Ethylene oxide (EtO), a known human carcinogen, is emitted from facilities across the United States. A 2018 assessment by the Environmental Protection Agency (EPA) showed that areas around EtO-emitting facilities had cancer risk levels up to 24 times the national average. The EPA notified the state Department of Environmental Protection (DEP) about the high cancer risk to their residents. Our aim was to analyze actions and implementation equity at the federal, state, and community levels since the EPA notification. Using publicly available data, we identified U.S. emitters of EtO and then analyzed community, state, and federal actions since the EPA notification through content analysis of internet data using the lens of the environmental inequality formation (EIF) theory. Thirty-one of a total 654 EtO-emitting facilities have an estimated cancer risk of over 100 in a million in neighboring census tracts and are located in 13 states and Puerto Rico, representing 7 EPA regions. Content analysis identified themes of community outcry, agency involvement, and legislative action and found no action without community outcry. By January 2021, 2 facilities had closed, 5 facilities had cut emissions, and 24 facilities in 9 states and 5 EPA regions had taken no action. Wealthier white neighborhoods saw facilities close or cut emissions. Differences in state response correlated with differences in community pressure and state priority setting, resulting in over 1 million people having continued significant EtO exposure for years. The impotence of the federal and state regulatory framework perpetuates environmental injustice in the United States.