Environmental Health Knowledge Research Articles

Dangerous trade: histories of industrial hazard across a globalizing world

List of Tables and Figures Acknowledgments Introduction: From Dangerous Trades to Trade in Dangers: Toward an Industrial Hazard History of the Present / Christopher Sellers and Joseph Melling Part I: The Late Nineteenth Century to the Early Twentieth Century Creating Industrial Hazards in the Developing World 1. Rubber Plantation Workers, Work Hazards, and Health in Colonial Malaya, 1900-1940 / Amarjit Kaur 2. Work, Home, and Natural Environments: Health and Safety in the Mexican Oil Industry, 1900-1938 / Myrna Santiago Knowing and Controlling in the Developed World 3. Global Markets and Local Conflicts in Mercury Mining: Industrial Restructuring and Workplace Hazards at the Almaden Mines in the Early Twentieth Century / Alfredo Menendez-Navarro 4. Trade, Spores, and the Culture of Disease: Attempts to Regulate Anthrax in Britain and Its International Trade, 1875-1930 / Tim Carter and Joseph Melling 5. Rayon, Carbon Disulfide, and the Emergence of the Multinational Corporation in Occupational Disease / Paul D. Blanc Part II: The Middle to the Late Twentieth Century New Transfers of Production 6. Shipping the Next Prize: The Trade in Liquefied Natural Gas from Nigeria to Mexico / Anna Zalik 7. New Hazards and Old Disease: Lead Contamination and the Uruguayan Battery Industry / Daniel E. Renfrew New Knowledge and Coalitions 8. Objective Collectives? Transnationalism and Invisible Colleges in Occupational and Environmental Health from Collis to Selikoff / Joseph Melling and Christopher Sellers 9. Bread and Poison: The Story of Labor Environmentalism in Italy, 1968-1998 / Stefania Barca 10. A New Environmental Turn? How the Environment Came to the Rescue of Occupational Health: Asbestos in France c. 1970-1995 / Emmanuel Henry New Arenas of Contest 11. A Tale of Two Lawsuits: Making Policy-Relevant Environmental Health Knowledge in Italian and U.S. Chemical Regions / Barbara Allen 12. Pesticide Regulation, Citizen Action, and Toxic Trade: The Role of the Nation-State in the Transnational History of DBCP / Susanna Rankin Bohme 13. Turning the Tide: The Struggle for Compensation for Asbestos-Related Diseases and the Banning of Asbestos / Barry Castleman and Geoffrey Tweedale Conclusion / Joseph Melling and Christopher Sellers, with Barry Castleman Contributors Index

Facilitating knowledge transfer: decision support tools in environment and health

The HENVINET Health and Environment Network aimed to enhance the use of scientific knowledge in environmental health for policy making. One of the goals was to identify and evaluate Decision Support Tools (DST) in current use. Special attention was paid to four “priority” health issues: asthma and allergies, cancer, neurodevelopment disorders, and endocrine disruptors.We identified a variety of tools that are used for decision making at various levels and by various stakeholders. We developed a common framework for information acquisition about DSTs, translated this to a database structure and collected the information in an online Metadata Base (MDB).The primary product is an open access web-based MDB currently filled with 67 DSTs, accessible through the HENVINET networking portal http://www.henvinet.eu and http://henvinet.nilu.no. Quality assurance and control of the entries and evaluation of requirements to use the DSTs were also a focus of the work.The HENVINET DST MDB is an open product that enables the public to get basic information about the DSTs, and to search the DSTs using pre-designed attributes or free text. Registered users are able to 1) review and comment on existing DSTs; 2) evaluate each DST’s functionalities, and 3) add new DSTs, or change the entry for their own DSTs.Assessment of the available 67 DSTs showed: 1) more than 25% of the DSTs address only one pollution source; 2) 25% of the DSTs address only one environmental stressor; 3) almost 50% of the DSTs are only applied to one disease; 4) 41% of the DSTs can only be applied to one decision making area; 5) 60% of the DSTs’ results are used only by national authority and/or municipality/urban level administration; 6) almost half of the DSTs are used only by environmental professionals and researchers. This indicates that there is a need to develop DSTs covering an increasing number of pollution sources, environmental stressors and health end points, and considering links to other ‘Driving forces-Pressures-State-Exposure-Effects-Actions’ (DPSEEA) elements. Of interest to both researchers and decision makers should be the standardization of the way DSTs are described for easier access to the knowledge, and the identification of coverage gaps.

