Journal of Environmental and Public Health The latest articles from Hindawi Publishing Corporation © 2016 , Hindawi Publishing Corporation . All rights reserved. Valuing the Economic Costs of Allergic Rhinitis, Acute Bronchitis, and Asthma from Exposure to Indoor Dampness and Mold in the US Sun, 29 May 2016 12:28:40 +0000 Two foundational methods for estimating the total economic burden of disease are cost of illness (COI) and willingness to pay (WTP). WTP measures the full cost to society, but WTP estimates are difficult to compute and rarely available. COI methods are more often used but less likely to reflect full costs. This paper attempts to estimate the full economic cost (2014$) of illnesses resulting from exposure to dampness and mold using COI methods and WTP where the data is available. A limited sensitivity analysis of alternative methods and assumptions demonstrates a wide potential range of estimates. In the final estimates, the total annual cost to society attributable to dampness and mold is estimated to be $3.7 (2.3–4.7) billion for allergic rhinitis, $1.9 (1.1–2.3) billion for acute bronchitis, $15.1 (9.4–20.6) billion for asthma morbidity, and $1.7 (0.4–4.5) billion for asthma mortality. The corresponding costs from all causes, not limited to dampness and mold, using the same approach would be $24.8 billion for allergic rhinitis, $13.5 billion for acute bronchitis, $94.5 billion for asthma morbidity, and $10.8 billion for asthma mortality. David H. Mudarri Copyright © 2016 David H. Mudarri. All rights reserved. The LINA Study: Higher Sensitivity of Infant Compared to Maternal Eosinophil/Basophil Progenitors to Indoor Chemical Exposures Thu, 26 May 2016 12:57:28 +0000 Purpose. Enhanced eosinophil/basophil (Eo/B) progenitor cell levels are known to be associated with allergic inflammation and atopy risk. The aim of the present study was to investigate the influence of different indoor exposures on the recruitment and differentiation of Eo/B progenitors in mother-child pairs. Methods. In 68 mother-child pairs of the LINA study peripheral blood mononuclear cells were used to assess Eo/B colony forming units (CFUs). Information about disease outcomes and indoor exposures was obtained from questionnaires. Indoor concentrations of volatile organic compounds (VOCs) were measured by passive sampling. Results. Infant’s Eo/B CFUs were positively associated with exposure to tobacco smoke, disinfectants, or VOCs. In contrast, for maternal Eo/B CFUs, only a few associations were seen. Higher numbers of infant Eo/B CFUs were observed in children with wheezing symptoms within the second year of life. Conclusions. We demonstrate that infant’s hematopoietic cells seem to respond with more sensitivity to environmental exposure compared to maternal cells. At least in infants, an activation of these hematopoietic cells by environmental exposure could contribute to an enhanced risk for the development of respiratory outcomes. Friederike Hörnig, Tibor Kohajda, Stefan Röder, Gunda Herberth, Martin von Bergen, Michael Borte, Ulrike Diez, Ulrike Rolle-Kampczyk, Jan-C. Simon, Judah A. Denburg, Irina Lehmann, and Kristin M. Junge Copyright © 2016 Friederike Hörnig et al. All rights reserved. The Impact of General Strike on Government Healthcare Delivery in Kerala State in India Tue, 03 May 2016 09:16:40 +0000 General strike (also known as hartal) is used as a mode of protest by organizations and political parties in India. It is generally thought that hartals negatively impact the healthcare delivery in a society. We used the Right to Information Act to obtain data from government health centers in Kerala state in India for four hartal days (H-day) and two control days (A-day and B-day) for each H-day, from sixteen health centers including 6 Community Health Center (CHC), 6 Secondary Health Center (SHC), and 4 Tertiary Health Center (THC). Data on emergency room visits was available for six HCs. 15 HCs had a statistically significant decrease in the number of outpatient visits on H-day. There was no difference in the number of outpatient visits between the two control days (A and B) in 15 HCs, suggesting the lack of a posthartal surge in visits. Median decrease in outpatient visits in CHCs, SHCs, and THCs was 50.4%, 59.5%, and 47.4%, respectively. Hartal did not impact