Bringing Real Inquiry-Based Science to Diverse Secondary Educational Environments: A Virtual Zebrafish Laboratory to Investigate Environmental Health

The goal of the University of Wisconsin-Milwaukee WInSTEP SEPA program is to provide valuable and relevant research experiences to students and instructors in diverse secondary educational settings. Introducing an online experience allows the expansion of a proven instructional research program to a national scale and removes many common barriers. These can include lack of access to zebrafish embryos, laboratory equipment, and modern classroom facilities, which often deny disadvantaged and underrepresented students from urban and rural school districts valuable inquiry-based learning opportunities. An online repository of zebrafish embryo imagery was developed in the Carvan laboratory to assess the effects of environmental chemicals. The WInSTEP SEPA program expanded its use as an accessible online tool, complementing the existing classroom experience of our zebrafish module. This virtual laboratory environment contains images of zebrafish embryos grown in the presence of environmental toxicants (ethanol, caffeine, and nicotine), allowing students to collect data on 19 anatomical endpoints and generate significant amounts of data related to developmental toxicology and environmental health. This virtual laboratory offers students and instructors the choice of data sets that differ in the independent variables of chemical concentration and duration of postfertilization exposure. This enables students considerable flexibility in establishing their own experimental design to match the curriculum needs of each instructor.

Environmental health in medical schools in France: A call from medical students

OBJECTIVE

Environmental factors contribute to more than 25% of all global disease but as medical student, we consider that environmental health is insufficiently taught. We are not armed for facing patient's questions, prevent diseases linked to environmental exposure and adapt care in susceptible population.

MATERIAL AND METHODS

We conducted a national French survey, using a web-based questionnaire from October to November 2021. All medical students were interrogated to assess their knowledge on environmental health and their desire to obtain a specific curriculum on this topic.

RESULTS

Two hundred and thirty-two students responded to the survey and most (62.7%) had never had any teaching on environmental health during their medical studies. The majority claimed to have no knowledge on environmental health (63.6%), and most had never been read or seen media content about it (59.2%). Those who had knowledge on environmental health, had been informed through social media, questioning the reliability of this content. Most (87.3%) were ready to take a specific course on environmental health issues during their medical studies in order to better inform their patients with evidence-based medicine and identify at risk population.

CONCLUSION

Through a survey, we identified the need and the emergency of implanting a curriculum on environmental medicine in our medical education.

Crosscutting environmental risk with design: A multi-site, multi-city socioecological approach for Iowa's diversifying small towns

Globally, the influx of refugee, migrant, and immigrant populations into small centers of industrialized agriculture has called attention to a looming public health crisis. As small towns shift from remote villages into rural, agri-industrial centers, they offer limited access to amenities needed to support human well-being. Our study focused on three Iowa towns that continue to experience an increase in under-represented minority populations and decline of majority populations as a proxy for studying shifting populations in an era of industrialized agriculture and global capital. We aimed to understand the socioecological impact of built environments-outdoor locations where people live and work-and likelihood of environmental exposures to impact vulnerable populations. Urban socioecological measures tend to present contradictory results in small towns due to their reliance on density and proximity. To compensate, we used post-occupancy evaluations (POE) to examine built environments for evidence of access to environmental design criteria to support healthy behaviors. The study systematically identified 44 locations on transects across three small towns to employ a 62 item POE and assess multiple environmental criteria to crosscut design with environmental health disparities. Principal-components factor analysis identified two distinct significant components for environmental risk and population vulnerability, supporting similar studies on parallel communities. Multilevel modeling found a divergence between supportive environmental design coupled with an increase environmental risk due to location. The combined effect likely contributes to environmental health disparities. The study provides a strategy for auditing small town built environments as well as insight into achieving equity.

Impact of an Educational Program on Behavioral Changes toward Environmental Health among Laotian Students

This study evaluates the effect of an integrated health care educational program on several behavioral changes related to environmental health among Laotian students. Students in the experimental group received education concerning environmental health-related issues, including air pollution and chemical exposure. Analyses of covariance (ANCOVA) and paired t-tests were conducted for the statistical analysis of the pre- and post-survey scores. The post-test scores of the experimental group regarding their risk perception and information-seeking behaviors towards air pollution and chemical exposure were higher than those of the control group after controlling for the pre-test scores. Moreover, in the experimental group, the girls' risk perception scores significantly increased after receiving the education, which was not observed in the control group. The risk perception score among non-drinking students also significantly increased after the program. These results indicate that the education program effectively enhanced the students' risk perception, especially that of girls and nondelinquent students.

