The Environmental Health Engagement Profile: What People Think and Do About Environmental Health

Development and Outcomes of Returning Polycyclic Aromatic Hydrocarbon Exposure Results in the Washington Heights, NYC Community

Report-back of research results (RBRR) is becoming standard practice for environmental health research studies. RBRR is thought to increase environmental health literacy (EHL), although standardized measurements are limited. For this study, we developed a report back document on exposure to air pollutants, Polycyclic Aromatic Hydrocarbons, during pregnancy through community engaged research and evaluated whether the report increased EHL. We used focus groups and surveys to gather feedback on the report document from an initial group of study participants (Group 1, n = 22) and then sent the revised report to a larger number of participants (Group 2, n = 168). We conducted focus groups among participants in Group 1 and discussed their suggested changes to the report and how those changes could be implemented. Participants in focus groups demonstrated multiple levels of EHL. While participant engagement critically informed report development, a survey comparing feedback from Group 1 (initial report) and Group 2 (revised report) did not show a significant difference in the ease of reading the report or knowledge gained about air pollutants. We acknowledge that our approach was limited by a lack of EHL tools that assess knowledge and behavior change, and a reliance on quantitative methodologies. Future approaches that merge qualitative and quantitative methodologies to evaluate RBRR and methodologies for assessing RBRR materials and subsequent changes in knowledge, attitudes, and behavior, may be necessary.

PERHLs of Wisdom: Environmental Reproductive Health Literacy and Phthalates

Most tools that measure environmental health literacy are broad in nature. Researchers have now developed a tool specific to phthalate awareness and behaviors as they relate to reproductive health.

The Expanded Theory of Planned Behavior in the Context of Environmental Protection Behaviors for Undergraduates: Roles of Moral Norms and University Class Standings

The expanded Theory of Planned Behavior (ETPB) was applied to examine undergraduates’ environmental protection behaviors. Moral norms were applied into the model as the predictor of attitude, social norms and perceived behavioral control. The effects of different class standings were also examined. A questionnaire survey was conducted and 380 responses underwent data analysis using structural equation modelling. According to Model ETPB, perceived behavioral control and subjective norms were strongly affected by moral norms, while attitude was moderately affected by moral norms. Environmental protection behaviors was moderately affected by environmental protection intention, while environmental protection intention was moderately affected by perceived behavioral control which was the strongest predictor, followed by attitude and subjective norms. Invoking moral emotions through posters or peers leading by examples, which over time might internalize into moral norms, played an important role in positively affecting perceived behavioral control and subjective norms. This could be followed by simple and convenient programs creating a positive self-perception of the abilities to carry out environmental protection behaviors. When separated by class standings, perceived behavioral control was the strongest predictor for the freshmen class, while subjective norms were non-significant. For the class standing of sophomores and above, attitude was the strongest predictor.

Psychometric Properties of the Korean Version of the Environmental Health Literacy Scale

The environmental health literacy (EHL) scale evaluates media-specific and general EHL levels in three domains: knowledge, attitude, and behavior. This study aimed to adapt the EHL scale developed by Lichtveld et al. into the Korean language (K-EHL scale) and to verify its reliability and validity. Survey data was collected from 492 adults (19-65 years) residing in Korea. The study process included translation procedures, content validity verification, pre-testing, the actual survey, and statistical analysis for validation and selection of the final items. The scale-level content validity index was 0.92, and one item was removed. Multiple exploratory factor analyses condensed the K-EHL into 2 factors and 38 items. The "Environmental health knowledge and attitude" factor (14 items) measures information, feelings, and thoughts about environmental health. The "Environmental health behavior" factor (24 items) comprises behaviors responding to environmental health. A construct validity (criterion and discriminant validity) was verified using confirmatory factor analysis for goodness of fit (CFI = 0.901, TLI = 0.863, GFI = 0.923, NFI = 0.862, and RMSEA = 0.08). Internal consistency reliability test results showed a Cronbach's α of 0.81 for the total items. This study is the first to introduce the EHL in Korea, and it also presents a validated evaluation tool. The K-EHL is expected to elucidate EHL levels in Korea. In the future, the EHL scale can be enhanced using this tool.