the number of emergency room visits in 6 out of 7 health centers assessed. Our study identified a significant harmful impact on government healthcare delivery due to hartals in Kerala. These findings have major public health implications. Aasems Jacob, Heidi Weiss, and Aju Mathew Copyright © 2016 Aasems Jacob et al. All rights reserved. Determinants of Early Marriage from Married Girls’ Perspectives in Iranian Setting: A Qualitative Study Wed, 30 Mar 2016 07:49:10 +0000 Early marriage is a worldwide problem associated with a range of health and social consequences for teenage girls. Designing effective health interventions for managing early marriage needs to apply the community-based approaches. However, it has received less attention from policymakers and health researchers in Iran. Therefore, the current study aimed to explore determinants of early marriage from married girls’ perspectives. The study was conducted from May 2013 to January 2015 in Ahvaz, Iran. A purposeful sampling method was used to select fifteen eligible participants. Data were collected through face-to-face, semistructured interviews and were analyzed using the conventional content analysis approach. Three categories emerged from the qualitative data including “family structure,” “Low autonomy in decision-making,” and “response to needs.” According to the results, although the participants were not ready to get married and intended to postpone their marriage, multiple factors such as individual and contextual factors propelled them to early marriage. Given that early marriage is a multifactorial problem, health care providers should consider a multidimensional approach to support and empower these vulnerable girls. Simin Montazeri, Maryam Gharacheh, Nooredin Mohammadi, Javad Alaghband Rad, and Hassan Eftekhar Ardabili Copyright © 2016 Simin Montazeri et al. All rights reserved. Food Insecurity Is Associated with Undernutrition but Not Overnutrition in Ecuadorian Women from Low-Income Urban Neighborhoods Wed, 23 Mar 2016 12:36:38 +0000 Household food insecurity (HFI) is becoming an increasingly important issue in Latin America and other regions undergoing rapid urbanization and nutrition transition. The survey investigated the association of HFI with the nutritional status of 794 adult women living in households with children in low-income neighborhoods in Quito, Ecuador. Data were collected on sociodemographic characteristics, household food security status, and nutritional status indicators (dietary intake, anthropometry, and blood hemoglobin). Data were analyzed using multivariate methods. The findings identified revealed a high HFI prevalence (81%) among the urban households that was associated with lower per capita income and maternal education; long-term neighborhood residency appeared protective. HFI was associated with lower dietary quality and diversity and an increased likelihood of anemia and short stature but not increased high-calorie food intake or generalized or abdominal obesity. Although significant progress has been made in recent years, low dietary diversity, anemia, and growth stunting/short stature in the Ecuadorian maternal-child population continue to be major public health challenges. The study findings suggest that improving urban food security may help to improve these nutritional outcomes. They also underscore the need for food security policies and targeted interventions for urban households and systematic surveillance to assess their impact. M. Margaret Weigel, Rodrigo X. Armijos, Marcia Racines, and William Cevallos Copyright © 2016 M. Margaret Weigel et al. All rights reserved. Factors Influencing Attitude, Safety Behavior, and Knowledge regarding Household Waste Management in Guinea: A Cross-Sectional Study Tue, 22 Mar 2016 16:02:09 +0000 Waste indiscriminate disposal is recognized as an important cause of environmental pollution and is associated with health problems. Safe management and disposal of household waste are an important problem to the capital city of Guinea (Conakry). The objective of this study was to identify socioeconomic and demographic factors associated with practice, knowledge, and safety behavior of family members regarding household waste management and to produce a remedial action plan. I found that no education background, income, and