From toxic waste in Love Canal, New York, to lead in Flint, Michigan, environmental contamination can cause chronically elevated psychosocial stress (see sidebar) in individuals and across families and communities (Cuthbertson, Newkirk, Loveridge, & Skidmore, 2016; Edelstein, 2004; Levine, 1983). Stress is a normal reaction to environmental contamination, not a mental health disorder. Still, stress can affect people’s health and quality of life.

Environmental contamination can cause psychosocial stress among affected community members for many reasons, including:

In addition, lengthy environmental and health investigations, loss of trust in institutions, financial strains, and other concerns associated with environmental contamination are sources of stress.

For affected community members, the stress of living with environmental contamination can pose physiological health risks on top of risks associated with direct exposure to the contamination. Chronic stress has been linked with cardiovascular effects, increasing the risk for development of hypertension and plaque formation in atherosclerosis (Kaplan, Pettersson, Manuck, & Olsson, 1991; Melin, Lundberg, Söderlund, & Granqvist, 1999; Seeman et al., 2010). Stress can also trigger complex headaches (e.g., migraines) and flares in autoimmune (Stojanovich & Marisavljevich, 2008) and dermatological conditions (Arndt, Smith, & Tausk, 2008). Disadvantaged and vulnerable populations might also disproportionately suffer from other psychosocial and environmental stressors (e.g., institutionalized discrimination, adverse childhood events) (Collaborative on Health and the Environment, 2016; Morello-Frosch & Shenassa, 2006). Further, stress and chemical exposures can interact, producing worse health outcomes than either independently (McEwen & Tucker, 2011).

Conversely, individual and community resilience can promote physical and psychological health and enhance well-being. Community resilience is the ability of a community to adapt to changing conditions and prepare for, withstand, and rapidly recover from disruption (The White House, 2015). Communities able to develop an actionable plan to cope with and recover from a disaster tend to have better outcomes (Wulff, Donato, & Lurie, 2015). While acute disasters affect communities differently from chronic environmental contamination incidents (Table 1), resilience theory and principles can be applied to help communities prepare for, survive, and recover from natural and technological disasters (Sandifer & Walker, 2018).

The Agency for Toxic Substances and Disease Registry (ATSDR) and other federal, state, and local health professionals with experience in communities affected by environmental contamination recognize stress as a challenge. ATSDR’s efforts to address this issue date back to a 1995 expert panel on the psychological effects of hazardous substances (Agency for Toxic Substances and Disease Registry [ATSDR], 1995). Following the expert panel, ATSDR established a community stress team that worked directly with communities to develop public health strategies to mitigate community stress from 1998–2002. The team also delivered trainings on stress and contamination for public health and environmental professionals, and in some communities, for local psychologists, healthcare providers, and social workers.

More recently, public health agencies, including ATSDR, have developed stress-focused materials for affected community members. These materials acknowledge stress and worry related to environmental contamination, validate these feelings as normal responses, offer ideas for coping, and point to helpful resources (ATSDR, 2017a; County of Los Angeles Public Fiealth, 2018, Multnomah County, 2016). ATSDR also developed tips for health professionals to review before addressing this topic with community members (ATSDR, 2017b) and has provided awareness-level training for public health and environmental professionals (U.S. Environmental Protection Agency, 2018). ATSDR’s fact sheet (in English and Spanish) and tips sheet are available at www.atsdr.cdc.gov/factsheets.html under the Stress and Environmental Contamination section.

Currently, ATSDR is taking a fresh look at psychosocial stress related to environmental contamination, with a focus on per- and polyfluoroalkyl substances (PFAS) in drinking water. This community-engaged project might enhance knowledge and understanding of PFAS contamination-related stressors, informing new tools, resources, and strategies to reduce stress and build resilience in affected communities.

The project includes the following activities:

ATSDR looks forward to engaging community members and public health partner organizations in this work. Contact Ben Gerhardstein at bgerhardstein@cdc.gov to learn more.