Evaluating Effectiveness of Online Learning Modules in Pediatric Environmental Health Education

OBJECTIVE

Content and training about pediatric environmental health are lacking in healthcare professionals' education. In an initiative to improve pediatric environmental health education, the Pediatric Environmental Health Specialty Unit (PEHSU) program offers free, interactive, web-based ("eLearning") modules on environmental health topics. The aim of this study is to determine the effectiveness of PEHSU eLearning modules in increasing knowledge about pediatric and reproductive environmental health.

METHODS

This is a retrospective analysis of 994 users who had completed at least one of the 12 PEHSU eLearning modules and its associated pre-test and post-test scores between March 2016 and November 2018. Users who completed modules between March 2016 and April 2018 received a 6-month follow-up survey to assess the impact of the knowledge gained on their clinical practice.

RESULTS

A wide range of clinical professionals and nonclinical professionals utilized and completed the PEHSU eLearning modules. For all users, post-test scores were significantly higher than pre-test scores, with an increase of 30.55% ± 22.37 (paired t-test, p < 0.0001), after completion of eLearning modules.

CONCLUSION

PEHSU eLearning modules are effective at increasing environmental health knowledge of clinical and nonclinical professionals. Further studies are needed to determine long-term knowledge retention and clinical impact.

'12 tips for teaching environmental sustainability to health professionals'

Background: As recognition of the health impacts of climate change and other environmental challenges increases, so too does the need for health care professionals to practice healthcare sustainably. Environmental sustainability in healthcare extends beyond our traditional understanding of environmental health, which is often limited to environmental hazards and disease. Health services, professional organizations, and training institutions are increasingly forming climate and sustainability position statements and policies accordingly. To prepare future health professionals for global environmental change, environmental sustainability must be meaningfully integrated into health curricula.Aim: To provide educators with 12 tips for integrating environmental sustainability into health professional education.Methods: The authors reviewed the literature relating to climate change, environmental sustainability and health, and health professional education. By combining findings from this search with reflections on their own experience in clinical and public health teaching across nursing and midwifery, paramedicine, medicine, and public health, the authors developed recommendations for integrating environmental sustainability into health professional education.Results: These 12 tips can be used to teach students and qualified health professionals in nursing, allied health, and medicine to practice healthcare in an environmentally sustainable manner.Conclusions: Empowering health professionals to practice environmentally sustainable healthcare has economic, social, health, and environmental benefits. Teaching environmental sustainability to health professionals enhances existing learning by updating curricula with the latest evidence of how environmental determinants of health are rapidly changing and enables both educators and students to make an important contribution to safeguarding human health, the environment, and healthcare for future generations.

Environmental Health Practice Challenges and Research Needs for U.S. Health Departments

BACKGROUND

Environmental health (EH) professionals, one of the largest segments of the public health workforce, are responsible for delivery of essential environmental public health services. The challenges facing these professionals and research needs to improve EH practice are not fully understood, but 26% of EH professionals working in health departments of the United States plan to retire in 5 y, while only 6% of public health students are currently pursuing EH concentrations.

OBJECTIVES

A groundbreaking initiative was recently launched to understand EH practice in health departments of the United States. This commentary article aims to identify priority EH practice challenges and related research needs for health departments.

METHODS

A horizon scanning approach was conducted in which challenges facing EH professionals were provided by 1,736 respondents working at health departments who responded to a web-based survey fielded in November 2017. Thematic analyses of the responses and determining the frequency at which respondents reported specific issues and opportunities identified primary EH topic areas. These topic areas and related issues informed focus group discussions at an in-person workshop held in Anaheim, California. The purpose of the in-person workshop was to engage each of the topic areas and issues, through facilitated focus groups, leading to the formation of four to five related problem statements for each EH topic.

DISCUSSION

EH professionals are strategically positioned to diagnose, intervene, and prevent public health threats. Focus group engagement resulted in 29 priority problem statements partitioned among 6 EH topic areas: a) drinking water quality, b) wastewater management, c) healthy homes, d) food safety, e) vectors and public health pests, and f) emerging issues. This commentary article identifies priority challenges and related research needs to catalyze effective delivery of essential environmental public health services for common EH program areas in health departments. An unprecedented initiative to revitalize EH practice with timely and strategic recommendations for student and professional training, nontraditional partnerships, and basic and translational research activities is recommended. https://doi.org/10.1289/EHP5161.

