Environmental Health Initiatives Research Articles

Implications of construction method and spatial scale on measures of the built environment.

BackgroundResearch surrounding the built environment (BE) and health has resulted in inconsistent findings. Experts have identified the need to examine methodological choices, such as development and testing of BE indices at varying spatial scales. We sought to examine the impact of construction method and spatial scale on seven measures of the BE using data collected at two time points.MethodsThe Children’s Environmental Health Initiative conducted parcel-level assessments of 57 BE variables in Durham, NC (parcel N = 30,319). Based on a priori defined variable groupings, we constructed seven mutually exclusive BE domains (housing damage, property disorder, territoriality, vacancy, public nuisances, crime, and tenancy). Domain-based indices were developed according to four different index construction methods that differentially account for number of parcels and parcel area. Indices were constructed at the census block level and two alternative spatial scales that better depict the larger neighborhood context experienced by local residents: the primary adjacency community and secondary adjacency community. Spearman’s rank correlation was used to assess if indices and relationships among indices were preserved across methods.ResultsTerritoriality, public nuisances, and tenancy were weakly to moderately preserved across methods at the block level while all other indices were well preserved. Except for the relationships between public nuisances and crime or tenancy, and crime and housing damage or territoriality, relationships among indices were poorly preserved across methods. The number of indices affected by construction method increased as spatial scale increased, while the impact of construction method on relationships among indices varied according to spatial scale.ConclusionsWe found that the impact of construction method on BE measures was index and spatial scale specific. Operationalizing and developing BE measures using alternative methods at varying spatial scales before connecting to health outcomes allows researchers to better understand how methodological decisions may affect associations between health outcomes and BE measures. To ensure that associations between the BE and health outcomes are not artifacts of methodological decisions, researchers would be well-advised to conduct sensitivity analysis using different construction methods. This approach may lead to more robust results regarding the BE and health outcomes.Electronic supplementary materialThe online version of this article (doi:10.1186/s12942-016-0044-x) contains supplementary material, which is available to authorized users.

Special Issue on Pacific Health

The World Health Organization (WHO) has defined a healthy island as an island that is committed to, and involved in, a process of achieving a better health and quality of life for its people and healthier physical and social environments in the context of sustainable environment. The main challenges facing island health include the increasing burden of noncommunicable diseases as well as the continuing, and sometimes reemerging, burden of communicable diseases. Human resources for heath in remote areas are always a problem, but it is even more difficult to develop and retain health workers on islands. Some remote island villages, be it in the Pacific region or elsewhere, have only the bare necessities for survival; no electricity, no proper toilets or clean drinking water. In India, for example, the Indian government brings electric power, education, and health services to rural villages. Together with UNICEF, the Indian government is attempting to bring basic health care to isolated island villages, such as those situated along the Brahmaputra River or in the Andaman archipelagoes. But the challenge of small populations, remoteness and an island environment make this difficult. Indonesia and the Philippines have the largest number of islands, countless thousands of them, and providing public health services in these remote island villages is difficult and challenging because of geography, culture, economics, and politics. In the Pacific islands, the “healthy island” concept provides a theoretical underpinning for efforts in health promotion and health protection in island countries. WHO began its healthy island initiatives in 1995. Healthy island initiatives are linked to community commitment and take various forms in several Pacific islands countries. Some initiatives focus on control of specific diseases or health problems, for example, malaria control in the Solomon Islands, environmental health and health promotion initiatives in Fiji, or on water supply and sanitation in Tonga. All these pose a challenge to the coordination of health programs and interventions and the strengthening of public health in these island countries. Binns et al, 1 in their article, discussed the issues and challenges of island health and its impact on public health and illustrated the scope of the problem of island health and how health services in islands required an integrated approach to public health and clinical services. The roles of schools of public health are highlighted in promoting healthy islands. There is a need to develop competency in knowledge and skills and in inculcating a right and positive attitude for island health with the hope of delivering island health leadership in health care. Furthermore, there is a need for intersectoral collaborations, and cooperation is a matter of necessity among Pacific island nations. 2

