This paper discusses the analytical results of a health survey conducted in Hartford by a coalition of organized concerned citizens. We begin by identifying the groups involved in the project and how they came to work together. This arrangement helps to clarify the main purposes for this research and serves as an introduction to the research model, the results, and their importance as the basis for community based health research and organizing.
 

The health survey form was designed and circulated by members of Organized Northeasterners/Clay Hill and North End (ONE/CHANE) of Hartford under a grant from the U.S. Environmental Protection Agency. ONE/CHANE is a neighborhood organization based in the North End of Hartford. It is affiliated with the Hartford Environmental Justice Network (HEJN). HEJN is a coalition of twenty-two health and neighborhood organizations and the local affiliate of the Connecticut Coalition for Environmental Justice (CCEJ). CCEJ is an umbrella group for a network of grassroots activists working in urban areas of Connecticut on local environmental issues (see Appendix II for a descritption).
 

The Coalition works with regional groups such as the Toxics Action Center (TAC). It was through the course of two conferences in Connecticut and Massachusetts hosted by the TAC that the CCEJ's Dr. Mark Mitchell met and began working with Dr. Brian Lipsett of the Environmental Background Information Center (EBIC). Dr. Mitchell is President of CCEJ, a director on the Greater Hartford Hispanic Health Council, and former director of the Hartford Health Department. He has a MD from the University of Missouri and a Masters in Public Health from John's Hopkins. Brian Lipsett is organizing director of the EBIC and has a PhD in Administration of Justice from Penn State University.

Dr. Lipsett offered and Dr Mitchell formally requested EBIC's assistance in mapping and analyzing the health survey data as a followup to the data collection and as a preliminary step in turning the research into a component of a broader organizing campaign in Hartford. The survey project is thus composed of several components, but was designed to determine if some types of health problems are concentrated in certain neighborhoods of Hartford.
 

Discussion
 

Chronic recurrent respiratory symptoms were found to be concentrated in Hispanic households. This suggests that the health risk is particularly pronounced in the southern half of the city where most of the Hispanic population lives. Further analysis is necessary but we can say for certain that there is a marked demographic pattern associated with asthma incidence in the city. These results bear out other research on the topic of asthma in Hartford. Most importantly, the relationship between asthma incidence and the incidence of coughs and sore throats needs to be further examined. Is this a new type of progressive illness and/or is it a sign of environmental stress. Certain facilities in closer proximity to these neighborhoods may be related to the problems. Other phenomenon such as housing stock may play a role. It is worth noting that the health variables we examined, particularly in our regression analysis may be multicollinear. Asthma and allergies, for example, are thought to coincide.

Methodology
 

A survey of certain acute and chronic symptoms was developed with input from a committee of community representatives, epidemiologists, health researchers and physicians based on other published surveys and anecdotal community experience. The survey instrument was field tested and validated. Community residents were recruited and trained to conduct the survey in randomly selected households citywide. Household heads answered the questionnaire for the whole household. 
 

The survey was conducted by volunteers who went through Hartford neighborhoods knocking on the doors of houses and apartments in Hartford. The households were randomly selected by dividing the city of Hartford up into 872 blocks. The sample contains a total of 415 household survey sites. The data is derived from interviews with 415 primary respondents who were interviewed during household visits. A total of 1088 persons at those household sites are included in the survey.
 

The data was initially compiled by Dr. Mark Mitchell. Dr. Mitchell had initial assistance from Deborah Dumin, a Connecticut Department of Environmental Protection employee, and Dr. Ellen Cromley, a professor of Geography at the University of Connecticut. The survey data was then split into two separate tables, one table containing health information for primary respondents and another table for the reported health of other household members, based on responses from the primary respondent.
 

Following survey design, implementation and data compilation, data analysis was conducted to determine if there were any clear geographic or demographic patterns associated with observed health problems. The community groups involved in the survey implementation were particularly concerned with asthma, respiratory disorders, and other acute human ailments which may be environmentally related. The suspicion is that there are potential clusters of these problems which may also be associated with sources of pollution. Questions in the survey were designed to document the occurrence and distribution of conditions of concern. In order to do this properly, it was necessary to accurately locate the exact positions of survey respondents households on a two dimensional surface - a map of the city of Hartford. 
 

