Topics A to Z

As part of NEHA's continuos effort to provide convenient access to information and resources, we have gathered together for you the links in this section. Our mission is "to advance the environmental health and protection professional for the purpose of providing a healthful environment for all,” as well as to educate and inform those outside the profession.

Jan/Feb 2014
76.6 | 66-67
Eduardo Massad, MD, Lêuda Olívêr, Marcelo N. Burattini, Francisco A. B. Coutinho
Additional Topics A to Z: Pathogens and Outbreaks


A cross-sectional survey was conducted in 2016 to identify the food safety training needs of government sanitation inspectors in the Philippines who carry out the role of food inspectors as a part of their job. The paper survey was answered by 235 sanitation inspectors of different cities selected randomly. Answers showed 67.2% did not attend any formal training on methods of inspection for food safety and 78.7% did not attend any formal training on hazard analysis critical control point (HACCP). Further, 80.4% did not receive any formal training on the Food Safety Act of 2013. Among these participants, 81.1% believed that their current performance could be improved by attending relevant training and 89.8% showed strong need to be trained on HACCP. It was concluded that a training program for sanitation inspectors, including an exam and refresher, needs to be enforced and that resources should be allocated for such a program to include at least the basics of food safety, HACCP, the Food Safety Act of 2013, and methods of risk-based food safety inspection for different food establishments.


September 2019
September 2019
82.2 | 18-23
Wessam M. Atif, MSc, MD, PHPD, ACIEH, GradIOSH, University of Manchester, Food Safety and Hygiene Academy of the Philippines (FoodSHAP, Inc.)


Nontuberculous mycobacteria (NTM), also known as environmental mycobacteria due to their ubiquitous nature, are opportunistic human pathogens of public health concern. They are the causative agent of lymphadenitis in children; pulmonary, skin, and soft tissue infections; and have been linked to Crohn’s disease. Human-to-human transmission is rare and as such it is essential to identify potential environmental sources and routes of exposure. This review explores studies written in English investigating the presence of NTM in pasteurized and unpasteurized milk over the last 20 years. Globally, it was demonstrated that NTM have been detected from milk products in Argentina, Austria, Brazil, Chile, Cyprus, the Czech Republic, Denmark, India, Iran, Iraq, Ireland, Italy, Switzerland, Tanzania, Turkey, UK, and U.S. We explored the relationships among the specific NTM species identified, pasteurized and unpasteurized milk, and different detection methods. Both experimental studies and detection from commercial milk suggests the NTM can survive the pasteurization process. Further research is required to explore the potential role of milk as a possible route of exposure to NTM and to identify potential management and control strategies.


May 2018
May 2018
80.9 | 24-31
Harriet Whiley, Environmental Health, College of Science and Engineering, Flinders University, Shraddha Adhikari, Environmental Health, College of Science and Engineering, Flinders University, Thilini Piushani Keerthirathne, Environmental Health, College of Science and Engineering, Flinders University, Tanya Caro Tohme, Environmental Health, College of Science and Engineering, Flinders University
Additional Topics A to Z: Pathogens and Outbreaks


Childhood obesity has increased rapidly over the last three decades in the U.S. Individual-level interventions targeting healthy eating and physical activity have not significantly impacted clinical measures of obesity in children. Focusing “upstream” on physical, social, cultural, political, and economic environments may be more effective. The purpose of this qualitative review is to analyze published environmental interventions that effectively prevented or reduced obesity in children ages 2–10 years by working within their family, school, and/or community environment to increase physical activity, reduce sedentary behaviors, or improve healthy diet. Through an electronic database search, 590 original articles were identified and 33 were read in full. Using Brennan and co-authors’ (2011) rating system, 18 were rated as effective intervention studies. This analysis showed that interventions targeting multiple environments (e.g., family, school, and community) show promise in reducing childhood obesity. Further research is needed to test interventions targeting multiple environments in different communities and populations.

October 2016
October 2016
79.3 | 18-26
Claudio R. Nigg, PhD, Md Mahabub Ul Anwar, PhD, Kathryn L. Braun, DrPH, Jobel Mercado, MA
Additional Topics A to Z: Children's Environmental Health

With the establishment of the Food Safety and Standards Authority of India (FSSAI) and new food safety regulations, a precedent has been set to prevent foodborne illness in India. The objective of the authors’ study was to identify knowledge gaps among food handlers in Chennai, Tamil Nadu, to establish priorities for future intervention. A 44-question survey was administered to 156 food handlers at 36 restaurants in Chennai between April and June of 2011. The overall mean knowledge score was 49% and knowledge gaps related to hand hygiene, proper food cooking and holding temperatures, and cross contamination were identified. Food handlers with a Medical Fitness Certificate scored significantly higher than those without a certificate, after controlling for food safety training and level of education (p < .05). As the FSSAI standards now require a medical certificate for restaurant licensure and registration, consideration should be given to include an educational component to this certification with an explanation of expected food safety behavior.