Improvements in Environmental Health Literacy along the Texas-Mexico Border Following Community-wide Health Education

Abstract The positive outcomes derived from the implementation of culturally sensitive educational programs in addressing disparities in environmental literacy and health among disadvantaged communities have not been rigorously examined. This report summarizes the results of a community-wide survey completed to test this hypothesis in the Cameron Park Colonia, one of the poorest communities along the Texas-Mexico border. The assessment followed a two-year training program in environmental health provided by community lay health workers using a train-the-trainer approach. Statistical analysis of data obtained from 498 households showed that educational intervention significantly improved residents' knowledge of environmental health and disease, particularly in general health knowledge and behavioral modifications to achieve healthier lifestyles. These findings show that culturally appropriate educational intervention enhanced environmental health literacy among Cameron Park Colonia residents. We advocate f...

How can scientists bring research to use: the HENVINET experience

BackgroundHealth concerns have driven the European environmental policies of the last 25 years, with issues becoming more complex. Addressing these concerns requires an approach that is both interdisciplinary and engages scientists with society. In response to this requirement, the FP6 coordination action “Health and Environment Network” HENVINET was set up to create a permanent inter-disciplinary network of professionals in the field of health and environment tasked to bridge the communication gap between science and society. In this paper we describe how HENVINET delivered on this task.MethodsThe HENVINET project approached the issue of inter-disciplinary collaboration in four ways. (1) The Drivers-Pressures-State-Exposure-Effect-Action framework was used to structure information gathering, collaboration and communication between scientists in the field of health and the environment. (2) Interactive web-based tools were developed to enhance methods for knowledge evaluation, and use these methods to formulate policy advice. (3) Quantification methods were adapted to measure scientific agreement. And (4) Open architecture web technology was used to develop an information repository and a web portal to facilitate collaboration and communication among scientists.ResultsTwenty-five organizations from Europe and five from outside Europe participated in the Health and Environment Network HENVINET, which lasted for 3.5 years. The consortium included partners in environmental research, public health and veterinary medicine; included medical practitioners and representatives of local administrations; and had access to national policy making and EEA and WHO expertise. Dedicated web-based tools for visualisation of environmental health issues and knowledge evaluation allowed remote expert elicitation, and were used as a basis for developing policy advice in five health areas (asthma and allergies; cancer; neurodevelopmental disorders; endocrine disruption; and engineered nanoparticles in the environment). An open searchable database of decision support tools was established and populated. A web based social networking tool was developed to enhance collaboration and communication between scientists and society.ConclusionsHENVINET addressed key issues that arise in inter-disciplinary research on health and environment and in communicating research results to policy makers and society. HENVINET went beyond traditional scientific tools and methods to bridge the communication gap between science and policy makers. The project identified the need for a common framework and delivered it. It developed and implemented a variety of novel methods and tools and, using several representative examples, demonstrated the process of producing politically relevant scientific advice based on an open participation of experts. It highlighted the need for, and benefits of, a liaison between health and environment professionals and professionals in the social sciences and liberal arts. By adopting critical complexity thinking, HENVINET extended the traditional approach to environment and health research, and set the standard for current approaches to bridge the gap between science and society.

