Urban Youth Knowledge and Attitudes Regarding Lead Poisoning

Knowledge, attitude, and practices related to lead pollution among adolescents and caregivers of young children living near Used Lead Acid Battery (ULAB) recycling sites in Bangladesh: a cross-sectional study

BACKGROUND

Lead, a potent neurotoxin, causes irreversible damage to the nervous system, and low- and middle-income countries face huge health and economic productivity losses due to childhood lead exposure. In Bangladesh, informal Used Lead Acid Battery (ULAB) recycling sites are an important source of lead pollution. Little is known about lead awareness among communities exposed to ULAB recycling. Therefore, this study aims to assess knowledge, attitudes, and practices related to lead pollution among caregivers of young children and adolescents living adjacent to informal ULAB sites.

METHODS

A cross-sectional study was conducted among 732 mothers of young children and adolescents in 4 districts of Bangladesh (survey and observation). Simple and multiple linear regression was conducted to describe patterns and predictors of lead-related knowledge and practices.

RESULTS

60% of respondents had heard the name 'lead' ("shisha"). The mean knowledge score was low (19 out of 44). Residents of high-risk districts, male respondents, and those with more than 5 years of schooling were significantly more likely to have higher knowledge scores than others. In terms of attitude, 52% of respondents perceived lead to be risky for human health but 43% thought lead pollution was controllable. Observation of households for lead exposure revealed that 63% of children and adolescents play or pass by ULAB sites, 29% ate non-food items, 41% of households had visible paint chips on the walls, 59% households used polished turmeric and 15% used lead-soldered cans to store foods. Among protective practices, 70% reported cleaning floors, 84% consumed iron-rich foods, and 48% consumed calcium-rich foods.

CONCLUSIONS

The population had a high potential for lead exposure. Their knowledge about lead was limited, and risk perception was moderate. To reduce lead exposure and increase knowledge and awareness among the at-risk population, it is crucial to take measures such as mass awareness campaigns through media and schools. It is important to strengthen the implementation of existing policies, such as policies on leaded gasoline, paints, and lead-acid batteries, that can address the sources of lead exposure for the community.

Using environmental health dialogue in a Diné-centered approach for individualized results reporting in an environmental exposure study following the Gold King Mine Spill

BACKGROUND

On August 5, 2015, the Gold King Mine Spill (GKMS) resulted in 3 million gallons of acid mine drainage spilling into the San Juan River impacting the Diné Bikeyah (traditional homelands of the Navajo people). The Gold King Mine Spill Diné Exposure Project was formed to understand the impacts of the GKMS on the Diné (Navajo). Reporting individualized household results in an exposure study is becoming more common; however, materials are often developed with limited community input with knowledge flowing in one direction - from researcher to participant. In this study we examined the development, dissemination, and evaluation of individualized results materials.

METHODS

In August 2016, Navajo Nation Community Health Representatives (Navajo CHRs) sampled household water, dust, and soil, and resident blood and urine for lead and arsenic, respectively. From May-July 2017, iterative dialogue with a wide range of community partners and a community focus groups guided the development of a culturally-based dissemination process. In August 2017, Navajo CHRs reported individualized results and they surveyed the participants on the report-back process at that time.

RESULTS

All of the 63 Diné adults (100%) who participated in the exposure study received their results by a CHR in person and 42 (67%) completed an evaluation. Most of those participants (83%) were satisfied with the result packets. Respondents ranked the individual and overall household results as the most important information they received (69% and 57%, respectively), while information on metals exposures and their health effects were the least helpful.

CONCLUSIONS

Our project illustrates how a model of environmental health dialogue, defined by iterative, multidirectional communication among Indigenous community members, trusted Indigenous leaders, Indigenous researchers, non-Indigenous researchers, can improve reporting individualized study results. Findings can inform future research to encourage multi-directional environmental health dialogue to craft more culturally responsive and effective dissemination and communication materials.