Joint Bayesian analysis of birthweight and censored gestational age using finite mixture models

Birthweight and gestational age are closely related and represent important indicators of a healthy pregnancy. Customary modeling for birthweight is conditional on gestational age. However, joint modeling directly addresses the relationship between gestational age and birthweight, and provides increased flexibility and interpretation as well as a strategy to avoid using gestational age as an intermediate variable. Previous proposals have utilized finite mixtures of bivariate regression models to incorporate well-established risk factors into analysis (e.g. sex and birth order of the baby, maternal age, race, and tobacco use) while examining the non-Gaussian shape of the joint birthweight and gestational age distribution. We build on this approach by demonstrating the inferential (prognostic) benefits of joint modeling (e.g. investigation of 'age inappropriate' outcomes like small for gestational age) and hence re-emphasize the importance of capturing the non-Gaussian distributional shapes. We additionally extend current models through a latent specification which admits interval-censored gestational age. We work within a Bayesian framework which enables inference beyond customary parameter estimation and prediction as well as exact uncertainty assessment. The model is applied to a portion of the 2003-2006 North Carolina Detailed Birth Record data (n=336129) available through the Children's Environmental Health Initiative and is fitted using the Bayesian methodology and Markov chain Monte Carlo approaches.

Drinking Water Quality: Lead Particles on Tap

Vol. 116, No. 5 EnvironewsOpen AccessDrinking Water Quality: Lead Particles on Tap Rebecca Renner Rebecca Renner Search for more papers by this author Published:1 May 2008https://doi.org/10.1289/ehp.116-a201AboutSectionsPDF ToolsDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InRedditEmail Lead exposure is a serious concern for children’s health. Lead impairs children’s brain development, and many scientists believe no dose is safe. High levels of lead in the paint used on children’s toys resulted in numerous toy recalls in 2007. But some school drinking water may also expose children to high levels of lead, according to environmental engineer Marc Edwards of Virginia Polytechnic Institute and State University.Children’s toys and jewelry are recalled if the accessible lead dose—the amount expected to actually make its way into a child—exceeds 175 μg. In an eight-ounce glass of water, 175 μg lead converts to 700 ppb, according to Edwards, who notes that levels this high have been reported in school drinking fountains in Washington, DC; Seattle, Washington; and communities in Virginia and Massachusetts.In 2007 more than 10% of the Washington, DC, schools Edwards tested had at least one fountain with lead levels greater than 700 ppb. He says the most contaminated sample contained 20,000 ppb lead, equivalent to eating 14 dime-sized pieces of paint containing more than 16 times the Consumer Product Safety Commission limit for lead in paint. Some of this lead is dissolved in the water, but much of it remains in particulate form, originating primarily from old lead solder. Edwards presented these findings at “20 Years of Success and a Vision for the Future,” a December 2007 meeting cosponsored by the NIEHS Superfund Basic Research Program.Elevated blood lead levels in children from North Carolina and Washington, DC, have been traced by local public health authorities back to particles of solder in drinking water. In each case a change in water treatment appears to have exacerbated corrosion of water pipes, releasing more particles from solder into the water. Water filters that are attached to the faucet remove both dissolved and particulate lead, but pitcher-type filters do not, according to NSF International, which certifies water filters.Scientists have considered solder to be a minor source of lead in drinking water because they believed that, over time, mineral films form barriers between the water and the solder. “In fact, just like lead paint ages and creates hazards as it degrades, so too does lead solder,” Edwards says. The presence of particles changes the importance of drinking water as a lead source, says Ralph Scott, community projects director of the Alliance for Healthy Homes, an advocacy group. “In most cases we have assumed and still assume that water is a small part of the problem compared to paint,” he says. “But now we are looking at a dimension of the water problem never considered before.”Lead, covered by the 1991 Lead and Copper Rule, is one of the few drinking water contaminants monitored at the household tap. However, Edwards says that current regulations may miss tap water lead for a number of reasons. These include the current testing method, which he believes does not adequately measure particulate lead. Also, regulations require 90% of tested dwellings to meet the regulatory requirements but say nothing about the upper 10% of dwellings, which can have very high lead levels. Edwards and colleagues described these concerns in the June 2007 Journal of the American Water Works Association.But EPA spokesperson Sakeba Carter-Jenkins says the agency has seen no data indicating its current methods miss particulate lead. “If EPA does receive data showing that these procedures need modification, it can be considered as part of the long-term revisions to the Lead and Copper Rule,” says Carter-Jenkins.The EPA plans to begin reviewing the Lead and Copper Rule next year. Last year, the agency changed the rule so that water providers must report to the state before changing their water treatment regimens. This will allow for more timely monitoring of any changes in water quality at the tap, says Martha Keating, outreach coordinator with the Children’s Environmental Health Initiative at Duke University.FiguresReferencesRelatedDetails Vol. 116, No. 5 May 2008Metrics About Article Metrics Publication History Originally published1 May 2008Published in print1 May 2008 Financial disclosures License information EHP is an open-access journal published with support from the National Institute of Environmental Health Sciences, National Institutes of Health. All content is public domain unless otherwise noted. Note to readers with disabilities EHP strives to ensure that all journal content is accessible to all readers. However, some figures and Supplemental Material published in EHP articles may not conform to 508 standards due to the complexity of the information being presented. If you need assistance accessing journal content, please contact [email protected]. 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Toxicology in Australia: A Key Component of Environmental Health