STUDENTS POPULATION'S ATTITUDE CONCERNING ENVIRONMENTAL ISSUES IN GEORGIA

The aim of this study were to investigate the attitude of university students on the environmental issues, analyze the information received and develop measures for the participation of students in environmental health-improving and preventive activities.. The qualitative study was conducted by using face to face interviewing method with university students. Environmental pollution is one of the most important threats in Georgia and arount the world. The immediate objects of pollution are land, water, soil, air, which directly affects human health and worsens it. The participants have favorable attitudes toward the environment, but they are less involved in environmental activities. Basically these measures are limited to the so-called one-time campaigns. Based on the results, it is recommended the development of integrated measures and schemes to stimulate student participation in the implementation of socially active algorithms to improve the environment.

Environmental Health Education for Asbestos-Contaminated Communities in Italy: The Casale Monferrato Case Study

BACKGROUND

Environmental health education contributes towards increasing awareness of communities to prevent exposure to hazardous substances. Casale Monferrato, the operating site for the Eternit asbestos-cement factory from 1907 to 1986, is a prioritized asbestos-contaminated site for remediation in Italy. The area is prone to severe asbestos-related diseases. About 50 cases of mesothelioma are diagnosed in Casale Monferrato annually; mesothelioma has been shown to be caused by occupational, environmental and domestic asbestos exposure.

OBJECTIVES

The goal of this paper is to analyze the Casale Monferrato case study in terms of youth engagement in environmental health education initiatives on asbestos risk and health impact. The paper aims at underlining the lessons learned in order to share the success of this initiative with other communities living in asbestos-contaminated sites in different countries.

METHODS

Peer education methodology has been used through the Asbestos Classroom to involve teachers, students and other local stakeholders in training activities, in selection of the contents for educational materials and interactive tools, as well as in choosing the presentation process for the aforementioned knowledge sharing instruments.

FINDINGS

From November 2014 to June 2018, 185 high school students and teachers were trained through the Asbestos Classroom. Through December 2018, they trained 3,241 classroom visitors. The Classroom relies on an inclusive participative process in which young people play a key role in the network of relationships within their community.

CONCLUSIONS

The paper corroborates the importance of engaging the educational system in communication efforts aimed at fostering collective awareness on environmental risk and health-related impacts for communities living in industrially contaminated sites. Considering the global dimension of the asbestos contamination and disease burden, this experience might be of relevance both in countries that banned asbestos and in those where asbestos is not yet prohibited.

Family medicine residents' knowledge of, attitudes toward, and clinical practices related to environmental health: Multi-program survey

OBJECTIVE

To assess family medicine residents' knowledge of, attitudes toward, and clinical practices related to environmental health (EH).

DESIGN

Two-part study with questionnaire construction using a modified Delphi method, and a Web-based questionnaire administered to family medicine residents between November 2015 and January 2016.

SETTING

All Canadian family medicine programs (for questionnaire construction) and 4 Ontario family medicine training programs (for questionnaire administration).

PARTICIPANTS

First- to third-year family medicine residents (for questionnaire administration).

MAIN OUTCOME MEASURES

Responses to 93 survey items that measured family medicine residents' knowledge of, attitudes toward, and clinical practices related to EH.

RESULTS

For the final administered questionnaire, 203 of 887 (22.9%) family medicine residents responded. Although 92.0% of respondents somewhat or strongly believed that taking an environmental exposure history was important, only 18.1% of them had specific training in taking environmental exposure history, and 48.4% believed that taking an exposure history takes up too much time in office practice. While 82.9% of residents correctly identified recreational water use as a cause of gastroenteritis, only 60.2% correctly identified radon as a cause of lung cancer and 37.6% knew that elevated ground-level ozone is associated with asthma. Only 10.8% believed their supervisors had a good understanding of environmental exposures. Residents who believed their supervisors understood environmental exposures were more likely to take exposure histories for patients with uncontrolled asthma (P < .05), and those who discussed EH exposure with supervisors frequently, or thought environmental exposure histories were very important, were more likely to provide patients with EH education materials (P < .01).

CONCLUSION

Although family medicine residents are aware of the importance of assessing patients' environmental exposures, they lack training and mentorship in EH. As a health determinant of critical importance, EH should be a high priority for inclusion in postgraduate family medicine education.