female individuals were independently associated with indiscriminate waste disposal. Unplanned residential area was an additional factor associated with indiscriminate waste disposal. I also found that the community residents had poor knowledge and unsafe behavior in relation to waste management. The promotion of environmental information and public education and implementation of community action programs on disease prevention and health promotion will enhance environmental friendliness and safety of the community. Keita Mamady Copyright © 2016 Keita Mamady. All rights reserved. Practices, Concerns, and Willingness to Participate in Solid Waste Management in Two Urban Slums in Central Uganda Mon, 14 Mar 2016 07:02:08 +0000 Poor solid waste management is among the major challenges facing urban slums in developing countries including Uganda. Understanding community concerns and willingness towards involvement in solid waste management improvement initiatives is critical for informing interventions in slums. Methods. We used a cross-sectional study to collect quantitative data from 435 residents in two urban slums in central Uganda. A semistructured questionnaire was used which assessed waste collection practices, separation and disposal methods, concerns regarding solid wastes, and willingness to participate in waste separation and composting. Data was analysed using STATA 12. Results. Food remains (38%) and plastics (37%) formed the biggest proportion of wastes generated in households. Most households (35.9%) disposed of general wastes by open dumping while 27% disposed of plastics by burning. Only 8.8% of households conducted composting while 55% carried out separation for some decomposable wastes. Separation was carried out for only banana peelings and leftover foods for feeding animals. Respondents expressed high willingness to separate (76.6%) and compost (54.9%) solid wastes. Conclusion. Practices in waste disposal and separation were poor despite high willingness to participate in initiatives to improve waste management, highlighting a need for authorities to engage residents of slums to improve their practices. Trasias Mukama, Rawlance Ndejjo, David Musoke, Geofrey Musinguzi, Abdullah Ali Halage, David O. Carpenter, and John C. Ssempebwa Copyright © 2016 Trasias Mukama et al. All rights reserved. Revisiting Nonresidential Environmental Exposures and Childhood Lead Poisoning in the US: Findings from Kansas, 2000–2005 Wed, 02 Mar 2016 08:56:12 +0000 Although blood lead levels (BLLs) in US children have dramatically declined over the past 40 years, there remain pockets of children living in areas with elevated BLLs. While some increases (≥10 μg/dL) may be associated with legacy lead paint, ambient air lead may be contributing to the problem. A deidentified dataset of information on over 60,000 Kansas children under 3 years of age who were tested for BLL was provided through the Kansas Environmental Public Health Tracking Network for the period 2000–2005. Using ArcGIS, we calculated distance (in miles) from a lead-emitting industry referred to as a toxic release inventory (TRI) site. The USEPA TRI database tracks the management of certain toxic chemicals that may pose a threat to human health. US facilities in different industry sectors must report annually amount of substances like lead into the environment including their exact location. Distance from a TRI site was inversely related to BLL after controlling for area-level poverty and pre-1950 housing. The results of our evaluation indicate there is a significant relationship between proximity to lead industry and childhood BLLs. Proximity to sources of lead emissions should be evaluated as a possible factor when identifying children for targeted BLL testing. Lu Ann Brink, Evelyn O. Talbott, Gary M. Marsh, Ravi Sharma, Stacey Benson, Wen Chi Wu, and Chunzhe Duan Copyright © 2016 Lu Ann Brink et al. All rights reserved. Heavy Metal Contamination of Soils around a Hospital Waste Incinerator Bottom Ash Dumps Site Mon, 29 Feb 2016 18:51:20 +0000 Waste incineration is the main waste management strategy used in treating hospital waste in many developing countries. However, the release of dioxins, POPs, and heavy metals in fly and bottom ash poses environmental and public health concerns. To determine