This task was accomplished by the use of Geographic Information Systems (GIS). Health survey data was geo-coded to the household/building level and appears on the map as point data. This approach was aided with data from the Metropolitan District Commission Water and Sewerage Company including line data of building footprints of structures in Hartford, street and sidewalk boundaries, interstates, and railroads. Demographic point data for census block groups was transformed into surface representations and was masked with the use of land use data from the MAGIC website at the University of Connecticut (http://magic.lib.uconn.edu). Land use data is based on analysis of satellite imagery.
 

Subsequent to incorporation of the health survey data into a GIS analysis, the same data was run in a statistics package and simple Chi Square analysis was performed. This analysis helped to bolster findings that could be derived from a more or less cursory visual examination of the plotted data. 
 

Results
 

Dr. Mitchell and CCEJ derived preliminary results from the analysis which showed that asthma is fairly evenly distributed among households throughout the city. However, a preliminary analysis of cough and sore throats lasting longer than two weeks and respiratory problems lasting longer than one month appeared to be more common in the southern part of the city. This result is consistent with anecdotal reports from residents that many Hartford residents get "colds" that last for months. This is contrary to the duration of viral upper respiratory illness (the common cold) reported in the medical literature which is described as lasting from 4 to 10 days.
 

Subsequent analysis of the data provided further support for these results and led to the observation that the Hispanic population is more at risk for asthma, colds lasting more than one week and other respiratory problems lasting more than one month. We term these observed respiratory health problems of people in Hartford as "Chronic Recurrent Respiratory Ailments (CRRA)." What follows is a more detailed discussion of our findings.
 

Asthma

A sample of 1088 individuals in 415 households was broken in two according to whether a particular record described the reported health of a primary survey respondent or one of 673 "other" members of households. In 87 households, the primary respondent reported asthma. An additional 30 individuals in 27 of those households were reported to have physician diagnosed asthma. A total of 117 persons have asthma in the 87 households where primary respondent has asthma. 2 Households were missing data in the asthma category for the primary respondent. In addition, there were 326 households where the primary respondent reported no asthma. Fifty other people in 41 of these households were reported to have physician diagnosed asthma. A total of 7 individuals in 7 households have missing data in the asthma category (2 primary respondents and 5 "other").
 
 
 
 
 
 
 

Table 1: CRRA in Hartford
 

	# of Persons	# Households	# of Housholds with Multiple Victims	# of Households with Single Victim
Primary Respondents with Asthma (of 413 with 2 missing cases)	87 (21)	87 (21)	na	na
Number of Other Persons with Asthma in households where primary resp. reports Asthma (of 154 persons in 87 household with one missing case)	30 (19.5)	27 (31)	na	na
Other Members with Asthma in households where primary resp. doesn't report Asthma (of 518 persons in 326 households with 4 missing)	50 (9.7)	41 (12.6)	na	na
Asthma Totals (%) (of 1081 persons with 9 missing in 413 households with 2 missing)	167 (15.4)	128 (31)	35 (8.5)	93 (22.5)
Primary Resp. with Colds or Sore Throats Lasting More than 1 Week (of 412 with 3 missing)	88 (21.4)	88 (21.4)	na	na
Other Members with Cold/Sore Throat Lasting More than 1 week where primary resp. reports same (of 171persons in 88 households with 4 missing cases)	31 (18.1)	21 (23.9)	na	na
Other Members with Cold/Sore Throat Lasting More than 1 week where primary resp. doesn't report same affliction (of 501 persons with 7 missing in 324 households with 3 missing)	47 (9.4)	36 (11.1)	na	na
Cough/ Sore Throat Totals (%) (of 1081 persons with 7 missing in 412 households with 3 missing)	165 (15.3)	123 (29.9)	28 (6.8)	95 (23.1)
Primary Respondent with Allergies (of 413 with 2 missing)	115 (27.9)	115 (27.9)	na	na
Other Household Members with Allergies in households where primary resp. reports allergies (of 189 persons in 115 households)	31 (16.4)	22 (19.1)	na	na
Allergies in households where primary resp. does not report allergies (of 482 persons in 298 households	39 (8.1)	34 (11.4)	na	na
Allergy Totals (%) (of 1081 persons with seven missing in 413 households with missing)	185 (17.1)	149 (36.1)	27 (6.5)	122 (29.5)
Primary Resp. with Respiratory Problems Lasting more than one Month (of 415)	29	29	na	na

