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Fiore M, Lorini C, Bonaccorsi G, Paoli S, Vaccaro G, Verani M, Federigi I, Ferrante M, Carducci A. Development and validation of the Environmental Health Literacy Index: a new tool to assess the environmental health literacy among university students. Eur J Public Health 2024:ckae120. [PMID: 39074352 DOI: 10.1093/eurpub/ckae120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2024] Open
Abstract
Environmental health literacy (EHL) is a rather recent concept that applies health literacy skills to environmental issues. Research in this field is still at the beginning, and there is currently no existing tool in the literature designed to comprehensively assess individual general EHL among university students. The aim of our study is to fill this gap through the validation of the Environmental Health Literacy Index (EHLI) in such a target group. We adapted a previously administered survey, originally completed by 4778 university students from various Italian universities. Starting from the original questionnaire, our methodology involved a three-round item selection process, followed by a comprehensive evaluation of the instrument's psychometric properties. The EHLI consists of 13 Likert-type items, covering three primary domains of health literacy: functional (six items), interactive (three items), and critical (four items). The Cronbach's alpha coefficient is 0.808 for the global scale, while it stands at 0.888 for the functional, 0.795 for the critical, and 0.471 for the interactive components. The area under the receiver operating characteristic curve reached a value of 0.643. Spearman correlation analysis revealed a significant yet slight correlation between EHLI and both functional health literacy score and the extent of pro-environmental behaviors adoption. Our study serves as an important initial step in developing a tool able to evaluate the EHL of university-aged individuals. Further research efforts may improve the questionnaire's validity and completeness, as well as to explore its applicability to different age groups.
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Affiliation(s)
- Maria Fiore
- Department of Medical, Surgical and Advanced Technologies "G.F. Ingrassia", University of Catania, Catania, Italy
- Health Literacy Laboratory, Department of Health Science, University of Florence, Florence, Italy
| | - Chiara Lorini
- Health Literacy Laboratory, Department of Health Science, University of Florence, Florence, Italy
| | - Guglielmo Bonaccorsi
- Health Literacy Laboratory, Department of Health Science, University of Florence, Florence, Italy
| | - Sonia Paoli
- School of Specialization in Hygiene and Preventive Medicine, University of Florence, Florence, Italy
| | - Gabriele Vaccaro
- School of Specialization in Hygiene and Preventive Medicine, University of Florence, Florence, Italy
| | - Marco Verani
- Department of Biology, University of Pisa, Pisa, Italy
| | | | - Margherita Ferrante
- Department of Medical, Surgical and Advanced Technologies "G.F. Ingrassia", University of Catania, Catania, Italy
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Riley KW, Burke K, Dixon H, Holmes D, Calero L, Barton M, Miller RL, Bramer LM, Waters KM, Anderson KA, Herbstman J, Rohlman D. Development and Outcomes of Returning Polycyclic Aromatic Hydrocarbon Exposure Results in the Washington Heights, NYC Community. ENVIRONMENTAL HEALTH INSIGHTS 2024; 18:11786302241262604. [PMID: 39055113 PMCID: PMC11271165 DOI: 10.1177/11786302241262604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 05/31/2024] [Indexed: 07/27/2024]
Abstract
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.
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Affiliation(s)
- Kylie W Riley
- Columbia Center for Children’s Environmental Health, Columbia University, New York, NY, USA
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Kimberly Burke
- Columbia Center for Children’s Environmental Health, Columbia University, New York, NY, USA
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Holly Dixon
- Environmental and Molecular Toxicology, Food Safety and Environmental Stewardship Program, Oregon State University, Corvallis, OR, USA
| | - Darrell Holmes
- Columbia Center for Children’s Environmental Health, Columbia University, New York, NY, USA
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Lehyla Calero
- Columbia Center for Children’s Environmental Health, Columbia University, New York, NY, USA
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Michael Barton
- Department of Environmental and Molecular Toxicology, Oregon State University, Corvallis, OR, USA
| | - Rachel L Miller
- Division of Clinical Immunology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lisa M Bramer
- Biological Sciences Division, Pacific Northwest National Laboratory, Richland, WA, USA
| | - Katrina M Waters
- Department of Environmental and Molecular Toxicology, Oregon State University, Corvallis, OR, USA
- Biological Sciences Division, Pacific Northwest National Laboratory, Richland, WA, USA
| | - Kim A Anderson
- Department of Environmental and Molecular Toxicology, Oregon State University, Corvallis, OR, USA
| | - Julie Herbstman
- Columbia Center for Children’s Environmental Health, Columbia University, New York, NY, USA
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Diana Rohlman
- School of Nutrition and Public Health, College of Health, Oregon State University, Corvallis, OR, USA
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Nicole W. PERHLs of Wisdom: Environmental Reproductive Health Literacy and Phthalates. ENVIRONMENTAL HEALTH PERSPECTIVES 2024; 132:64002. [PMID: 38916968 PMCID: PMC11218698 DOI: 10.1289/ehp15126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 05/03/2024] [Indexed: 06/27/2024]
Abstract
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.