heavy metal (Hg, Pb, Cd, Cr, and Ag) in levels in incinerator bottom ash and soils 100 m around the incinerator bottom ash dump site, ash samples and surrounding soil samples were collected at 20 m, 40 m, 60 m, 80 m, 100 m, and 1,200 m from incinerator. These were analyzed using the absorption spectrophotometer method. The geoaccumulation () and pollution load indices (PLI) were used to assess the level of heavy metal contamination of surrounding soils. The study revealed high concentrations in mg/kg for, Zn (16417.69), Pb (143.80), Cr (99.30), and Cd (7.54) in bottom ash and these were above allowable limits for disposal in landfill. The study also found soils within 60 m radius of the incinerator to be polluted with the metals. It is recommended that health care waste managers be educated on the implication of improper management of incinerator bottom ash and regulators monitor hospital waste incinerator sites. M. Adama, R. Esena, B. Fosu-Mensah, and D. Yirenya-Tawiah Copyright © 2016 M. Adama et al. All rights reserved. Body Mass Index Trajectories among Middle-Aged and Elderly Canadians and Associated Health Outcomes Wed, 27 Jan 2016 12:54:59 +0000 Background. Whether there is heterogeneity in the development of BMI from middle-age onward is still unknown. The primary aim of this study is to analyze long-term obesity and how BMI trajectories are associated with health outcomes in midlife. Methods. Latent Class Growth Modelling was used to capture the changes in BMI over time. In this study, 3070 individuals from the National Population Health Survey (NPHS), aged 40–55 years at baseline, were included. Results. Four BMI trajectory groups, “Normal-Stable” (N-S), “Overweight-Stable” (OV-S), “Obese I-Stable” (OB I-S), and “Obese II-Stable” (OB II-S), were identified. Men, persons of White ancestry, and individuals who had no postsecondary education had higher odds of being in the latter three groups. Moreover, members of the OV-S, OB I-S, and OB II-S groups experienced more asthma, arthritis, hypertension, diabetes, heart disease, cognitive impairment, and reduced self-rated overall health. Individuals in the OB II-S group were at greater risk for back problems, chronic bronchitis or emphysema, and emotional issues when compared to the N-S group. Conclusion. Understanding different BMI trajectories is important in order to identify people who are at the highest risk of developing comorbidities due to obesity and to establish programs to intervene appropriately. Meng Wang, Yanqing Yi, Barbara Roebothan, Jennifer Colbourne, Victor Maddalena, Peizhong Peter Wang, and Guang Sun Copyright © 2016 Meng Wang et al. All rights reserved. Consumption Frequency of Foods Away from Home Linked with Higher Body Mass Index and Lower Fruit and Vegetable Intake among Adults: A Cross-Sectional Study Tue, 26 Jan 2016 06:57:04 +0000 Introduction. Consumption of foods prepared away from home (FAFH) has grown steadily since the 1970s. We examined the relationship between FAFH and body mass index (BMI) and fruit and vegetable (FV) consumption. Methods. Frequency of FAFH, daily FV intake, height and weight, and sociodemographic data were collected using a telephone survey in 2008-2009. Participants included a representative sample of 2,001 adult men and women (mean age years) residing in King County, WA, with an analytical sample of 1,570. Frequency of FAFH was categorized as 0-1, 2–4, or 5+ times per week. BMI was calculated from self-reported height and weight. We examined the relationship between FAFH with FV consumption and BMI using multivariate models. Results. Higher frequency of FAFH was associated with higher BMI, after adjusting for age, income, education, race, smoking, marital status, and physical activity (women: ; men: ). There was a negative association between frequency of FAFH and FV consumption. FAFH frequency was significantly () higher among males than females (43.1% versus 54.0% eating out 0-1 meal per week, resp.). Females reported eating significantly () more FV than males. Conclusion. Among adults, higher frequency of FAFH was related to higher BMI and less FV consumption. Rebecca A. Seguin, Anju Aggarwal, Francoise Vermeylen, and Adam Drewnowski Copyright © 2016 Rebecca A. Seguin et al. All rights reserved. Noise Exposure and Hearing Capabilities of Quarry