Risk perception is an important factor in individual and community disaster response, but there is a paucity of research on specific factors that influence it, particularly in rural and disadvantaged populations. In this observational study after the 2023 East Palestine train derailment, 288 participants (84 male; 198 female, 6 unknown; 94% white), completed a survey of their health and environmental concerns about drinking water, soil and air due to chemical exposures from the derailment. Factors potentially related to risk perception, {demographic, health (new and pre-existing symptoms), and temporal and geographic proximity to the derailment site], were measured. Binomial logistic regression assessed the relative relationships of these factors to outcomes. Residents with new symptoms had > 10 times the odds of having extreme health concerns (OR: 10.67, 95% CI: 3.90 – 29.19,) and >4 times the odds of environmental concerns (OR: 4.32, 95% CI: 1.70 – 10.99) than those without new symptoms, controlling for all other factors. Residents closer to the site had greater health and environmental concerns and had higher economic disadvantage. Environmental concerns increased over time and were higher for households with children and for non-smokers. Continued symptom monitoring and longitudinal studies are needed to accurately inform public health communications to residents. Messaging strategies in public health disasters should consider determinants of risk perception to achieve a balance between reducing perceived risk and validating community concerns.