Environmental Health Literacy as Knowing, Feeling, and Believing: Analyzing Linkages between Race, Ethnicity, and Socioeconomic Status and Willingness to Engage in Protective Behaviors against Health Threats

This study investigates the relationships between environmental health literacy, the characteristics of people (race, ethnicity, and socioeconomic status) associated with health disparities, and people's willingness to engage in protective behaviors against environmental health threats. Environmental health literacy is a framework for capturing the continuum between the knowledge of environmental impacts on public health, and the skills and decisions needed to take health-protective actions. We pay particular attention to three dimensions of environmental health literacy: factual knowledge (knowing the facts), knowledge sufficiency (feeling ready to decide what to do), and response efficacy (believing that protective behaviors work). In June 2020, we collected survey data from North Carolina residents on two topics: the viral infection COVID-19 and industrial contaminants called per- and polyfluoroalkyl substances (PFAS). We used their responses to test stepwise regression models with willingness to engage in protective behaviors as a dependent variable and other characteristics as independent variables, including environmental health literacy. For both topics, our results indicated that no disparities emerged according to socioeconomic factors (level of education, household income, or renting one's residence). We observed disparities in willingness according to race, comparing Black to White participants, but not when comparing White to American Indian, Alaska Native, Asian, Native Hawaiian, or Pacific Islander participants nor Hispanic to non-Hispanic participants. The disparities in willingness between Black and White participants persisted until we introduced the variables of environmental health literacy, when the difference between these groups was no longer significant in the final regression models. The findings suggest that focusing on environmental health literacy could bridge a gap in willingness to protect oneself based on factors such as race/ethnicity and socioeconomic status, which have been identified in the environmental health literature as resulting in health disparities.

Characterizing the Environmental Health Literacy and Sensemaking of Indoor Air Quality of Research Participants

This study is based on in-depth semi-structured interviews with the participants of an indoor air quality monitoring study. The purpose of the interviews was to capture participants’ perceptions of indoor air quality and engage them in a discussion of those factors that influenced their behavior. Interview study participants (n = 20) noted the importance of family health concerns and their own sensory awareness of possible contaminants. They discussed their level of personal control over their home environment as well as their access to needed resources. This study is based on grounded theory and applies interpretivist epistemological methods. Study findings offer insights into how people perceive their home environment and what influences their decision making and action. Analyses indicate that perceived agency, risk perception, access to resources, and information all influenced participants’ sense of ability to take action as well as their interest in taking action. These insights serve to challenge some of the current work in environmental health literacy which tends to focus on and measure an individual’s knowledge or skills. Our analysis suggests that consideration be given to a number of factors that include perceived agency, access to resources, and the quality of information provided.

Developing a Short Assessment of Environmental Health Literacy (SA-EHL)

Environmental health literacy (EHL) is defined as the understanding of how the environment can impact human health, yet there are few tools to quantify EHL. We adapted the Short Assessment of Health Literacy (SAHL) to create the Short Assessment of Environmental Health Literacy (SA-EHL). Using the Amazon mTurk platform, users (n = 864) completed the 18-item SAHL and the 17-item SA-EHL. The SA-EHL was originally tested with 30 items; 13 items were removed because they were outside the acceptable difficulty parameters (DIFF: −0.4–4.0) or because of limited variance (>90% correct or incorrect), resulting in the final 17 items. Overall, participants scored highly on the SAHL, with 89.9% exhibiting high literacy. In contrast, the majority had low EHL (<1.0% high literacy, 99.2% low literacy) measured by the SA-EHL. The two scales were not correlated with each other (R² = 0.013) as measured via linear regression and dichotomous variables. Scores on the SAHL and the SA-EHL were positively correlated with education. The SAHL was positively correlated with age, gender and marital status, whereas the SA-EHL was not. The SA-EHL can be used to gauge EHL for communities, and the results used to improve interventions and research translation materials.