Workers in Ghana: A Cross-Sectional Study Thu, 21 Jan 2016 11:20:11 +0000 Introduction. Although quarry operations have high economic significance, the effects they cause to the workers in terms of excessive noise production cannot be overlooked. This cross-sectional study assessed the extent of noise exposure and its influence on hearing capabilities among quarry workers in Ashanti region. Methods. The study involved 400 workers randomly selected from five quarries in Ashanti region from April to June 2012. Data was collected using structured questionnaires, physical examination, and audiological assessments. A logistic regression model was fitted to assess independent predictors of hearing loss. Results. All the machines used at the various quarries produced noise that exceeded the minimum threshold with levels ranging from 85.5 dBA to 102.7 dBA. 176 (44%) of study respondents had hearing threshold higher than 25 dBA. 18% and 2% of these were moderately (41–55 dBA) and severely (71–90 dBA) impaired, respectively. Age, duration of work, and use of earplugs independently predicted the development of hearing loss. Use of earplugs showed a protective effect on the development of hearing loss (OR = 0.45; 95% CI = 0.25, 0.84). Conclusion. This study provides empirical evidence on the extent of damage caused to quarry workers as a result of excessive noise exposure. This will support the institution of appropriate protective measures to minimize this threat. Charles Kwame R. Gyamfi, Isaac Amankwaa, Frank Owusu Sekyere, and Daniel Boateng Copyright © 2016 Charles Kwame R. Gyamfi et al. All rights reserved. Compliance with Iron-Folate Supplement and Associated Factors among Antenatal Care Attendant Mothers in Misha District, South Ethiopia: Community Based Cross-Sectional Study Tue, 29 Dec 2015 13:45:00 +0000 Background. In Ethiopia, higher proportions of pregnant women are anemic. Despite the efforts to reduce iron deficiency anemia during pregnancy, only few women took an iron supplement as recommended. Thus, this study aimed to assess compliance with iron-folate supplement and associated factors among antenatal care attendant mothers in Misha district, South Ethiopia. Method. Community based cross-sectional study supported with in-depth interview was conducted from March 1 to March 30, 2015. The sample size was determined using single population proportion to 303. Simple random sampling technique was used to select the study participants. Bivariate and multivariable logistic regression analyses were employed to identify factors associated with compliance to iron-folate supplement. Results. The compliance rate was found to be 39.2%. Mothers knowledge of anemia (AOR = 4.451, 95% CI = ()), knowledge of iron-folate supplement (AOR = 3.509, 95% CI = ()), and counseling on iron-folate supplement (AOR = 4.093, 95% CI = ()) were significantly associated with compliance to iron-folate supplement. Conclusions. Compliance rate of iron-folate supplementation during pregnancy remains very low. This study showed that providing women with clear instructions about iron-folate tablet intake and educating them on the health benefits of the iron-folate tablets can increase compliance with iron-folate supplementation. Abinet Arega Sadore, Lakew Abebe Gebretsadik, and Mamusha Aman Hussen Copyright © 2015 Abinet Arega Sadore et al. All rights reserved. Regional Variation in Human Exposure to Persistent Organic Pollutants in the United States, NHANES Tue, 29 Dec 2015 11:02:57 +0000 We examined serum levels of persistent organic pollutants (POPs) among geographical regions of the United States as defined by the US Census Bureau. National Health and Nutrition Examination Survey (NHANES) data for adults aged 20 years and older are presented for selected survey periods between 1999 and 2010. From NHANES 1999 through 2004, dichlorodiphenyldichloroethylene (DDE) concentration levels were consistently higher among people living in the West than in the Midwest, Northeast, or South. In 2003–2010, perfluorinated compound concentrations tended to be highest in the South. The sum of 35 polychlorinated biphenyls (PCBs) congeners was significantly higher in the Northeast [GM: 189; 95% CI: 173–204 ng/g lipid] than the remaining regions. The regional differences in higher body burdens of exposure