Health Impact from Air Pollution in Thailand: Current and Future Challenges

Emerging from an agricultural base to more industrialization, Thailand now faces many environmental problems, particularly air pollution, resulting in adverse health consequences. The three major sources of air pollution are vehicular emissions in cities, biomass burning and transboundary haze in rural and border areas, and industrial discharges in concentrated industrialized zones. Recent air quality data suggest that particulate matter < 10 μm in aerodynamic diameter (PM10) is the most important air pollutant in urban and rural areas. In cities such as Bangkok, air quality monitoring performed by the Pollution Control Department (PCD) for the past 10 years revealed that the levels of PM10 have exceeded both annual (50 μg/m3) and 24-hr (120 μg/m3) national standards (PCD 2010). The main source of PM10 in Bangkok is vehicular emissions (Chuersuwan 2008; Parsons International Ltd. 2001). In the rural and border areas, most notably Chiangmai, agricultural burning and forest fires, including transboundary haze from Myanmar, have contributed to high levels of PM10, which have increased to critical levels since 2006 [250 μg/m3, 300 μg/m3, 175 μg/m3, and 220 μg/m3 in 2006, 2007, 2008, and 2009, respectively (PCD 2010)]. More importantly, many consecutive days of high PM10 levels resulted in increases in hospital admissions and outpatient visits (Chiangmai Provincial Public Health Office 2007). Moreover, the Southeast Asian haze that originated in Indonesia has continually affected the health of residents of the southern provinces, particularly in 1996 and 1997, where the maximum PM10 levels reached as high as 314 μg/m3 (PCD 2010). The most severe haze episode occurred in 1997 and resulted in sharp increases in outpatient visits (26%) and hospital admissions (33% for all respiratory, 36% for pneumonia, 40% for bronchitis/chronic pulmonary obstructive disease, 12% for asthma) within a period of a few months (Health Systems Research Institute 1998). Several studies worldwide have demonstrated that PM10 is associated with premature mortality and a wide range of morbidity outcomes. As part of the Public Health and Air Pollution in Asia (PAPA) multicities study, results for Bangkok showed that each 10-μg/m3 increase in PM10 is associated with a 1.25% increase in all-cause mortality, which is higher than for the three other participating cities [0.53% for Hong Kong, 0.26% for Shanghai, and 0.43% for Wuhan (Wong et al., 2008)] and higher than multicities studies conducted in Western countries (Katsouyanni et al. 2001). The higher effects in Bangkok may be related to high temperatures in Bangkok throughout the year, higher exposures to air pollution from longer periods of time spent outdoors, and less availability and use of air-conditioning. As a developing country, Thailand strives for a continual economic growth. Consequently, expansion of petrochemical plants rose sharply, particularly, in the coastal province of Rayong, with > 73 million tons of chemicals used annually (Department of Industrial Works 2010). Although environmental management has been instituted, levels of volatile organic compounds (VOCs) continue to exceed Thailand’s standards (PCD 2010). Epidemiological studies have been limited, with only sporadic reports of respiratory symptoms and illnesses after episodic events of accidental releases from industries. However, a recently completed large-scale population-based epidemiology study with > 26,000 subjects indicated that residents who live near the petrochemical industrial estate have higher risks in adverse pregnancy outcomes, neuropsychological symptoms, and poor performance on neuropsychological tests (Vichit-Vadakan et al. 2010). In particular, results show significant excess risk of preterm birth before < 34 weeks among mothers residing < 4 km from the industrial estate [odds ratio (OR) = 3.34; 95% confidence interval (CI), 1.18–9.47]; nonsignificant increased risks were found for all pregnancy outcomes (OR = 1.60; 95% CI, 0.87–2.93), preterm birth before 37 weeks (OR = 1.68; 95% CI, 0.85–3.30), low birth weight (OR = 1.42; 95% CI, 0.52–3.78), and small for gestational age (OR = 1.24; 95% CI, 0.31–4.90. Generally, the excess risk decreases with increased distances. Obtaining sustainable development that balances environmental conservation and the well-being of the population remains a challenge for Thailand. In national strategies for development, policy makers often rely only on economic information fbecause of the lack of empirical data on health, social, and environmental impacts from developmental policies and projects. Fostering and strengthening epidemiological research in Thailand not only provides the necessary perspective for policy development but contributes to the larger body of knowledge in environmental health.

A spatial epidemiological analysis of self-rated mental health in the slums of Dhaka

BackgroundThe deprived physical environments present in slums are well-known to have adverse health effects on their residents. However, little is known about the health effects of the social environments in slums. Moreover, neighbourhood quantitative spatial analyses of the mental health status of slum residents are still rare. The aim of this paper is to study self-rated mental health data in several slums of Dhaka, Bangladesh, by accounting for neighbourhood social and physical associations using spatial statistics. We hypothesised that mental health would show a significant spatial pattern in different population groups, and that the spatial patterns would relate to spatially-correlated health-determining factors (HDF).MethodsWe applied a spatial epidemiological approach, including non-spatial ANOVA/ANCOVA, as well as global and local univariate and bivariate Moran's I statistics. The WHO-5 Well-being Index was used as a measure of self-rated mental health.ResultsWe found that poor mental health (WHO-5 scores < 13) among the adult population (age ≥15) was prevalent in all slum settlements. We detected spatially autocorrelated WHO-5 scores (i.e., spatial clusters of poor and good mental health among different population groups). Further, we detected spatial associations between mental health and housing quality, sanitation, income generation, environmental health knowledge, education, age, gender, flood non-affectedness, and selected properties of the natural environment.ConclusionsSpatial patterns of mental health were detected and could be partly explained by spatially correlated HDF. We thereby showed that the socio-physical neighbourhood was significantly associated with health status, i.e., mental health at one location was spatially dependent on the mental health and HDF prevalent at neighbouring locations. Furthermore, the spatial patterns point to severe health disparities both within and between the slums. In addition to examining health outcomes, the methodology used here is also applicable to residuals of regression models, such as helping to avoid violating the assumption of data independence that underlies many statistical approaches. We assume that similar spatial structures can be found in other studies focussing on neighbourhood effects on health, and therefore argue for a more widespread incorporation of spatial statistics in epidemiological studies.

