Nursing Science and Environmental Determinants of Health: A Call for Environmental Health Nurse Scientists and Educators

Nursing science has long recognized the effect of social determinants of health on individual and population well-being. Guided by the Social Ecological Model (SEM), nurses are trained to consider the broader context of our patients’ lives—including poverty, education, housing, and access to care—across individual, interpersonal, community, and structural levels. Yet among these interconnected social determinants, there remains an underrecognized area in nursing science: environmental health. Air pollution, chemical toxicants, and the built environment are not isolated from social determinants; in fact, they overlap with social and structural factors to compound health risks and amplify disparities. This commentary explores how environmental determinants intersect with social determinants across the SEM and calls for multilevel nursing engagement through environmental health education, research, practice, and advocacy. Through this lens, it is clear that environmental health is not a specialty area, but instead an underlying determinant of health that should be integrated across all aspects of nursing science. HISTORY OF ENVIRONMENTAL HEALTH NURSING Nurses have a rich history as environmental health scientists and environmental justice advocates who influence institutional and policy changes to protect communities. Florence Nightingale herself recognized the importance of the lived environment and spearheaded advancements in sanitation reform. Over 100 years later, environmental activist Lillian Mood noted that environmental health is a good fit with the values of the nursing profession regarding disease prevention and social justice (Mood, 1995). Building on these deep roots, many nurses today have forged new paths in environmental health science, addressing physical hazards (e.g., natural disasters), chemical hazards (e.g., toxicants), biological hazards (e.g., communicable diseases), and social hazards (McCauley Rizzo Carroquino et al., 2012). Environmental exposures do not exist in isolation. They instead intersect with social determinants of health at all levels of the SEM, such as poverty, racism, and housing and structural inequalities, creating compounding health disparities that place the greatest burden on already marginalized communities. This leads to multilevel vulnerability, where environmental and social determinants interact within and between SEM levels to affect health outcomes. For example, at the individual level, low-income families may face increased exposure to harmful toxicants through food packaging. These intersections become more apparent at the community and structural levels, where historical structural factors have led certain communities to experience greater levels of harmful exposures. Lead exposure is a prominent example of this, where historical redlining led to structural disinvestment and perpetuation of lead-lined pipes in specific neighborhoods. As a result, generations of lower socioeconomic and often minority families have been more likely to be exposed to lead through their water supply (Muller et al., 2018). Elsewhere, the construction of highways through minority communities has chronically exposed generations of families and children to heightened levels of traffic-related air pollution (Jones et al., 2014; Alvarez, 2023). These inequitable environmental exposures result in continued and widening health disparities that can have intergenerational effects. Despite many large-scale efforts, individuals and communities are still being exposed to longstanding and newly emerging exposures on a daily basis. As noted by McCauley Pope et al., 1995). Many schools have responded to that call by integrating modules, simulations, and developing whole courses or certificate programs in their undergraduate-level and graduate-level curriculum (McElroy et al., 2021; Wang et al., 2025). Often, environmental health is introduced in undergraduate modules related to population or community health, which may limit students’ ability to link environmental health concepts across their training. Instead, environmental health concepts should be integrated throughout the nursing curriculum, in addition to standalone courses. Full curriculum integration would emphasize the effect of environmental determinants of health across life stages, body systems, and the levels represented in the SEM. Students at undergraduate and graduate levels should receive training on types of environmental exposures, sources of exposure, screening tools, health effects, and resources to stay up-to-date on new information. These concepts could be integrated throughout learning modules organized by body systems or developmental stages and can take a more specified approach when integrated into graduate specialty programs. Additional learning objectives could include environmental health equity, disaster preparedness, sustainability, environmental justice and advocacy, and the historical and present roles of nurses in environmental health spaces. The Alliance of Nurses for Health Environments (ANHE), founded by Executive Director and environmental nurse expert Dr. Katie Huffling, is an excellent resource for educators and schools wanting to integrate environmental health into their curriculum. ANHE offers a free online undergraduate environmental health nursing textbook as well as guided lesson plans for single lectures or standalone courses (McDermott-Levy et al., 2023). As environmental health is an expansive area, guest speakers from public and environmental health, medicine, social sciences, and urban planning can be beneficial and a visible demonstration for students of successful interprofessional collaboration and team science approaches. Nursing students interested in environmental health research should be supported to seek out a constellation of mentors in nursing and these interdisciplinary spaces to pursue their research questions and further grow the environmental health nurse discipline. RESEARCH Advancing environmental health requires a broad nursing research agenda across all levels of the SEM. Critical gaps remain in our understanding of how environmental exposures, ranging from toxicants to climate-related extreme heat and water insecurity, contribute to health outcomes and disparities across populations. Further, in addition to preventing exposures from occurring, research is needed to protect individuals and communities even after they have been exposed. To address these gaps, both qualitative and quantitative research approaches are required. Qualitative research can explore individuals’ perceptions of environmental risk, experiences of cumulative exposures at the individual and community level, and how structural barriers are navigated. Quantitative research should continue examining