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they notice sludge odor for periods lasting from 2 days to 6 months after application. Over half (18/34) of the interview respon- dents associated acute physical symptoms that lasted a short period of time with sludge application events near their home (Table 1). The most commonly reported symptoms were eye, nose, and throat irritations and gastro- intestinal symptoms (nausea, vomiting, diar- rhea). Other symptoms reported by more than one respondent include cough, difficulty breathing, sinus congestion or drainage, and skin infections or sores. One respondent described recurring physi- cal reactions coincident with sludge applications near her home: All I know is [the sludge] will make your eyes burn. It will make your throat burn. And then you'll start coughing, and after that, you can't breathe. And that's when I go to the doctors. A farmer and long -time resident described the nauseating effects of sludge odor: The stench it would actually make you sick. It takes a lot to bother me, but it certainly got to me. I'd get nauseated after being out for about an hour in the morning. Other physical symptoms or conditions that were mentioned by no more than one respondent include pneumonia, swelling of brain arteries, increased seizures, temporary blindness, swollen tongue, closed throat, lung infection, and migraine. A few respondents expressed concern that they or their family members have chronic health problems, such as asthma or cancer, that make them more sensitive to harmful constit- uents in sludge. The parents of a child with chronic respiratory problems said they keep him indoors as long as sludge odors from a neighbor- ing field are present —up to 2 or 3 months —to protect him from possible airborne pollutants. Mental well- being. Over half of the respondents (18/34) said sludge application in their neighborhoods stirred unsettling emo- tions, including anger, frustration, misery, fear, worry, anxiety, insecurity, and helplessness. Respondents most commonly expressed anger related to not being informed about sludge application in their neighborhood, reckless sludge truck drivers, regulators who seem unconcerned with violations of land applica- tion rules, public officials who do not respond to reported concerns, and health impacts. A woman who reported that she and other family members get sick after nearby sludge applications described the emotional impact of sludge this way: I'm bitter and frustrated and angry because [sludge] is affecting my family .... And it's going to alter the rest of their lives because of something that's been laid down next to them that we knew nothing about, and had no control over. Sewage sludge, health, and environmental justice Malodor from sludge seemed to affect some respondents' mental states. As one interviewee said, I'm outside cutting grass or working in the garden and constantly smelling that [sludge] .... Your atti- tude changes by disturbances in your environment. A war veteran with posttraumatic stress dis- order reported experiencing flashbacks from sludge odor reminiscent of the smell of burning waste in a warzone: [Sludge] is not just a nuisance; it's a medical prob- lem for me .... I am not able to get myself to a place where I can begin to heal if they're constantly driving me backwards ... every time I've got to walk out of my house and smell the freaking warzone. Most respondents (26/34) shared ways that sludge odor and other related nuisances inter- fere with their enjoyment of home, property, and the outdoors. One long -time rural resident who joined her husband in the country after they married volunteered this common senti- ment about the impact of sludge odor on her home life: I don't want to come home because when we come home, we're Locked in the house. My husband says, "This is not the same. It's just not the same. We can't really enjoy where we live." Social well- being. Some respondents (8/34) said sludge odors disrupt their oppor- tunities to socialize with family and friends. Several lamented they are unable to spend time walking, playing, eating, or sitting out- side as a family when sludge odor is present. One father said, We have a gazebo outside. We sit outside. At least, that was our conversation in planning it. Family - ness. And [sludge] took that away. A few respondents said they refuse visits from extended family members because of the intensity of the sludge odor and concerns about its health impacts. A mother and grand- mother said, My daughter wants to come up with the grandkids, with the family —1 won't let her come when they're sludging. She got so hurt one year. "Mommy, we're coming for a week." I said, "No, you can't." Others said sludge odors interfere with social gatherings. One respondent whose fam- ily has lived in his neighborhood for genera- tions recalled, They first put [sludge] out right before the Fourth of July .... We had to put our plans to the side on doing something on the outside. We usually have cookouts, but you can't cook out in nothing like that. A total of 22 respondents named specific activities they are unable to do because of malodor from sludge during and for up to several months after a sludge application event (Table 2). The most frequently mentioned activity limitations were letting children play outdoors, opening house and car windows, and hosting relatives or outdoor social gath- erings. Others include line -drying laundry, walking freely around the neighborhood, gar- dening or working outside, sitting outside as a family, and staying home. A few respon- dents described ways of coping with the odor so they could continue their usual activities. One woman said she wears a mask to do barn chores when sludge odor is strong. Another said she wears a mask to leave the house when the odor is present. Environmental impacts. Over half of the interview respondents (18/34) reported observ- ing land application activities of environmen- tal concern to them. The most commonly reported concerns include sludge spillage on public roadways and private property, grazing cattle on land- applied pasture soon after appli- cation, the absence of signage at land appli- cation sites, and sludge runoff into surface waters. Table 3 lists these and other observa- tions of concern to respondents, as well as the number of respondents who reported them. In some cases, self- informed respondents said that the land application activities they observed were violations of state standards and that they attempted to report them to officials. In other cases, respondents had no knowledge of their state's land application standards. About one -third of the respondents (12/34) said they noticed changes in the natu- ral environment since sludge application began Table 1. Acute (short duration) physical symp- toms respondents attributed to sludge exposure (n = 18/34 respondents). Let children play outdoors No. of respondents Acute symptom reporting symptom Eye, nose, throat irritation 8 Nausea, vomiting, diarrhea 8 Cough 5 Difficulty breathing 4 Sinus congestion, drainage 4 Skin infection, irritation, sore 2 Table 2. Activities respondents said they are unable to do because of malodor from sludge during and for up to several months after a sludge application event (n = 22/34 respondents). No. of respondents reporting activity Activity limitation Let children play outdoors 8 Open house/car windows 8 Host relatives or outdoor social 6 gatherings Line -dry laundry 5 Walk freely around the neighborhood 5 Garden or work outside 4 Sit outside as a family 3 Stay home 3 Environmental Health Perspectives • VOLUME 121 1 NUMBER 51 May 2013 539 IIIIIIIIIIII