Environment, Health, &amp;amp; Nursing Practice

The purpose of this study was to explore the connection nurses see between the environment and health concerns of their patients. The study surveyed registered nurses (RNs) in a western state to determine whether they evaluated themselves as knowledgeable about environmental health (EH) hazards and if they felt prepared by their nursing curriculum to share this information with their patients. The study replicates a survey of Wisconsin nurses concerning issues related to EH knowledge among RNs in Idaho. Data from 170 respondents to a mailed survey indicated that although nurses agreed that they should be knowledgeable about EH hazards, few were adequately prepared. Overall, many nurses felt unprepared from their nursing curricula to address EH issues in the field. Corrective measures are discussed.

Environmental health knowledge, healthy lifestyles and better environmental living conditions among slum dwellers in Dhaka

Introduction: Millions of slum dwellers in cities suffer from higher burden of diseases partly because of stressful environmental living conditions (ELC), poor socio-economic status and lifestyles. We assessed the association of environmental health knowledge (EHK) with healthy lifestyles and ELC among adults (n=1,937) living in nine big slums of Dhaka megacity, assuming that better EHK is associated with healthy lifestyles and better ELC. Methods: The baseline information from a recent cohort study was used. Background: characteristics e.g. area, age, education, and migration including a composite variable (based on three EHK-related questions, one is explained) of EHK were used as covariates. One EHK-related question was „Do you think that logged/polluted water surrounding your house spreads diseases or increases health risk (yes/no)?“ When they answered yes, they were asked why (open-ended answers)? Some answered correctly (coded, yes=1) and some not (no=0). Scores of the composite variable, ranging from 0–3, were dichotomised, where scores=2–3 indicated „better EHK“. SPSS 17.0 was used for analyses. Although many dependent variables reflecting lifestyles and ELC were analysed, only few results are reported here. Results: About 80% of the total sample reported better EHK, which significantly differed by study area and education. According to multivariable logistic regression analysis, odds ratios (ORs) for cigarette smoking (OR=0.72, p=0.037), smoking inside home (OR=0.70, p=0.040) and not purchasing bottle water for drinking while staying outside home (OR=0.28, p&lt;0.001) were significantly lower among people having better EHK. Similarly ORs for ELC-related variables namely „garbage was collected regularly in their areas“ (OR=1.39, p=0.009) and „living in a house getting sufficient light and air“ (OR=1.31, p=0.056) were higher among people having better EHK. Conclusion: Evidence suggests that better EHK in slum dwellers is positively associated with healthy lifestyles and better ELC. Therefore we recommend to improve area-specific EHK by emphasising e.g. better education.

Survival of Escherichia coli in the environment: fundamental and public health aspects.

In this review, our current understanding of the species Escherichia coli and its persistence in the open environment is examined. E. coli consists of six different subgroups, which are separable by genomic analyses. Strains within each subgroup occupy various ecological niches, and can be broadly characterized by either commensalistic or different pathogenic behaviour. In relevant cases, genomic islands can be pinpointed that underpin the behaviour. Thus, genomic islands of, on the one hand, broad environmental significance, and, on the other hand, virulence, are highlighted in the context of E. coli survival in its niches. A focus is further placed on experimental studies on the survival of the different types of E. coli in soil, manure and water. Overall, the data suggest that E. coli can persist, for varying periods of time, in such terrestrial and aquatic habitats. In particular, the considerable persistence of the pathogenic E. coli O157:H7 is of importance, as its acid tolerance may be expected to confer a fitness asset in the more acidic environments. In this context, the extent to which E. coli interacts with its human/animal host and the organism's survivability in natural environments are compared. In addition, the effect of the diversity and community structure of the indigenous microbiota on the fate of invading E. coli populations in the open environment is discussed. Such a relationship is of importance to our knowledge of both public and environmental health.