What Do Childcare Providers Know about Environmental Influences on Children's Health? Implications for Environmental Health Literacy Efforts

Children are uniquely vulnerable to toxicant exposures in their environment, which can have long-lasting impacts on their health. Childcare providers are an important population to target for environmental health literacy, as most children in the United States under five years of age spend a significant number of waking hours in non-parental care. There is an increasing body of evidence that children are exposed to toxicants in the childcare environment, and yet little is known about what childcare providers know about environmental influences on the health of children in their care. We conducted semi-structured interviews with 36 home- and center-based Illinois childcare providers to better understand their knowledge, attitudes, and behaviors as they relate to environmental influences on children’s health. We found that the majority of providers had a low level of understanding of potential sources of exposure in the childcare environment, and they did not feel that environmental exposures posed a significant risk to children. Future efforts to increase environmental health literacy should focus on raising awareness and knowledge of environmental health issues for childcare providers before addressing ways that providers can reduce or prevent toxicant exposures to children in their care.

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.

Development of Environmental Health Competencies through Compulsory Education. A Polyhedral Approach Based on the SDGs

This paper focuses on the competencies in environmental health acquired by students during compulsory education. Questionnaires addressing environmental health problems were completed by 923 students of primary and secondary schools from five different Spanish regions. The results for five challenging situations related to hunger, consumerism, climate change, pollution in the cities and allergies are analysed according to the internal coherence of each sub-competency, i.e., addressing knowledge, skills and attitudes towards these topics. Our results show that problems related to air and water pollution were the most commonly described by the students. Focusing on competency achievement, the higher the educational level, the higher the score students obtained, especially regarding pollution and climate change, two problems that appear directly in the school curriculum. The complexity of the concept of environmental health matches with the necessary holistic perspective of the Sustainable Development Goals in a polyhedral approach including as many factors (facets) as necessary to complete the approach to this evolving concept.

Pro-environmental health behaviour and educational needs among pregnant women: A cross-sectional survey

AIM

To investigate pro-environmental health perceptions, behaviour and educational needs among pregnant women in Korea.

BACKGROUND

Based on concerns about the effects of environmental hazards and pollution on their babies and themselves, pregnant women behave in ways that protect their health. The framework of this study was based on Rogers' protection motivation theory.

DESIGN

Cross-sectional survey using questionnaires.

METHOD

The sample comprised 358 pregnant women recruited from July - August 2018 in South Korea. Participants were recruited from prenatal classes at two healthcare centres and patients receiving prenatal check-ups at two women's hospitals.

RESULTS

Perceived educational needs were ranked in the following order: particulate matter (23.7%), electromagnetic waves (11.7%), instant food (food additives) (9.0%) and environmental hormones (8.3%). Age (β = 0.17, p = .001), perceived severity (β = 0.19, p = .001) and response efficacy (β = 0.28, p < .001) affected pro-environmental behaviour, which explained 23.0% of the variance.

CONCLUSION

Educational programs are necessary for mitigating environmental risks during pregnancy. Pregnant women engage in pro-environmental behaviour influenced by pro-environmental perceptions, especially perceptions of severity regarding environmental diseases and the efficacy of health behavioural responses. Nursing professionals can use these results to promote pro-environmental health in pregnant women.

IMPACT

This study demonstrated that pregnant women need environmental health programs in prenatal education. Pro-environmental perceptions regarding the severity of the environmental diseases and behavioural efficacy preceded the formation of environmental health behaviours. Nurses should support pregnant women's environmental health through educational interventions including air, electromagnetic, food pollution and endocrine disruptors.