Managing public concerns relating to chemical exposures can consume substantial public health resources, particularly as the scientific basis around these issues is often contentious. Toxicology remains underrecognized as a public health discipline in Australia, although Australian toxicologists are making significant contributions from academia, government, and the commercial sector toward assessing the level of risk and protecting the community from environmental hazards. Internationally, the growth of environmental toxicology and the promotion of sound science in risk assessment as a basis for making regulatory decisions have been, to some extent, driven by the outcomes of the 1992 UNCED Conference on Sustainable Development (Rio Summit) and its Chapter 19 Agenda 21 activities. The promotion of safe chemical management practices and the need for global strengthening of capabilities in toxicology are among the initiatives of the Intergovernmental Forum on Chemical Safety (IFCS), which was formed after the Rio Summit to manage these programs. This article describes some of the initiatives in capacity building that marked the development of environmental toxicology in Australia since 1992 in response to these international environmental health initiatives.

Society Builds Sustainability in Africa

With the speed of industrialization in today’s global community, the costs of disparities in environmental health and risk assessment can be dangerously high in developing countries without broad, stable regulatory and protective measures in place. Addressing capacity-building problems will depend largely upon the implementation of proactive measures within the borders of these developing nations—measures that participants sought to create at the Risk Assessment and Quality Assurance Training Workshop of the African Society for Toxicological Sciences (ASTS), held 21–28 October 2006 in Limbe, Cameroon. The workshop was cosponsored by the NIEHS as part of its efforts to expand global environmental health initiatives, as outlined in the institute’s Strategic Plan. Forty-seven experts in toxicology research, environmental policy, and government from Cameroon, Nigeria, Sudan, South Africa, the United States, and Europe convened for the purpose of generating ideas for new sustainable development initiatives. Attendees also took part in training modules and a site visit to a local oil refinery. Sanmi Areola, a toxicologist with the Metro Nashville/Davidson County (Tennessee) Public Health Department and incoming ASTS president, says that organizations such as the ASTS serve as necessary bridges of communication between developed and developing nations. “Continuing and emerging environmental [and] public health issues present differently in Africa compared to the developed countries of the world primarily because of the lack of enforceable policies and regulations and the nonexistence of infrastructures, [which are] poor where and when they exist,” says Areola. He explains that the negative impacts of environmental stressors on public health in Africa are exacerbated by poverty, political instability, urbanization, and overpopulation, among other factors. “These issues must be addressed through a multifaceted, multidisciplinary, region-specific approach where the identification of hazards and characterization of the risks take into consideration the uniqueness of the African geopolitical and ecological divides,” he says. According to Areola, the ASTS is uniquely positioned to provide a platform and serve as the facilitator for a collaborative partnership with agencies from developed nations to build approaches for managing and alleviating these risks. In the past 10 years, the ASTS has built solid networking structures, working with policy makers, scientists, and agencies within and outside Africa. Outgoing ASTS president Hoffman Moka Lantum, director of practice variance with Excellus BlueCross BlueShield, agrees, saying that a multidisciplinary, international exchange of ideas has been and will continue to be integral to the success of the ASTS’s efforts. He points out that very few data are based on studies done in Africa despite exponential growth in the use of large-volume chemicals in the petrochemical, mining, agrochemical, textile, and food industries, plus disproportionate underlying disease and nutritional disorders from food deficiency and toxicity. “The effects of the chemical burden from imported new classes of drugs, detergents, and industrial hydrocarbons on the biology and ecology of Africa are largely unknown and unappreciated, and may never be talked about if our colleagues in developed countries do not participate in this [ongoing] discussion,” he says. Kenneth Olden, a founding member of the ASTS and past director of the NIEHS and the National Toxicology Program, says all parties can benefit from such collaborative efforts. “Environmental health issues are national in scope, so it is important that nations, including the United States, cooperate in research, training, and exchange of prevention and remediation technology. All nations, including the African nations, have much to contribute to environmental protection,” he says.