Assessing the citizen science approach as tool to increase awareness on the marine litter problem

This paper provides a quantitative assessment of students' attitude and behaviors towards marine litter before and after their participation to SEACleaner, an educational and citizen science project devoted to monitor macro- and micro-litter in an Area belonging to "Pelagos Sanctuary" (Mediterranean Sea). This approach produced interesting outcomes both for the research sector of marine pollution and environmental monitoring, as well for the scientific and environmental education. Here we focus on citizen science as an effective vector for raising young people awareness of marine litter and fostering sound behaviors. A specially designed questionnaire was administered to 87 High School students, to test the validity of such approach. The results state that the students change quantitatively their perception of beach-litter causes and derived problems, and they improved their knowledge about the main marine litter sources and the role of the sea in the waste transport and deposition along the coast.

It's Time for Medical Schools to Introduce Climate Change Into Their Curricula

Climate change presents unprecedented health risks and demands universal attention to address them. Multiple intergovernmental organizations, health associations, and health professions schools have recognized the specific importance of preparing physicians to address the health impacts of climate change. However, medical school curricula have not kept pace with this urgent need for targeted training.The authors describe the rationale for inclusion of climate change in medical education and some potential pathways for incorporating this broad topic into physician training and continuing medical education. Reasons include the magnitude and reach of this transboundary issue, the shared responsibility of the U.S. health care sector as a major contributor to greenhouse gas emissions, and the disproportionate effects of climate change on vulnerable populations. The integration of climate-change-related topics with training of essential physician skills in a rapidly changing environment is feasible because many health topic areas already exist in medical school curricula in which climate change education can be incorporated. To fully integrate the health topics, underlying concepts, and the needed clinical and system-wide translations, content could be included across the scope of training and into continuing medical education and faculty development. The authors provide examples of such an approach to curricular inclusion.

Educating speech-language pathologists working in early intervention on environmental health

BACKGROUND

The goals of this study were (1) to determine early intervention (EI) Speech-Language Pathologists' (SLPs) level of training and knowledge on environmental toxicants and their effect on infant and child development; and (2) to examine the effectiveness of a continuing education (CE) event designed to enhance the knowledge of EI SLPs on environmental toxicants and their effects on child development.

METHODS

A survey was launched via Qualtrics and posted on the American Speech-Language Hearing Association's Early Intervention Community page to assess environmental health knowledge of SLPs. Results from this survey were used to create an environmental health CE event targeted towards EI SLPs. Attendees were given a pre- and post-test to assess the effectiveness of our program.

RESULTS

One hundred and fifty-eight participants completed the online survey and a majority (61%, n = 97) of participants reported some level of dissatisfaction with their previous training in regards to environmental exposures. Fifty-six percent (n = 89) of the participants also reported feeling unprepared to be a health advocate regarding environmental exposure concerns within their community. Forty-eight people (26 SLPs and 22 SLP master's students) attended the CE event. Paired t-tests revealed significant improvements from the pre- to the post- test results among all attendees.

CONCLUSIONS

These findings suggest that SLPs who work in EI feel undertrained and unprepared to advocate for environmental health to the families they serve. This study reveals that CE is one way by which to increase the knowledge base of SLPs on environmental health.

["The eco-nurse is an expert in environmental health"]

Eco-nurses are trained in environmental health in order to act as a resource person with the public and health professionals. Experts in the field, their scope of action is broad, both targeted and on a more global scale. Philippe Perrin is an eco-nurse and the director of the Environmental Health Training Institute in France.

[Environmental health, the patient's point of view and expectations]

The place which people give to their living environment is dependent on how much information they have and their perception of the risks for their health. Nowadays, patients are asking more questions regarding outdoor and indoor pollution. However, the information they are given is not always sufficient. The answers provided by nursing and medical professionals could be complemented by information from relevant associations.

[Environmental health education]

Environmental health education aims to reduce the impact of risk factors for patients. The caregiver's role is to adopt a positive education approach with concrete ways of controlling the living environment. He or she must support people in asserting their choices in terms of health and to make their own contribution to reducing risks.

The Importance of Clinicians and Community Members Receiving Timely and Accurate Information about Waterborne Hazards

It is important for clinicians and community members to receive up-to-date information about the microbiological and elemental composition of local water supplies. Clinicians play an important role in helping their patients to interpret water quality data and understand the potential impact of water quality on their health. Expanding the medical school curriculum to include environmental health, public health, and health disparities-including disparities related to environmental quality and waterborne hazards-is key to clinicians' fulfilling this role.

