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2013 Journal of Environmental Health Abstracts
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January/February 2013, Volume 75, No. 6

Fish Consumption Patterns and Mercury Exposure Levels Among Women of Childbearing Age in Duval County, Florida
Sharleen Traynor, MPH, Mayo Clinic, Jacksonville, Florida
Greg Kearney, MPH, DrPH, RS, East Carolina University
David Olson, PhD, National Center for Environmental Health, Centers for Disease Control and Prevention
Aaron Hilliard, PhD, Duval County Health Department
Jason Palcic, PhD, Bureau of Laboratories, Florida Department of Health
Marek Pawlowicz, PhD, Bureau of Laboratories, Florida Department of Health

Consumption of fish containing methylmercury can pose serious health concerns including neurotoxic effects in adults and toxicity to the fetuses of mothers exposed during pregnancy. In the study described in this article, the authors examined fish consumption patterns and measured hair mercury levels of women of childbearing age in a coastal county in Florida. Women from the community participated in a risk factor assessment survey (N = 703). Hair samples (n = 698) were collected and analyzed for mercury. The authors identified 74.8% below detection limit; 25.2% had detectable limits of mercury, while 7% exceeded 1 µg/g. Hair mercury levels increased with fish consumption and age. Race, income, and education levels were also associated with increased hair mercury levels. Women of Asian/Pacific Islander origin had the highest levels. Although reported fish consumption exceeded the recommendations for women of childbearing age, the study population had lower mercury levels than other comparative studies in Florida and at national levels.


Lead Detection in Food, Medicinal, and Ceremonial Items Using a Portable X-Ray Fluorescence (XRF) Instrument
Ginger Reames, Childhood Lead Poisoning Prevention Branch, California Department of Public Health
Valerie Charlton, MD, MPH, Childhood Lead Poisoning Prevention Branch, California Department of Public Health

The authors evaluated a Niton XLp303A X-ray fluorescence (XRF) instrument, used to identify lead hazards in housing, to determine its effectiveness to screen food, medicinal, and ceremonial items during lead poisoning investigations. Fifty-eight suspect exposure items were tested for lead by XRF and then sent to the laboratory for confirmation. A lead content cut-point of 10 parts per million (ppm; the lower level at which the XRF model could reliably determine the presence of lead) was used to evaluate the results. The Niton consistently identified the presence of lead spectra emissions and gave quantitative readings above 10 ppm for the nine samples with lead content that exceeded 10 ppm in laboratory testing. The authors’ study suggests that the Niton XLp303A is an effective screening method for food and similar items with lead content ≥10 ppm, provided the operator is trained to identify lead spectra. Rapid, on-site identification of lead exposure sources allows an investigator to inform the family of immediate steps they can take to decrease their child’s lead exposure.


State Public Health Laboratory Biomonitoring Programs: Implementation and Early Accomplishments
Mary A. Fox, PhD, MPH, Johns Hopkins Bloomberg School of Public Health
Megan Latshaw, PhD, MHS, Association of Public Health Laboratories, Inc.

In 2009, the Centers for Disease Control and Prevention funded three state-based public health laboratory biomonitoring programs. These programs are the foundation for a National Biomonitoring Plan that consists of a larger network of state and local biomonitoring programs. To understand the utility of these programs and plan for the larger network, interviews were conducted with the program officials. The goal was to gather information on the challenges, successes, and lessons learned in program launch and implementation. Representatives of all programs participated. Projects range from statewide efforts to focused community investigations. Each program focuses on specific analytes including metals, pesticides, and other organics. Main accomplishments reported include development of laboratory and field capacity as well as generation of analytical results. Common challenges reported were laboratory setup and operation, sample collection and logistics, and staff recruitment. Respondents made specific recommendations for improving effectiveness of the current programs as well as ways to advance the National Biomonitoring Plan.


Compendium—Evaluation of Metal Impurities in Foods Preserved With Sodium Lactate
Kimberly Ferren Carter, PhD, RN
Gregory L. Carter MS, PG

The public is being bombarded by the media almost daily with real and potential food health concerns leading to a public sentiment that questions the vulnerability and quality of our food. Sodium lactate is a food-grade product that in recent years has been used in bioremediation to stimulate microbial growth and contaminant breakdown processes. In previous work, impurities including arsenic and chromium were discovered to be present in the sodium lactate concentrate. The study described in this article was performed to determine whether arsenic and chromium were at detectable levels, posing a potential concern in food products preserved with sodium lactate available to the general public. A pilot sampling of three sodium-lactate-preserved food products was obtained from a local market and used to determine the commercial laboratory’s detection and reporting limits for arsenic and chromium for these food products. Arsenic was not reported above the detection limits in either the pilot or subsequent study, but chromium was detected at concentrations up to 0.30 parts per million in a pilot test sample and lower concentrations in the subsequent study. This study suggests that the sodium lactate in the sampled products was diluted enough for the arsenic concentration to be below the laboratory detection limit. Chromium was detected and may be an unaccounted source of chromium in diets of vulnerable populations.


Compendium—Mutagenicity and Genotoxicity of Water Treated for Human Consumption Induced by Chlorination By-products
Elizabeth Rincón-Bedoya, PhD
Nelly Velásquez
Jairo Quijano, PhD
Claudio Bravo-Linares, PhD

Water used for human consumption may contain mutagens and carcinogens generated during the disinfection process with chlorine. In the study described in this article, the mutagenicity and genotoxicity of water samples taken from the San Cristobal treatment plant in Medellin, Colombia, were evaluated. Short-term mutagenic and genotoxic assays using Ames and comet assay, respectively, were employed to examine the genotoxic activity of the extracts of these water samples. Two samples were taken before and after the chlorination process. The treated water samples without chlorination did not show mutagenic effects using the Ames test, while the chlorinated samples produced mutagenic activity in both strains. A dose-response relationship for the comet assay was obtained only in the chlorinated samples. MX (3-chloro-4-[dichloromethyl]-5-hydroxy-2[5H]-furanone), E-MX ([E]-2-chloro-3-[dichloromethyl]-4-oxobutenoic acid), and some trihalomethanes were detected at low concentrations. These concentrations were enough, however, to cause detectable mutagenic and genotoxic activity in the extracts of chlorinated water samples.


Compendium—Mercury, Lead, and Cadmium in Umbilical Cord Blood
Ewa King, PhD, State Health Laboratories, Rhode Island Department of Health
Susanna R. Magee, MPH, MD, Warren Alpert Medical School of Brown University Grace Shih, MD, Memorial Hospital of Rhode Island
Dhitinut Ratnapradipa, PhD, Rhode Island Department of Health
Daniela N. Quilliam, MPH, Rhode Island Department of Health
John Morton, MD, Memorial Hospital of Rhode Island

The study described in this article aimed to determine if measurable levels of mercury, lead, and cadmium are detected in the umbilical cord blood specimens collected in a community hospital in Rhode Island and if prenatal exposure correlates with prematurity or fetal growth indicators. Total mercury, lead, and cadmium concentrations were measured in 538 specimens of cord blood and correlated with demographic characteristics and pregnancy outcomes for each mother-infant pair. Lead concentrations determined in the cord blood of Rhode Island women (geometric mean 0.99 μg/dL) were similar to those reported in U.S. biomonitoring studies. The overall geometric mean for mercury concentration (0.52 μg/L) was slightly lower than in other comparable studies. Cadmium concentrations were generally below the limit of detection. A statistically significant correlation was detected between elevated mercury concentrations and racial and ethnic characteristics of the study participants. Non-Hispanic African-American mothers were 9.6 times more likely to have a mercury concentration ≥5.8 μg/L compared to women of other racial/ethic backgrounds. No association was detected between elevated mercury levels and adverse birth outcomes.


Compendium—Health and Safety Inspection of Hairdressing and Nail Salons by Local Authority Environmental Health Practitioners
Joanne Harris-Roberts, Human Sciences Unit and Centre for Workplace Health, Health and Safety Laboratory
Jo Bowen, Human Sciences Unit and Centre for Workplace Health, Health and Safety Laboratory
Jade Sumner, Human Sciences Unit and Centre for Workplace Health, Health and Safety Laboratory        David Fishwick, Human Sciences Unit and Centre for Workplace Health, Health and Safety Laboratory

The objective of the study described in this article was to provide environmental health practitioners (EHPs) with an evaluation of the levels of understanding of, and compliance with, health and safety legislation in hairdressing and nail salons. EHPs carried out a series of inspections of 205 salons in a large British city, consisting of a site assessment and an assessment of employee knowledge of relevant regulations, including those relating to control of exposure to hazardous substances.

Two-fifths of senior salon employees understood Control of Substances Hazardous to Health (COSHH) assessments and could provide evidence of their completion. Most employees had been trained and made aware of the health hazards associated with carrying out their work and took suitable precautions to protect themselves and their clients.

The results suggest that senior employees within the salons sampled, have knowledge of the risks to health and have been taking measures to control these risks. Initiatives such as the Health and Safety Executive’s (in collaboration with local authorities and the hairdressing industry) “Bad Hand Day?” campaign and sector-specific COSHH essentials guidance help raise awareness levels and aim to support good control practice in salons.


Compendium—Community-Associated Methicillin-Resistant Staphylococcus aureus in College Residential Halls
Katelynn Tonn, Environmental Health Sciences Program, Ohio University
Timothy J. Ryan, PhD, CIH, CSP, School of Public Health Sciences, Ohio University

Methicillin-resistant Staphylococcus aureus (MRSA) was once a predominantly hospital-acquired organism but community-associated MRSA (CA-MRSA) has become a concern in athletics, prisons, and other nonclinical closed populations. As such, college residential hall occupants and workers may be at elevated risk of spreading or contracting MRSA.