to particular POPs could be attributed to a variety of activities, including region-specific patterns of land use and industrial and agricultural chemical applications, as well as different levels of regulatory activity. Wendy A. Wattigney, Elizabeth Irvin-Barnwell, Marian Pavuk, and Angela Ragin-Wilson Copyright © 2015 Wendy A. Wattigney et al. All rights reserved. Pesticide Application among Farmers in the Catchment of Ashaiman Irrigation Scheme of Ghana: Health Implications Mon, 21 Dec 2015 09:05:31 +0000 Pesticide use in modern day agriculture has increased tremendously. Pesticides are used to control pests and weeds, as well as protect crops from postharvest losses; however, their effects on humans and the environment cannot be overstated. This study examined pesticide acquisition, handling, and use among 120 farmers within the catchment of a small urban irrigation scheme. Also, in-depth interviews and focus group discussions were conducted among selected farmers through which further data was collected to augment that of the survey. Twelve types of pesticides, including herbicides, insecticides, and fungicides, were found in use in the study areas. Three main sources of information about pesticides were identified, 43.3% from extension officers, 39.2% from agrochemical dealers, and 10% from colleague farmers. Seventy-five percent (75%) of the respondents purchased the pesticides from agrochemical shops. Out of 74 farmers who were observed spraying pesticides on their farms, only 25.7% wore dresses that covered their whole body but without goggles. About sixty-seven percent (66.7%) of the farmers whose chemical got finished left the containers on their farms or threw them into the bushes around. The frequency of application was influenced by affordability and size of farm, among others. The study recommended that training of farmers on pesticide handling and use should be intensified. Memuna M. Mattah, Precious A. D. Mattah, and Godfred Futagbi Copyright © 2015 Memuna M. Mattah et al. All rights reserved. Assessing Factors Related to Waist Circumference and Obesity: Application of a Latent Variable Model Thu, 03 Dec 2015 09:25:39 +0000 Background. Because the use of BMI (Body Mass Index) alone as a measure of adiposity has been criticized, in the present study our aim was to fit a latent variable model to simultaneously examine the factors that affect waist circumference (continuous outcome) and obesity (binary outcome) among Iranian adults. Methods. Data included 18,990 Iranian individuals aged 20–65 years that are derived from the third National Survey of Noncommunicable Diseases Risk Factors in Iran. Using latent variable model, we estimated the relation of two correlated responses (waist circumference and obesity) with independent variables including age, gender, PR (Place of Residence), PA (physical activity), smoking status, SBP (Systolic Blood Pressure), DBP (Diastolic Blood Pressure), CHOL (cholesterol), FBG (Fasting Blood Glucose), diabetes, and FHD (family history of diabetes). Results. All variables were related to both obesity and waist circumference (WC). Older age, female sex, being an urban resident, physical inactivity, nonsmoking, hypertension, hypercholesterolemia, hyperglycemia, diabetes, and having family history of diabetes were significant risk factors that increased WC and obesity. Conclusions. Findings from this study of Iranian adult settings offer more insights into factors associated with high WC and high prevalence of obesity in this population. Sahar Dalvand, Jalil Koohpayehzadeh, Masoud Karimlou, Fereshteh Asgari, Ali Rafei, Behjat Seifi, Seyed Hassan Niksima, and Enayatollah Bakhshi Copyright © 2015 Sahar Dalvand et al. All rights reserved. Preliminary Study on the Skin Lightening Practice and Health Symptoms among Female Students in Malaysia Thu, 26 Nov 2015 06:06:11 +0000 Many cases of dermatologic complication were reported with the use of skin lightening products. This study assessed the skin lightening practice and health symptoms among female students. Self-administered questionnaire was distributed to 104 female students (56 undergraduates and 48 postgraduates) aged years in Universiti Putra Malaysia. A total of 60.6% () of the female students used skin lightening products (61.9% of undergraduates and 38.1% of