Advancing Environmental Health Literacy: Validated Scales of General Environmental Health and Environmental Media-Specific Knowledge, Attitudes and Behaviors

Environmental health literacy (EHL) involves understanding and using environmental information to make decisions about health. This study developed a validated survey instrument with four scales for assessing media-specific (i.e., air, food, water) and general EHL. The four scales were created as follows: 1) item generation: environmental health scientists and statisticians developed an initial set of items in three domains: knowledge, attitudes, and behaviors; 2) item review: items were reviewed for face validity; 3) validation: 174 public health students, the exploratory sample, and 98 community members, the test sample, validated the scales. The scales’ factor structure was based on exploratory factor analysis (EFA) and model fit was assessed through confirmatory factor analysis (CFA). For each scale, the final EFA resulted in an independent three-factor solution for knowledge, attitudes, and behaviors. Good fit for the three-factor structure was observed. Model fit for CFA was generally confirmed with fit indices. The scales showed internal consistency with Cronbach’s alpha from 0.63 to 0.70. The 42-item instrument represents an important contribution towards assessing EHL and is designed to enable meaningful engagement between researchers and community members about environmental health. The intended outcome is sustained community–academic partnerships benefiting research design, implementation, translation, dissemination, and community action.

Public Perceptions of Environmental Public Health Risks in the United States

Understanding public perceptions about environmental health hazards, exposures, and health impacts can help environmental public health practitioners to target and prioritize community activities, policy needs, and communication strategies. The online cross-sectional 2013 summer wave of the ConsumerStyles survey sampled U.S. adults and used questions from the Centers for Disease Control’s Environmental Public Health Tracking Program to measure public awareness of governmental efforts to track environmental exposures and links to health impacts, as well as perceptions of environmental health issues. Unadjusted and adjusted logistic regressions examined the associations between demographic characteristics and level of awareness of government environmental public health efforts or level of concern about health risks associated with environmental pollutants. Responses were received from 4033 participants, yielding a response rate of 66.0%. More than half of respondents (57.8%) noted concerns about health risks from environmental pollutants. More than one-third (40.0%) of respondents reported awareness of government efforts. Nearly 40% of respondents felt that none of the health impacts listed in the survey were related to environmental issues. Multiple logistic regression models showed that non-Hispanic blacks, other races, females, people with a college or higher education, and people living in the Midwest or South regions were more likely than their counterparts to be concerned about how the environment affects their health. Future work should focus on improving risk communication, filling the information gap on environmental health issues, and understanding how perceptions change over time.

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.

Environmental Health: Advancing Emancipatory Policies for the Common Good

Human health is substantially impacted by the state of the environment, and environmental degradation has a disproportionate impact on persons with less immediate access to financial and social power. This article calls for upstream nursing action to address the natural environment in order to turn about health injustices and improve health for all. Such action would move nursing towards a greater actualization of the nursing environmental domain. The health impacts of climate change, air and water quality, and toxic chemical exposure are substantiated and specific policy leadership recommendations are proposed. Recommended actions include work to build environmental health literacy and empowerment, advocacy for regulatory protection and enforcement, and environmental engagement within health care systems.

Health behaviors related to endocrine-disrupting chemicals and the associated factors of adolescent Korean girls

In this cross-sectional study, we examined the relationships among knowledge about endocrine-disrupting chemicals (EDCs), recognition of EDCs-related female reproductive illnesses, concern for the environment, perceived susceptibility to EDCs-related diseases, self- appraisal of exposure to EDCs, and health behaviors related to EDCs in adolescent Korean girls. A convenience sample of 218 girls was recruited during July and August 2015 from middle and high schools located in a city in Korea. The self-administered questionnaire incorporated four characteristics of the participants, five related factors, and a dependent variable of health behaviors. Four of the factors explained 20.4 percent of variance in health behaviors, and after controlling covariates, concern for the environment and self-appraisal of exposure to EDCs were still significant factors explaining 29.0 percent of the variance in health behaviors. However, for one factor, knowledge about EDCs, no independent contribution to health behaviors was observed. The findings indicated that education for young women should focus on enhancing their interests in the environment and awareness of environmental hazards. Further, clear and reliable guidelines to protect young women from the exposure to EDCs should be provided to adolescent girls.