Environmental samples were obtained to identify the occurrence of MRSA on surfaces in bathrooms of 15 university residential halls. Sterile swabs and BBL CHROMagar plates were used to sample seven categories of potentially contaminated surfaces in each location. Frequencies and descriptive statistics were prepared. All sites had at least one positive sample for MRSA, and shower floors displayed the greatest prevalence (50%). These results indicate areas for heightened sanitation, and illustrate CA-MRSA potential from such surfaces. The need for hygiene education of affected persons about skin and soft tissue infections like MRSA, and intervention opportunities for public health professionals, are discussed.


Compendium—Prevalence of Methicillin-Resistant Staphylococci Species Isolated From Computer Keyboards Located in Secondary and Postsecondary Schools
Tyler T. Boa, University of Regina
Teddie O. Rahube, University of Regina
Bastien Fremaux, PhD, University of Regina
Paul N. Levett, PhD, Saskatchewan Health
Christopher K. Yost, PhD, University of Regina

Methicillin-resistant Staphylococcus aureus (MRSA) is a public health threat within the general community, thereby warranting identification of MRSA reservoirs within the community. Computer terminals in schools were sampled for S. aureus and methicillin-resistant staphylococci. The overall prevalence of MRSA on computer keyboards was low: 0.68% for a postsecondary institution and 2% and 0% for two secondary institutes. The MRSA isolate from the postsecondary institution did not correspond to the Canadian epidemic clusters, but is related to the USA 700 cluster, which contains strains implicated in outbreaks within the U.S.

The isolate from the secondary institute’s keyboard was typed as CMRSA7 (USA 400), a strain that has been implicated in both Canadian and U.S. epidemics. Methicillin-resistant S. haemolyticus and S. epidermidis were also isolated from keyboards, indicating that a mixed community of methicillin-resistant staphylococci can be present on keyboards. Although the prevalence was low, the presence of MRSA combined with the high volume of traffic on these student computer terminals demonstrates the potential for public-access computer terminals and computer rooms at educational institutes to act as reservoirs.


Compendium—Water Quality and Management of Private Drinking Water Wells in Pennsylvania
Bryan R. Swistock, MS, The Pennsylvania State University
Stephanie Clemens, MS
William E. Sharpe, PhD
Shawn Rummel, PhD, Trout Unlimited

Pennsylvania has over three million rural residents using private water wells for drinking water supplies but is one of the few states that lack statewide water well construction or management standards. The study described in this article aimed to determine the prevalence and causes of common health-based pollutants in water wells and evaluate the need for regulatory management along with voluntary educational programs. Water samples were collected throughout Pennsylvania by Master Well Owner Network volunteers trained by Penn State Extension. Approximately 40% of the 701 water wells sampled failed at least one health-based drinking water standard. The prevalence of most water quality problems was similar to past studies although both lead and nitrate-N were reduced over the last 20 years. The authors’ study suggests that statewide water well construction standards along with routine water testing and educational programs to assist water well owners would result in improved drinking water quality for private well owners in Pennsylvania.


Compendium—Relationship Between Food Safety and Critical Violations on Restaurant Inspections: An Empirical Investigation of Bacterial Pathogen Content
Valerie A. Yeager, MPH, Mphil, DrPH, Tulane University
Nir Menachemi, MPH, PhD, University of Alabama at Birmingham
Bruce Braden, Jefferson County Department of Health
Devon M. Taylor, MPH, Jefferson County Department of Health
Bryn Manzella, MPH, Jefferson County Department of Health
Claude Ouimet, MD, FAAFP, SuccessEHS

While various safety control measures exist within the U.S. food system, foodborne illness remains a costly and persistent problem. The purpose of the study described here was to examine the relationship between violations of critical restaurant inspection items (“critical items”) and food safety as measured by the bacterial load of illness-causing pathogens. Specifically, the authors’ study looked at bacterial pathogens present in foods of two groups of restaurants, those that consistently scored poorly on critical items as compared to restaurants that performed superiorly in the same types of evaluation in Jefferson County, Alabama. Laboratory analyses indicated that 35.7% of the foods tested had detectable levels of Staphylococcus aureus, but no difference occurred between the two groups of restaurants. No other bacterial pathogens were found in any of the tested samples. A total of 45.2% of the food samples were received outside of recommended temperatures. Findings draw attention to the ongoing need to improve temperature control and hygienic practices, specifically hand-washing practices, in restaurants.


Compendium—Common Phenotypic and Genotypic Antimicrobial Resistance Patterns Found in a Case Study of Multiresistant E. coli From Cohabitant Pets, Humans, and Household Surfaces
Liliana Raquel Leite Martins, DVM, Institute for the Biomedical Sciences Abel Salazar, Porto University
Susana Maria Rocha Pina, PhD, Institute for the Biomedical Sciences Abel Salazar, Porto University
Romeo Luís Rocha Simões, DVM, Institute for the Biomedical Sciences Abel Salazar, Porto University
Augusto José Ferreira de Matos, DVM, PhD, Institute for the Biomedical Sciences Abel Salazar, Porto University
Pedro Rodrigues, PhD, Institute for Molecular and Cell Biology, Porto University
Paulo Martins Rodrigues da Costa, DVM, PhD, Center of Marine & Environment Research, Porto University

The objective of the study described in this article was to characterize the antimicrobial resistance profiles among E. coli strains isolated from cohabitant pets and humans, evaluating the concurrent colonization of pets, owners, and home surfaces by bacteria carrying the same antimicrobial-resistant genes. The authors also intended to assess whether household surfaces and objects could contribute to the within-household antimicrobial-resistant gene diffusion between human and animal cohabitants. A total of 124 E. coli strains were isolated displaying 24 different phenotypic patterns with a remarkable percentage of multiresistant ones. The same resistance patterns were isolated from the dog’s urine, mouth, the laundry floor, the refrigerator door, and the dog’s food bowl. Some other multiresistant phenotypes, as long as resistant genes, were found repeatedly in different inhabitants and surfaces of the house. Direct, close contact between all the cohabitants and the touch of contaminated household surfaces and objects could be an explanation for these observations.


Compendium—Prevalence of Legionella Strains in Cooling Towers and Legionellosis Cases in New Zealand
Robert Lau, PhD, Massey University Wellington
Saadia Maqsood, MSc, Massey University Wellington
David Harte, MSc, Institute of Environmental Science and Research, Porirua, New Zealand
Brian Caughley, MSc. Massey University Wellington
Rob Deacon, Environmental Laboratory Services, Lower Hutt, New Zealand

Over 3,900 water samples from 688 cooling towers were tested for Legionella in 2008 in New Zealand. Of80 (2.05% isolation rate) Legionella isolates, 10 (12.5%) were Legionella pneumophila serogroup 1; 10 (12.5%) were L. anisa; nine (11.2%) were L. pneumophila serogroup 8; and one (1.2%) was L. longbeachae serogroup 2. Forty-one (51.2%) Legionella isolates were L. pneumophila serogroups. Over 3,990 water samples from 606 cooling towers were tested for Legionella in 2009 in New Zealand. Of 51 (1.28% isolation rate) Legionella isolates, 18 (35.3%) were L. pneumophila serogroup 1, and 39 (76.4%) were other L. pneumophila serogroups.

L. pneumophila serogroups were significantly associated with legionellosis cases in 2008 and 2009. L. longbeachae serogroups were equally significantly associated with legionellosis cases. This significant association of L. longbeachae with legionellosis particularly of L. longbeachae serogroup 1 is unique in that part of the world. The authors’ study also showed that the aqueous environment of the cooling tower is not a natural habitat for pathogenic L. longbeachae. Regular monitoring and maintenance of cooling towers have prevented outbreaks of legionellosis.


Direct From CDC: Kick Off 2013 With Exciting Workforce Development Opportunities
Elaine Curtiss, MEd

With the New Year, many people make resolutions to improve upon themselves. This month’s column highlights several training opportunities to help environmental public health professionals improve upon their knowledge, skills, and abilities. These trainings include environmental public health online courses, environmental assessments for foodborne-illness outbreaks training, the Environmental Health Training in Emergency Response (EHTER) course, and integrated pest management training.


Demystifying the Future: City of the Future: Part One
Thomas Frey

This month’s column is the first part of a series that explores the city of the future. It talks about the diminishing value of proximity in our decisions on where to live, work, and conduct business. It also explores how factors such as human interaction, trends, money, and income will affect our future cities. The April Journal of Environmental Health will include the second part of this column.

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March 2013, Volume 75, No. 7

Persistence of Salmonella and E. Coli on the Surface of Restaurant Menus
Sujata A. Sirsat, PhD, Conrad N. Hilton College of Hotel and Restaurant Management, University of Houston
Jin-Kyung K. Choi, PhD, Department of Hospitality and Tourism Management, Purdue University
Barbara A. Almanza, PhD, Department of Hospitality and Tourism Management, Purdue University
Jack A. Neal, PhD, Conrad N. Hilton College of Hotel and Restaurant Management, University of Houston

To the authors’ knowledge, the role of restaurant menus as a vehicle for pathogens has not been explored. Menus, however, can pose as a vector for bacterial contamination and transfer. Sampling menus from two restaurants in the Houston, Texas, area showed the presence of up to 100 CFU/cm2 aerobic bacteria. Follow-up studies designed to investigate the ability of Salmonella and E. coli to persist on paper and laminated menus at various time points (0, 6, 24, 48, and 72 hours) demonstrated that bacteria persist more efficiently on laminated menus as compared to paper menus. Transfer studies performed to quantitatively determine the ability of bacteria to transfer from menus to fingertips and from fingertips to clean menus showed that bacteria can be transferred for up to 24 hours. The study described here showed that restaurant menus may serve as vehicles for pathogens and hence present a public health issue within the retail food environment.