Health Awareness of Rural Adolescent Girls: An Intervention Study

Adolescent girls of age 13 to 19 years constitute nearly 66 million of population in India. The lives of these girls are characterized by limited education, lack of knowledge pertaining to social as well as health aspects and also limited influence on decisions affecting their lives. Thus, awareness is one major factor for development of this group of population because of the fact that these adolescent girls would be the future housewives. A study was undertaken to see the awareness of adolescent girls regarding health aspects through an intervention study. The study adopted a pretest - post test design with an intervention for a specific period. A total of 112 adolescent girls in the age group of 14 to 18 years were selected randomly from government schools of five villages in two blocks of Kangra district of Himachal Pradesh. The tools for assessment consisted of socio-economic status scale and a general awareness scale. The sample group was pretested on their level of general awareness which focused specifically on health aspects. An intervention package was developed on the aspects of health including general health, reproductive and child health, environmental health and nutritional aspects. The intervention was given for nine months to the girls though lectures, discussions and demonstrations. Post testing was done on the girls after the period of intervention. Results showed that the knowledge of girls regarding health aspects improved significantly after intervention. There was a considerable increase in the awareness levels of girls with regard to knowledge of health problems, environmental health, nutritional awareness and reproductive and child health. Thus informative and educable intervention seem to have a positive effect on awareness levels which would eventually encourage expansion of knowledge and positive health habits.

Children’s Environmental Health Faculty Champions Initiative: A Successful Model for Integrating Environmental Health into Pediatric Health Care

BackgroundPediatric medical and nursing education lack the environmental health content needed to properly prepare health care professionals to prevent, recognize, manage, and treat environmental exposure–related diseases. The need for improvements in health care professionals’ environmental health knowledge has been expressed by leading institutions. However, few studies have evaluated the effectiveness of programs that incorporate pediatric environmental health (PEH) into curricula and practice.ObjectiveWe evaluated the effectiveness of the National Environmental Education Foundation’s (NEEF) Children’s Environmental Health Faculty Champions Initiative, which is designed to build environmental health capacity among pediatric health care professionals.MethodsTwenty-eight pediatric health care professionals participated in a train-the-trainer workshop, in which they were educated to train other health care professionals in PEH and integrate identified PEH competencies into medical and nursing practice and curricula. We evaluated the program using a workshop evaluation tool, action plan, pre- and posttests, baseline and progress assessments, and telephone interviews.ResultsDuring the 12 months following the workshop, the faculty champions’ average pretest score of 52% was significantly elevated (p < 0.0001) to 65.5% on the first posttest and to 71.5% on the second posttest, showing an increase and retention of environmental health knowledge. Faculty champions trained 1,559 health care professionals in PEH, exceeding the goal of 280 health care professionals trained. Ninety percent of faculty champions reported that PEH had been integrated into the curricula at their institution.ConclusionThe initiative was highly effective in achieving its goal of building environmental health capacity among health care professionals. The faculty champions model is a successful method and can be replicated in other arenas.

Reviewing the environmental and human health knowledge base of carbon nanotubes

Carbon nanotubes (CNTs) are one of the most promising materials in nanotechnology. The various synthesis, purification and postprocessing methods produce CNTs with diverse physical characteristics, appliable in many fields. Their extensive projected use makes it important to understand their potential harmful effects. Besides showing a notable range of results of some toxicology studies, this review concluded that: a) there are different types of CNTs; thus, they cannot be considered a uniform group of substances; and b) in environmental compartments, CNTs can be bioavailable to organisms. Their properties suggest a possible accumulation along the food chain and high persistence. In organisms, CNT absorption, distribution, metabolism, excretion and toxicity depend on the inherent physical and chemical characteristics (e.g., functionalization, coating, length and agglomeration state), influenced by external environmental conditions during CNT production, use, and disposal. Thus, characterized exposure scenarios could be useful in toxicology studies. However, upon reaching the lungs in enough quantity, CNTs produce a toxic response (time and dose-dependent). The risks to human health and environment should be identified for a successful introduction of CNTs in future applications.