Waterborne Disease Case Investigation: Public Health Nursing Simulation

BACKGROUND

The lack of safe drinking water is a significant public health threat worldwide. Registered nurses assess the physical environment, including the quality of the water supply, and apply environmental health knowledge to reduce environmental exposures. The purpose of this research brief is to describe a waterborne disease simulation for students enrolled in a public health nursing (PHN) course.

METHOD

A total of 157 undergraduate students completed the simulation in teams, using the SBAR (Situation-Background-Assessment-Recommendation) reporting tool. Simulation evaluation consisted of content analysis of the SBAR tools and debriefing notes.

RESULTS

Student teams completed the simulation and articulated the implications for PHN practice. Student teams discussed assessment findings and primarily recommended four nursing interventions: health teaching focused on water, sanitation, and hygiene; community organizing; collaboration; and advocacy to ensure a safe water supply.

CONCLUSION

With advanced planning and collaboration with partners, waterborne disease simulation may enhance PHN education. [J Nurs Educ. 2017;56(1):39-42.].

Quality means decency-on the quality of teaching through accreditation of the course?

The term "accreditation" applies to the attempts in various fields of scientific work and administration. It refers to an acknowledgement of some particular positive (wanted) property being present in or brought about by either a procedure or technical system, an acknowledgement which is then formally issued by some authority generally accepted to be able to prove and file such statements. Bioindication & Biomonitoring (B&B) technologies are highly influenced by accreditation procedures, because both B&B technologies are often related to accreditation during the overall instrumental measurement processes applied. As an example, tuna fish used for (bio) monitoring salt water systems on pollution by Pb will be presented. Analytical measurement results from the International Measurement Evaluation Programme (IMEP 20) and additionally the construction of the university course "Integrative sustainable management: quality, environmental, health, safety and risk management (QUAR)" are reviewed in this respect. It was a serious finding by the multi-participant IMEP study that neither quality control measures nor accreditation actually ensure improved quality of measurement results, i.e. data produced by analytical laboratories. Accordingly, even though the accreditation of study curricula is often done with utmost diligence and precision, and while it is fairly important for making study curricula throughout Europe (and the World) fitting and comparable to each other to get study results produced and tested at university X also be accepted when changing to university Y, we cannot assume or take for granted that the mere protocol of accreditation will do anything positive to improve the chance to get better or "more correct" results. A single member of lab staff or professor changing to some other position might seriously compromise the turnout of some analytical lab or university course at least in the short term regardless of whether accreditation was done or not. As consequence, data obtained by B&B technologies have to be discussed and handled with the highest care to reach acceptable and scientifically sound goals of quality.

Incorporating one health into medical education

One Health is an emerging concept that stresses the linkages between human, animal, and environmental health, as well as the need for interdisciplinary communication and collaboration to address health issues including emerging zoonotic diseases, climate change impacts, and the human-animal bond. It promotes complex problem solving using a systems framework that considers interactions between humans, animals, and their shared environment. While many medical educators may not yet be familiar with the concept, the One Health approach has been endorsed by a number of major medical and public health organizations and is beginning to be implemented in a number of medical schools. In the research setting, One Health opens up new avenues to understand, detect, and prevent emerging infectious diseases, and also to conduct translational studies across species. In the clinical setting, One Health provides practical ways to incorporate environmental and animal contact considerations into patient care. This paper reviews clinical and research aspects of the One Health approach through an illustrative case updating the biopsychosocial model and proposes a basic set of One Health competencies for training and education of human health care providers.

A Community-Based Participatory Research Approach to Identifying Environmental Concerns

A community-based participatory research process was used to develop an environmental initiative in Wichita, Kansas, called the Wichita Initiative to Renew the Environment (WIRE). The two-year project, led by University of Kansas School of Medicine–Wichita faculty and a community-based organization, was funded by the U.S. Environmental Protection Agency. The project aimed to identify, prioritize, and address Wichitans’ environmental concerns by engaging the community to assist in developing the project design, establish a community-based environmental leadership council to guide the project, and identify and prioritize the community’s environmental concerns based on impact and perceived urgency for action. The collaboration identified community priorities as: trash disposal, pollution in the Arkansas River and groundwater, and mobile source air pollution. Through WIRE, community members actively engaged and participated in identifying and prioritizing 19 environmental concerns most pertinent to the community, establishing an organization of 25 community members, and setting the stage for future projects to address those problems.

