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<br />Lowman et al.
<br />Methods
<br />Community members who reported health
<br />impacts and nuisances from land - applied
<br />sludge near their homes brought this research
<br />topic to our attention. We worked with
<br />community-based groups in North Carolina
<br />and Virginia to identify and invite eligible
<br />individuals to respond to an in- depth, semi -
<br />structured interview about their experiences
<br />living near treated sludge application sites.
<br />Some eligible participants contacted us after
<br />learning about our research through pub-
<br />lic documents or word of mouth. Interview
<br />respondents often referred the interviewers
<br />to other individuals who were willing to talk
<br />about living near sludge application sites.
<br />This recruitment method is a type of pur-
<br />posive sampling commonly used in qualita-
<br />tive research (Merriam 2009; Patton 2002).
<br />Rather than using random samples to general-
<br />ize findings to populations, purposive sam-
<br />pling selects a sample for its ability to provide
<br />insight on a research topic (Ulin et al. 2005).
<br />Qualitative findings based on purposive sam-
<br />pling may be transferable or relevant to other
<br />populations if key elements of the population
<br />and context are similar to those of the original
<br />research (Bernard 2010; Patton 2002).
<br />To be eligible for the study, participants
<br />needed to be >_ 18 years of age, live within
<br />1 mile of a permitted sewage sludge land
<br />application site, speak English, and be will-
<br />ing to spend 1 -2 hr responding to a semi -
<br />structured, open -ended interview about their
<br />experiences living near the site. To show
<br />appreciation for interviewees' time, we sent
<br />each participant a $25 honorarium.
<br />We (all of the authors) had interviewing
<br />experience and all of us conducted interviews
<br />between 2009 and 2011. We typically inter-
<br />viewed in pairs at residents' homes or at pri-
<br />vate meeting places of their choosing. We
<br />completed part of one interview by phone.
<br />Often we interviewed two people together,
<br />such as a husband and wife. At the beginning
<br />of each interview, we explained the research
<br />project and obtained informed signed con-
<br />sent from participants to participate in a
<br />recorded interview. Interviewers followed a
<br />semistructured open -ended discussion guide
<br />that included the following topics: partici-
<br />pants' history with the community and their
<br />land and what these mean to them; common
<br />indoor and outdoor activities; observations or
<br />concerns about the surrounding natural envi-
<br />ronment; perceptions of and experiences with
<br />sludge application near their home; individual
<br />and community response to the application
<br />of sludge; coping mechanisms; and efforts to
<br />obtain information, contact authorities, and
<br />investigate avenues for action. The guide drew
<br />from input from persons living near sludge
<br />application sites and from a guide developed
<br />for previous research on air pollution from
<br />industrial hog operations in North Carolina
<br />(Tajik et al. 2008; Wing et al. 2008).
<br />Interviews lasted from 45 min to 2 hr. At
<br />each interview, participants provided infor-
<br />mation about their date of birth, sex, race,
<br />and ethnicity. After the interview, research-
<br />ers wrote or dictated field notes that included
<br />observations of the interview context and other
<br />information not captured in the recording; for
<br />example, descriptions of participants' homes
<br />and yards that provided information on social
<br />and economic background, participants' inau-
<br />dible reactions that captured depth of feeling
<br />on a subject, and observed similarities and dif-
<br />ferences among participant responses that con-
<br />tributed to the development of themes. When
<br />we determined that all interview topics had
<br />reached data saturation, that is, when nothing
<br />new or contradictory was emerging from the
<br />interviews, we concluded data collection.
<br />We transcribed recorded interviews and
<br />field notes and reviewed them for accuracy.
<br />We read and discussed the interviews as they
<br />were completed and transcribed so that early
<br />interviews informed later ones. This itera-
<br />tive process enabled us to identify important
<br />themes, note areas where we needed more
<br />information, and determine whether there
<br />were topics that needed further clarification
<br />and additional research (Gibson and Brown
<br />2009; Guest et al. 2012; Patton 2002).