Private Drinking Water Quality in Rural Wisconsin
Lynda Knobeloch, PhD, Wisconsin Department of Health Services
Patrick Gorski, PhD, Wisconsin State Laboratory of Hygiene
Megan Christenson, MS, MPH, Wisconsin Department of Health Services
Henry Anderson, MD, Wisconsin Department of Health Services

Between July 1, 2007, and December 31, 2010, Wisconsin health departments tested nearly 4,000 rural drinking water supplies for coliform bacteria, nitrate, fluoride, and 13 metals as part of a state-funded program that provides assistance to low-income families. The authors’ review of laboratory findings found that 47% of these wells had an exceedance of one or more health-based water quality standards. Test results for iron and coliform bacteria exceeded safe limits in 21% and 18% of these wells, respectively. In addition, 10% of the water samples from these wells were high in nitrate and 11% had an elevated result for aluminum, arsenic, lead, manganese, or strontium. The high percentage of unsafe test results emphasizes the importance of water quality monitoring to the health of nearly one million families including 300,000 Wisconsin children whose drinking water comes from a privately owned well.


Nitrate and Ammonia Contaminations in Drinking Water and the Affecting Factors in Hailun, Northeast China
Xinfeng Zhao, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences
Liding Chen, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences
Haiping Zhang, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences

Drinking water samples (N = 228) from domestic tube wells (DTWs) and seven samples from public water supply wells (PWSWs) were collected and tested in Hailun, northeast China. The percentage of samples with nitrate and ammonia concentrations above the maximum acceptable concentration of nitrate, 10 mg N/L, and the maximum ensure concentration of ammonia, 1.5 mg/L, for the DTWs were significantly higher than for the PWSWs. Of the DTWs, an important observation was that the occurrence of groundwater nitrate contamination was directly related to well tube material with different joint pathways. Nitrate in seamless-tube wells was lower statistically significantly than those in multiple-section-tube wells (p < .001). Furthermore, well depth and hydrogeological setting might have some impacts on nitrogen contamination and the major sources of inorganic nitrogen contamination may be nitrogenous chemical fertilizer. Therefore, PWSWs built for all families are the best way to ensure the drinking water safety in villages. For DTWs it is necessary to use seamless tubes and to dig deep enough according to the depth of groundwater level. Improving the efficiency of chemical fertilizer use would also reduce the risk of groundwater contamination.


Noise Disturbances in Daycare Centers Before and After Acoustical Treatment
Lars Gerhardsson, MD, Occupational and Environmental Medicine, Sahlgrenska Academy and University Hospital
Erling Nilsson, Saint-Gobain Ecophon AB

The authors’ aim was to study noise-related problems in personnel at Swedish daycare  centers. The authors’ study comprised staff (N = 81) who completed a questionnaire (noise, illumination, indoor climate, hearing problems) at five daycare centers with noise problems. After basic and activity sound measurements, absorbers were attached to the ceilings and to two adjacent walls in the playing and dining rooms. Thereafter, basic and activity sound measures were repeated and the questionnaire was also repeated six months later. The acoustical treatment reduced the sound pressure levels by 2 to 6 dB in the playing rooms and by 0 to 3 dB in the dining rooms. The reverberation time was reduced by 20% to 50%. After the treatment the perceived noise disturbance level decreased slightly but not significantly and the proportion of the staff that often or very often planned the daily activities to reduce the noise level had decreased from about 39% to 25%. Similarly, the percentage that often or very often had a need for silence after work had decreased from 42% to 37%.


Lead Contamination of Paint Remediation Workers’ Vehicles
Carol Boraiko, MS, PhD, Engineering Technology Department, Middle Tennessee State University
Eva M. Wright, MS, Antea Group USA
Faye Ralston, MS, Tennessee Lead Elimination Action Program, Middle Tennessee State University

Exposure to lead has been shown to be harmful to adults; it is a teratogen, it can damage the peripheral nervous system, and it adversely affects the reproductive system. Professional lead-based paint remediation workers are at risk of exposure to lead dust. The authors’ study was conducted to determine if these remediation workers transfer lead from their work site to their vehicles and then potentially expose their families. It was hypothesized that remediation workers transported the lead from the remediation work site to the floorboards of their vehicles due to not following required protective equipment use. The laboratory’s level of quantitation for lead on the wipe samples, 10 µg/ft², was used to indicate lead contamination. This level was exceeded in 50% of the floorboards sampled. These results confirm that many vehicle floorboards used by remediation workers are contaminated with lead dust, potentially resulting in transfer of lead dust. The ultimate detrimental outcome could be the transfer of lead particles to other family members, causing the poisoning of a child or other at-risk person.


Direct From ATSDR: The Toxicological Profile Program at ATSDR
Henry G. Abadin, MSPH

The Superfund Amendments and Reauthorization Act of 1986 (SARA) directs ATSDR to develop a prioritized list of hazardous substances of greatest public health concern at facilities on the National Priorities list and to develop comprehensive Toxicological Profiles for those substances. This month’s column describes the process ATSDR follows to create and update toxicological profiles.


Direct From CDC: EHS-Net Restaurant Food Safety Studies: What Have We Learned?
Laura Green Brown

CDC’s Environmental Health Specialists Network (EHS-Net) is a collaborative network focused on understanding factors that contribute to foodborne illness and improving environmental public health practice. Over the past several years, EHS-Net has conducted a number of studies on restaurant food safety. This month’s column covers some of the trends concerning factors related to safer food preparation in areas such as food worker and manager food safety training and experience, restaurant and food worker busyness, and restaurant ownership.


Demystifying the Future: City of the Future: Part Two
Thomas Frey

In this second part, Frey continues to discuss features that might be included within the cities of the future. These include building culture through the novel concepts of tournament centers, participatory parks, and live music plans.

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April 2013, Volume 75, No. 8

Wind Turbines: Is There a Human Health Risk?
Jennifer D. Roberts, MPH, DrPH, F. Edward Hébert School of Medicine, Uniformed Services University
Mark A. Roberts, MD, PhD, Exponent®

The term “Wind Turbine Syndrome” was coined in a recently self-published book, which hypothesized that a multitude of symptoms such as headache and dizziness resulted from wind turbines generating low frequency sound (LFS). The objective of this article is to provide a summary of the peer-reviewed literature on the research that has examined the relationship between human health effects and exposure to LFS and sound generated from the operation of wind turbines.

At present, a specific health condition has not been documented in the peer-reviewed literature that has been classified as a disease caused by exposure to sound levels and frequencies generated by the operation of wind turbines. Communities are experiencing a heightened sense of annoyance and fear from the development and siting of wind turbine farms. High-quality research and effective risk communication can advance this course from one of panic to one of understanding and exemplification for other environmental advancements.


Hand Washing Practices in a College Town Environment
Carl P. Borchgrevink, PhD, The School of Hospitality Business, Michigan State University
JaeMin Cha, PhD, The School of Hospitality Business, Michigan State University
SeungHyun Kim, PhD, The School of Hospitality Business, Michigan State University

Many people do not wash their hands when the behavior in which they engage would warrant it. Most research of hand washing practices to date has taken place in high-traffic environments such as airports and public attraction venues. These studies have established a persistent shortcoming and a gender difference in hand washing compliance. Using field observations of 3,749 people in a college town environment, the research described in this article replicates and extends earlier work while identifying potential environmental and demographic predictors of hand washing compliance. Additionally, the authors’ research suggests that proper hand washing practices, as recommended by the Centers for Disease Control and Prevention, are not being practiced. Finally, the authors’ research raises a question as to the accuracy of earlier measurements of “proper” hand washing practices, suggesting that compliance rates are inflated. The results can help increase hand washing rates for the general public and thus decrease the risk of transmitting disease.


Primary Amebic Meningoencephalitis in Florida: A Case Report and Epidemiological Review of Florida Cases
Philip J. Budge, MD, PhD, Epidemic Intelligence Service, Centers for Disease Control and Prevention
Becky Lazensky, MPH, Bureau of Epidemiology, Florida Department of Health
Kathleen W. Van Zile, MSEH, RS, Bureau of Epidemiology, Florida Department of Health
Karen E Elliott, MPH, CHES, Duval County Health Department, Florida Department of Health
Carrie A. Dooyema, MSN, MPH, Epidemic Intelligence Service, Centers for Disease Control and Prevention
Govinda S. Visvesvara, PhD, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention
Michael J. Beach, PhD, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention
Jonathan S. Yoder, MSW, MPH, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention

Primary amebic meningoencephalitis (PAM) is a rare but nearly always fatal infection of the central nervous system caused by the thermophilic, free-living ameba Naegleria fowleri. Since its first description in 1965 through 2010, 118 cases have been reported in the U.S.; all cases are related to environmental exposure to warm freshwater; most have occurred in children and adolescents and are associated with recreational water activities, such as swimming, diving, or playing in freshwater lakes, ponds, or rivers. Over one-fourth of all national PAM cases have occurred in Florida. The authors describe here a fatal case of PAM in a resident of northeast Florida and the ensuing environmental and public health investigation; they also provide a review of all cases of PAM in Florida from 1962 to 2010 and discuss public health responses to PAM in Florida, highlighting opportunities for positive collaboration between state and local environmental health specialists, epidemiologists, and the Centers for Disease Control and Prevention.