Environmental pediatrics: an introduction and evaluation of online resources

INTRODUCTION

The World Health Organization (WHO) estimates that three million children under the age of 5 die annually from environmentally related disease. In the United States, the cost of environmentally related public health concerns is estimated as greater than $55 billion. Environmental exposure is among parents' top health concerns for children. Yet, the study of the effects of environmental exposure on health outcomes is a developing field, and clinicians feel inadequately prepared to address these concerns. The Children's Environmental Health Clinic (ChEHC) is the first clinic of its kind in Canada. Their website includes a list of online resources on major topics related to child health and the environment. There has not yet been an objective evaluation of the comprehensiveness of the topics or scientific quality of the information on the website. This study seeks to offer an accessible introduction to the field of environmental pediatrics, including an online resource for evidence-based information on key topics in the field. These resources assist in disease prevention, health promotion, education, and the increasing need to balance environmental health risks.

METHODS

A scoping review of scientific and gray literature in the field of environmental pediatrics was performed to inform a written introduction to the field and to identify gaps in the content of the ChEHC website. The content of the ChEHC website was then objectively evaluated using the National Network of Libraries of Medicine checklist for health websites.

RESULTS

Ten categories within the field of environmental pediatrics emerged from the literature review. A small number of gaps were identified on the website and in the literature. The content of the ChEHC website was found to be of high quality.

FUTURE DIRECTIONS

The website will be updated using the results of the study as a guide, to make it as relevant, complete, and evidence-based as possible.

CONCLUSIONS

Environmental pediatrics is an important, emerging topic. There is a need for accessible, evidence-based pediatric environmental health resources for clinicians and the general public. The products of this study (a publication and website) respond to that need and thus assist in disease prevention and health promotion.

A Multimedia E-Book-A Story of Health: Filling a Gap in Environmental Health Literacy for Health Professionals

Narrative approaches and storytelling are emerging as powerful health promotion tools that can spark interest, increase understanding of determinants of health, and translate complex science. A Story of Health, a multimedia e-book with continuing education credits was designed to harness the power of storytelling to increase environmental health literacy. Health professionals are a key audience. They recognize that patients may be suffering from preventable illnesses of environmental origin but often feel ill-equipped to educate individuals and families about risks associated with common exposures. A Story of Health seeks to fill this gap and help readers develop the competencies they need in order to help patients make informed choices, reduce health risks, improve quality of life, and protect the environment. Americans rate nurses and medical doctors as having the highest honesty and ethical standards of all professions. These medical professionals can play a key role in changing patterns of patient behavior and influencing public policies. The e-book provides an easily accessible method of developing environmental health competency. The multimedia format with graphical interpretations allows for quick reviews of topics or for more in-depth analysis via links to additional resources. The CE evaluations have been overwhelmingly positive.

Survey of Accredited Master of Public Health (MPH) Programs With Health Education Concentrations: A Resource for Strengthening the Public Health Workforce

The authors designed survey research to assess accredited master of public health (MPH) programs with health education concentrations. A Web-based survey was distributed to program directors and was used to collect characteristics of program faculty, students, graduates, internships, employment, and competency development. Results indicate that students and graduates are diverse; 72% of students complete internships and 61% of graduates work in government or community public health–related agencies; 98% of faculty hold a doctoral degree and 67% have at least one degree from an accredited public health school or program; and 85% of programs build competencies in most of the Institute of Medicine–suggested areas. The authors conclude that accredited MPH programs with a concentration in health education train diverse public health practitioners highly likely to work in a government or community public health agency with competencies to enhance public health.

New Emergency Response Training for Environmental Health Professionals

NEHA strives to provide up-to-date and relevant information on environmental health and to build partnerships in the profession. In pursuit of these goals, we feature a column from the Environmental Health Services Branch (EHSB) of the Centers for Disease Control and Prevention (CDC) in every issue of the Journal. In these columns, EHSB and guest authors share insights and information about environmental health programs, trends, issues, and resources. The conclusions in this article are those of the author(s) and do not necessarily represent the views of CDC. Martin Kalis is a public health advisor with CDC’s EHSB. He is the program manager for CDC’s Environmental Health Training in Emergency Response (EHTER). Bernice Zaidel is the assistant director of curriculum development and evaluation at the Federal Emergency Management Agency’s Center for Domestic Preparedness (CDP). She is CDP’s lead for partnering with EHSB and developing EHTER courses.