Home Environmental Health Risks

Home environmental health risks and the pollution of indoor residential air are becoming increasingly recognized as sources of injury and exacerbation of illness, particularly in vulnerable populations such as pregnant women, infants, children, the elderly, and those living with a chronic medical condition or disability. Nurses play a key role in prevention, education, and screening activities for patients. Core environmental health knowledge is essential for all nurses regardless of setting or population of practice. This article provides a review of the literature of five common home environmental health risks: lead, carbon monoxide, radon, pesticides, and the broad chemical category of volatile organic compounds. Particular emphasis is placed on the review of articles that address low-dose exposures, such as those most commonly found in the residential environment. Current standards of practice regarding risk minimizations are discussed, and nationally recognized preventative action steps and environmental health resources are presented.

Reviewing the Environmental and Human Health Knowledge Base of Carbon Nanotubes

Carbon nanotubes (CNTs) are considered one of the most promising materials in nanotechnology, with attractive properties for many technologic applications. The different synthesis, purification, and postprocessing methods produce CNTs with different physical characteristics, which can be applied in different fields ranging from composite materials, medical applications, and electronics to energy storage. The widespread projected use of CNTs makes it important to understand their potential harmful effects. In this environmental health review we observed a remarkable range of results of some of the toxicology studies. The comparability should be improved by further standardization and introduction of reference materials. However, at present the findings of this review suggest several key points: a) there are different types of CNTs, and therefore they cannot be considered a uniform group of substances; and b) in environmental compartments, CNTs can be bioavailable to organisms. The properties of CNTs suggest a possible accumulation along the food chain and high persistence. In organisms the absorption, distribution, metabolism, excretion, and toxicity of CNTs depend on the inherent physical and chemical characteristics such as CNT functionalization, coating, length, and agglomeration state that are influenced by the external environmental conditions during CNT production, use, and disposal stages. Characterized exposure scenarios could therefore be useful when conducting toxicologic studies. However, CNTs produce a toxic response upon reaching the lungs in sufficient quantity; this reaction is produced in a time-and dose-dependent manner. The identification of possible risks to human health and environment is a prerequisite for a successful introduction of CNTs in future applications.

Challenges and Successes of Infusing Environmental Health Content in a Nursing Program

Environmental health has received minimal attention in nursing curricula over the past decade, despite efforts by the Institute of Medicine (1995) and others to advance the environmental health agenda in nursing education, practice, and research. This paper describes an initiative that was first funded as a part of the Environmental Health Scholars Program in 2000 to incorporate environmental health into master's and undergraduate nursing programs at one university. Evaluation of this initiative highlights the challenges and successes experienced in this academic setting. A number of recommendations based on this experience and the literature are offered. There is a perceived need to define the critical body of knowledge and skills in environmental health and to develop tools to enable educators and practitioners to apply this knowledge in public health nursing and other specialty practices. In tandem, opportunities and incentives are needed to encourage faculty development and the infusion of environmental health into existing curricula. Changes are also needed across practice settings to proactively address environmental health issues so that environmental health becomes and remains an integral part of nursing.

Environmental Pollution and its Effect on Health: A Knowledge Study among a Group of Preparatory School Children in Alexandria

Environmental pollution is now increasingly recognized as a major threat to social and economic development and even to human survival. Environmental education [EE] increases public awareness and knowledge of environmental and health issues and challenges. There is now an advanced placement course for environmental science in Egyptian schools. The present study aimed at measuring the extent of some environmental health knowledge among children in some preparatory schools. Knowledge of environmental health was assessed in a sample of 400 students at four preparatory schools. The questionnaire sheet included information about the social status of families of students, school environment as perceived by students, and some important essential environmental health knowledge. A sizable rate of students’ families of language schools [100%] and of the governmental school [over 75%] scored high and middle social status. The students critically assessed their schools giving rates of bad standard ranging from 6-11%. The overall results of responses of students on the effect of presence of environmental pollutants on their health were poor, where 67-80% of students scored low. When relating knowledge of students to the social level of their families, it revealed a poor relation. An important recommendation is that theoretical subject matter in schools must be strengthened by practical training. Parents association in schools should be provided by educational materials aids to help their reference information to their children.