A behavioral strategy to minimize air pollution exposure in pregnant women: a randomized controlled trial

Background

Pregnant women and their fetus belong to a sensitive group in response to air pollution hazards. The aim of this study was to evaluate the effectiveness of a theory-based educational program to change pollution exposure behavior in pregnant women.

Methods

In this randomized controlled trial, pregnant women attending a prenatal clinic in Tehran, Iran were selected and randomized into the experimental and control groups. The inclusion criteria were age between 18 and 35 years, having a history of pregnancies without adverse outcomes and not suffering from chronic diseases. Data collected at baseline and 2-month follow-up. At baseline face-to-face interviews were conducted using a valid and reliable questionnaire including items on demographic characteristics, stages of change, self-efficacy, decisional balance and practice regarding air pollution preventive behaviors. The intervention composed of three parts: motivational interviewing, a booklet and daily small message service (SMS). The control group received no intervention except receiving usual care. Follow-up data were collected after the intervention. Data were analyzed performing t-test, Mann–Whitney U test, and chi-squared.

Results

In all the data for 104 pregnant women (53 in the intervention and 51 in the control group) were analyzed. The mean age of participants was 27.2 (SD = 4.11) years and it was 22.89 (SD = 8.75) weeks for gestational age. At baseline there were no significant statistical differences between intervention and control groups on the study measures while we found significant group differences in terms of stages of change, self-efficacy, perceived benefits and practice regarding air pollution preventive behaviors at follow-up assessment (P < 0.05).

Conclusion

The findings indicated that the TTM-based intervention was effective in increasing air pollution preventive behaviors among pregnant women. This study provided a framework to modify some psychosocial determinants of air pollution preventive behavior other than knowledge using constructs of Transtheoretical model of behavior change, additionally results suggests the importance of education and makes enlightenment of the air pollution risk knowledge accelerate.

Trial registration

IRCT2012091010804N1

Nutrition and Other Protective Behaviors Motivated by Environmental Health Risk Awareness

Background

Research findings have suggested that exposure to environmental pollutants contributes to increased health risks, which may be modulated by certain nutrition and other protective health behaviors. Nutrition professionals play an important role in effectively disseminating this information and in devising specific community-based nutrition education programs for audiences located in areas with environmental health issues.

Objective

To assess awareness of environmental health problems and motivation to adopt protective health behaviors for use in planning nutrition education programs for communities exposed to environmental pollutants.

Method

Data were collected from a modified, validated Environmental Health Engagement Profile (EHEP) survey instrument administered to adults (n=774) participating in community events in Kentucky based on location relative to hazardous waste sites.

Results

The modified EHEP survey instrument showed good internal consistency reliability, and demographic characteristics were evaluated. Correlation analyses revealed significant positive correlations in all groups, separately and combined, between awareness of environmental pollution in an individual’s surroundings and the extent of concern that pollutants cause adverse health effects (P < 0.01) and between concern that pollutants cause adverse health effects and taking personal actions to protect against such environmental insults (P < 0.01). The groups having the highest level of awareness posed by pollution are those residing near federally designated hazardous waste sites.

Conclusion

These results suggest that determining and expanding an audience’s knowledge and perceptions of environmental health risks will enhance effective nutrition education program planning.

Development and validation of the pro-environmental behaviour scale for women's health

AIM

This study was aimed to develop and test the Pro-environmental Behavior Scale for Women's Health.

BACKGROUND

Women adopt sustainable behaviours and alter their life styles to protect the environment and their health from environmental pollution. The conceptual framework of pro-environmental behaviours was based on Rogers' protection motivation theory and Weinstein's precaution adoption process model.

DESIGN

The cross-sectional design was used for instrument development.

METHOD

The instrument development process consisted of a literature review, personal depth interviews and focus group interviews. The sample comprised 356 adult women recruited in April-May 2012 in South Korea using quota sampling. For construct validity, exploratory factor analysis was conducted to examine the factor structure, after which convergent and discriminant validity and known-group comparisons were tested.