<br />As a team, we developed a detailed code -
<br />book to analyze the interviews. One team
<br />member (A.L.) used Atlas.ti (Scientific Software
<br />Development GmbH, Berlin, Germany) to
<br />code segments of text from the the interview
<br />transcripts and to combine similarly coded
<br />passages across all interviews. These grouped
<br />passages enabled us to conduct team -based eval-
<br />uations of the coding, refine code definitions,
<br />examine topics that included a range of experi-
<br />ences or opinions, and identify themes and rep-
<br />resentative quotations (Guest et al. 2012; Ulin
<br />et al. 2005). We based our analytic themes and
<br />codes on our interview questions and on domi-
<br />nant themes present in participants' responses.
<br />Throughout the analysis we referred to the texts
<br />to check that our interpretations were consistent
<br />with the data (Guest et al. 2012).
<br />To further enhance the trustworthiness
<br />of our analysis, we solicited feedback from
<br />five randomly selected respondents about
<br />the three main themes we used to summa-
<br />rize our findings and our interpretations of
<br />their personal statements. We telephoned the
<br />five respondents and presented them with the
<br />themes and transcriptions of their interview
<br />statements related to those themes. Then we
<br />asked whether the themes accurately captured
<br />what they said. All five respondents were in
<br />complete agreement with the themes and
<br />interpretations reported in this article.
<br />The research was approved by the institu-
<br />tional review boards (IRBs) at The University
<br />of North Carolina at Chapel Hill (08 -0813)
<br />and The Duke University Medical Center
<br />(Pro00016294). In addition to following
<br />the IRB- approved protocol for protecting
<br />the confidentiality of study participants, we
<br />obtained a certificate of confidentiality from
<br />the National Institutes of Health to help pro-
<br />tect personally identifiable information from
<br />being released in any federal, state, or local
<br />legal proceedings, even under court order
<br />orsubpoena.
<br />Results
<br />We completed 26 interviews with 34 indi-
<br />viduals 35 -83 years of age living in rural and
<br />semirural areas within approximately 1 mile of
<br />sewage sludge land application sites in North
<br />Carolina, South Carolina, and Virginia. Twenty
<br />participants were from North Carolina, 6 from
<br />South Carolina, and 8 from Virginia. Nineteen
<br />interviews were with individuals, 5 with mar-
<br />ried couples, 1 with a brother and sister, and
<br />1 with a married couple and a relative. Of
<br />the respondents, 17 were male, 17 female,
<br />21 white, 12 African American, and 1 Hispanic.
<br />Interviewers observed that most participants
<br />lived in modest homes and neighborhoods that
<br />could be described as working or middle class,
<br />although a few lived in larger, newer homes that
<br />could be described as upper - middle class.
<br />At the time of the interviews, all but
<br />5 respondents had lived in their homes for
<br />5 years or more. Almost half (16/34) of the
<br />respondents had lived in their homes or
<br />neighborhoods most of their lives, and 11 lived
<br />on property or in neighborhoods where their
<br />families had lived for more than a generation.
<br />Eleven reported having a background in farm-
<br />ing. About half maintained gardens on their
<br />property, and many tended outdoor animals,
<br />including horses, goats, fowl, and dogs.
<br />The study results are categorized accord-
<br />ing to key themes identified in the interviews
<br />about the experience of living near land -
<br />applied sewage sludge fields: health impacts,
<br />environmental impacts, and environmental
<br />justice.
<br />Health impacts. Most respondents felt
<br />that sludge applications had a negative impact
<br />on some aspect of their health. The World
<br />Health Organization (WHO) defines health
<br />as a state of well- being, and not just the
<br />absence of disease (WHO 1948). We drew
<br />on this definition to categorize respondents'
<br />remarks on health impacts into the following
<br />subthemes: physical well- being, mental well-
<br />being, and social well- being.
<br />Physical well- being. Nearly all respon-
<br />dents (30/34) described offensive odors asso-
<br />ciated with sludge. The extent to which the
<br />odor affected the respondents varied. Some
<br />described it as "unbearable," others as an odor
<br />they "got used to," and one respondent said,
<br />"it don't bother me." Respondents reported
<br />538 VOLUME 121 1 NUMBER 51 May 2013 • Environmental Health Perspectives
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