Environmental Health and Nursing: Piloting a Technology-Enhanced Distance Learning Module

The results of a pilot study evaluating a technology-enhanced distance learning module to impart environmental health core concepts to nurses are presented in this article. The internet-based module was developed for continuing professional education and imparts principles of adult education through interactive features including simulated clinical vignettes, an environmental justice case study, and hyperlinks to websites related to environmental protection and health regulation. Mean gains between pre- and post-tests; participant identification of adult learning principles as advanced by Knowles, Holton, and Swanson (1998); and satisfaction were measured among participating RNs (N = 34). A 6% mean gain in learning occurred between pre- and post-tests (95% CI .51 to 1.37, p < .0001). No significant differences in learning occurred for those who prefer face-to-face instruction and those who tend to procrastinate. Ninety-four percent of respondents indicated they were satisfied or very satisfied with the module. A strong association was found between recognition of adult learning principles as enhancing the assimilation of knowledge and competencies of environmental health and high satisfaction with the module. Distance learning via the Internet shows promise as a format to promote environmental health education for nurses.

ADOLESCENT OCCUPATIONAL EXPOSURES AND PEDIATRIC-ADOLESCENT TAKE-HOME EXPOSURES

Thousands of adolescents are employed and routinely incur occupational exposures as part of their work. Case reports of adolescent exposure-related fatalities and illness, coupled with observational studies of chemical and other exposures with potential health risks, create a strong case for better tracking of work-related exposures and illness, better training for all working adolescents, education of their parents about risks, more clinical involvement in the health and safety of working adolescents, and advocacy for safer adolescent work environments. Because adolescents are neither children nor adults, much research is needed to clarify exposure patterns and risks; however, existing data on adolescent occupational injury and knowledge of exposures to adults in similar work environments permit immediate interventions. The most applicable information from the growing knowledge of environmental health in young children also can be borrowed and applied, especially to younger workers, such as those on farms, who may be children rather than adolescents. Crucial to future protection of working youth from occupational exposures are application of knowledge that already is possessed about occupational risks to adults, a cultural change in the way the US population views risks of chemical exposures, and improved occupational health and safety protection for all adult workers. Improving occupational health for working adolescents may be more politically acceptable and thus feasible than starting with adults, but ultimately the two are linked inextricably. These are new realms for pediatricians, but pediatrician input is needed greatly on all of these levels.

Environmental Health Education for Health Professionals and Communities

1. AAOHN is implementing a 3 year environmental health education grant to enhance the environmental health knowledge of nursing faculty and nurses practicing in community health settings, as well as the citizens in their communities. 2. The process for implementation of the cooperative agreement with ASTDR involves collaboration with ATSDR, EPA, and other agencies who have responsibilities for informing, educating, and encouraging participation of community members in the agencies' work at hazardous waste sites. 3. Through a train the trainer approach, nurses serving populations near selected hazardous waste sites will receive education and technical support. In turn, they will act as resources for community education and health promotion. 4. AAOHN will evaluate the impact of the education on the communities and on the practice of the nurses who participate in the education, disseminating the results of the project at a future American Occupational Health conference and through other means, such as the Internet.

Teaching Basic Environmental Health in Universities Utilizing an Interdisciplinary Holistic Approach and Interactive Learning Methods

ABSTRACTThe need to transcend disciplinary boundaries in the teaching of environmental studies has become increasingly obvious. It has been particularly recognized that the relationship between environmental factors and human health needs to be taught much more broadly at universities. An international collaborative effort was begun to develop a course to teach core knowledge in environmental health to health professionals as well as others from a wide variety of disciplinary backgrounds. The course utilizes interactive learning methods and takes a holistic approach to the subject matter, linking the macro socioeconomic issues with the physical, chemical, biological, mechanical, and psychological hazards, as well as with the human health effects. It also aims to build skills in risk assessment, management, and communication. Several meetings (with representatives from the World Health Organization, the United National Environment Programme, the United Nations Educational, Scientific, and Cultural Organisation, and the Council of Rectors of European Universities), a survey completed by 120 universities, a 3‐day workshop (with teachers from across the globe), and three 2‐week train‐the‐trainer courses (one in the Baltic, one in the Danube region, and one in South Africa) led to the conclusion that interdisciplinary, interactive teaching materials were highly desired, feasible to develop through international collaboration, and conducive to conveying the basic principles and methodologies needed to address environmental health problems.