Environmental Health Literacy Research Articles

Empowering Sustainable Healthcare: The Role of Health Literacy

The imperative of sustainability in healthcare is becoming more pressing due to global health crises, climate change, and the rising burden of chronic diseases. Sustainability in healthcare involves social, economic, and environmental dimensions, each important for equitable and robust healthcare delivery. Health literacy may play a central role in embracing all three dimensions, bridging the gap between complex health information and individuals’ capability to understand and use it effectively: In fact, as a factor influencing the link between adverse social and economic conditions and subsequent health issues, health literacy could represent a practical target for mitigating health disparities within various demographic groups, thereby enhancing social sustainability. Furthermore, when people possess a solid understanding of their health conditions and the necessary steps for health management, they can contribute to a reduction in generated healthcare costs. Finally, health literacy and environmental health literacy equips individuals and communities with the knowledge and skills to understand how environmental factors affect health and empowers them to take proactive measures to protect the environment, potentially reducing the environmental impact of healthcare services. Therefore, integrating health literacy into education curricula and healthcare professional training is crucial for promoting sustainability. Despite some known barriers to the advancement and improvement of health literacy, such as limited awareness of its importance, the collaboration between academia, healthcare institutions, and community organizations is a path to follow to overcome these challenges.

Development and validation of a Context-sensitive Positive Health Questionnaire (CPHQ): A factor analysis and multivariate regression study

BackgroundThe concept of Positive Health (PH) has gained increasing attention as a way of measuring individuals’ ability to adapt in the face of contextual challenges. However, a suitable measurement instrument for PH that encompasses contextual factors has not yet been developed. This paper responds to this need by developing a Context-specific Positive Health (CPH) measurement instrument that aligns with the Capability Approach (CA).MethodsThe measurement instrument was developed and tested among a representative sample of 1002 Dutch internet survey panel members with diverse sociodemographic backgrounds. The instrument was developed in two stages: a preparation phase consisting of focus groups and expert consultations, and a validation among a representative panel of Dutch citizens. The goal of the preparation phase, was to pilot test and refine previously proposed Positive Health questionnaires into an initial version of the CPHQ. The validation phase aimed to examine the initial CPHQ’s factorial validity using Factor Analysis, and its concurrent validity using Multivariate Regression Analysis.ResultsThe developed questionnaire demonstrated adequate factorial and concurrent validity. Furthermore, it explicitly includes an assessment of resilience, this being a key component of PH.ConclusionsThe introduced measurement tool, the CPHQ, comprises 11 dimensions that we have labeled as follows: relaxation, autonomy, fitness, perceived environmental safety, exclusion, social support, financial resources, political representation, health literacy, resilience, and enjoyment. In this article, we present four major contributions. Firstly, we embedded the measurement in a theoretical framework. Secondly, we focused the questionnaire on a key concept of Positive Health - the “ability to adapt.” Thirdly, we addressed issues of health inequality by considering contextual factors. Finally, we facilitated the development of more understandable measurement items.

Development of a Phthalate Environmental Reproductive Health Literacy (PERHL) Scale.