The Use of Deer Vehicle Accidents as a Proxy for Measuring the Degree of Interaction Between Human and Deer Populations and Its Correlation With the Incidence Rate of Lyme Disease
Daniel H. Wiznia, MD, Department of Orthopaedics and Rehabilitation, Yale School of Medicine
Paul J. Christos, MS, DrPH, Department of Public Health, Weill Cornell Medical College
Andrew M. LaBonte, MS, Connecticut Department of Environmental Protection

The study described in this article examined the relationship between the incidence rate of deer vehicle accidents (DVAs), a proxy for measuring the interaction between populations of humans and deer, and human Lyme disease incidence rate. The authors also examined the relationship between deer population density and human Lyme incidence rate. They analyzed data from Connecticut’s Department of Environmental Protection and the Department of Public Health from 1999 through 2008 by deer management zone (DMZ) and town. For DVA incidence rate versus Lyme incidence rate for both DMZs and towns, most of the correlation coefficients computed yearly were moderate to strong and all of the p-values were significant. A weak correlation was observed between deer population density and Lyme disease incidence rate by DMZ. The authors propose DVAs as a proxy for measuring the interaction between coexisting populations of humans and deer. The authors’ study suggests that additional investigations of DVAs and their relationship to Lyme disease to further assess the utility of public health interventions are warranted.


2011 NEHA Sabbatical Report: From Then to Now, and Here to There: A Glimpse at Contaminated Lands and Environmental Health Issues
Julia Campbell, MPH, Environmental Health Section, Georgia Department of Public Health

This guest commentary shares the experiences and lessons learned from the 2011 NEHA Sabbatical winner. Ms. Campbell chose to conduct her sabbatical for three week in the UK to study landfills and brownsfields in a high-precipitation, high-groundwater table, limited-land-space environment. She also chose to look at the environmental factors, sociocultural factors, and community involvement in the UK. The article ends with Ms. Campbell sharing some of the lessons learned during this experience.


Direct From CDC: Monitoring and Controlling West Nile Virus: Are Your Prevention Practices in Place?
Roger S. Nasci, PhD

This column provides a brief history of West Nile virus (WNV), from the 1999 outbreak in New York City to the recent 2012 epidemic that spanned 48 states. It goes on to stress the importance of personal protection activities and integrated mosquito management programs targeting vector mosquitoes as primary prevention. It further describes the integrated mosquito management concept including the data that supports it and program objectives, maintenance, and available guidance.


Demystifying the Future: Macro Trends for 2013 and Beyond: The First Two
Thomas Frey

This month’s column explores two of the four unexpected macro trends for 2013 Frey sees as dramatically influencing our future—the shift to natural gas vehicles and the great insourcing movement.


Legal Briefs: Raw Milk: An Issue of Safety or Freedom?
Drew Falkenstein

The debate over raw milk has been a subject of passion, politics, and attempted persuasion. This month’s column is intended as a short critique on the authority of state and federal legislatures to do as they chose with this lightening-rod food item.


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May 2013, Volume 75, No. 9

Complaints Associated With Animal Feeding Facilities as Reported to Ohio Local Health Departments, 2006–2008
Sara M. Morrow, MPH-VPH, College of Public Health, The Ohio State University
Jeanette O’Quin, MPH-VPH, DVM, College of Veterinary Medicine, The Ohio State University
Armando E. Hoet, DVM, PhD, DACVPM , College of Veterinary Medicine, College of Public Health, The Ohio State University
J. R. Wilkins III, DrPH, College of Public Health, The Ohio State University
Fred DeGraves, DVM, PhD, Ogden College of Science and Engineering, Western Kentucky University
Kathleen A. Smith, MPH, DVM, RS, Zoonotic Disease Program, Ohio Department of Health

Confined animal feeding facilities of all sizes have long been targeted as a source of human health and quality of life concerns. In order to describe and quantify these concerns in Ohio, a retrospective survey of local health departments was conducted focusing on reported complaints associated with animal feeding facilities. During 2006–2008, the most common complaints pertaining to any type of animal feeding facility were air quality and odor outside the home, followed by manure storage and application issues. The study described here showed that larger permitted livestock feeding facilities were not a major source of health and nuisance complaints associated with animal feeding facilities as reported to Ohio local health departments. Local health departments received few health complaints associated with any animal feeding facility. None were validated or confirmed by a physician in 2008.


A Community-Based Participatory Research Partnership to Reduce Vehicle Idling Near Public Schools
Cynthia Eghbalnia, MPH, CIH, Cincinnati Public Schools
Ken Sharkey, MPH, RS, Cincinnati Health Department
Denisha Garland-Porter, MPH, RS, Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center
Mohammad Alam, PhD, Cincinnati Health Department
Marilyn Crumpton, MPH, MD, Cincinnati Health Department
Camille Jones, MPH, MD, Cincinnati Health Department
Patrick H. Ryan, PhD, Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center; Department of Environmental Health, University of Cincinnati

The authors implemented and assessed the effectiveness of a public health initiative aimed at reducing traffic-related air pollution exposure of the school community at four Cincinnati public schools. A partnership was fostered with academic environmental health researchers and community members. Anti-idling campaign materials were developed and education and training were provided to school bus drivers, students, parents, and school staff. Pledge drives and pre- and posteducation assessments were documented to measure the effectiveness of the program. After completing the educational component of the public health initiative, bus drivers (n = 397), community members (n = 53), and staff (n = 214) demonstrated significantly increased knowledge about the health effects of idling (p < .05). More than 30% of parents signed the pledge to reduce idling after the public health intervention.A community-driven public health initiative can be effective in both 1) enhancing community awareness about the benefits of reducing idling vehicles and 2) increasing active participation in idling reduction. The partnership initially developed has continued to develop toward a sustainable and growing process.


Lead-Based Paint Awareness, Work Practices, and Compliance During Residential Construction and Renovation
James D. Blando, MHS, PhD, College of Health Sciences, Old Dominion University
Nickita Antoine, MPH, College of Health Sciences, Old Dominion University
Daniel Lefkowitz, MS, PhD, Occupational and Environmental Health Surveillance Program, New Jersey Department of Health

The U.S. Environmental Protection Agency recently implemented the Renovation, Repair and Painting (RRP) rule that applies to pre-1978 residences because of the potential presence of lead-based paint. Enforcement of these rules may be difficult and therefore it is crucial to understand the awareness and beliefs of contractors and the general public because these will likely be major determinants of exposures resulting from residential renovation work. The study described in this article utilized two mailed surveys: one directed to the general public and the other directed to contractors. The surveys were conducted in New Jersey and Virginia. Field observations were also recorded for work sites in New Jersey. Results indicated a high awareness among the general public about the hazards of lead, a low level of screening by children’s doctors for lead exposure, frequent use of work practices that generate lots of dust, poor hygiene among contractors, and the potential for low compliance of contractors with the RRP rule. In particular, contractors who do not believe lead is a serious health hazard are expected to have the lowest compliance with the RRP rule. These findings serve as targets for effective public health interventions through education and outreach.


An Outbreak of Cryptosporidium at a Recreational Water Park in Niagara Region, Canada
Jessica Hopkins, MHSc, MD, CCFP, FRCPC, Niagara Region Public Health, McMaster University
Heather Hague, MEd, RN, CIC, Infectious Disease Program, Niagara Region Public Health
Glen Hudgin, CPHI(C), CEHA, Environmental Health, Niagara Region Public Health
Lorrie Ross, RN, Infectious Disease Program, Niagara Region Public Health
Deborah Moore, MSc, Niagara Region Public Health

Cryptosporidium is a parasitic protozoan found in water sources and spread through the fecal-oral route. It is characterized by gastroenteritis and is increasingly associated with recreational water sources. On December 3, 2010, Niagara Region Public Health was informed of a laboratory-confirmed case of Cryptosporidium. Over the subsequent two weeks, a total of three additional laboratory-confirmed cases were reported. All cases had visited the same water park in Niagara Region, Canada, over November 14–16, 2010. A total of 12 cases associated with the outbreak ranged in age from 1 to 66 years. This article describes the outbreak, environmental investigation, and control measures. The environmental investigation revealed that the ultraviolet disinfection system was offline on November 14, 2010, which may have allowed for the transmission of Cryptosporidium to bathers. Further research into the detection of Cryptosporidium outbreaks and regulations and guidelines for water park operators may help to decrease future outbreaks.


Direct From the ATSDR: Community Exposures to Chemicals Through Vapor Intrusion: A Review of Past Agency for Toxic Substances and Disease Registry Public Health Evaluations
Tonia Burk, PhD
Gregory Zarus, MS

Volatile contaminants in subsurface soil or groundwater can migrate up into buildings—vapor intrusion—and present a unique inhalation exposure pathway. As U.S. Environmental Protection Agency (U.S. EPA) and Agency for Toxic Substances and Disease Registry (ATSDR) awareness of this phenomenon increases, the large number of historical solvent and petroleum releases is resulting in an ever-increasing number of sites with a vapor intrusion component. This column summarizes information showing which chemicals occur most frequently above screening values at sites ATSDR has reviewed and how many of the sites with these contaminants were classified as a public health hazard. The potential for vapor intrusion and possible adverse health effects to building occupants are important pieces of information for communities to be aware of, especially during redevelopment activities and land use decision making.


Direct From CDC: Healthy and Safe Swimming: Pool-Chemical Associated Health Events
Michele Hlavsa, RN, MPH
Michael Beach, PhD

Pool chemical-associated health events lead to 3,000–5,000 visits to emergency departments across the U.S. State and local investigations into the factors leading to these health events reveal common themes. This column covers the educational, engineering, and environmental health policy prevention efforts CDC has implemented. It also covers the creation of the Model Aquatic Health Code.


Demystifying the Future: Four Unexpected Macro Trends for 2013 and Beyond: The Last Two
Thomas Frey

The April column covered the first two unexpected macro trends for 2013 and beyond. This month’s column covers the last two—multidimensional literacy and the legalized marijuana movement.