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Tomsho KS, Quinn MR, Adamkiewicz G, James-Todd T. Development of a Phthalate Environmental Reproductive Health Literacy (PERHL) Scale. ENVIRONMENTAL HEALTH PERSPECTIVES 2024; 132:47013. [PMID: 38669179 PMCID: PMC11050996 DOI: 10.1289/ehp13128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 03/23/2024] [Accepted: 03/27/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Substantial evidence exists linking phthalate exposure to adverse reproductive health outcomes. Current US federal regulations of consumer product chemicals place the onus on individuals to mitigate their exposure to phthalates, with assumptions of sufficient environmental health literacy (EHL). Few validated scales for people of reproductive age exist to evaluate phthalate-specific EHL. OBJECTIVES Our objective is to develop a multidimensional scale characterizing latent factors of phthalate knowledge, risk perception, and self-efficacy to inform individual-level interventions for reducing phthalate exposure. METHODS We distributed a survey with 31 items to 117 participants in the Environmental Reproductive and Glucose Outcomes (ERGO) cohort who gave birth within the last 5 years. Exploratory factor analysis (EFA) was used to identify underlying latent factors. Internal reliability was assessed via omega hierarchical coefficient. Average sum scores for each latent factor and the overall Phthalate Environmental Reproductive Health Literacy (PERHL) score were calculated. Associations between latent factors, overall PERHL score, and sociodemographic characteristics were explored using linear models. RESULTS Six latent factors were identified as follows: "Awareness of Phthalate Reproductive Health Impacts," "Uncertainty," "Protective Behavior/Risk Control," "Regulatory Interest," "Awareness of Phthalate Exposure Pathways," and "General Phthalate Knowledge." Each factor demonstrated acceptable to strong internal reliability, with coefficients ranging between 0.63 and 0.93. Non-white participants had lower scores for the "Awareness of Phthalate Reproductive Health Impacts" [β : - 0.35 , 95% confidence interval (CI): - 0.63 , - 0.07 ], "Awareness of Phthalate Exposure Pathways" (β : - 0.32 , 95% CI: - 0.57 , - 0.07 ), and "General Phthalate Knowledge" (β : - 0.36 , 95% CI: - 0.66 , - 0.06 ), but no significant difference in scores on "Uncertainty" (β : 0.17, 95% CI: - 0.16 , 0.50), "Protective Behavior/Risk Control" (β : - 0.04 , 95% CI: - 0.36 , 0.28), or "Regulatory Interest" (β : - 0.21 , 95% CI: - 0.51 , 0.09). No associations were seen for age or educational attainment and latent or sum factors. DISCUSSION Six latent factors were identified for the PERHL scale. Non-white race and ethnicity was associated with lower scores for knowledge-related scale factors. https://doi.org/10.1289/EHP13128.