Substantial evidence exists linking phthalate exposure to adverse reproductive health outcomes. Current US federal regulations of consumer product chemicals place the onus on individuals to mitigate their exposure to phthalates, with assumptions of sufficient environmental health literacy (EHL). Few validated scales for people of reproductive age exist to evaluate phthalate-specific EHL. Our objective is to develop a multidimensional scale characterizing latent factors of phthalate knowledge, risk perception, and self-efficacy to inform individual-level interventions for reducing phthalate exposure. We distributed a survey with 31 items to 117 participants in the Environmental Reproductive and Glucose Outcomes (ERGO) cohort who gave birth within the last 5 years. Exploratory factor analysis (EFA) was used to identify underlying latent factors. Internal reliability was assessed via omega hierarchical coefficient. Average sum scores for each latent factor and the overall Phthalate Environmental Reproductive Health Literacy (PERHL) score were calculated. Associations between latent factors, overall PERHL score, and sociodemographic characteristics were explored using linear models. Six latent factors were identified as follows: "Awareness of Phthalate Reproductive Health Impacts," "Uncertainty," "Protective Behavior/Risk Control," "Regulatory Interest," "Awareness of Phthalate Exposure Pathways," and "General Phthalate Knowledge." Each factor demonstrated acceptable to strong internal reliability, with coefficients ranging between 0.63 and 0.93. Non-white participants had lower scores for the "Awareness of Phthalate Reproductive Health Impacts" [: , 95% confidence interval (CI): , ], "Awareness of Phthalate Exposure Pathways" (: , 95% CI: , ), and "General Phthalate Knowledge" (: , 95% CI: , ), but no significant difference in scores on "Uncertainty" (: 0.17, 95% CI: , 0.50), "Protective Behavior/Risk Control" (: , 95% CI: , 0.28), or "Regulatory Interest" (: , 95% CI: , 0.09). No associations were seen for age or educational attainment and latent or sum factors. Six latent factors were identified for the PERHL scale. Non-white race and ethnicity was associated with lower scores for knowledge-related scale factors. https://doi.org/10.1289/EHP13128.

Environmental Health Literacy Regarding Fine Particulate Matter and Related Factors Among Village Health Volunteers in Upper Northern Thailand.

Fine particulate matter pollution has emerged as a significant life-threatening issue in Thailand. Recognizing the importance of environmental health literacy (EHL) in disease prevention is crucial for protecting public health. This study investigated EHL levels and aimed to identify associated factors among village health volunteers (VHVs) in the upper northern region of Thailand. A cross-sectional study was conducted to collect data from 710 VHVs using the EHL assessment tool developed by the Department of Health, Thailand. The overall EHL score was moderate (mean, 3.28 out of a possible 5.0), with the highest and lowest domain-specific mean score for the ability to make decisions (3.52) and the ability to access (3.03). Multiple linear regression revealed that the factors associated with EHL score were area of residence (urban areas in Chiang Mai: B=0.254; urban areas in Lampang: B=0.274; and rural areas in Lampang: B=0.250 compared to rural areas in Chiang Mai), higher education levels (senior high school: B=0.212; diploma/high vocational certificate: B=0.350; bachelor's degree or above: B=0.528 compared to elementary school or lower), having annual health checkups compared to not having annual health check-ups (B=0.142), monthly family income (B=0.004), and individuals frequently facing air pollution issues around their residence (B=0.199) compared to those who reported no such issues. The VHVs exhibited moderate EHL associated with residence area, education, health check-ups, family income, and residential air pollution. Considering these factors is vital for enhancing VHVs' EHL through strategic interventions.

Understanding the perspectives and needs of multiple stakeholders: Identifying key elements of a digital health intervention to protect against environmental hazards.

AirRater is a free environmental health smartphone app developed and available in Australia that collects individual health data and disseminates environmental hazard information to populations. Following previous evaluations with app users, the aim of this study was to better understand how clinicians, government agency and non-government advocacy group representatives perceive an app designed to reduce the impacts of environmental hazards on individual and public health. Nine government agency and non-government advocacy group representatives, along with 11 clinicians based in Australia participated in a semi-structured interview or focus group to explore perspectives on AirRater. Interview and focus group data were transcribed and analysed using the qualitative data analysis software NVivo. Results indicate that for clinicians, apps like AirRater can add value as an educational, patient self-management and diagnostic tool. For government and peak bodies, apps can add value by addressing environmental health literacy and monitoring and forecasting gaps, as well as supporting advocacy efforts and public health surveillance. We conclude that environmental health smartphone apps can support a range of stakeholders to achieve shared goals and priorities related to individual and public health outcomes. Further research is needed to better understand how apps could be embedded into clinical practice and policy settings.