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June 2013, Volume 75, No. 10


Impact of Internet Posting of Restaurant Inspection Scores on Critical Violations
A. Blake Waters, MPA, PhD, LEHS, Environmental Health Division, Salt Lake Valley Health Department
James VanDerslice, MSEE, PhD, Division of Public Health, University of Utah
Christina A. Porucznik, MSPH, PhD, Division of Public Health, University of Utah
Jaewhan Kim, PhD, Division of Public Health, University of Utah
Royal DeLegge, MPA, PhD, REHS, Environmental Health Division, Salt Lake Valley Health Department
Lynne Durrant, MS, PhD, Department of Health, University of Utah  

Posting restaurant inspection scores on the Internet as a tool for improving food safety is becoming more common. The purpose of the study described in this article was to evaluate the association between Internet posting of restaurant inspection scores and the five most frequently cited critical violations in Salt Lake County, Utah. The study examined 2,995 inspections conducted at 796 full service and fast food restaurants for a one-year period before and after launch of a restaurant inspection Web site. Critical violations decreased significantly after the Web site launch compared to before-launch levels. The greatest improvements were found in temperature holding violations (odds ratio = 0.75, p < .001), hygiene practices violations (odds ratio = 0.68, p < .001) and equipment cleanliness violations (odds ratio = 0.58, p < .001). Restaurant type (full service, fast food), inspector experience, and season were significantly associated with the decrease in violations.


A Health and Environmental Profile of the Dry Cleaning Industry in King County, Washington
Stephen G. Whittaker, PhD, Local Hazardous Waste Management Program, Public Health-Seattle & King County
Chantrelle A. Johanson, MS, Local Hazardous Waste Management Program, Public Health-Seattle & King County and Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington

Workers in the dry cleaning industry are exposed to a variety of harmful solvents, and poor work practices can result in extensive environmental contamination. Of particular concern is perchloroethylene (PERC), which is the most commonly used cleaning solvent. This chlorinated hydrocarbon is a pervasive environmental contaminant and a probable human carcinogen. PERC is also a neurotoxin and is toxic to the liver and kidneys.

The study described here was comprised of key informant interviews, site visits, and a countywide business survey. The 64% response rate to the survey suggests that the results are likely representative of King County’s dry cleaning industry. Dry cleaning was determined to be dominated by small, Korean-owned, family-run businesses. Although the use of PERC as the primary dry cleaning agent has decreased in recent years, this solvent is still used by the majority of businesses. This industry would benefit from regulatory intervention in concert with an educational campaign and enhanced technical and financial assistance. For any intervention to be effective, however, it must account for the unique financial and demographic characteristics of this industry.


Public Infrastructure Disparities and the Microbiological and Chemical Safety of Drinking and Surface Water Supplies in a Community Bordering a Landfill
Christopher D. Heaney, PhD, Bloomberg School of Public Health, Johns Hopkins University
Steve Wing, PhD, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
Sacoby M. Wilson, PhD, School of Public Health, University of Maryland
Robert L. Campbell, Rogers-Eubanks Neighborhood Association
David Caldwell, Rogers-Eubanks Neighborhood Association
Barbara Hopkins, Rogers-Eubanks Neighborhood Association
Shannon O’Shea, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
Karin Yeatts, PhD, Gillings School of Global Public Health, University of North Carolina at Chapel Hill

The historically African-American Rogers-Eubanks community straddles unincorporated boundaries of two municipalities in Orange County, North Carolina, and predates a regional landfill sited along its border in 1972. Community members from the Rogers-Eubanks Neighborhood Association (RENA), concerned about deterioration of private wells and septic systems and a lack of public drinking water and sewer services, implemented a community-driven research partnership with university scientists and community-based organizations to investigate water and sewer infrastructure disparities and the safety of drinking and surface water supplies. RENA drafted memoranda of agreement with partners and trained community monitors to collect data (inventory households, map water and sewer infrastructure, administer household water and sewer infrastructure surveys, and collect drinking and surface water samples). Respondents to the surveys reported pervasive signs of well vulnerability (100%) and septic system failure (68%). Each 100-m increase in distance from the landfill was associated with a 600 most probable number/100 mL decrease in enterococci concentrations in surface water (95% confidence interval = -1106, -93). Pervasive private household water and sewer infrastructure failures and poor water quality were identified in this community bordering a regional landfill, providing evidence of a need for improved water and sanitation services.


The Exploration of Effects of Chinese Cultural Values on the Attitudes and Behaviors of Chinese Restaurateurs Toward Food Safety Training
Pei Liu, PhD, Department of Nutrition and Dietetics, Louisiana Tech University
Junehee Kwon, PhD, RD, Department of Hospitality Management and Dietetics, Kansas State University

Foodborne illness is a challenge in the production and service of ethnic foods. The purpose of the study described in this article was to explore variables influencing the behaviors of U.S. Chinese restaurant owners/operators regarding the provision of food safety training in their restaurants. Seventeen major Chinese cultural values were identified through individual interviews with 20 Chinese restaurant owners/operators. Most participants felt satisfied with their previous health inspections. Several expressed having difficulty, however, following the health inspectors’ instructions and in understanding the health inspection report. A few participants provided food safety training to their employees due to state law. Lack of money, time, labor/energy, and a perceived need for food safety training were recognized as major challenges to providing food safety training in Chinese restaurants. Videos, case studies, and food safety training handbooks were the most preferred food safety training methods of Chinese restaurant owners/operators, and Chinese was the preferred language in which to conduct the training.


Integrating Research and Community Organizing to Address Water and Sanitation Concerns in a Community Bordering a Landfill
Robert L. Campbell, Rogers-Eubanks Neighborhood Association
David Caldwell, Rogers-Eubanks Neighborhood Association
Barbara Hopkins, Rogers-Eubanks Neighborhood Association
Christopher D. Heaney, PhD, Bloomberg School of Public Health, Johns Hopkins University
Steve Wing, PhD, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
Sacoby M. Wilson, PhD, School of Public Health, University of Maryland
Shannon O’Shea, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
Karin Yeatts, PhD, Gillings School of Global Public Health, University of North Carolina at Chapel Hill

In many underserved communities of color in the U.S. some residents are still living without safe and clean water and sewer infrastructure, storm water drainage, paved roads, sidewalks, and emergency services. These basic amenities provide a foundation for public health and well-being. Addressing disparities in access to these basic amenities lies at the historical root of the public health, hygiene, and sanitation movements. This guest commentary explores how to integrate research and community organizing to address these disparities.


Direct From CDC: Environmental Public Health Online Course (EPHOC) Series: Are We Making a Difference?
Lisa C. McCormick, DrPH
Jesse Pevear, II, MSPH

JCDH), NEHA, and the Centers for Disease Control and Prevention’s National Center for Environmental Health (CDC/NCEH) partnered to begin development of a comprehensive online package of courses for environmental public health (EPH) practitioners. This series of courses, known as the Environmental Public Health Online Courses (EPHOC), was developed in response to the 2005 National Profile of Local Health Departments, which indicated that many local health departments suffer from a lack of basic workforce development infrastructure, insufficient training budgets, and a shortage of designated staff persons to coordinate training. This series of courses, launched in its completion in 2010, is the first of its kind for public health discipline-specific workforce development training. This month’s column looks at the results from a survey of course participants to explore how useful the courses are.


Demystifying the Future: Moving From Just-in-Case to Just-in-Time Learning
Thomas Frey

This month’s column explores the shift in our thinking about ownership of physical products to digital ones and how that impacts business and our lives.


Legal Briefs: Why Your Jobs Are Important
Bill Marler, JD

In looking back at his personal experience with the Jack in the Box E. coli O157:H7 outbreak 20 years ago, Mr. Marler reflects on how important food safety professionals are in ensuring the safety and well-being of the public.


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July/August 2013, Volume 76, No. 1


Nanomaterials for Environmental Remediation: Investigating the Role of Nanoinformatics in Support of Environmental, Health, and Safety Oversight of Nanotechnologies at the Local Level
Ephraim Massawe, PhD, Department of Industrial Hygiene and Environmental Health Southeastern Louisiana University

Nanotechnology is the science and practice of manipulating matter at or near atomic scale to create new materials of unique and novel properties for specific applications. Nanomaterials, including engineered nanoparticles (ENPs), have been used successfully for remediation since they are superior in technical performance and cost-effectiveness than traditional remedial technologies. Evidence indicates, however, that exposure to nanomaterials may lead to significant safety and health impacts. To protect human health against undesired risks from nanomaterials requires that safe and sustainable development of nanotechnology is in tandem with the availability of relevant information.

State agencies responsible for the environment, safety, and public health were surveyed to understand their current and future information needs and capabilities to regulate nanomaterials. Because significant data gaps still exist on the toxicity and ecological impacts of nanomaterials, precautionary measures should be taken. Research to develop techniques for exposure assessments, surveillance and monitoring, databases, and characteristics of workplaces where ENPs are used is encouraged.


