the multilevel vulnerabilities of marginalized communities in the context of environmen- tal disasters. Policymakers should prioritize developing equitable disaster preparedness, response, and recovery plans that account for the unique needs of racial and eth- nic minority populations. This includes enhancing com- munication strategies, ensuring accessible evacuation procedures, and providing comprehensive economic and health support systems. By addressing these disparities through policies that reduce social-ecological stressors, it is possible to mitigate the disproportionate impacts of environmental hazards on marginalized communities, promote better health outcomes, and improve resilience and equity in disaster management.

Our study aligns with several previous studies exam- ining the mental and social impacts of ecological disas- ters. For example, a study focusing on the experiences of displaced residents after Hurricane Katrina found that income and access to support networks heavily influ- enced evacuation decisions, echoing our findings about the role of resources in evacuation behaviors [35]. Addi- tionally, participants in both studies expressed feelings of abandonment by government officials, during and after the disaster [35]. Ecological disasters often inflict trauma that extends beyond physical harm, creating emotional and existential distress in communities already burdened by historical injustices [37]. Research on man-made dis- asters, such as the Gulf of Mexico spill, shows that these events can have more severe mental health impacts than natural disasters, with exposed residents reporting higher rates of anxiety, depression, and post-traumatic stress disorder [25, 38–41].

In the future, governments should implement plans that address both the psychological and physical needs of individuals affected by environmental and ecologi- cal disasters. Establishing networks that provide acces- sible mental health resources, financial assistance, and medical care before disaster exposure could mitigate

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the long-term impacts on vulnerable communities. The extended repercussions of the Weaver fire on local resi- dents have highlighted the need for sustained support and resources to build resilience.

Strengths and limitations

There were several strengths to our study. Theoretically, the study team exhibits a strong commitment to commu- nity engagement with CBPR principles and partnership with local community agencies active in fire response that were engaged throughout the process of this study. We also employed a rigorous approach to data collection, grounded in the EHD Framework, to allow for the exami- nation of the multilevel influence on health outcomes fol- lowing the fire. Methodologically, the study incorporated member-checking techniques, such as using I-poems and community validation events, to enhance the trustwor- thiness and authenticity of the findings. By involving par- ticipants in interpreting and validating the data, the study increased the credibility and relevance of the results. To accommodate for participants with transportation or mobility barriers, our team performed interviews via phone or in participant homes, which was a strength, but could also affect the quality of data collected.

Our study has potential limitations. First, interviews were completed over a year after the Weaver fertilizer plant fire, which may have contributed to recall bias. Sec- ond, while most interviewers were racially or ethnically congruent with participants (a strength), they were not residents of the affected area, and their occupations (e.g., a radio host, clergy member, university student, etc.) may have impacted how participants responded. Most of the participants were female, limiting the viewpoints cap- tured by men affected by the fire. Additionally, one of the study co-investigators conducted several interviews with Black participants, and her role as a clinician and identity as White may have impacted participant trust. The participants were recruited via a convenience sam- ple, which may disproportionately represent participants with strong opinions. Although our team held a mem- ber checking event, inviting both Black and Latino par- ticipants to review I-poems and provide feedback, only Black participants were present, limiting feedback.

Conclusions and next steps

Our findings underscore the urgent need for compre- hensive disaster preparedness and response strategies that prioritize the needs of vulnerable and marginalized communities and are inclusive of people who have dis- abilities or language barriers. Moving forward, efforts should focus on improving communication, enhancing

support services, and addressing systemic inequities to mitigate the disproportionate impact that environmen- tal disasters have on marginalized populations. Future research is needed to explore the longitudinal effects of the fire on the participants’ physical and mental health.

Abbreviations

AN Ammonium nitrate
CBPR Community based participatory research EHD Environmental Health Disparities
QPRO Qualitative Patient Reported Outcomes

Supplementary Information

The online version contains supplementary material available at https://doi. org/10.1186/s12889-024-20235-z.

Supplementary Material 1. Supplementary Material 2.

Acknowledgements

We would like to acknowledge the many community partners and interview- ers who helped make this study possible, including Rev. Tembila Covington and Veronica Bitting with Neighbors for Better Neighborhoods, Rev. Kenneth Holly, Rev. Daniel Sostaita with Iglesia Cristiana Sin Fronteras, Rev. Enrique Cantana-Ramiro, Rocio Celis-Salvador, Spencer Aubrey, Tonia Edwards, the Piedmont Environmental Agency, and the Authoring Action team. The lead author used Grammarly to assist in the final editing of this paper.

Authors’ contributions

RZ, AS, AA, led the interviews of participants and trained community interviewers, DP, KM, RZ, AH, CP, MY, JM, RK, CD, and CB all contributed to the design of this study and interpretation of findings. RZ was lead author and drafted the manuscript. All authors contributed to the forming, editing, and final approval of this manuscript.

Funding

This study was supported by the National Center for Advancing Translational Sciences (NCATS), National Institutes of Health (grant UL1TR001420) and the Z. Smith Reynolds Foundation. Dr. Palakshappa’s work on this project was supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health under Award Number K23HL146902. Dr. Brown was supported by a grant from the National Institute for Child Health and Human Development (grant K23HD099249). The content is solely the responsibility
of the authors and does not necessarily represent the official views of the funders. The funding organizations had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Availability of data and materials

Data is provided within Supplementary File 2.

Declarations

Ethics approval and consent to participate

Our study was approved by The Wake Forest School of Medicine Research Ethics Committee (approval no. 00083530). All participants provided verbal informed consent before enrollment in the study.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Zimmer et al. BMC Public Health (2024) 24:2817

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Received: 29 July 2024

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