Virtually prepared: designing remote environmental health practicum experiences

The push for virtual education modes continues to grow and develop following unprecedented acceleration during the COVID-19 pandemic. Environmental and occupational health education echoes that demand, where programs are seeing the focus expand from lab-based bench work to include greater practice emphasis in areas such as environmental health equity, environmental justice, environmental policy, and environmental health literacy. Part of the educational foundation for Environmental and Occupational Health MPH programs includes a practicum designed to provide students with “real-world” experience beyond classroom applications. Given the expected increased demand for virtual educational models from students and virtual employees from the professional sector, higher education programs that require practicum experiences must seek innovative approaches that meet both student and employer needs. The University of Pittsburgh’s Department of Environmental and Occupational Health is a practicum host site for local universities. Recently, faculty have sought to co-create virtual environmental health practicums in response to requests for these types of opportunities. This article expands upon work on “virtual” or “remote” practicum placements and builds upon best practices to contribute to continuing research in this area. The article also shares insight into creating additional virtual opportunities in the environmental health field. This work presents a case study of the development of a virtual student practicum, documents the processes and procedures followed to develop work grounded in best practices, and shares lessons learned and recommendations for developing future virtual practicums for public health students. The student and practicum host provide reflections on the practicum design and experience.

The contribution of community-based libraries in climate action to strengthen the face of climate change supports the SDGs

Introduction: Climate change is one of the goals to be achieved in the Sustainable Development Goals (SDGs) which requires various groups to participate in adaptation and mitigation of global warming. This is because climate change causes various problems that have a direct impact on human life. The objectives of this research are to find out the role of libraries as a medium for climate change literacy and the role of libraries in climate action addressing climate change. Data Collection Methods: The research method used is literature study which is concerned with methods of collecting library data, reading and taking notes, and managing research materials from literary sources in the form of textbooks, journals, scientific articles, conducting studies by studying material obtained from literary sources in the form of articles. Results and Disccusion: The research results show that libraries can act as media that teach climate change literacy to the public. Libraries act as providers of information, libraries play a role in teaching environmental health literacy by educating the public to learn information about climate change. The library becomes an example of reduce and reuse behaviour by showing examples of how to reduce waste disposal emissions through actions to reduce the use of paper materials and the role in implementing go green. Conclusion: Community-based libraries contribute to climate action by becoming information providers, educators, given an examples and become role models.

Climate change perception and its association with cancer screening intent.

As the climate crisis deepens, its adverse effects on human health are becoming evident, including impacts on cancer pathogenesis and treatment. This study explored the link between individuals' awareness of the health impacts of climate change and interest in cancer screening. Using the 2021 Health Information National Trends Survey, our study demonstrated astatistically significant association between recognition of climate change as a personal health threat and interest in cancer screening. Although the study's retrospective nature and self-reported data pose some limitations, these findings signal a promising avenue for future research on the intersection of climate and cancer risk. This research supports the development of public health interventions that incorporate components of environmental health literacy alongside cancer screening efforts.

Beauty Beware: Associations between Perceptions of Harm and Safer Hair-Product-Purchasing Behaviors in a Cross-Sectional Study of Adults Affiliated with a University in the Northeast.

(1) Background: Widespread personal care product (PCP) use can expose individuals to endocrine-disrupting chemicals (EDCs) associated with adverse health outcomes. This study investigated the association between harm perceptions and hair-product-purchasing behaviors in adults enrolled in a cross-sectional study. (2) Methods: Respondents rated their agreement with five PCP-related harm statements using a five-point Likert scale. Multivariable-adjusted logistic regression models were used to examine the associations between harm perceptions with hair-product-purchasing behaviors and hair product use (i.e., number of products used). (3) Results: Among 567 respondents (non-Hispanic White, 54.9%; non-Hispanic Black, 9.5%; Hispanic/Latinx, 10.1%; Asian American/Pacific Islander, 20.1%; and multiracial/other, 5.5%), stronger harm perceptions around PCP use were associated with potentially "safer" hair-product-purchasing behaviors. Respondents who strongly agreed that consumers should be concerned about the health effects of PCPs had more than fourfold increased odds of always/usually using healthy product apps (OR 4.10, 95% CI: 2.04-8.26); reading ingredient labels (OR 4.53, 95% CI: 2.99-6.87); and looking for natural, non-toxic, or eco-friendly product labels (OR 4.53, 95% CI: 2.99-6.88) when buying hair products. (4) Conclusions: Promoting environmental health literacy and raising awareness of potential PCP use-related harms might encourage healthier hair product use behaviors.