Baseline Knowledge Survey of Restaurant Food Handlers in Suburban Chicago: Do Restaurant Food Handlers Know What They Need To Know To Keep Consumers Safe?
Mindi R. Manes, School of Public Health, University of Illinois at Chicago
Li C. Liu, School of Public Health, University of Illinois at Chicago
Mark S. Dworkin, School of Public Health, University of Illinois at Chicago

In the U.S., foodborne disease causes millions of illnesses annually, resulting in thousands of deaths. To reduce food poisoning, restaurant food handlers need accurate knowledge of food safety principles as a starting point for the outcome of optimal food safety behavior. The study described in this article determined food safety knowledge gaps among suburban Chicago restaurant food handlers. A cross-sectional survey of 729 food handlers at 211 suburban Chicago restaurants was conducted from June 2009 through February 2010. A 50-question survey was administered by a trained interviewer in either English or Spanish. Mixed-effects regression analysis identified risk factors associated with an overall food safety knowledge score. The mean overall knowledge score was only 72% and substantial knowledge gaps related to cross contamination, cooking, and holding and storage of food were identified. Spanish-speaking food handlers scored significantly lower than English-speaking food handlers (p < .05). Although certified food managers scored significantly higher than noncertified food handlers, their score was only 79%. These data provide targets for educational interventions to remedy knowledge gaps in food handlers in order to prevent food poisoning from restaurants.


Can Realtor Education Reduce Lead Exposures for Vulnerable Populations?
Janet A. Phoenix, MPH, MD, School of Public Health and Health Services, George Washington University
Rodney D. Green, PhD, Department of Economics, Howard University, Howard University Center for Urban Progress
Aisha M. Thompson, MBA, Howard University Center for Urban Progress

Lead is known for its devastating effects on people, particularly children under the age of six. Disturbed lead paint in homes is the most common source of lead poisoning of children. Preventive approaches including consumer education on the demand side of the housing market (purchasers and renters of housing units) and disclosure regulations on supply side of the housing market (landlords, homeowners, developers, and licensed realtors) have had mixed outcomes. The study described in this article considered whether a novel supply-side intervention that educates licensed real estate agents about the specific dangers of lead poisoning would result in better knowledge of lead hazards and improved behavior with respect to the information they convey to potential home buyers. Ninety-one licensed realtors were trained for four hours on lead hazards and their health impacts. Pre- and postsurveys and a six-month follow-up interview were conducted to assess the impact of the intervention on their knowledge and self-reported behaviors with clients. The findings suggest that supply-side education could have a salutary impact on realtor knowledge and behavior.


Self-Reported Bed Bug Infestation Among New York City Residents: Prevalence and Risk Factors
Nancy Ralph, MPH, CUNY School of Public Health at Hunter College
Heidi E. Jones, MPH, PhD, CUNY School of Public Health at Hunter College
Lorna E. Thorpe, MPH, PhD, CUNY School of Public Health at Hunter College

Bed bug infestations have risen precipitously in urban areas. Little is known about risk factors for infestations or health outcomes resulting from these infestations. In the 2009 Community Health Survey, which is a representative population-based survey, 9,934 noninstitutionalized adults in New York City reported on bed bug infestations requiring an exterminator in the past year. The authors estimated infestation prevalence and explored predictors of infestation and associations between infestations and health outcomes using logistic regression. Seven percent of adults in New York City reported bed bug infestations. Significant individual and household risk factors were younger age, increased household poverty, and having three or more adults in the household. Environmental risk factors included living in high poverty neighborhoods and in buildings with more housing units, suggesting apartment-to-apartment transmission. Bed bug infestations were not associated with stress-related outcomes of alcohol consumption or recent depression, and, unlike cockroach infestation, were not associated with recent asthma episodes caused by allergens or contaminants.


Environmental Health—Champions of One Health
Christopher Eddy, MPH, REHS, RS, Boonshoft School of Medicine, Wright State University
Paul A. Stull, DVM, Montgomery County Office of Emergency Management, University of Dayton
Erik Balster, MPH, REHS, RS, Preble County General Health District

The authors find overwhelming evidence among environmental health practitioners that One Health disease reporting concepts are essential to the early detection of, and expedient recovery from, pandemic disease events. The authors also find, however, extraordinary evidence that local public health is not prepared, and potentially unaware of their responsibility, to be the initiator of the zoonotic infectious disease information intelligence necessary to make such early event mitigation possible. The authors propose that NEHA take an affirmative step towards the development of local public health–initiated biosurveillance systems by organizing and leading a tabletop study group that includes the Centers for Disease Control and Prevention, American Veterinary Medical Association, American Medical Association, Food and Drug Administration, U.S. Department of Agriculture, Institute of Medicine, and a robust panel of NEHA state affiliates. This study group should discuss the infrastructure necessary for local public health—the frontline against community-acquired infectious disease—to be the initiators of environmental health, veterinary, and medical One Health biosurveillance systems. The need to establish a community-focused, integrated disease prevention strategy that cautions people about the risks associated with food, water, animal, and contaminated environmental media, both prior to and during epidemic and pandemic events is equally important.


Direct From ATSDR: An Indicator Framework to Measure Effects of Brownfields Redevelopment on Public Health
Laurel Berman, PhD
Tina Forrester, PhD

Brownfields and land reuse sites are formerly used industrial, commercial, and residential properties stigmatized by real or perceived contamination. The effects of blight and potential contamination associated with these sites can weigh heavily on communities. ATSDR’s Brownfields/Land Reuse Health Initiative offers technical support and resources to communities to encourage the inclusion of public health in revitalization plans. The ATSDR Brownfields/Land Reuse Health Action Model is one resource designed to integrate public health in redevelopment by creating community-driven health status indicators. This month’s column looks at two different communities that utilized the Action Model.


Direct From CDC: Public Health Accreditation and Environmental Public Health: Sustaining the Collaboration
LCDR Justin Gerding, MPH, REHS
Valeria P. Carlson, MPH, CHES
Robin Wilcox, MPA

The first national voluntary accreditation program for public health departments was launched in September 2011 and the first cohort of public health department was accredited in February 2013. This month’s column explores how environmental public health is expected to be a major contributor to the accreditation process and many of the accreditation standards and measures specifically involve environmental public health.


Demystifying the Future
Thomas Frey

This month’s column explores cities of the future and the rising influence of cities, from recent demographic shifts to the competitiveness of cities to the concept of private cities.


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September 2013, Volume 76, No. 2


Examination of the Association Between Announced Inspections and Inspection Scores
A. Blake Waters, MPA, PhD, LEHS, Environmental Health Division, Salt Lake Valley Health Department
James VanDerslice, MSEE, PhD, Division of Public Health, University of Utah
Christina A. Porucznik, MSPH, PhD, Division of Public Health, University of Utaht
Jaewhan Kim, PhD, Division of Public Health, University of Utah
Royal DeLegge, MPA, PhD, REHS, Environmental Health Division, Salt Lake Valley Health Department
Lynne Durrant, MS, PhD, Department of Health, University of Ut

In 2010 the Salt Lake Valley Health Department conducted a pilot of an announced inspection program utilizing a randomized assignment of restaurants to an intervention group with announced inspections and a control group that remained on the usual schedule of unannounced inspections. After adjusting for food type, visible kitchen, outside quality assurance, season, and standardized inspector, significant reductions were found in the odds ratios of personal hygiene (adjusted odds ratios [aOR] = 0.11, p = .00) and equipment cleanliness (aOR = 0.19, p = .00) violations. In the models for the control group, none of the odds ratios were statistically different from one, indicating no change in the postintervention time period as compared to the preintervention period.


Food Safety Training Needs at Evacuation Shelters Operated by Faith-Based Organizations
Junehee Kwon, PhD, RD, Department of Hospitality Management and Dietetics, Kansas State University
Lisa Zottarelli, PhD, Department of Sociology and Social Work, Texas Woman’s University
Sockju Kwon, PhD, RD, Department of Biomedical Sciences, Missouri State University
Yee Ming Lee, PhD, Department of Nutrition, Dietetics, and Hospitality Management, Auburn University
Dojin Ryu, PhD, School of Food Science, University of Idaho

The authors conducted a survey to identify food safety training needs at evacuation shelters operated by faith-based organizations (FBOs) in four hurricane-prone states. Five thousand randomly selected FBO leaders were asked questions about their food safety attitudes and food handling practices at evacuation shelters. Descriptive statistics and multivariate analysis of variance were calculated to summarize and prioritize the responses. Results from 138 leaders revealed that on average, 590 ± 4,787 evacuees were served for 36 ± 72 days at FBO-operated shelters. Only 19.6% felt they were well prepared for the shelter. Only 5.8% had professional food preparation staff and many accepted hot (47.8%) and cold (37%) prepared food donations. Some lacked adequate refrigerator (18.8%) or freezer (16.7%) spaces, but 40% kept hot food leftovers for later use. The majority did not provide food safety training before opening the shelters (73.2%), yet 76.9% said they will provide food to evacuation shelters again. The results show a need for food safety training and specific strategies for training at FBOs.


Promoting Healthy School Environments: A Step-by-Step Framework to Improve Indoor Air Quality in Tangipahoa Parish, Louisiana
Ephraim Massawe, PhD, Department of Computer Science and Industrial Technology (Industrial Hygiene and Environmental Health), Southeastern Louisiana University
Laura Vasut, Saratoga Resources, Inc.

Poor indoor air quality (IAQ) is highly correlated with asthma and other respiratory illnesses. As a chronic lung disease, asthma can have significant impacts on the respiratory system and other complications in large populations of the young, the elderly, and the infirm. This disease is associated with various environmental triggers in indoor environments including schools and homes. Reducing these sources of asthma triggers can lead to improved health outcomes in children.

Environmental triggers of asthma and other respiratory illnesses can be reduced by systematically identifying and evaluating their sources and then developing a plan of action to prevent, control, and eliminate them. This article presents a step-by-step framework including easy-to-adopt strategies to support the development and implementation of an IAQ improvement and management plan for schools in semiurban environments with a focus on Tangipahoa Parish, Louisiana. The framework presented here encourages outreach, training, and consultations as key parameters for implementation of a sustainable IAQ program.