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Affiliation(s)
- Kathryn S. Tomsho
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Marlee R. Quinn
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Gary Adamkiewicz
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Tamarra James-Todd
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Pansakun N, Naksen W, Boonchieng W, Ong-artborirak P, Prapamontol T. Environmental Health Literacy Regarding Fine Particulate Matter and Related Factors Among Village Health Volunteers in Upper Northern Thailand. J Prev Med Public Health 2024; 57:138-147. [PMID: 38374711 PMCID: PMC10999306 DOI: 10.3961/jpmph.23.434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/18/2023] [Accepted: 12/28/2023] [Indexed: 02/21/2024] Open
Abstract
OBJECTIVES Fine particulate matter pollution has emerged as a significant life-threatening issue in Thailand. Recognizing the importance of environmental health literacy (EHL) in disease prevention is crucial for protecting public health. This study investigated EHL levels and aimed to identify associated factors among village health volunteers (VHVs) in the upper northern region of Thailand. METHODS A cross-sectional study was conducted to collect data from 710 VHVs using the EHL assessment tool developed by the Department of Health, Thailand. RESULTS The overall EHL score was moderate (mean, 3.28 out of a possible 5.0), with the highest and lowest domain-specific mean score for the ability to make decisions (3.52) and the ability to access (3.03). Multiple linear regression revealed that the factors associated with EHL score were area of residence (urban areas in Chiang Mai: B=0.254; urban areas in Lampang: B=0.274; and rural areas in Lampang: B=0.250 compared to rural areas in Chiang Mai), higher education levels (senior high school: B=0.212; diploma/high vocational certificate: B=0.350; bachelor's degree or above: B=0.528 compared to elementary school or lower), having annual health checkups compared to not having annual health check-ups (B=0.142), monthly family income (B=0.004), and individuals frequently facing air pollution issues around their residence (B=0.199) compared to those who reported no such issues. CONCLUSIONS The VHVs exhibited moderate EHL associated with residence area, education, health check-ups, family income, and residential air pollution. Considering these factors is vital for enhancing VHVs' EHL through strategic interventions.
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Affiliation(s)
- Nattapon Pansakun
- Faculty of Public Health, Chiang Mai University, Chiang Mai, Thailand
| | - Warangkana Naksen
- Faculty of Public Health, Chiang Mai University, Chiang Mai, Thailand
| | | | - Parichat Ong-artborirak
- Department of Medical Research and Innovation, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bankkok, Thailand
| | - Tippawan Prapamontol
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
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Hoover AG. Invited Perspective: Making the Implicit Explicit-Connecting Environmental Health Literacy and Exposure Report-Back. ENVIRONMENTAL HEALTH PERSPECTIVES 2023; 131:91301. [PMID: 37682723 PMCID: PMC10489875 DOI: 10.1289/ehp13493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/25/2023] [Accepted: 08/10/2023] [Indexed: 09/10/2023]
Affiliation(s)
- Anna Goodman Hoover
- Department of Epidemiology and Environmental Health, College of Public Health, University of Kentucky, Lexington, Kentucky, USA
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Lindsey M, Richmond B, Quintanar DR, Spradlin J, Halili L. Insights into Improving Risk and Safety Communication through Environmental Health Literacy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5330. [PMID: 35564724 PMCID: PMC9104598 DOI: 10.3390/ijerph19095330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/11/2022] [Accepted: 04/20/2022] [Indexed: 12/04/2022]
Abstract
Messages and materials developed to communicate risk to the public are often misunderstood because the public misperceives risk, science information is too complex, leading to audience misunderstandings, and an overarching focus on the details of the problem without supplying solutions or actions to keep the public safe. This article describes the creation of a communication model to improve risk communication that includes safety information. The authors describe essential components of Risk and Safety Communication based on features of Environmental Health Literacy (EHL), which informed the creation of a protocol for developing risk communication messages and materials. An online training module was developed to aid communicators in creating information to enable the public to protect themselves, their family, and their community, leading to improved comprehension of how the environment impacts health. These principles were developed in a series of focus groups, identifying how the public perceives risk, how they prefer to receive communication, and how participants respond to materials developed using the principles. Important topics discussed are understanding the literacy levels of the target audience, applying that understanding to developing messages, how risk perception leads to misperceptions and how to address those misperceptions by using plain language when developing focused messages and materials.
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Affiliation(s)
- Marti Lindsey
- Southwest Environmental Health Sciences Center, College of Pharmacy, University of Arizona, Tucson, AZ 85721, USA; (B.R.); (J.S.); (L.H.)
| | - Ben Richmond
- Southwest Environmental Health Sciences Center, College of Pharmacy, University of Arizona, Tucson, AZ 85721, USA; (B.R.); (J.S.); (L.H.)
| | | | - Jordan Spradlin
- Southwest Environmental Health Sciences Center, College of Pharmacy, University of Arizona, Tucson, AZ 85721, USA; (B.R.); (J.S.); (L.H.)
| | - Loren Halili
- Southwest Environmental Health Sciences Center, College of Pharmacy, University of Arizona, Tucson, AZ 85721, USA; (B.R.); (J.S.); (L.H.)
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