Exploring the association of Brownfield remediation status with socioeconomic conditions in Wayne County, MI

Urban neighborhoods with locations of environmental contamination, known as brownfields, impact entire neighborhoods, but corrective environmental remedial action on brownfields is often tracked on an individual property basis, neglecting the larger neighborhood-level impact. This study addresses this impact by examining spatial differences between brownfields with unmitigated environmental concerns (open site) and sites that are considered fully mitigated or closed in urban neighborhoods (closed site) on the US census tract scale in Wayne County, MI. Michigan's Department of Environment, Great Lakes, and Energy's leaking underground storage tank (LUST) database provided brownfield information for Wayne County. Local indicators of spatial association (LISA) produced maps of spatial clustering and outliers. A McNemar's test demonstrated significant discordances in LISA categories between LUST open and closed sites (p < 0.001). Geographically weighted regressions (GWR) evaluated the association between open and closed site spatial density (open-closed) with socioeconomic variables (population density, proportion of White or Black residents, proportion of college educated populations, the percentage of owner-occupied units, vacant units, rented units, and median household value). Final multivariate GWR showed that population density, being Black, college education, vacant units, and renter occupied units were significantly associated (p < 0.05) with open-closed, and that those associations varied across Wayne County. Increases in Black population was associated with increased open-closed. Increases in vacant units, renter-occupied units, and college education were associated with decreased open-closed. These results provide input for environmental justice research to identify inequalities and discover the distribution of environmental hazards among urban neighborhoods.

The Environmental Health Literacy of Italian General Population: The SPeRA Cross-Sectional Study

Environmental health literacy (EHL) includes knowledge of health effects due to environmental exposure and skills to protect health from environmental risks. This study investigated some aspects about EHL of the Italian adult population. Data were collected through questionnaires (n = 672) and analysed through multivariable logistic regression models. Results showed that participants with incomplete/insufficient self-perceived knowledge of health effects due to environmental risks verified less information about this topic (adjOR = 0.38 (CI95% 0.25-0.59)/0.09 (0.04-0.21); p < 0.001/<0.001), potentially spreading fake news. The self-perceived exposure to pollution was higher in participants living in towns than in rural areas (small, medium, big towns adjOR = 2.37 (1.41-3.97), 2.10 (1.11-3.96), 3.11 (1.53-6.31); p = 0.001, 0.022, 0.002) and lower in participants with incomplete/insufficient knowledge about pollution effects (adjOR = 0.54 (0.32-0.92)/0.30 (0.13-0.67); p = 0.022/0.004), confirming that knowledge is essential to achieve awareness. Since insufficient self-perceived knowledge of pollution effects was negatively associated with the adoption of pro-environmental behaviours (adjOR = 0.37 (0.15-0.90); p = 0.028), EHL was proven to be a virtuous behaviour promoter. Finally, a lack of institutional support, time and cost were identified as barriers to pro-environmental behaviours. This study provided useful data to design prevention programmes, underlined some barriers to pro-environmental behaviours and highlighted the need to promote attitudes and behaviours aimed at contrasting environmental pollution, thus protecting human health.

A scoping review of youth advisory structures in the United States: Applications, outcomes, and best practices

Although youth advisory structures (YASs) have proliferated internationally to facilitate the voice of young people, little is known about the practices of such groups, especially in the United States. To address this gap of knowledge, this study describes the findings of a scoping review of scholarly research on YAS in the United States. The review found that although the use of YAS is increasing, current scholarship offers little information about YAS processes or how youth are engaged. Most YAS in the review partnered with marginalized young people to inform research and programming around sensitive health topics, such as human immunodeficiency virus prevention. Youth who participated in YAS experienced positive outcomes such as leadership and skill development, healthier decision-making, and confidence. Although most studies involved youth in minimal ways, there is a growing body of literature where youth are engaged in long-term partnerships that support positive youth development. This review details other key characteristics of YAS and provides recommendations for best practices, such as building consensus around terms used to refer to YAS and promoting the dissemination of process details around YAS facilitation.

Environmental contaminants and child development: Developmentally-informed opportunities and recommendations for integrating and informing child environmental health science

Child environmental health (CEH) science has identified numerous effects of early life exposures to common, ubiquitous environmental toxicants. CEH scientists have documented the costs not only to individual children but also to population-level health effects of such exposures. Importantly, such risks are unequally distributed in the population, with historically marginalized communities and the children living in these communities receiving the most damaging exposures. Developmental science offers a lens and set of methodologies to identify nuanced biological and behavioral processes that drive child development across physical, cognitive, and socioemotional domains. Developmental scientists are also experts in considering the multiple, hierarchically-layered contexts that shape development alongside toxicant exposure. Such contexts and the individuals acting within them make up an overarching "child serving ecosystem" spanning systems and sectors that serve children directly and indirectly. Articulating how biobehavioral mechanisms and social-ecological contexts unfold from a developmental perspective are needed in order to inform CEH translation and intervention efforts across this child-serving ecosystem. Developmentalists can also benefit from integrating CEH science findings in their work by considering the role of the physical environment, and environmental toxicants specifically, on child health and development. Building on themes that were laid out by Trentacosta and Mulligan in 2020, this commentary presents recommendations for connecting developmental and CEH science and for translating such work so that it can be used to promote child development in an equitable manner across this child-serving ecosystem. These opportunities include (1) Using Developmentally-Informed Conceptual Models; (2) Applying Creative, Sophisticated, and Rigorous Methods; (3) Integrating Developmentally-Sensitive Intervention Considerations; and (4) Establishing Interdisciplinary Collaborations and Cross-Sector Partnerships.