Community-based efforts in health promotion in indigenous villages on the Thailand-Myanmar border

This case study of mainly Karen and Mon communities in Kanchanaburi Province, western Thailand, offers insight into the challenges that these rural villages face with regard to food security and environmental health issues. As non-Thai communities, these villages receive little support from the Thai government, and are often vulnerable in terms of access to food markets, infrastructure, and education and livelihood opportunities. This discussion further considers the involvement of Pattanarak Foundation, a Thai NGO, in health promotion and economic development in these villages as an example of a community partnership at the grassroots level. Examining Pattanarak's efforts to build skills in household vegetable gardening and livestock-raising, raise awareness about child nutrition issues, and improve community sanitation illustrates the value of a participatory process, and also demonstrates some of the challenges associated with on-the-ground health promotion in disadvantaged rural communities. Applying a community-based participatory research (CBPR) framework to pursue partnerships between communities, NGOs, and researchers may offer an avenue for effective interventions to improve health in marginalized communities.

A Scoping Review of Maternal and Child Health Clinicians Attitudes, Beliefs, Practice, Training and Perceived Self-Competence in Environmental Health

Clinicians regularly assess, diagnose and manage illnesses which are directly or indirectly linked to environmental exposures. Yet, various studies have identified gaps in environmental assessment in routine clinical practice. This review assessed clinicians' environmental health practices, attitudes and beliefs, and competencies and training. Relevant articles were sought using a systematic search strategy using five databases, grey literature and a hand search. Search strategies and protocols were developed using tailored mesh terms and keywords. 43 out of 11,291 articles were eligible for inclusion. Clinicians' attitudes and beliefs towards environmental health and routine clinical practice were generally positive, with most clinicians believing that environmental hazards affect human health. However, with the exception of tobacco smoke exposure, environmental health assessment was infrequently part of routine clinical practice. Clinicians' self-competence in environmental assessment was reported to be inadequate. Major challenges were the time required to complete an assessment, inadequate training and concerns about negative patients' responses. Clinicians have strong positive attitudes and beliefs about the importance of environmental health assessments. However, more concerted and robust strategies will be needed to support clinicians in assuming their assessment and counselling roles related to a wider range of environmental hazards.

Needs assessment survey for Master's of Science training in environmental health science in Swaziland

A needs assessment survey research was carried out for Master's of Science training in environmental health in Swaziland. The objective of the survey was to acquire information on training needs, gaps, options of specializations, program structure, courses, topics, and research areas that are relevant to the needs of the stakeholders and sector organizations related to environmental health. A document study, focus group discussion with key informants, stakeholder forum workshop, and needs assessment questionnaire to the wider stakeholders were used for the study described here. The findings of the authors' study point to a shortage of qualified personnel in environmental health; lack of capacity in strategy planning and project management; and lack of capacity in research, data collection, and environmental monitoring skills, among other things. A program structure that takes into account the multidisciplinary nature of environmental health with provisions for specialization was favored. Suggestions on course content, mode of delivery, and research topics to be addressed were also given.

Acceptability of health information technology aimed at environmental health education in a prenatal clinic

OBJECTIVE

To describe the acceptability of an interactive computer kiosk that provides environmental health education to low-income Latina prenatal patients.

METHODS

A mixed-methods approach was used to assess the acceptability of the Prenatal Environmental Health Kiosk pregnant Latina women in Salinas, CA (n=152). The kiosk is a low literacy, interactive touch-screen computer program with an audio component and includes graphics and an interactive game.

RESULTS

The majority had never used a kiosk before. Over 90% of women reported that they learned something new while using the kiosk. Prior to using the kiosk, 22% of women reported their preference of receiving health education from a kiosk over a pamphlet or video compared with 57% after using the kiosk (p<0.01). Qualitative data revealed: (1) benefit of exposure to computer use; (2) reinforcing strategy of health education; and (3) popularity of the interactive game.

CONCLUSION

The Prenatal Environmental Health Kiosk is an innovative patient health education modality that was shown to be acceptable among a population of low-income Latino pregnant women in a prenatal care clinic.

PRACTICE IMPLICATIONS

This pilot study demonstrated that a health education kiosk was an acceptable strategy for providing Latina prenatal patients with information on pertinent environmental exposures.