5 Translating developmental neurotoxicity for the public: A large, international, randomized-control trial investigating children's environmental health literacy

Objective:Exposure to toxic chemicals during early brain development increases the risk of neurodevelopmental problems in children. Parents' and prospective parents' understanding of the impact of toxic chemicals on brain development and the efficacy of translation tools for children's environmental health literacy are poorly understood. We developed and validated a questionnaire, PRevention of Toxic chemicals in the Environment for Children Tool (PRoTECT) to assess knowledge of toxic chemicals and neurodevelopment, intentions to reduce exposures to toxic chemicals, and preferences for actions by government and industry to prevent neurodevelopmental disorders. Using PRoTECT, we surveyed people of child-bearing age across five countries (Canada, United States (US), United Kingdom (UK), India, and Australia) to identify general patterns of responses on this questionnaire by demographic characteristics, including country, age, gender, parental status, pregnancy status, and education. We also employed a randomized control design to examine the efficacy of a knowledge translation video to instill knowledge and prompt behavioral changes to reduce exposures to toxic chemicals immediately following its presentation and after a six-week follow-up period.Participants and Methods:We recruited 15,594 participants, ages 18 to 45, via CloudResearch's Prime Panels between October-December 2021. After completing the PRoTECT survey, participants were randomly assigned to watch the video Little Things Matter: Impact of Toxic Chemicals on Brain Development (i.e., the experimental group) or to serve as the control group. Next, both groups answered a series of questions to assess their knowledge of toxic chemicals, their intentions to reduce exposures to toxic chemicals, and barriers to changing their behaviours. After six-weeks, we recontacted a subset (N=4,842) of participants to repeat PRoTECT and answer the same series of behavioural questions assessing whether they modified any of their behaviours to reduce exposure and why or why not.Results:Most participants (i.e., 75-85%) agreed that toxic chemicals can impact brain development and endorsed preferences (∼85%) for allocating more resources to prevent neurodevelopmental disorders, especially people with higher education, parents and pregnant women, and people who lived in India. Despite this, a large proportion of participants (∼50%) trusted industry and believed that government effectively regulated toxic chemicals. After the six-week follow-up, experimental participants showed greater changes in scores on PRoTECT (i.e., between 5-15% change), indicating greater knowledge about harms posed by toxic chemicals, more intentions to reduce exposure, and stronger preferences for prevention as compared to the control group. Differences were larger among people from the US, those who were more highly educated, and people in their thirties. However, the differences between groups in making behavioural changes to reduce exposures were attenuated at the six-week follow up as compared to baseline. Significant barriers to reduce exposure to toxic chemicals were reported by both groups and included cost, inconvenience, and not knowing how to determine whether a product is non-toxic or where to purchase non-toxic products.Conclusions:We observed greater knowledge and concerns about toxic chemicals among more affluent respondents, pregnant women and parents, and people living in India across both groups. While the video enhanced participants' knowledge about toxic chemicals and intentions to reduce exposure, they indicated that barriers hindered them from making behavioral changes.