Overall 128 households report asthma in one or more members. Those households contain 167 persons who have physician diagnosed asthma 31% (128/413) of households sampled have one or more cases of diagnosed asthma. 15.4% (167/1081) of all persons in 415 households have physician diagnosed asthma. 38 households have more than one asthma sufferer. That is 9.2% of the overall household sample and 30% of households with asthma.
 
 
 

Asthma and Gender 

There were 295 females and 118 males acting as primary respondents. Three hundred and eleven females and 357 males were found among the other members. A total of 5 records were missing gender descriptors. Thus a total of 606 (56%) females and 475 (44%) males were in the sample. A total of 64 males out of 471 (13.6%) and 103 females out of 605 (17%) have asthma. Thus woman were more likely than men to have asthma, although the difference is statistically significant at better than the .01 level for primary household respondents only.

Age and Asthma

Amongst primary respondents, only 2 were under the age of 18. One of these reported having asthma. (Edit this expression "had asthma" and add percentages) There were 89 people who were between the ages of 18-29. Twenty three of these people had asthma. There were 130 people between 30-44, 24 of which had asthma. Likewise there were 130 people between age 45-65. Thirty had asthma. Finally, 64 people were over 65. Nine had asthma. Amongst other household members, there were 350 people under age 18. Fifty-five had asthma. There were 94 people were between 18-29. Eight had asthma. There were 103 people between 30-44. Eight had asthma. Amongst the 78 other members between 45-65, 5 had asthma. Twenty nine other people were over 65, with only 2 having asthma. Nineteen cases were missing data on age, two cases of which have asthma.
 

Asthma Concentrations

Asthma appears to be concentrated in particular households. Ninety three households had one member with reported asthma. An additional 35 households contain an 74 more persons with reported asthma. That means that 8.4% of all households in the sample contain 44.3% of all reported asthmatics while an additional 22.4% of all households contain the remaining 65.7% of all reported asthmatics. This phenomenon holds consistent for other respiratory tract ailments.
 

Coughing, Sore Throats and Other Respiratory Ailments

Twenty nine primary respondents reported having respiratory problems that lasted more than 1 month. Less than half, 13 of those persons, report not having been diagnosed with asthma and do not report having coughs that last more than 2 weeks. Data on respiratory problems lasting more than one month are only available for primary respondents. However, data on coughs and sore throats lasting more than two weeks was available for both primary and other household members. A total of 165 people reportedly have coughs and/or sore throats lasting more than two weeks. 6.7% (28) of the households have multiple cases of this ailment going on. So, in addition to having 167 diagnosed cases of asthma in the sample, we have 165 people with reported coughs and sore throats that last more than two weeks. Ninety-five households (22.9%) of all households have one case of cough/sore throat lasting more than two weeks. Twenty eight additional households (6.7%) contain 42.4% of all cough/sore throats lasting more than 2 weeks. 
 

Allergies

One hundred and eighty five persons in 149 households reportedly have allergies. Twenty seven of those households have multiple allergy victims. One hundred and twenty two households have a single victim. Allergies are even more concentrated in certain households. Twenty seven households (6.5%) hold 34% of all allergy victims, while 29 households contain the other 66% of all allergy victims.
Table 2: Total Allergies in Household
 

		Frequency	Percent	Valid Percent	Cumulative Percent
Valid	.00	263	63.4	63.8	63.8
	1.00	122	29.4	29.6	93.4
	2.00	22	5.3	5.3	98.8
	3.00	3	.7	.7	99.5
	4.00	1	.2	.2	99.8
	6.00	1	.2	.2	100.0
	Total	412	99.3	100.0
Missing	System	3	.7
Total		415	100.0

 
 
 

Correlation and Regression Analysis

The apparent clustering of these maladies in certain households strongly suggests that not all demographic groups share equally in their distribution. Bivariate correlation analysis yields results which strongly suggest that these ailments are being borne disproportionately by Hartford's Hispanic population.
 