January 2016
January/February 2016
78.6 | 18-25
Mindi R. Manes, Paraswami Kuganantham, Murugesan Jagadeesan, M. Laxmidevi

Article Abstract

The importance of clean food contact surfaces has been recognized; however, the importance of cleanliness on nonfood contact surfaces such as menus may be underestimated. The aim of the study described in this article was to determine the cleanliness of restaurant menus, evaluate typical cleaning methods used in a restaurant, and provide recommendations for improving menu cleanliness. The authors’ study used an adenosine triphosphate meter to assess the cleanliness of the menus. A pretest identified the most commonly touched areas of the menu by consumers. Based on the results of the pretest, menus were collected from casual-family dining restaurants and analyzed for cleanliness. Results suggested that menus should be cleaned after each shift and that menus distributed by the staff when guests are seated are cleaner than those kept on the table.

June 2014
76.1 | 18-24
Jinkyung Choi, PhD, Barbara Almanza, PhD, Douglas Nelson, PhD, Jay Neal, PhD
Additional Topics A to Z: Food Safety


Adequate and appropriate water, sanitation, and hygiene (WaSH) infrastructure is important for reducing pathogen exposures in developing communities. To improve the ability of field practitioners in optimizing WaSH infrastructure within communities, models can provide insight into the complex interactions among WaSH infrastructure, health outcomes, and geographies. This study investigated the significant correlations between WaSH infrastructure variables and three different health outcomes (diarrhea, environmental enteric dysfunction, and stunting) over five geographic regions within Guatemala. Exploratory structural equation modeling was used to build WaSH models from U.S. Agency for International Development (USAID) 2012 Food for Peace Survey data (n = 2,103). The models were then tested using USAID 2013 Western Highlands Integrated Program survey data collected from the same regions (n = 4,633). Our results support that significant WaSH infrastructure variables vary widely over health outcome and geographic region. Improved sanitation had the highest prevalence of significance among all models. The floor transmission route for pathogens was identified as significant across all geographies for child stunting. Additionally, commonalities in potential pathogen transmission routes were identified among environmentally similar geographies. Practitioners and policy makers must account for the specific geography and health outcome to identify which set of WaSH infrastructure interventions are most appropriate at the correct scale.


July 2019
July/August 2019
82.1 | 20-28
Lee E. Voth-Gaeddert, MS, PhD, EIT, Missouri University of Science and Technology, Daniel B. Oerther, MS, PhD, PE, BCEE, CEng, FAAN, Missouri University of Science and Technology
Additional Topics A to Z: General Environmental Health


The growth in the number of pools to more than 7.4 million in the U.S. has been accompanied by a rise in recreational water illnesses (RWIs). Effective pool management, though, can mitigate RWI risks. Inadequate management presumably occurs more frequently where training is less formalized and/or pool operation is a minor aspect of the job of the responsible pool manager(s). During summer 2018, weekly evaluations were performed at public venues in Louisville, Kentucky. Disinfectant levels and other items were monitored and compared with venue-specific (pool or spa) criteria. Among 1,312 venue surveys, 1,173 (89.4%) met criteria and 139 (10.6%) did not meet criteria. Overall, multivariable logistic regression showed a significant association between the likelihood of a venue meeting criteria and setting type. Specifically, hotels had 120% increased odds of not meeting criteria (adjusted odds ratio = 2.2; 95% confidence interval [1.3, 3.8]) compared with other settings. Despite spas having an 80% elevated odds of not meeting criteria compared with pools in a univariate analysis, upon adjusting for setting, spas were not associated with an increased risk of not meeting criteria. Research identifying reasons for these differences in meeting criteria between settings would be beneficial for informing public health interventions for aquatic environments.


July 2020
July/August 2020
83.1 | 18-24
Thomas Gerding, MPH, Department of Environmental Health Science, Eastern Kentucky University, Tim Wilder, RS, Department of Public Health and Wellness, City of Louisville, Jason W. Marion, MS, PhD, Department of Environmental Health Science, Eastern Kentucky University
Additional Topics A to Z: Recreational Waters