Symposium 15: Impact of Environmental Contaminants on Child Neurodevelopment

Summary Abstract:Children are exposed to toxic chemicals throughout development and the long-term consequences of this exposure can be profound. Despite decades of research documenting the vulnerability of the developing brain to environmental contaminants, there has been little progress in protecting against developmental neurotoxicity. This symposium will discuss recent research in developmental neurotoxicology using a "developmental origins of health and disease" (DOHaD) framework that examines the context in which environmental contaminants exert their effects. We will examine the timescale for developmental toxicity, windows of vulnerability, and the bases of individual differences in vulnerability, including sex-specific effects of chemical exposures. This symposium will feature new pregnancy and birth cohort studies that have implicated fluoride as a developmental neurotoxin and endocrine disruptor. In addition, we will discuss emerging issues in epidemiology, including how environmental contaminants may interact with non-chemical stressors and have lifelong impacts on cognition and behaviours. This symposium will be capped with a discussion of the public's knowledge, attitudes, and behaviours related to developmental toxicity and strategies to reduce exposure. All speakers will be asked to draw conclusions on research priorities, and discuss how to balance regulators' need for "ideal evidence" with a public health strategy that aims to protect the public from critical environmental hazards. The symposium will consist of the following five presentations, each 12 minutes in length, followed by a 15 minute discussion.1. John Krzeckowski, PhD, York University, Toronto, Canada.TITLE: Applying a Dimensional Framework to the Study of Developmental Neurotoxicity2. Carly Goodman, PhD candidate, York University, Toronto, CanadaTITLE: Sex difference of Developmental Neurotoxicants on Intellectual abilities: A systematic review and meta-analysis3. Meaghan Hall, PhD candidate, York University, Toronto, Canada.TITLE: Fluoride Exposure and Hypothyroidism in Pregnant Women: A Potential Mechanism of Fluoride Neurotoxicity4. Ashley Malin, PhD, University of Florida,Florida, USA.TITLE: Urinary Fluoride Levels and Metal Co-Exposures among Pregnant Women in Los Angeles, California5. Rivka Green, PhD, The Hospital for Sick Children, Toronto, Canada.TITLE: Translating developmental neurotoxicity for the public: A large, multi-country, randomized-control trial investigating children's environmental health literacy

Effects of environmental health literacy-based interventions on indoor air quality and urinary concentrations of polycyclic aromatic hydrocarbons, volatile organic compounds, and cotinine: A randomized controlled trial

Indoor air pollution (IAP) caused by particulate matter (PM), aromatic and volatile chemicals is one of the leading causes of adverse reproductive health effects, such as infertility, decreased gestational age, and low birth weight. It is well documented that environmental health literacy (EHL) can promote reductions in IAP and the level of environmental pollutants in the body. We conducted randomized control trial to evaluate the effect of EHL-based intervention on the indoor air quality and urinary levels of polycyclic aromatic hydrocarbons (PAHs), volatile organic compounds (VOCs), and cotinine in reproductive aged women in Korea. The concentration of indoor PM2.5, PM10, CO2, and total VOCs (measured with a personal air quality monitoring device) as well as the urinary concentrations of PAHs, VOCs, and cotinine were measured in an experimental (n = 32) and control group (n = 31). The geometric mean concentrations of 2-NAP, tt-MA, and cotinine were 4.74, 82.82, and 0.60 μg/L respectively. The EHL intervention resulted in significant differences between experimental and control groups in the level of tt-MA (z = −1.44, p = .031), cotinine (z = −1.07, p = .015) in urine and PM2.5 (z = 56.39, p < .01), PM10 (z = 57.85, p < .01), CO2 (z = 8.92, p < .01), and total VOCs (z = 10.11, p < .01) of indoor air, and the mean score of EHL (z = 6.30, p < .01). Our results show the value in developing EHL interventions to reduce exposure to air pollutants originating from indoor activity and daily-life materials. Further studies are required to find ways to optimize general EHL for use in populations around the world.

Environmental Health Literacy and The Hope Tree Metaphor: Reflective Studies in Peatlands Communities

This research aim to develop the concept of EHL by reflecting the wish tree metaphor in supporting interactions between government, communities, companies, and agencies to achieve the vision of environmental health. This research used a qualitative methodology with a phenomenological perspective. The community, the penghulu, the village secretary, the village midwife, as well as businesses, professionals, and peatlands specialists served as the study's informants. The peatlands where the study is being conducted is in Indonesia's Riau Province's Rokan Hilir Regency. As a result of this research, it is hoped that stakeholders will become more knowledgeable about the detrimental effects of peatlands management and that they will be able to lessen the negative effects of poor community sanitation on peatlands, protecting the environment and lowering health risks. This metaphor of the wishing tree is said to be upbeat and holding on to improvements in the quality of life in the future. This research is a reflection study that results in a wish tree metaphor that expresses the desire that stakeholders would adopt EHL successfully.