Readability levels and thematic content analysis of online and printed lead poisoning informational materials

BACKGROUND

Lead poisoning prevention efforts include preparing and disseminating informational materials such as brochures and pamphlets to increase awareness of lead poisoning, lead exposures and lead poisoning prevention. However, studies have demonstrated that patient education materials for diseases and health conditions are prepared at a reading level that is higher than the recommended 7th-8th grade reading level. This study, therefore, aims to assess the reading levels of lead poisoning informational materials.

METHODS

Lead poisoning materials (N = 31) were accessed from three states; Michigan, New York and Pennsylvania. The readability levels of the materials were assessed using the Flesh Kincaid Grade Level readability test. The Kruskal-Wallis test was conducted to determine if the readability levels differed between the materials obtained from the different states. Thematic content analyses were carried out to assess the inclusion of four themes; definition of lead poisoning, risk factors and exposures, testing and referral and prevention covering 12 subtopics. The Wilcoxon rank sum test was used to examine if there was a difference in the number of subtopics by readability level (dichotomized to >8th grade and < 8th grade).

RESULTS

The median readability level of the informational materials was 6.7 (IQR: 5.1-8.1). However, there was variability in the readability levels of the materials (range 3.5 to 10.6); materials obtained from Michigan had the highest median reading level of 8.1 (IQR: 6.9-9.0) followed by Pennsylvania. Heterogeneity was observed in the content of the materials. Most of the materials (80%) from Michigan focused on water as a source of lead poisoning, whereas materials from New York and Pennsylvania focused on lead-based paint and other sources. The materials prepared at >8th grade reading level contained fewer topics than materials prepared at <8th grade reading level.

CONCLUSIONS

We find that the materials were often prepared at reading levels lower than the recommended 8th grade reading level. However, there is variability in the reading levels and in the content of the materials. While the materials met the general readability guidelines, they did not necessarily meet the needs of specific groups, especially groups at risk.

Children and Youth Environmental Action: The Case of Children and Youth with Disabilities

Youth environmental activism is on the rise. Children and youth with disabilities are disproportionally impacted by environmental problems and environmental activism. They also face barriers towards participating in activism, many of which might also apply to their participation in environmental activism. Using a scoping review approach, we investigated the engagement with children and youth with disabilities by (a) academic literature covering youth environmental activism and their groups and (b) youth environmental activism group (Fridays For Future) tweets. We downloaded 5536 abstracts from the 70 databases of EBSCO-HOST and Scopus and 340 Fridays For Future tweets and analyzed the data using directed qualitative content analysis. Of the 5536 abstracts, none covered children and youth with disabilities as environmental activists, the impact of environmental activism or environmental problems such as climate change on children and youth with disabilities. Fourteen indicated that environmental factors ‘caused’ the ‘impairments’ in children and youth with disabilities. One suggested that nature could be beneficial to children and youth with disabilities. The tweets did not mention children and youth with disabilities. Our findings suggest the need for more engagement with children and youth with disabilities in relation to youth environmental activism and environmental challenges.

Insights into the Slow Uptake of Residential Lead Paint Remediation Funds: A Lancaster, Pennsylvania, Case Study

Lead poisoning is a preventable condition that continues to affect thousands of children each year. Given that local governments and municipalities are eligible to apply for federal funds to perform lead remediation in low-income family homes, we sought to understand how lead poisoning knowledge levels may affect the uptake of these funds. We recruited and conducted 28 in-depth, semi-structured interviews with community members from Lancaster County in the state of Pennsylvania in the USA. We audio-recorded and transcribed each interview, and analyzed each transcript for salient themes. The interviewed participants displayed a varying degree of knowledge about lead and lead poisoning. Most of the participants were unaware of the lead paint remediation funds. Participants learned about lead from various sources, such as social media, and personal experiences with lead poisoning appeared to enhance knowledge. Some participants assumed lead poisoning prevention would be addressed by other stakeholders if necessary, including healthcare professionals and landlords. The results of this study suggest that in order to increase the timely uptake of the remediation funds, community-based organizations should design interventions that aim to increase awareness and knowledge about lead poisoning and lead poisoning prevention. These interventions should be tailored for different audiences including community members, healthcare professionals, and landlords.