Human Milk Research for Answering Questions about Human Health

Concerns regarding human milk in our society are diverse, ranging from the presence of environmental chemicals to the health of breastfed infants and the economic value of breastfeeding to society. The panel convened for the Technical Workshop on Human Milk Surveillance and Biomonitoring for Environmental Chemicals in the United States, held at the Hershey Medical Center, Pennsylvania State College of Medicine, on 24–26 September 2004, considered how human milk research may contribute to environmental health initiatives to benefit society. The panel concluded that infant, maternal, and community health can benefit from studies using human milk biomonitoring. Unlike other biological specimens, human milk provides information regarding exposure of the mother and breastfed infant to environmental chemicals. Some of the health topics relevant to this field of research include disorders of growth and development in infants, cancer origins in women, and characterization of the trend of exposure to environmental chemicals in the community. The research focus will determine the design of the study and the need for the collection of alternative biological specimens and the long-term storage of these specimens. In order to strengthen the ability to interpret study results, it is important to identify reference ranges for the chemicals measured and to control for populations with high environmental chemical exposure, because the amount of data on environmental chemical levels in human milk that is available for comparison is extremely limited. In addition, it will be necessary to validate models used to assess infant exposure from breastfeeding because of the variable nature of current models. Information on differences between individual and population risk estimates for toxicity needs to be effectively communicated to the participant. Human milk research designed to answer questions regarding health will require additional resources to meet these objectives. We thank the following organizations for generously providing support for the workshop: the American Chemistry Council; the Centers for Disease Control and Prevention (C13/CCU323635-01); the Department of Health and Human Services, Health Resources and Services Administration (HHSH240200415021P); Health Canada (H405-03-ExSD079/4500078209); 3M; Pennsylvania State University College of Medicine; the Research Foundation for Health and Environmental Effects; and the U.S. Environmental Protection Agency, Office of Children’s Health (CH-83213101-0). The opinions expressed in this article are those of the authors and do not necessarily reflect the views and/or policies of their affiliations.