Irish population knowledge, attitudes, and perception of air pollution

Abstract Aim Air pollution remains a major global public health challenge; and Ireland is no exception to the human health implications of exposure ambient air pollutants. Accurate and timely information can be critical to mitigate the harmful effects of air pollution. This study aimed to assess the knowledge, perceptions, and attitudes to poor air quality in Ireland to assist stakeholders in developing and implementing effective communication pieces and policies about the management of air pollution. Study design Cross-sectional population-based cohort. Methods Quantitative data on knowledge, attitudes, and perceptions (KAP) were collected from respondents living across Ireland, and the results were analysed with SPSS (Version 28.0). Results Among the 1,005 respondents included in this study, the mean [SD] age was 46.1 [15.3] years; 53% were female (n = 530); and 66% and 35% of respondents were aware of air pollution and its adverse effects on health at a national and local level respectively (n = 668 and n = 353 respectively). In addition, there were significant relationships between socio-demographic and air pollution awareness. There were correlation between respondent's age, gender, socio-economic group, and locality in Ireland. Conclusions This study demonstrates that environmental health literacy around air pollution in critically lacking among respondents. Given that air pollution is an increasingly important global priority, opportunities need to created to improve reach and impact of communication of air quality health risk and mitigation measures. Key messages • Most respondents acknowledge that air pollution is a national problem. • Females were more aware of air pollution among the respondents.

Educator beliefs and organizational constraints: Factors that influence informal education about fish consumption advisories in a southeastern US state.

All US states, and many countries around the world, have waterways with environmental health advisories intended to protect individuals from harmful chemicals in fish, yet little is known about how informal science educators, even those who engage anglers along waterways, incorporate advisory information into their educational activities. This study, grounded in environmental health literacy, investigated the practices, knowledge, and beliefs of 24 informal educators housed in varied agencies and organizations in a southeastern US state. Participants described a range of educational activities and identified organizational constraints on their education about fish consumption advisories, which varied by organization type. Their knowledge of relevant environmental health concepts was incomplete, and they described health and teaching beliefs consistent with limited focus on advisory education. Local government and nonprofit educators were well positioned to educate anglers about advisories, due to their freedom to design and deliver instruction and their regular contact with anglers. Educators in wildlife agencies had more contact with anglers and were identified as potential conduits given their interactions, but organizational constraints (such as educators' ability to choose content/pedagogy and conflicting missions of agencies) would need to be addressed.

Integrating participant feedback and concerns to improve community and individual level chemical exposure assessment reports

BackgroundAs exposure assessment has shifted towards community-engaged research there has been an increasing trend towards reporting results to participants. Reports aim to increase environmental health literacy, but this can be challenging due to the many unknowns regarding chemical exposure and human health effects. This includes when reports encompass a wide-range of chemicals, limited reference or health standards exist for those chemicals, and/or incompatibility of data generated from exposure assessment tools with published reference values (e.g., comparing a wristband concentration to an oral reference dose).MethodsHouston Hurricane Harvey Health (Houston-3H) participants wore silicone wristbands that were analyzed for 1,530 organic compounds at two time-points surrounding Hurricane Harvey. Three focus groups were conducted in separate neighborhoods in the Houston metropolitan area to evaluate response to prototype community and individual level report-backs. Participants (n = 31) evaluated prototype drafts using Likert scales and discussion prompts. Focus groups were audio-recorded, and transcripts were analyzed using a qualitative data analysis program for common themes, and quantitative data (ranking, Likert scales) were statistically analyzed.ResultsFour main themes emerged from analysis of the transcripts: (1) views on the report layout; (2) expression of concern over how chemicals might impact their individual or community health; (3) participants emotional response towards the researchers; and (4) participants ability to comprehend and evaluate environmental health information. Evaluation of the report and key concerns differed across the three focus groups. However, there was agreement amongst the focus groups about the desire to obtain personal exposure results despite the uncertainty of what the participant results meant.ConclusionsThe report-back of research results (RBRR) for community and individual level exposure assessment data should keep the following key principles in mind: materials should be accessible (language level, data visualization options, graph literacy), identify known information vs unknown (e.g., provide context for what exposure assessment data means, acknowledge lack of current health standards or guidelines), recognize and respect community knowledge and history, and set participant expectations for what they can expect from the report.