For both primary respondents and other family members, there is a statistically significant relationship between Hispanic status and increases in the incidence of asthma as well as coughs and sore throats lasting more than two weeks. For respiratory problems lasting more than one month, the relationship between race and incidence amongst primary respondents is also statistically significant. All of these relationships are significant at the .05 level or better. Hispanics are between 1.5 and 3 times more likely than other demographic groups to have asthma, coughs and/or sore throats lasting more than 1 week and, for primary respondents, Hispanics are more likely to have respiratory problems lasting more than 1 month.
 

This pattern holds true with multivariate regression analysis. For total asthma in households, the population most at risk is Hispanic. Important contributing factors include the presence in the household of other respiratory and allergy problems. 
 

Connecticut Coalition for Environmental Justice 
 

The Connecticut Coalition for Environmental Justice is an organization that was established in Hartford in the summer of 1997. It was formed in response to community concerns about the siting of yet another fossil-fueled power generator in South Hartford as a consequence of the closure of Connecticut's nuclear power plants. Residents were concerned that this was the tenth power generator to be situated next to a neighborhood that is 80% Black and Latino and that this neighborhood is already overburdened with significant sources of air pollution, and its denizens suffer accordingly. CCEJ researched the issue, raised public awareness about the relationship between air pollution and respiratory health, requested a public hearing, and arranged the first environmental public information session sponsored by competing neighborhood groups. This was a highly successful strategy that led to an agreement whereby Northeast Utilities took the unprecedented step of removing the new power generator.
 

Major Accomplishments and Ongoing Activities
 

Since that time, CCEJ has been active in many areas. In 1999, CCEJ's focus has been to form, nurture, and staff the Hartford Environmental Justice Network (HEJN). This first funded year of the Hartford Environmental Justice Network has far exceeded our expectations. Our major accomplishments have been:
 

1. Banning medical waste in Hartford. Hartford is already home to more regional waste disposal facilities than any other Connecticut town. It receives waste from 77 Connecticut towns, Vermont, Massachusetts, Rhode Island, and New York City. Medwaste Management, Inc. of New England proposed to add a ninth type of regional waste facility--a medical waste treatment facility--to our overburdened city. Hartford Environmental Justice Network was able to educate the community and policymakers to the point that the Hartford City Council enacted legislation banning medical waste storage and disposal in the City of Hartford.
 

2. Sewage Sludge Compost Fire Accountability. For more than eight days in November and December, one of Hartford's eight regional waste disposal facilities--the MDC sewage sludge compost facility--burned uncontrollably to the ground, thereby presenting an infectious disease and air toxin hazard to nearby residents. HEJN hosted the only community forum asking for an explanation of the cause of the fire, the response of building, health and fire officials to the fire, and how to prevent this from occurring at the other 7 regional waste facilities. Our efforts led to an in-depth self-critical investigation of the fire by MDC. 
 

3. Protecting Coltsville Residents and Children. We were able to get the state Department of Environmental Protection to declare the former Colt's Firearm factory property to be a hazardous waste storage facility. In addition, we were able to get the Headstart Program moved off this contaminated site in June of 1999. 
 

4. Raised Awareness about the Relationship of Airborne Toxins From Incineration of Trash and Asthma. Now, a substantial portion of residents know about the large amount of trash that we import to burn and the potential link with asthma. We have persuaded the appropriate agencies to document asthma rates. This has lead to the finding that, at 41 percent, Hartford has the highest documented childhood asthma rate in the United States. 
 

5. Raised Environmental Concerns about the Cleanup of Adriaen's Landing. HEJN members trained other residents to ask questions of the developers to make sure that the contaminated site proposed for Adriaen's Landing and the Patriots' Stadium is properly cleaned with a minimum of risk to residents and workers before the project proceeds.
 