The Development of a Standards-Based National Curriculum Framework for Regulatory Food Safety Training in the United States
Craig Kaml, EdD, International Food Protection Training Institute
Kieran J. Fogarty, PhD, College of Health and Human Services, Western Michigan University
Gerald Wojtala, International Food Protection Training Institute
William Dardick, PhD, Graduate School of Education and Human Development, George Washington University
Allan Bateson, PhD, Office of Regulatory Affairs, Food and Drug Administration
Julia E. Bradsher, PhD, Global Food Protection Institute
Christopher C. Weiss, PhD, Global Food Protection Institute

In response to the recognized need for a training system to support an integrated food safety system in the U.S., the International Food Protection Training Institute (IFPTI) in Battle Creek, Michigan, designed a career-spanning curriculum framework. IFPTI collaborated with a national curriculum team consisting of regulatory officials and university academics. The curriculum framework encompasses and organizes existing professional development for the estimated 45,000 federal, state, and local food regulators in the U.S. into efficient, standards-driven learning paths. This article describes the development process leading to an integrated national food protection training curriculum framework.


Listeria monocytogenes Strains Isolated From Dry Milk Samples in Mexico: Occurrence and Antibiotic Sensitivity
O.R. Rodas-Suárez, PhD, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional
E.I. Quiñones-Ramírez, PhD, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional
F.J. Fernández, PhD, División de Ciencias Biológicas y de la Salud, Universidad Autónoma Metropolitana
C. Vázquez-Salinas, PhD, División de Ciencias Biológicas y de la Salud, Universidad Autónoma Metropolitana

Dry milk is a particular concern in Mexico, as approximately 150,000 metric tons of dry milk are imported every year at a cost of around $250 million. Dry milk is used to make many products, most of which are dairy products widely distributed among the population covered by welfare programs. The purpose of the study described in this article was to determine the presence of Listeria spp. in imported dry milk samples in Mexico, and to determine the sensitivity of the Listeria monocytogenes isolates to different antimicrobial agents. Listeria isolates (7.8% of 550 bacterial isolates) were identified as L. monocytogenes (53.49%), L. innocua (30.23%), L. seeligeri (13.95%), and L. ivanovii (2.33%). L. monocytogenes strains isolated showed multiresistance to ampicillin, erythromycin, tetracycline, dicloxacillin, and trimethoprim-sulfamethoxazole (9%–14%). The results provide additional evidence of the emergence of multiresistant Listeria strains both in nature and in widely consumed dairy products, representing a potential threat to human health.


Direct From CDC: InFORM: An Innovative, Integrated Food Safety Meeting
Robert G. Blake
Christopher R. Braden
Laura G. Brown

This month’s column talks about an upcoming food safety meeting: the Integrated Foodborne Outbreak Response Management (InFORM) Meeting. The InForm Meeting was conceived to bring together laboratorians, epidemiologists, and environmental health professionals who are responsible for foodborne disease outbreak surveillance and response activities. The meeting will take place November 18–21, 2013, in San Antonio, Texas. For more information, visit


Demystifying the Future: Hi, I’m a Robot and I’m Here to Take Your Job
Thomas Frey

Frey writes about the rise of technology and the displacement of labor. He explores the common fallacy that people are being replaced by machines. Rather, he says, machines don’t work without people and it is more fitting to say that a large number of people are being replaced by a smaller number of people using machines. He explores this thought in this month’s column as well as how we are moving into an era of super-efficient humans and names some potential jobs in the future.


Legal Briefs: Food Safety and the Global Supply Chain
Bill Marler, JD

This month’s column discusses some recent foodborne illnesses associated with imported foods and stresses that food safety is “farm to fork” and around the world. It goes on to further stress that producers, shippers, importers, exporters, retailers, health officials, inspectors, and consumers need to pay attention to the whole supply chain, even if it stretches around the world.

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October 2013, Volume 76, No. 3


Mexican-American Children’s Perspectives: Neighborhood Characteristics and Physical Activity in Texas-Mexico Border Colonias
Nelda Mier, PhD, School of Rural Public Health, Texas A&M Health Science Center
Chanam Lee, PhD, College of Architecture, Texas A&M University
Matthew Lee Smith, MPH, PhD, CHES, College of Public Health, University of Georgia
Xiaohui Wang, PhD, Department of Mathematics, The University of Texas Pan American
David Irizarry, School of Rural Public Health, Texas A&M Health Science Center
Elias H. Avila-Rodriguez, PhD, Facultad de Medicina y Nutricion, Universidad Juárez del Estado de Durango
Laura Trevino, ME, College of Architecture, Texas A&M University
Marcia G. Ory, PhD, School of Rural Public Health, Texas A&M Health Science Center

The qualitative study described in this article investigated perceptions about environmental factors influencing physical activity (PA) among children from underserved neighborhoods known as colonias in the U.S.-Mexico border. Ten focus groups were conducted with 67 Mexican American colonia children ages 8 to 13 living in one of the poorest border counties in the U.S. Analyses indicated that PA among children was influenced by neighborhood characteristics, including litter, speeding cars, unleashed dogs, and dark streets. The children also underlined intrapersonal and social environmental factors. Findings may inform policy makers and public health professionals about ways to promote PA among underserved children through urban planning and programs focusing on PA-supportive infrastructure, neighborhood safety, and family- and home-based physical activities.


Physical Conditions of a House and Their Effects on Measured Radon Levels: Data From Hillsborough Township, New Jersey, 2010–2011
Derek G. Shendell, MPH, DEnv, School of Public Health, and Center for School and Community-Based Research and Education, Rutgers University Biomedical and Health Sciences
Michael Carr, MPH, REHS, Hillsborough Health Department

Concentrations of radon in homes are thought to be dependent on several factors, including the presence of certain physical conditions of the house that act as entry points for this colorless, odorless gas. Drains and sump pits are currently sealed as part of radon mitigation, but doing so may cause drainage problems and mold. The authors attempted to determine if specific attributes and physical conditions of homes are associated with measured residential concentrations of radon. Radon tests were conducted in 96 participating homes in rural Hillsborough Township, New Jersey, November 2010–February 2011. Samplers were placed and a walk-through survey was conducted. Test devices were analyzed by a New Jersey certified radon testing laboratory and results compared to survey data. Overall, 50% of houses with a perimeter drain and 30% of houses with a sump pit exceeded the New Jersey and federal radon action level of 4.0 picocuries per liter, and 47% of homes with both a sump and a perimeter “French” drain exceeded this action level. The authors’ results suggested certain physical conditions act as pathways allowing radon entry into homes. Results could be used by local and state agencies to start local initiatives, e.g., increased testing or to seal these components as partial mitigation.


Residential Carbon Monoxide Poisoning Risks: Correlates of Observed CO Alarm Use in Urban Households
Eileen M. McDonald, MS, Johns Hopkins Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health
Andrea C. Gielen, ScM, ScD, Johns Hopkins Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health
Wendy C. Shields, MPH, Johns Hopkins Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health
Rebecca Stepnitz, MHS, Johns Hopkins Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health
Elizabeth Parker, MHS, Johns Hopkins Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health
Xia Ma, MPH, Johns Hopkins Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health
David Bishai, MPH, MD, PhD, Johns Hopkins Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health.

The authors conducted a household survey and observation to assess carbon monoxide (CO) knowledge and risks as well as prevalence of CO alarms in an urban community prior to the enactment of a mandatory ordinance requiring CO alarms in one U.S. city. From July to December 2009, household surveys and observations were completed in 603 residences. Participants were mostly African-American (61%), women (70%), 25–54 years in age (66%), and with a high school education or less (51%). Most homes visited contained CO-producing appliances, including gas stoves (86%), gas furnaces (82%), and gas water heaters (79%). Participants’ overall mean percentage correct knowledge score was 57%. CO alarms were reported by 33% of participants and observed among 28% of households. Low rates of CO knowledge and CO alarm ownership, combined with high rates of CO-producing sources in homes, suggests the need for widespread campaigns to promote CO alarms. Recommendations are also made to integrate the lessons learned from the public health community’s experience promoting smoke alarms.


Multilevel Analysis of Childhood Nonviral Gastroenteritis Associated With Environmental Risk Factors in Quebec, 1999–2006
Henri Kaboré, MSc, DVM, PhD, Institut national de santé publique du Québec, Centre de recherche du CHU de Québec, Département de médecine sociale et préventive, Université Laval
Alexandre Lebel, PhD, École supérieure en aménagement du territoire et développement regional, Université Laval, Department of Social and Behavioral Sciences, Harvard School of Public Health
Patrick Levallois, MSc, MD, FRCPC, Institut national de santé publique du Québec, Centre de recherche du CHU de Québec, Département de médecine sociale et préventive, Université Laval
Pascal Michel, DVM, PhD, Laboratory for Foodborne Zoonoses, Public Health Agency of Canada, FMV, Université de Montréal
Pierre Payment, PhD, INRS-Institut-Armand-Frappier
Pierre Déry, MD, PhD, Département de pédiatrie, Université Laval, CHU de Québec
Germain Lebel, MSc, Institut national de santé publique du Québec

Childhood nonviral gastroenteritis is a priority for various public health authorities. Given that waterborne transmission is sometimes incriminated during investigation of gastroenteritis outbreaks, the authors hypothesized that watershed characteristics may influence the occurrence of this disease and could contribute additional insights for better prevention and control. The study described here aimed to investigate watershed characteristics in relation to nonviral gastroenteritis and specifically three bacterial and parasitic forms of childhood gastroenteritis to assess their relative importance in the province of Quebec, Canada.