Development and assessment of an instrument measuring environmental health perception and behavior toward reproductive health of female adolescents

AIM

This study is aimed to develop and test the measurement of environmental health perceptions and behavior concerning female adolescents' reproductive health.

METHODS

The scales constructed through literature review, in -depth interview, and factor analysis based on the protection motivation theory. The sample comprised 384 female adolescents for exploratory factor analysis, aged 18-22 years, and recruited in September-November 2019 in South Korea. The construct was validated using factor analysis, convergent validity, and known-group comparisons. Reliability was examined using Cronbach's alpha for internal consistency and half-split reliability.

RESULTS

The environmental health perception for female adolescents (EHP-FA) comprises "Sensitivity," "Susceptibility," "Response efficacy," and "Self-efficacy." The environmental health behavior for female adolescents (EHB-FA), based on principal component analysis, yielded 19 items with five factors, including "Chemical reduction," "Electromagnetic reduction," "Food selection," "Cosmetic selection," "Dust & Gas reduction," and explained 62.6% of the variance (Cronbach's α = .93).

CONCLUSION

The utility of EHP-FA and EHB-FA recommend assessment of female youth's environmental attention and health behavior in the community. Nursing professionals can use the scales to promote female adolescents' reproductive health.

Professionals' Perceptions: "Why is Lead Poisoning Prevalent in Lancaster County?"

Background: The prevalence of lead poisoning in children under the age of six years living in Lancaster County, Pennsylvania continues to be greater than the state-wide prevalence for this age group. This study aims to determine the factors that contribute to the high lead poisoning rates. Methods: For this qualitative study, the researchers recruited a convenience sample of professionals providing healthcare and social welfare services in the county. Researchers conducted in-depth interviews with participants. The research team audio recorded, transcribed verbatim, and analyzed each interview using NVivo 12 software. Results: The 16 interviewed participants identified factors that contribute to high lead poisoning rates including knowledge levels, housing status, and competing interests. Specifically, low knowledge levels, renting as opposed to home ownership, and having competing interests seemed to minimize the attention directed towards preventing lead poisoning. The experts offered recommendations to address the high lead poisoning rates including increasing lead knowledge levels of both community members and landlords, through creating and distributing health promotion material, enacting policies to empower renters, and systematically collaborating to streamline lead poisoning related information and services. Conclusions: Findings provide insights to factors that Lancaster can address to achieve a decrease in lead poisoning rates. This study provides information that can be utilized by public health professionals to develop appropriate interventions.

More than gangsters and girl scouts: Environmental health perspectives of urban youth

The purpose of this study was to explore environmental health perspectives among urban youth. A total of 12 focus groups with 64 youth were conducted. Youth defined environmental health in a multidimensional manner which integrated aspects of the physical, social, and built environment and concentrated on the neighborhood context. A theme of environmental health resilience factors and sub-themes of safety, trust, engagement, leadership, and representation were identified and described. A second theme of underlying structural drivers of environmental health with sub-themes of equitable opportunities and power inform environmental health. A conceptual model was developed to guide future environmental health research and action.

From Content Knowledge to Community Change: A Review of Representations of Environmental Health Literacy

Environmental health literacy (EHL) is a relatively new framework for conceptualizing how people understand and use information about potentially harmful environmental exposures and their influence on health. As such, information on the characterization and measurement of EHL is limited. This review provides an overview of EHL as presented in peer-reviewed literature and aggregates studies based on whether they represent individual level EHL or community level EHL or both. A range of assessment tools has been used to measure EHL, with many studies relying on pre-/post-assessment; however, a broader suite of assessment tools may be needed to capture community-wide outcomes. This review also suggests that the definition of EHL should explicitly include community change or collective action as an important longer-term outcome and proposes a refinement of previous representations of EHL as a theoretical framework, to include self-efficacy.