postgraduates). Reasonable price (, 55.6%) and ingredients (, 46%) were considered the most important factors in the product selection. Most respondents purchased the product from drugstores (, 61.9%). Twenty-two respondents (34.9%) in this study experienced skin problem from the products they used. Skin peeling (, 12.5%) and acne (, 8.7%) were the most frequent symptoms experienced. Most of the respondents have the perception that lighter skin provides high self-esteem (, 53.8%) and looks beautiful and healthier (, 51.9%). The use of skin lightening products is common among female students in this study and some of these products can cause skin problems such as skin peeling, acne, and itching. Siti Zulaikha Rusmadi, Sharifah Norkhadijah Syed Ismail, and Sarva Mangala Praveena Copyright © 2015 Siti Zulaikha Rusmadi et al. All rights reserved. ZnO-PLLA Nanofiber Nanocomposite for Continuous Flow Mode Purification of Water from Cr(VI) Mon, 23 Nov 2015 16:05:58 +0000 Nanomaterials of ZnO-PLLA nanofibers have been used for the adsorption of Cr(VI) as a prime step for the purification of water. The fabrication and application of the flexible ZnO-PLLA nanofiber nanocomposite as functional materials in this well-developed architecture have been achieved by growing ZnO nanorod arrays by chemical bath deposition on synthesized electrospun poly-L-lactide nanofibers. The nanocomposite material has been tested for the removal and regeneration of Cr(IV) in aqueous solution under a “continuous flow mode” by studying the effects of pH, contact time, and desorption steps. The adsorption of Cr(VI) species in solution was greatly dependent upon pH. SEM micrographs confirmed the successful fabrication of the ZnO-PLLA nanofiber nanocomposite. The adsorption and desorption of Cr(VI) species were more likely due to the electrostatic interaction between ZnO and Cr(VI) ions as a function of pH. The adsorption and desorption experiments utilizing the ZnO-PLLA nanofiber nanocomposite have appeared to be an effective nanocomposite in the removal and regeneration of Cr(VI) species. T. Burks, F. Akthar, M. Saleemi, M. Avila, and Y. Kiros Copyright © 2015 T. Burks et al. All rights reserved. Metals Exposures of Residents Living Near the Akaki River in Addis Ababa, Ethiopia: A Cross-Sectional Study Sun, 22 Nov 2015 10:01:29 +0000 Background. The Akaki River in Ethiopia has been found to contain elevated levels of several metals. Our objectives were to characterize metals exposures of residents living near the Akaki River and to assess metal levels in their drinking water. Methods. In 2011, we conducted a cross-sectional study of 101 households in Akaki-Kality subcity (near the Akaki River) and 50 households in Yeka subcity (distant to the Akaki River). One willing adult in each household provided urine, blood, and drinking water sample. Results. Urinary molybdenum (), tungsten (), lead (), uranium (), and mercury () were higher in Akaki-Kality participants compared to Yeka participants. Participants in both subcities had low urinary iodine; 45% met the World Health Organization (WHO) classification for being at risk of moderate iodine deficiency. In Yeka, 47% of households exceeded the WHO aesthetic-based reference value for manganese; in Akaki-Kality, only 2% of households exceeded this value (). There was no correlation between metals levels in water samples and clinical specimens. Conclusions. Most of the exposures found during this investigation seem unlikely to cause acute health effects based on known toxic thresholds. However, toxicity data for many of these metals are very limited. Ellen Yard, Tesfaye Bayleyegn, Almaz Abebe, Andualem Mekonnen, Matthew Murphy, Kathleen L. Caldwell, Richard Luce, Danielle Rentz Hunt, Kirubel Tesfaye, Moa Abate, Tsigereda Assefa, Firehiwot Abera, Kifle Habte, Feyissa Chala, Lauren Lewis, and Amha Kebede Copyright © 2015 Ellen Yard et al. All rights reserved. An Investigation of Cancer Rates in the Argentia Region, Newfoundland and Labrador: An Ecological Study Sun, 08 Nov 2015 08:35:35 +0000 Background. The Argentia region of Newfoundland and Labrador, Canada, was home to a US naval base during a 40-year period between the 1940s and the 1990s. Activities on the base resulted in contamination of the soil and groundwater in the region with chemicals such