biological mechanisms and ways in which environmental and social determinants interact to influence health across the life course. There is also a pressing need for translational research to identify effective clinical, individual, and community-level interventions to promote protection and resiliency in vulnerable populations. Nurses interested in developing research skills can apply to the Environmental Health Research Institute for Nurse and Clinician Scientists (EHRI-NCS; NIEHS/NIH R25ES033452 PI: Castner) workshop, which has been developed and led by many leading environmental health nurse experts including Drs. Julie Postma, Barbara Polivka, Lisa M. Thompson, Azita Amiri, Jeannie Rodriquez, Luz Huntington-Moskos, Kamal Eldeirawi, Katie Huffing, and Jessica Castner (Castner Incorporated, 2024). This competitive workshop is open to all nurse scientists interested in incorporating environmental health into their work and provides training on multiple types of research designs, measures of environmental exposures, analytical techniques, and translational frameworks, in addition to yearlong mentorship from the expert leaders of the workshop. Environmental health research questions can be addressed with both primary and secondary data. Working with primary data could involve qualitative interviews and community engagement, biospecimen collection, electronic medical record data, or utilizing data from exposure monitoring stations (e.g., air pollution or heat). Secondary data is another excellent approach and could include population-level datasets and cohort studies. The National Health and Nutrition Examination Survey (NHANES), the Environmental Protection Agency’s Environmental Justice Screening Tool (EJScreen), or the National Institutes of Health All of Us datasets are excellent repositories of population-level data that include environmental exposure risk scores and biomarkers, social determinants or health, and a myriad of health outcomes. There are many open-access data repositories that harmonize data from multiple single observational cohorts. For example, the Environmental Influences on Child Health Outcomes (ECHO) study includes dozens of harmonized cohort studies, which have collected data on a mix of prenatal and early life environmental and social determinants of health and child developmental outcomes as they age (Environmental Influences on Child Health Outcomes, 2025). Data for ECHO are freely available through the Eunice Kennedy Shriver National Institute of Child Health and Development (NICHD) Data and Specimen Hub (DASH). Another harmonized cohort, the Adolescent Brain and Cognitive Development study (ABCD) is an NIH funded study of brain development and child health in the United States. Data from a compilation of 21 research sites are available on the NIH Brain Development Cohorts Data Hub for early life environmental and social determinants and adolescent brain development and imaging (ABCD Study, 2025). There are also single observational cohorts to consider. The Early Life Exposures in Mexico to ENvironmental Toxicants (ELEMENT) cohort, based in Mexico City, enrolled pregnant mothers beginning in 1994 and has followed them and their children for the past 30 years with rich data on toxicant and social exposures as well as neurocognitive, physical, and mental health outcomes across childhood, adolescence, and young adulthood. Each observational cohort will have its own process for project approval and data sharing, which often involves a written project request and data use agreement between institutions. Altogether, environmental health research requires a team science approach to address research questions at individual, community, and structural levels. Public health researchers, in particular, are often looking for collaborators with psychological health and clinical training to answer health research questions, a perfect place for nurses to collaborate. Collaborations with local community organizations can amplify this work and provide greater insight into the experiences and perceptions communities have toward particular environmental determinants of health. Further, there is an increasing need to translate research findings. Nurse scientists are well-positioned to collaborate with teams to develop clinical or community-level interventions. Additional collaborations with environmental engineers, urban planners, medical doctors, and social scientists would further the team science mission and create even more well-integrated interventions across the SEM. PRACTICE Environmental health can be integrated within all levels of nursing practice when providing care for individuals and communities. Patients are not routinely tested for measurable biomarkers of environmental exposures, nor is it recommended. However, one notable area is childhood lead exposure, which remains a persistent public health problem worldwide. Nurses who care for families and children must diligently advocate for childhood lead testing at the recommended 12 and 24 month checkups (required for children enrolled in Medicaid), assist families with follow up testing, and provide resources for lead abatement as needed. In clinical settings, nurses should assess their patients’ risk for environmental exposures. There are many freely available health assessment tools that can be used to assess home, community, school, and hospital exposure risk (Alliance of Nurses for Healthy Environments, 2025). Specialized tools are also available for pediatric patients and women pre-conception. While these tools do not assess levels of exposure, they are a thorough assessment of risk for exposures and provide education to patients regarding sources of a variety of environmental exposures, including toxicants, air pollution, heat, and overall environmental safety. Nurses working in community settings, such as schools or local health departments, should routinely assess potential exposures using the above-mentioned tools. These nurses may be the first to recognize an emerging exposure-health linkage or respond to an acute event. For example, nurses living near the East Palestine, Ohio, train derailment site have been vocal about the sharp increase in bronchitis and other respiratory systems in the community (Bendix & Victoria Lozano, 2023). As climate change accelerates and natural disasters become more frequent, communities will be increasingly facing simultaneous exposure to both environmental exposures and traumatic events. In developing and supporting disaster preparedness efforts, nurses must be equipped to respond to these overlapping environmental challenges and provide trauma-informed and environmentally informed care. ADVOCACY Finally, nurses must engage in advocacy to promote upstream change and protect the long-term wellness and environmental health of individuals and communities. 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