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.

From conception, project design, results, and lessons learned along the way, hear a case study about collaboration between federal, state and local agencies to obtain and use water quality data related to private wells while marketing the use of the data. This case study involves multiple agencies sharing data, data display using geographic information systems (GIS), and unanticipated obstacles. We learned the hard way so you don't have to.

July 2015
Hope Dalton, MPA
Potential CE Credits: 0.50

Abstract

We describe a 2016 community-wide recreational water-associated cryptosporidiosis outbreak investigation and response in Maricopa County, Arizona. Persons with a laboratory-confirmed illness were interviewed using a standardized questionnaire that assessed exposures 2 weeks before symptom onset. A convenience sample of managers and operators of chlorine-treated public aquatic facilities was surveyed regarding permanent supplemental treatment systems for Cryptosporidium. Among 437 cases identified (median age 12, range <1–75 years), 260 persons were interviewed. Public-treated recreational water was the most frequently reported exposure (177, 68%) of interviewed persons; almost 1 in 5 (43, 17%) swam when diarrhea was ongoing.

After the 2016 outbreak, managers of some facilities expressed intentions to install supplementary water treatment systems, and by May 2017, at least one large facility installed an ultraviolet light system. Strategies to prevent additional illness included community messaging, education, and targeted remediation of affected facilities on the basis of interviews. Challenges to remediation during a cryptosporidiosis outbreak in a large jurisdiction with primarily outdoor pools underscore the importance of promoting healthy swimming practices that help prevent contamination from occurring.

 

November 2018
November 2018
81.4 | 14-21
Sally Ann Iverson, MPH, DVM, Centers for Disease Control and Prevention, Maricopa County Department of Public Health, Nicole Fowle, MPH, LPN, Maricopa County Department of Public Health, Gregory Epperson, RS, Maricopa County Environmental Services Department, Jennifer Collins, MPH, Maricopa County Department of Public Health
Additional Topics A to Z: Recreational Waters

Abstract

Preventing lead exposure from all sources is critical for children’s optimal health and development. The crisis in Flint, Michigan, drew attention to the role of drinking water in lead exposure. School drinking water might pose significant risks due to aging infrastructure and the particular conditions of water use in schools. In 2016, New Jersey mandated that school districts test all drinking water outlets for lead and specified procedures that districts must follow. This study assessed compliance with this mandate. Districts were required to report results on their websites, so we used district websites as the unit of analysis to assess compliance with testing and reporting procedures and to identify schools that had reported maximum concentrations of lead in water. Most districts complied with the mandate to test their drinking water (90%) and the majority complied with online reporting requirements to some extent (87%). Most districts (79%) had one or more outlets in their district that exceeded the U.S. Environmental Protection Agency’s action level of 15 ppb. Mandated testing for lead in drinking water in schools is an important policy that can prevent childhood lead exposure. New Jersey should consider lowering the action level at which lead in drinking water should be remediated.

 

July 2019
July/August 2019
82.1 | 14-19
Marianne Sullivan, MPH, DrPH, William Paterson University of New Jersey, Marcos Lopez, William Paterson University of New Jersey
Additional Topics A to Z: Institutions / Schools

Abstract

The Food and Drug Administration recommended restaurant inspection scores change to a format that incorporated three new categories of violations: priority, priority foundation, and core. It was uncertain whether interested consumers would value the more in-depth information or become more confused. The purpose of this study was to assess consumer perception of the recommended inspection system. Data were collected from an online survey. Results showed that consumers want convenient access to the information either online or on the wall of restaurants, and some consumers do want to read inspection reports and use them in making dining decisions. Choice of restaurant inspection format did appear to change consumer understanding and perceptions about some of the violations. Results also demonstrated the importance of the words used to categorize violations.

June 2017
June 2017
79.10 | 20-25
Jooho Kim, PhD, Jing Ma, PhD, Barbara Almanza, PhD, RD

Abstract

The purpose of this study was to measure particulate matter (PM2.5) in pubs and bars prior to the adoption of a comprehensive, citywide smoke-free ordinance, as well as at multiple time points after adoption. Ten venues in a Southern U.S. city were measured at 1-month preordinance and at 1-, 3-, and 6-month postordinance. Air quality risk was determined by the U.S. Environmental Protection Agency’s Air Quality Index. Data revealed a statistically significant difference (p < .001; Eta2 = .889) in PM2.5 levels for the four time points. Air quality measurements showed that PM2.5 was 202.17 ± 97.89 (mean ± SD) at 1-month preordinance, 25.53 ± 14.18 at 1-month postordinance, 18.00 ± 8.43 at 3-month postordinance, and 10.77 ± 2.45 at 6-month postordinance. At the preordinance measurement, no venue was found to be in the “good” (minimal risk) range of the Air Quality Index; however, 100% of venues presented minimal air quality risk by the 3-month postordinance measurement. This study shows that adoption of smoke-free ordinances yields immediate reductions in health risks with continued air quality improvements up to 6-month postordinance (the last time point measured).