Invited Perspective: Making the Implicit Explicit-Connecting Environmental Health Literacy and Exposure Report-Back.

Invited Perspective: Making the Implicit Explicit-Connecting Environmental Health Literacy and Exposure Report-Back.

Health Literacy in Higher Education: A Systematic Scoping Review of Educational Approaches

Over the past decade, health literacy has received increased attention as a tool for promoting health, well-being, and sustainable development. So far, educational approaches to health literacy have mainly been implemented in health sciences education and linked to the needs of health professionals in communication with patients. The main objective of this systematic scoping review was to investigate health literacy educational approaches in higher education study programs, including the covered content and the learning activities employed. Altogether, 26 studies on health literacy training in higher education study programs were included. The most frequent study programs represented were medicine and pharmacy. A wide range of health literacy content was extracted from the studies; by far the most frequently studied skill was patient communication, which was identified in 20 studies, followed by identification of patients with low literacy in 12 studies and conceptual knowledge of health literacy in 11 studies. All studies except one reported the use of student active learning as part of the educational approach, and 17 studies reported the use of educational technology. The scientific literature indicates that current health literacy educational approaches mainly focus on the individual components of health literacy and fail to address environmental components and health literacy in vulnerable population groups. Despite the rather extensive use of active learning in educational approaches, pedagogical foundations were scarcely reported. In addition, the use of educational technology was rarely pedagogically integrated.

Air Pollution Health Literacy among Active Commuters in Hamilton, Ontario.

The promotion of active transportation (AT), which has been broadly defined as a physical effort performed by the traveller to produce motion, has been a popular strategy to reduce vehicular emissions, improve air quality, and promote physical activity. However, individuals who engage in AT may incur increased exposure to air pollutants and thus potential health impacts. This research sought to determine how active commuters understand the health risks associated with air pollution during their commutes, and whether they engage in any behaviours to limit exposure. An online survey was adapted from the Environmental Health Literacy framework to assess air pollution health literacy among active commuters in Hamilton, ON, and generated a sample size of 192 AT users. Analyses involved the use of frequency tables and cross-tabulations for the quantitative data, and the Health Belief Model and thematic analysis to interpret the qualitative data. Results revealed that most AT users do not adopt behaviours that would limit air pollution exposure on commutes and exhibited low self-rated knowledge of the health impacts of air pollution exposure. Issues of perceived susceptibility and severity, barriers, cues to action, and self-efficacy all further impacted the likelihood of adopting health protective behaviours. Conclusively, air pollution is an often-neglected consideration among active commuters, with air pollution knowledge predicting the likelihood of behavioural modification.

Knowledge, attitudes, and perception of air pollution in Ireland

AimAir pollution remains a major global public health challenge; and Ireland is no exception to the human health implications of exposure ambient air pollutants. Accurate and timely information can be critical to mitigate the harmful effects of air pollution. This study aimed to assess the knowledge, perceptions, and attitudes to poor air quality in Ireland to assist stakeholders in developing and implementing effective communication pieces and policies about the management of air pollution. Study designCross-sectional population-based cohort. MethodQuantitative data on knowledge, attitudes, and perceptions (KAP) were collected from respondents living across Ireland, and the results were analysed with SPSS (Version 28.0). ResultsAmong the 1005 respondents included in this study, the mean [SD] age was 46.1 [15.3] years; 53% were female (n = 530); and 66% and 35% of respondents were aware of air pollution and its adverse effects on health at a national and local level respectively (n = 668 and n = 353 respectively). In addition, there were significant relationships between socio-demographic and air pollution awareness. There were correlation between respondent’s age, gender, socio-economic group, and locality in Ireland. ConclusionThis study demonstrates that environmental health literacy around air pollution in critically lacking among respondents. Given that air pollution is an increasingly important global priority, opportunities need to create to improve reach and impact of communication of air quality health risk and mitigation measures.