Nursing education's response to the 1995 Institute of Medicine Report: Nursing, Health, and the Environment

PROBLEM

Although environmental health has been central to nursing practice since the work of Florence Nightingale, the inclusion of environmental health concepts into nursing education has, for the most part, been confined to public health and occupational health nursing. The 1995 Institute of Medicine report, Nursing, Health, and the Environment, clearly stated that environmental health was an important aspect of nursing practice, but nurses were not adequately educated to address such in their practice.

METHODS

This article highlights the initiatives by nurse educators, faculty development programs, federal agencies, nonprofit organizations, and private foundations to educate and engage nurses in environmental health since 1995, with a focus on the Alliance of Nurses for Healthy Environments. The historical summary was developed using professional literature, documents, personal interviews, and survey data.

FINDINGS

Nurses responded to the mandates of the 1995 Institute of Medicine report, Nursing, Health, and the Environment, in formal educational programs, through continuing education for nurses, workshops, symposia, and regional faculty development trainings. Since the formation of the Alliance of Nurses for Healthy Environments, collaborative efforts led to the development of competencies, nursing outreach to organizations such as the American Nursing Association, the National Council of State Boards of Nursing, and the American Association of Colleges of Nursing to advance practice standards, academic curriculum, and the development of an electronic textbook.

CONCLUSION

The environmental health nursing agenda moved forward since the publication of the 1995 IOM report; however, the development of the Alliance of Nurses for Healthy Environments accelerated the educational accomplishments through organizational collaboration.

A novel integration of online and flipped classroom instructional models in public health higher education

BACKGROUND

In 2013, a cohort of public health students participated in a 'flipped' Environmental and Occupational Health course. Content for the course was delivered through NextGenU.org and active learning activities were carried out during in-class time. This paper reports on the design, implementation, and evaluation of this novel approach.

METHODS

Using mixed-methods, we examined learning experiences and perceptions of the flipped classroom model and assessed changes in students' self-perceived knowledge after participation in the course. We used pre- and post-course surveys to measure changes in self-perceived knowledge. The post-course survey also included items regarding learning experiences and perceptions of the flipped classroom model. We also compared standard course review and examination scores for the 2013 NextGenU/Flipped Classroom students to previous years when the course was taught with a lecture-based model. We conducted a focus group session to gain more in-depth understanding of student learning experiences and perceptions.

RESULTS

Students reported an increase in knowledge and survey and focus group data revealed positive learning experiences and perceptions of the flipped classroom model. Mean examination scores for the 2013 NextGenU/Flipped classroom students were 88.8% compared to 86.4% for traditional students (2011). On a scale of 1-5 (1 = lowest rank, 5 = highest rank), the mean overall rating for the 2013 NextGenU/Flipped classroom students was 4.7/5 compared to prior years' overall ratings of 3.7 (2012), 4.3 (2011), 4.1 (2010), and 3.9 (2009). Two key themes emerged from the focus group data: 1) factors influencing positive learning experience (e.g., interactions with students and instructor); and 2) changes in attitudes towards environmental and occupation health (e.g., deepened interest in the field).

CONCLUSION

Our results show that integration of the flipped classroom model with online NextGenU courses can be an effective innovation in public health higher education: students achieved similar examination scores, but NextGenU/Flipped classroom students rated their course experience more highly and reported positive learning experiences and an increase in self-perceived knowledge. These results are promising and suggest that this approach warrants further consideration and research.

[The air belongs to us: the importance of maintaining air quality]

Interest in identifying the long-term harmful effects of atmospheric pollution on respiratory health, and concern about this issue, has prompted several studies, whose results have been published throughout this year. On the occasion of the Spanish Society of Pneumology and Thoracic Surgery's Year of the Environment, from the Section of Occupational and Environmental Respiratory Diseases, we review the advances made in the effects of atmospheric pollution on respiratory health and the actions undertaken by the Society. The main objective of the Society's Year of the Environment is to inform citizens in general and respiratory patients in particular of the benefits of breathing clean air. The first step in achieving this aim is education. The goal is to educate young people in lasting habits that promote a respectful attitude to the environment, inculcating them with the need for sustainable development through responsible energy consumption and reduction of the emission of pollutants. Informed citizens will demand public health policies aimed at maintaining the quality of the air we breathe from politicians. The website www.elaireesnuestro.com provides information and educational material on the subject.