Strategic Planning: Establishing Need and Clarifying Motivation

Strategic Planning: Establishing Need and Clarifying Motivation

Air Pollution and the Heart

There has been increasing awareness in recent years of the adverse cardiovascular effects of ambient air pollution. The recent publication of a statement from the Expert Panel on Population and Prevention Science of the American Heart Association has highlighted this issue. It has been appreciated for several decades that major pollution episodes, such as that associated with the London Fog of 1952, are responsible for increased numbers of deaths and most of these are due to cardiorespiratory causes. Realisation of this prompted government and environmental health initiatives to reduce emissions through establishing air quality standards. Previously, the major sources of air pollution were related to domestic coal burning and industry. However, the pattern of emissions in modern developed countries has changed, resulting in a pollution mixture of different composition to that on which early air quality standards were based. Even current 'lower' levels of air pollution have been shown consistently to be associated with adverse health effects. Over the past two decades, a wealth of epidemiological studies have considered both long- and short-term health effects of air pollution. Although the relative risk of respiratory disease in relation to air pollution exposure seems to be higher than that of cardiovascular disease, the latter are of greater absolute significance in population terms. A number of hypotheses have been proposed in order to explain the observed associations, and recent research efforts have focused on examining the mechanisms underlying the effects. It is suggested that certain subgroups of the population such as the elderly or those with pre-existing cardiorespiratory disease may be more susceptible to the effects of air pollution, and analysis of survival data from cohort studies supports this observation.

Human exposure monitoring and evaluation in the Arctic: the importance of understanding exposures to the development of public health policy.

Arctic indigenous peoples face significant challenges resulting from the contamination of Arctic air, water, and soil by persistent organic pollutants, heavy metals, and radionuclides. International cooperative efforts among governments and research institutions are under way to collect the information needed by environmental health scientists and public health officials to address environmental contamination in the Arctic. However, the climatic, political, and cultural conditions of the land and its native populations combine to present a unique set of scientific and logistic challenges to addressing this important public health issue. Public health officials have the responsibility to respect the cultural traditions of indigenous communities, while simultaneously designing strategies that will reduce their exposure to environmental contaminants and rates of disease and dysfunction. Researchers can better understand the link between environmental exposures and disease through monitoring programs for both the subsistence diets and health status of the indigenous populations. We suggest that the incorporation of community-based participatory research methods into programs designed to assess biomarkers of contaminant exposure in children and adults may be a valuable addition to ongoing and newly developed research programs. This approach could serve as a model for international environmental health initiatives, because it involves the participation of the local communities and seeks to builds trust between all stakeholders.

Real-time application of automated ribotyping and DNA macrorestriction analysis in the setting of a listeriosis outbreak.

A cluster of three cases of listeriosis cases occurred against a background of endemic listeriosis in Western Australia. Human and environmental isolates of Listeria monocytogenes obtained during the outbreak investigation were rapidly subtyped by automated ribotyping using an EcoRI protocol and a RiboPrinter. DNA macrorestriction analysis by pulsed-field gel electrophoresis (PFGE) was used to confirm the relatedness of isolates. Serogroup 1/2 predominated among the food samples and the four clinical isolates from the outbreak cluster were also of this serogroup. All isolates from chicken material were serogroup 1/2 and indistinguishable by ribotype pattern. PFGE subdivided strains of this ribotype into four subtypes. The preliminary analysis had an immediate impact on hypothesis generation, environmental health investigations, environmental specimen collection and initial control measures. Sufficient typing data to guide environmental health and disease control initiatives was generated in less than one week by combining automated ribotyping with PCR-based detection of L. monocytogenes in suspect foodstuffs and an L. monocytogenes DNA probe. There were no further cases of bacteriologically confirmed listeriosis in Western Australia for six months after completion of the investigation.

Sustaining the mission through range environmental planning

Maintaining access to the Department of Defense's (DOD) airspace, land, and water ranges for military test and training is critical to national defense. Yet very few ranges have comprehensive planning programs in place to proactively address current and future mission needs. As a result the Air Force leadership announced “Environmental, Safety and Occupational Health Initiatives” in 1995 that called for the development of comprehensive airspace and range plans to address both operational and environmental issues in order to maintain access to ranges and sustain readiness. Largely in response to these initiatives, the Air Force Development Test Center (AFDTC) at Eglin Air Force Base established a Range Environmental Planning Office in July 1995. This paper will introduce the range challenge, report on an innovative range planning partnership that has evolved over the last three years at Eglin, and address the importance of range planning to mission sustainability.