 

July 2018
July/August 2018
81.1 | 8-15
Ronald D. Williams, Jr., PhD, CHES, Department of Health and Human Performance, Texas State University, Jeff M. Housman, PhD, MCHES, Department of Health and Human Performance, Texas State University, Jennifer L. Evans, MEd, CHES, Department of Health Science, University of Alabama

Abstract

Cooling towers have been linked to outbreak-related and nonoutbreak-related legionellosis. Proper cooling tower maintenance and disinfection are imperative for legionellosis prevention but not monitored in Allegheny County, Pennsylvania, which is a high incidence area. To investigate cooling tower maintenance and Legionella positivity, the Allegheny County Health Department (ACHD) performed a survey regarding the presence and maintenance of cooling towers and tested cooling towers for Legionella pneumophila (Lp). ACHD surveyed healthcare facilities, senior apartment buildings, and county-owned buildings.

Associations between maintenance practices and Lp were assessed using Wilcoxon rank-sum tests and multivariable linear regression. Of 408 building managers contacted, 377 (92%) completed the survey and 56 (15%) reported managing a building with a cooling tower. Among 42 cooling towers sampled, 20 (48%) tested positive for Lp. Factors associated with positivity included larger tower capacity, year-round usage, hospital status, and older tower age. Only cooling tower age was associated with Lp after stepwise regression.

Despite maintenance practices, many cooling towers were Lp positive. ACHD recommends that facilities develop a water management plan that is compliant with standards of the American Society of Heating, Refrigerating, and Air-Conditioning Engineers and also conduct annual basin water emptying, quarterly cleaning, and diligent inspection of older towers.

 

December 2018
December 2018
81.5 | 16-24
Lauren T. Orkis, MPH, CIC, Allegheny County Health Department, University of Pittsburgh, Kristen J. Mertz, MPH, MD and LuAnn L. Brink, MPH, PhD, Allegheny County Health Department, Maria M. Brooks, PhD, University of Pittsburgh, Robert M. Wadowsky, ScD, D(ABMM) and Stacy Gatto, Allegheny County Health Department
Additional Topics A to Z: Pathogens and Outbreaks
Jan|Feb 2014
76.6 | 48-54
Mubashir Ahmed, MBBS, MSc, Zafar Fatmi, MBBS, FCPS, Claudio J. Struchiner, Eduardo Massad, MD
Additional Topics A to Z: Hazardous Materials

Abstract

Windborne fungal spores are able to move across international borders, which is a health issue because many fungi are pathogenic and can infect humans. Moreover, pathogens can shift their geographic range under climate change, infecting previously unexposed populations. We used a macrosystems approach to identify future research priorities related to windborne dispersal of fungal pathogens. We focused on the fungus Coccidioides, the causal agent for valley fever in humans. The geographic range of Coccidioides spp. includes the U.S.–Mexico border region, where cases of valley fever have increased. As Coccidioides does not adhere to international boundaries, we advocate for a binational approach to understand valley fever from a public health and ecological perspective. Knowledge gained from research on Coccidioides can be leveraged to other windborne fungal pathogens, especially those that have an environmental stage in their life cycle. Finally, we argue that air dispersal of Coccidioides should be a research priority in light of future climate challenges that will require informed science policy decisions.

 

April 2019
April 2019
81.8 | 14-22
Linh Anh Cat, MS, Department of Ecology and Evolutionary Biology, University of California, Irvine, Morgan E. Gorris, MS, Department of Earth System Science, University of California, Irvine, James T. Randerson, PhD, Department of Earth System Science, University of California, Irvine, Meritxell Riquelme, PhD, Department of Microbiology, Ensenada Center for Scientific Research and Higher Education

Abstract

We investigated a gastrointestinal illness cluster among persons who attended a baseball tournament (>200 teams) during July 2015. We interviewed representatives of 19 teams; illness was reported among only the 9 (47%) teams that stayed at Hotel A (p < .01). We identified 55 primary cases. A case-control study demonstrated that pool exposure at Hotel A was significantly associated with illness (odds ratio: 7.3; 95% confidence interval: 3.6, 15.2). Eight out of nine (89%) stool specimens tested were positive for Cryptosporidium, with C. hominis IfA12G1 subtype identified in two specimens. The environmental health assessment detected a low free available chlorine level, and pool water tested positive for E. coli and total coliforms. A possible diarrheal contamination event, substantial hotel pool use, and use of cyanuric acid might have contributed to this outbreak and magnitude. Aquatic facilities practicing proper operation and maintenance (e.g., following the Centers for Disease Control and Prevention’s Model Aquatic Health Code) can protect the public’s health.

May 2017
May 2017
79.9 | 16-22
Mary-Margaret A. Fill, MD, Centers for Disease Control and Prevention, Tennessee Department of Health, Jennifer Lloyd, MSPH, Shelby County Health Department, Tamal Chakraverty, MPH, MD, CPH, Shelby County Health Department, David Sweat, MPH, Shelby County Health Department
Additional Topics A to Z: Pathogens and Outbreaks

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