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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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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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Pfleger E, Lutz R, Drexler H. [Environmental risks and health literacy: a systematic review]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2024; 67:85-98. [PMID: 37823907 PMCID: PMC10776732 DOI: 10.1007/s00103-023-03782-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 09/21/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Environmental factors can play an important role in pathogenesis. However, the understanding of the relationship between environmental risks and health in the general population appears to be poor. The aim of this systematic review is to describe the state of research on the relationship between health literacy (HL) or environmental health literacy (EHL) and environmental risks differentiated by the researched environmental risks, the affected population, the measurement and level of HL or EHL, and their interaction with other variables. METHODS A systematic literature search was conducted using the Pubmed, Scopus, and LIVIVO databases. Original studies in German or English that investigated HL or EHL in the context of an environmental risk or pollutant in a population were included. The Navigation Guide was used to assess the methodological quality of the studies. RESULTS Twenty-four studies were included in the qualitative analysis. The operationalization of HL or EHL was heterogeneous in 22 studies. Nine studies referred to environmental issues in general, and 15 studies analyzed individual environmental risks. Eleven studies referred to the general population, 12 to specified target groups, and 1 study examined both. The level of HL or EHL proved to be in need of improvement in all populations. Interventions such as trainings were able to increase HL or EHL. DISCUSSION The heterogeneous operationalizations impede the comparability of the studies. Future work should target the standardization of methodological aspects. Overall, it appears that interventions such as trainings were conducive to improving HL or EHL. In practice, this should therefore be given greater focus in order to increase HL or EHL.
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Affiliation(s)
- Elisabeth Pfleger
- Institut und Poliklinik für Arbeits‑, Sozial- und Umweltmedizin, Friedrich-Alexander-Universität Erlangen-Nürnberg, Henkestraße 9-11, 91054, Erlangen, Deutschland.
| | - Regina Lutz
- FOM Hochschule für Oekonomie & Management, Essen, Deutschland
| | - Hans Drexler
- Institut und Poliklinik für Arbeits‑, Sozial- und Umweltmedizin, Friedrich-Alexander-Universität Erlangen-Nürnberg, Henkestraße 9-11, 91054, Erlangen, Deutschland
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Vrotsou K, Subiza-Pérez M, Lertxundi A, Vergara I, Marti-Carrera I, Ochoa de Retana L, Duo I, Ibarluzea J. Environmental health knowledge of healthcare professionals: Instrument development and validation using the Rasch model. ENVIRONMENTAL RESEARCH 2023; 235:116582. [PMID: 37454800 DOI: 10.1016/j.envres.2023.116582] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/05/2023] [Accepted: 07/06/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION environmental risk factors constitute a major public health issue, calling for preventive actions and interventions at multiple levels. An important step in this direction is increasing the environmental health (EH) knowledge of the healthcare professionals. In this context, tools designed to measure such knowledge are of imperative importance. The aim of the present study was to develop an EH knowledge tool for healthcare professionals. METHODS a group of experts defined the knowledge areas of the EH tool and their corresponding items. An online pilot and a validation study were performed. Internal consistency reliability was measured with the Kuder-Richardson 20 (KR-20) estimate, the construct validity and uni-dimensionality of the tool were assessed with the Rasch model. Known-groups validity was analysed with the two-sample t-test. RESULTS a total of n = 151 and n = 444 healthcare professionals and end-year medical and nursing students, participated in the pilot and the validation study, respectively. The resulting 33-item EH knowledge questionnaire for healthcare professionals (EHKQ-HP) obtained a KR-20 = 0.82. The scale is uni-dimensional. Its construct validity was verified, and its items cover a wide range of difficulties. Separation statistics were adequate and known-groups behaved as hypothesized. CONCLUSIONS the EHKQ-HP is a valuable resource for measuring the EH knowledge of the healthcare professionals. As such it will be useful in detecting EH knowledge gaps, and helping public health agents in making informed decisions when developing interventions for increasing this very knowledge. This would consequently help in improving the health of the general population.