RESULTS

Principal component analysis yielded 17 items with four factors, including 'women's health protection,' 'chemical exposure prevention,' 'alternative consumption,' and 'community-oriented behaviour'. The Cronbach's α was 0·81. Convergent and discriminant validity were supported by performing correlations with other environmental-health and health-behaviour measures.

CONCLUSION

Nursing professionals can reliably use the instrument to assess women's behaviours, which protect their health and the environment.

Predicator of Pregnant Women's Self-care Behavior against Air Pollution: An explanation based on the Extended Parallel Process Model (EPPM)

Introduction

Air pollution is one of the most important problems of metropolitan cities. The level of air pollution in the city of Ahvaz is so much higher than the standard level, that it can create risks, particularly for pregnant women in the area. The aim of the study was to examine the predictors of self-care behavior of pregnant women against air pollution according to Extended Parallel Process Model (EPPM) in Ahvaz.

Methods

In this cross-sectional study, 330 pregnant women who were referred to health care centers in western Ahvaz in 2015 were examined. The data collection tool was a reliable and valid researcher-made questionnaire consisting of three parts: The first part was demographic information, the second part according to the extended parallel process model, included perceived susceptibility, perceived severity, response efficacy, and self-efficacy. The third part examined self-care behavior. Then, the collected data was analyzed by using the software SPSS 16. Data analysis was done by using Spearman’s correlation coefficient and linear regression.

Results

The average age of study subjects was 26.07 ± 2.3 years, and most (45.5%) were in the second trimester of pregnancy. These findings showed that self-efficacy constructs (β = 0.41) and response efficacy (β= 0.15) have predictive power of self-care behavior (p < 0.05).

Conclusion

The findings showed that self-efficacy and response efficacy, are important factors to predict air pollution self-care behavior. Therefore, to develop a theory-based behavioral modification program for pregnant women, more emphasis on these constructs is recommended.

Introducing a new measure for assessing self-efficacy in response to air pollution hazards for pregnant women

A self-efficacy instrument should be condition-specific. There are several instruments for measuring self-efficacy, but none are air pollution-specific. This study aimed to develop a self-efficacy measure for assessing pregnant women's responses to air pollution hazards. A random sample of pregnant women aged between 18 and 35 years attending three prenatal care centers were entered into the study. Prenatal care centers randomly selected from a list of centers located in different geographical regions of Tehran, Iran. After careful consideration and performing content and face validity, a 4-item measure was developed and participants completed the questionnaire. Reliability was estimated using internal consistency and validity was assessed by performing confirmatory factor analysis (CFA) and known group comparison. In all 200 eligible pregnant women were studied. The mean age of participants was 26.9 (SD = 4.8) years and it was 27.9 (SD = 9.1) weeks for gestational age. The findings showed almost perfect results for both content validity ratio (CVR = 1) and content validity index (CVI = 1). The confirmatory factor analysis indicated a good fit to the data, and known group comparison revealed satisfying results. Internal consistency as measured by the Cronbach's alpha coefficient was found to be 0.74. In general, the findings suggest that this new generated scale is a reliable and valid specific measure of self-efficacy in response to air pollution hazards for pregnant women. However, further studies are needed to establish stronger psychometric properties for the questionnaire.

Developing the community environmental health role of the nurse

This paper is a report from one phase of an exploratory case study. It investigated the environmental health concerns of members of communities within one city in the North East of Scotland. Individual interviews with stakeholders (n=21) and four focus groups were conducted with a convenience sample of community nurses (n=19). Community nurse participants believed that their environmental health role remains underdeveloped. They indicated that they do not view the NHS as a resource for environmental health information. An environmental role is constrained by the NHS not being perceived as a source of information or expert in environmental health. They described limited contact between community nurses and public health medicine and uncertainty and conflict of interest between clinical groups regarding the scope of an environmental health role. Policy makers could support the development of an environmental advocacy role--a pilot of this is required.