Crosscutting environmental risk with design: A multi-site, multi-city socioecological approach for Iowa's diversifying small towns.

Globally, the influx of refugee, migrant, and immigrant populations into small centers of industrialized agriculture has called attention to a looming public health crisis. As small towns shift from remote villages into rural, agri-industrial centers, they offer limited access to amenities needed to support human well-being. Our study focused on three Iowa towns that continue to experience an increase in under-represented minority populations and decline of majority populations as a proxy for studying shifting populations in an era of industrialized agriculture and global capital. We aimed to understand the socioecological impact of built environments-outdoor locations where people live and work-and likelihood of environmental exposures to impact vulnerable populations. Urban socioecological measures tend to present contradictory results in small towns due to their reliance on density and proximity. To compensate, we used post-occupancy evaluations (POE) to examine built environments for evidence of access to environmental design criteria to support healthy behaviors. The study systematically identified 44 locations on transects across three small towns to employ a 62 item POE and assess multiple environmental criteria to crosscut design with environmental health disparities. Principal-components factor analysis identified two distinct significant components for environmental risk and population vulnerability, supporting similar studies on parallel communities. Multilevel modeling found a divergence between supportive environmental design coupled with an increase environmental risk due to location. The combined effect likely contributes to environmental health disparities. The study provides a strategy for auditing small town built environments as well as insight into achieving equity.