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Affiliation(s)
- Kalliopi Vrotsou
- Osakidetza Health Care Directorate, PC-IHO Research Unit of Gipuzkoa, San Sebastian, Spain; Biodonostia Health Research Institute, Primary Care Group, San Sebastian, Spain; Network for Research on Chronicity, Primary Care and Health Promotion (RICAPPS), Spain
| | - Mikel Subiza-Pérez
- Biodonostia Health Research Institute, Group of Environmental Epidemiology and Child Development, San Sebastian, Spain; Department of Clinical and Health Psychology and Research Methods, University of the Basque Country UPV/EHU, San Sebastian, Spain; Bradford Institute for Health Research, Bradford, UK; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, Madrid, Spain.
| | - Aitana Lertxundi
- Biodonostia Health Research Institute, Group of Environmental Epidemiology and Child Development, San Sebastian, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, Madrid, Spain; Faculty of Medicine, University of the Basque Country (UPV/EHU), San Sebastian, Spain
| | - Itziar Vergara
- Osakidetza Health Care Directorate, PC-IHO Research Unit of Gipuzkoa, San Sebastian, Spain; Biodonostia Health Research Institute, Primary Care Group, San Sebastian, Spain; Network for Research on Chronicity, Primary Care and Health Promotion (RICAPPS), Spain
| | - Itxaso Marti-Carrera
- Biodonostia Health Research Institute, Paediatric Group, San Sebastian, Spain; Donostia University Hospital-Osakidetza, Department of Paediatrics, San Sebastian, Spain; Department of Paediatrics, University of the Basque Country UPV/EHU, San Sebastian, Spain
| | - Lourdes Ochoa de Retana
- Osakidetza Health Care Directorate, Sub-directorate for the Coordination of Primary Care, Active Patient Programme, San Sebastian, Spain
| | - Irene Duo
- Osakidetza Health Care Directorate, Sub-directorate for the Coordination of Primary Care, Active Patient Programme, San Sebastian, Spain
| | - Jesus Ibarluzea
- Biodonostia Health Research Institute, Group of Environmental Epidemiology and Child Development, San Sebastian, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, Madrid, Spain; Ministry of Health of the Basque Government, Sub-Directorate for Public Health and Addictions of Gipuzkoa, San Sebastian, Spain; Faculty of Psychology, University of the Basque Country (UPV/EHU), San Sebastian, Spain
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Elshaer S, Martin LJ, Baker TA, Roberts E, Rios-Santiago P, Kaufhold R, Butsch Kovacic M. Environmental Health Knowledge Does Not Necessarily Translate to Action in Youth. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3971. [PMID: 36900981 PMCID: PMC10001797 DOI: 10.3390/ijerph20053971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 02/15/2023] [Accepted: 02/21/2023] [Indexed: 06/18/2023]
Abstract
Environmental challenges pose serious health problems, especially for children, and lay public action is lacking. This study sought to characterize the relationship between environmental health knowledge and behavior in youth. A cross-sectional, descriptive survey with quantitative and qualitative questions was conducted. Open-ended questions were coded to generate themes/subthemes. Subscales' scores were presented as mean ± SD or median and interquartile range (IQR). T- and Mann-Whitney tests were used to compare groups, and correlations were used to evaluate covariation. A total of 452 children were surveyed. Youth verbalized concerns about their environments and their impact on health. Air pollution was the most concerning issue. Participants had moderate knowledge scores. Few described the three health domains; even fewer included environment. Behavior scores were low and weakly correlated with knowledge, but were moderately correlated with attitude and self-efficacy. Participation in environmental classes, activities, and clubs was associated with higher scores. We found variable environmental health knowledge, limited understanding of the local environment's impact on health, and a weak association between youth's knowledge and behavior. Focused formal and non-formal educational experiences were associated with improved scores, indicating the value of targeted youth educational programming to increase environmental health knowledge and action.
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Affiliation(s)
- Shereen Elshaer
- Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
- Department of Public Health and Preventive Medicine, Mansoura University Faculty of Medicine, Mansoura City 35516, Egypt
| | - Lisa J. Martin
- Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
| | - Theresa A. Baker
- Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
| | - Erin Roberts
- Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
| | - Paola Rios-Santiago
- Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
| | - Ross Kaufhold
- Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
- Shriver National Institute of Child Health and Human Development, Bethesda, MD 20847, USA
| | - Melinda Butsch Kovacic
- Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
- Department of Rehabilitation, Exercise, and Nutrition Sciences, The University of Cincinnati College of Allied Health Sciences, Cincinnati, OH 45267, 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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Miller AL. Environmental contaminants and child development: Developmentally-informed opportunities and recommendations for integrating and informing child environmental health science. New Dir Child Adolesc Dev 2022; 2022:173-193. [PMID: 36040401 PMCID: PMC9804544 DOI: 10.1002/cad.20479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
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.
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Affiliation(s)
- Alison L. Miller
- School of Public HealthUniversity of MichiganAnn ArborMichiganUSA
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