Information on children aged 0–4 years with bacterial or parasitic enteric infections reported through ongoing surveillance between 1999 and 2006 in the province of Quebec was collected. Factors measured at the municipal and watershed levels were analyzed using multilevel models with a Poisson distribution and log link function. Childhood nonviral gastroenteritis, giardiasis, and campylobacteriosis were positively associated with small ruminants and cattle density. Childhood salmonellosis was positively associated with cattle density. Also, childhood campylobacteriosis incidence was positively associated with larger watershed agricultural surface. In addition to local agroenvironmental factors, this analysis revealed an important watershed effect.


Direct From ATSDR: The Emergency Response Program at the Agency for Toxic Substances and Disease Registry
James Holler, PhD

This month’s column discusses the Emergency Response Program at the Agency for Toxic Substances and Disease Registry (ATSDR). The program is staffed by trained emergency response coordinators that possess the knowledge and experience to address any acute release of hazardous materials. Information about what the program does and its resources is covered.


Direct From CDC: Culture Shift: Strengthening the Role of Environmental Health in Public Health Performance Improvement Efforts
Julianne R. Price
C. Meade Grigg
Maggie K. Byrne

This column discusses two case studies in which environmental health improvement tools were effectively integrated with broader performance initiates, resulting in a clearer understanding of how environmental health issues intersect with larger public health concerns and the importance of environmental health in addressing them.


Direct From NCSL: 2013 Environmental Health Legislation
Doug Farquhar, JD
Amy C. Ellis

Concerns about environmental management, water and wastewater systems, toxics and chemicals, food safety, and indoor air quality were addressed during the 2013 state legislative session. Unlike their federal counterpart, the state legislatures were able to enact several significant pieces of environmental health legislation, as well as adopt budgets for their states. This column discusses these bills and laws that cover topics such as asbestos; asthma; biomonitoring, tracking, and surveillance; body modification; children’s environmental health; drinking water; food safety; indoor air quality; lead; mercury; pesticides; swimming pools; toxics and chemicals; wastewater; and environmental health management.


Demystifying the Future: By 2030 Over 50% of Colleges Will Collapse: Part 1
Thomas Frey

This column explores the changes that higher education could potentially go through over the next twenty-plus years. The first part of this series talks about the importance of the digital era in this trend, as well as key metrics that may lead to the demise of traditional colleges. Next month’s column will explore the eight reasons why over 50% of colleges will fail by 2030, as well as provide some final thoughts on this subject.

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November 2013, Volume 76, No. 4


Kombucha Brewing Under the Food and Drug Administration Model Food Code: Risk Analysis and Processing Guidance
Brian A. Nummer, PhD, Retail-Foodservice Food Safety Consortium, Utah State University Cooperative Extension

Kombucha is a fermented beverage made from brewed tea and sugar. The taste is slightly sweet and acidic and it may have residual carbon dioxide. Kombucha is consumed in many countries as a health beverage and it is gaining in popularity in the U.S. Consequently, many retailers and food service operators are seeking to brew this beverage on site. As a fermented beverage, kombucha would be categorized in the Food and Drug Administration model Food Code as a specialized process and would require a variance with submission of a food safety plan. This special report was created to assist both operators and regulators in preparing or reviewing a kombucha food safety plan.


Preschool Children’s Environmental Exposures: A Case-Control Epidemiological Study of the Presence of Asthma-Like Symptoms
Dhitinut Ratnapradipa, MPA, PhD, MCHES, Department of Health Education and Recreation, Southern Illinois University
Anthony G. Robins, PhD, Director, Program and Research, Center for Black Male Educational Success, Robert Morris University
Kendra Ratnapradipa, MSW

The heterogeneity of asthma and asthma-like symptoms results in difficulty defining, diagnosing, and therefore estimating environmental exposures and associations with wheezing or asthma-like symptoms. Determining the disease burden for young children is particularly challenging. In the study described in this article, counter-matched sampling design was used to select participants from the Woman, Infants, and Children (WIC) program for this nested case-control study (N = 691, with 412 controls). Data were collected through structured interviews. Exposure to wood or oil smoke, soot, or exhaust was significantly associated with early-life asthma, as was exposure to cockroaches. Multivariate analyses showed that increasing age, male gender, presence of allergies (although not the type of allergies), and the presence of eczema at birth predicted wheezing behaviors in the authors’ study. The authors estimated the prevalence of wheezing behavior in a population of low-income preschool children was 31% with prevalence rates higher among African-American children as compared to other races/ethnicities. Fifty-one percent of those children whose caregivers reported wheezing, however, had not received a diagnosis of asthma. Further study is recommended to compare the differences in the wheezing experiences between those diagnosed with asthma and those who are undiagnosed, with the intent of designing primary prevention interventions tailored to parents and caregivers of young children.


Radon-Contaminated Drinking Water From Private Wells: An Environmental Health Assessment Examining a Rural Colorado Mountain Community’s Exposure
Michael Anthony Cappello, MPH, PhD, REHS, Northeast Colorado Health Department
Aimee Ferraro, MPH, PhD, College of Health Sciences, Walden University
Aaron B.Mendelsohn, MPH, PhD, College of Health Sciences, Walden University
Angela Witt Prehn, PhD, College of Health Sciences, Walden University

In the study discussed in this article, 27 private drinking water wells located in a rural Colorado mountain community were sampled for radon contamination and compared against (a) the U.S. Environmental Protection Agency’s (U.S. EPA’s) proposed maximum contaminant level (MCL), (b) the U.S. EPA proposed alternate maximum contaminate level (AMCL), and (c) the average radon level measured in the local municipal drinking water system. The data from the authors’ study found that 100% of the wells within the study population had radon levels in excess of the U.S. EPA MCL, 37% were in excess of the U.S. EPA AMCL, and 100% of wells had radon levels greater than that found in the local municipal drinking water system. Radon contamination in one well was found to be 715 times greater than the U.S. EPA MCL, 54 times greater than the U.S. EPA AMLC, and 36,983 times greater than that found in the local municipal drinking water system. According to the research data and the reviewed literature, the results indicate that this population has a unique and elevated contamination profile and suggest that radon-contaminated drinking water from private wells can present a significant public health concern.


The Efficacy of a Theory-Based, Participatory Recycling Intervention on a College Campus
Erin Largo-Wight, PhD, Department of Public Health, University of North Florida
Dedee DeLongpre Johnston, MA, Office of Sustainability, Wake Forest University
Jeff Wight, PhD, Department of Clinical and Applied Physiology and Movement Science, University of North Florida

Recycling solid waste is an important primary prevention focus to protect environmental resources and human health. Recycling reduces energy consumption and emissions and the need to harvest raw material, which protects air, water, and land. In the study described in this article, the authors conducted an eight week field study to test the efficacy of an intervention aimed to increase can and bottle recycling on a college campus. Recycling volume was assessed in three campus buildings (two treatments and one control) over eight weeks. The control building had standard outdoor-only recycling. The treatment buildings had standard outdoor recycling plus four weeks with the treatment indoor recycling. Total can and bottle recycling volume increased 65%–250% in the treatment buildings compared to the control building. Recycling significantly increased in both the classroom (t = -2.9, p < .05) and administrative (t = -12.4, p < .001) treatment buildings compared to the control building (t = -.13, p = .91). Results suggest that convenience of receptacles alone, without education or additional promotion, resulted in significantly more recycling. Heath promoters should prioritize efforts to make recycling easy and convenient.


Investigation of Radon and Heavy Metals in Xuanwei and Fuyuan, High Lung Cancer Incidence Areas in China
Jungang Lv, Procuratoral Technology and Information Research Center, Supreme People’s Procuratorate, China
Wen Zhang, Key Laboratory for Applied Microbiology of Shandong Province, Biology Institute of Shandong Academy of Sciences
Renji Xu, National Environmental Monitoring Center, Beijing

Xuanwei and Fuyuan, two counties located in southwest China, are areas with known high lung cancer incidence. Pollution relative to coal combustion, especially serious air pollution generated by burning smoky coals in unvented households, has been thought to be the most predominant cause. Possible inorganic carcinogenic matter including radon in air and arsenic, lead, chromium, cadmium, nickel, and beryllium in water, soil, and coal were sampled and examined to find the current pollution status, distributions, characteristics, and relationships to the lung cancer incidence. The concentrations of mercury in air of Xuanwei and Fuyuan ranged from 1.7 to 205.3 ng/m3 (indoor), 1.3 to 7.5 ng/m3 (ambient). No radon concentration exceeded the World Health Organization standard. Results indicated that household stove improvement by changing stoves from unvented to vented obviously alleviated the indoor air pollution of carcinogenic metals. Most of the carcinogenic metals were also found at very low levels in water and soil, which therefore had little influence on human health. Concentrations of these elements at different sites did not vary in any relation to lung cancer incidence. The study described in this article added basic data; the results of the authors’ study will be helpful in determining pollution status and to future studies on the etiology of lung cancer.


Direct From CDC: Groundwater Vulnerability Assessments: Prioritizing Water Safety in Times of Austerity
Mansoor A. Baloch, PhD, LEED-AP, EIT

In the wake of government austerity measures, many environmental health permitting programs will curtail services associated with private wells. In its efforts to support local environmental health programs, the Centers for Disease Control and Prevention’s Environmental Health Specialists Network (EHS-Net) Water Program has developed a groundwater vulnerability assessment tool, Land-use Hydrology and Topography (LHT). This column presents a case for using a groundwater vulnerability mapping approach to prioritize intervention programs for those private or individual wells most vulnerable to contamination.


Demystifying the Future: By 2030 Over 50% of Colleges Will Collapse: Part 2
Thomas Frey

In the second part of this column, the eight reasons why over 50% of colleges will fail by 2030 will be explored. The column also provides a scenario on declining enrollment in colleges and offers some final thoughts on the topic.

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