Environmental Background Information Center (EBIC)
 

EBIC is a non-profit organization which provides strategic research and assistance to community organizations. We specialize in corporate, demographic and geographic research on conditions and characters and other matters important to community groups. 
 

EBIC s mission is to strengthen the advocacy and technical capacity of grassroots groups seeking to preserve, sustain and improve the quality of their environment and health and prevent the disproportionate burden of toxic pollution in poor and minority areas. We do this by providing information technology tools and other support that will assist local communities in making their voices heard, stopping harmful projects whose focus is on the bottom line rather than the community, holding corporate polluters accountable, facilitating networking and building power locally. 

Race of Respondent * Has a physician ever told you you have asthma
 

			Has a physician ever told you you have asthma		Total
			yes	no
Race of Respondent	White	Count	13	63	76
		% within Race of Respondent	17.1%	82.9%	100.0%
	Hispanic	Count	36	70	106
		% within Race of Respondent	34.0%	66.0%	100.0%
	Black	Count	28	154	182
		% within Race of Respondent	15.4%	84.6%	100.0%
	West Indian	Count	7	29	36
		% within Race of Respondent	19.4%	80.6%	100.0%
	Asian, American Indian, or Other	Count	3	10	13
		% within Race of Respondent	23.1%	76.9%	100.0%
Total		Count	87	326	413

 

Chi-Square Tests
 

	Value	df	Asymp. Sig. (2-sided)
Pearson Chi-Square	14.941	4	.005
N of Valid Cases	413

 
 
 

Race of Respondent * Do you get a cough or soar throat lasting longer than two weeks
 
 
 

			Do you get a cough or soar throat lasting longer than two weeks		Total
			yes	no
Race of Respondent	White	Count	14	62	76
		% within Race of Respondent	18.4%	81.6%	100.0%
	Hispanic	Count	39	67	106
		% within Race of Respondent	36.8%	63.2%	100.0%
	Black	Count	28	153	181
		% within Race of Respondent	15.5%	84.5%	100.0%
	West Indian	Count	2	34	36
		% within Race of Respondent	5.6%	94.4%	100.0%
	Asian, American Indian, or Other	Count	4	9	13
		% within Race of Respondent	30.8%	69.2%	100.0%
Total		Count	87	325	412

 

Chi-Square Tests
 

	Value	df	Asymp. Sig. (2-sided)
Pearson Chi-Square	25.394	4	.000
N of Valid Cases	412

 
 
 

From Dr. Ellen Cromley
 

Dear Mr. Lipsett, I am sending the corrected shape file (I moved the two points to the correct locations). You will need all of the files I'm sending. If there is a problem, let me know.
 

The file that I am sending is Connecticut Coordinate System State Plane Coordinates, NAD-27, Clark spheroid. The map units are feet. 
 

The parcel boundaries and annotation of building numbers and so on are in ArcInfo coverage format. These are also NAD-27, etc.
 

I think it would be best for you to handle all of the conversions to lat/lon, if that is what you wish. All of DEP's data and data for the Metropolitan District Commission (they prepared the building footprints, parcel boundaries, etc.) are projected data. This is what was supplied to Mark Mitchell. If you wish to work with the data in some other projection or unprojected, it would be best for you to put the data into that format. Mark Mitchell has all of these data.
 

Also,the MAGIC website at the University of Connecticut is a source for digital geospatial data for all of the towns of Connecticut. You can download data for Hartford (1990 census tracts, and a lot of other data) in ESRI exchange (.e00) format, unzip the data, and bring it into

ArcView. These data are projected. The URL is http:\magic.lib.uconn.edu.
 

From Arcview
 

The State Plane Coordinate System was originally designed to use the North American Datum of 1927, or NAD27. It uses the Clarke spheroid of 1866 to represent the shape of the earth. The origin of this datum is a point on the earth referred to as Meades Ranch in Kansas. Many NAD27 control points were calculated from observations taken in the 1800s. These calculations were done manually and in sections over many years. Therefore, errors varied from station to station. To use one of the State Plane projections in NAD27, select State Plane - 1927 from Projection Properties.