Mountain Air Project Uses Photovoice to Engage Appalachian Youth in Environmental Health Research

November 12, 2019

A team of investigators working with the Mountain Air Project (MAP) based at the University of Kentucky College of Public Health equipped young research volunteers with digital cameras to allow them to document environmental health issues in their local environments in what is believed to be the first effort at using photovoice to engage youth in environmental health research in Appalachia. Their findings appear in the International Journal of Environmental Research and Public Health.  Dr. Kathryn M. Cardarelli, associate professor of Health, Behavior & Society at the UK College of Public Health, is first author. Co-authors include Dr. Marcy Paul of the Univ. of North Texas, MAP staff member Beverly May, MD/PhD student in Epidemiology and Biostatistics Madeline Dunfee, associate professor of Epidemiology Dr. Steven Browning, and professor of Behavioral Science in the UK College of Medicine Dr. Nancy Schoenberg.


Appalachian Kentucky reports some of the highest rates of respiratory illness in the United States, including chronic obstructive pulmonary disease and asthma. While smoking rates are high in the region, researchers observe that unexplained variation remains and community-engaged research approaches are warranted to identify contributing factors. The MAP community advisory board recommended that investigators invite youth to provide their perspectives on possible contributing factors to respiratory illness, and investigators undertook an exploratory study to determine the utility of photovoice to elicit such perspectives with this population.


While photovoice has been employed for other youth-focused health studies in Appalachia, to the investigators’ knowledge this work represents the region's first environmental study using photovoice by youth. Over eight weeks, ten participants ages 12 to 18 represented their perspectives through photographs and accompanying narratives.


A brief thematic content analysis of the youth narratives that accompanied the photos revealed three primary themes of environmental determinants of respiratory illness. These themes included compromises community members make regarding respiratory health in order to secure a livelihood; tension between cultural legacies and respiratory health; and consequences of geographic forces. This study demonstrates the value of incorporating youth perspectives in environmental health research, and the utility of photovoice as an approach to elicit such perspectives.