as heavy metals and dioxins, and residents have expressed concern about higher rates of cancer in their community. This study investigated the rate of cancer diagnosis that is disproportionately high in the Argentia region. Methods. Cases of cancer diagnosed between 1985 and 2011 were obtained for the Argentia region, two comparison communities, and the province of Newfoundland and Labrador. Crude and age-standardized incidence rates of cancer diagnosis were calculated and compared. The crude incidence rate was adjusted for differences in age demographics using census data, and age-standardized incidence rates were compared. Results. Although the Argentia region had a higher crude rate of cancer diagnosis, the age-standardized incidence rate did not differ significantly from the comparison communities or the provincial average. Argentia has an aging population, which may have influenced the perception of increased cancer diagnosis in the community. Conclusions. We did not detect an increased burden of cancer in the Argentia region. Pauline Duke, Marshall Godwin, Mandy Peach, Jacqueline Fortier, Stephen Bornstein, Sharon Buehler, Farah McCrate, Andrea Pike, Peizhong Peter Wang, and Richard M. Cullen Copyright © 2015 Pauline Duke et al. All rights reserved. Linking Environmental Exposure with Public Health: Dichlorodiphenyltrichloroethane Extracted from Soils and Water of Recently Exposed Communities of Selected Locations in Zambia Thu, 22 Oct 2015 08:24:16 +0000 Background. In 2000, a Zambian private mining company reintroduced the use of dichlorodiphenyltrichloroethane (DDT) to control malaria in two districts. From 2000 to 2010, DDT had been applied in homes without any studies conducted to ascertain its fate in the environment. We aimed to quantify the presence of DDT and its metabolites in the soil and water around communities where it was recently used. Methods. We collected superficial soil and water samples from drinking sources of three study areas. DDT was extracted by QuEChERS method and solid phase extraction for soils and water, respectively. Analysis was by gas chromatography-mass spectrometry. A revalidated method with limits of detection ranging from 0.034 to 0.04 ppb was used. Results. Median levels of total DDT were found at 100.4 (IQR 90.9–110) and 725.4 ng/L (IQR 540–774.5) for soils and water, respectively. No DDT above detection limits was detected in the reference area. These results are clinically significant given the persistent characteristics of DDT. Conclusion. DDT presence in these media suggests possible limitations in the environmental safeguards during IRS. Such occurrence could have potential effects on humans, especially children; hence, there is a need to further examine possible associations between this exposure and humans. Nosiku Sipilanyambe Munyinda, Charles Michelo, and Kwenga Sichilongo Copyright © 2015 Nosiku Sipilanyambe Munyinda et al. All rights reserved. Rules regarding Marijuana and Its Use in Personal Residences: Findings from Marijuana Users and Nonusers Recruited through Social Media Tue, 20 Oct 2015 12:27:00 +0000 Recent changes in policy and social norms related to marijuana use have increased its use and concern about how/where marijuana should be used. We aimed to characterize rules regarding marijuana and its use in homes. We recruited 1,567 US adults aged 18–34 years through Facebook advertisements to complete an online survey assessing marijuana use, social factors, perceptions of marijuana, and rules regarding marijuana and its use in the home, targeting tobacco and marijuana users to ensure the relevance of this topic. Overall, 648 (41.6%) were current marijuana users; 46.0% of participants reported that “marijuana of any type is not allowed in their home or on their property.” Of those allowing marijuana on their property, 6.4% prohibited use of marijuana in their home. Of the remainder, 29.2% prohibited smoking marijuana, and 11.0% prohibited vaping, eating, or drinking marijuana. Correlates of more restrictive rules included younger age, being female, having <Bachelor’s degree, not having parents or people living with them who use marijuana, perceiving use to be less socially acceptable and more harmful, and being a nonuser (’s ). Attitudes and subjective norms regarding marijuana are correlates of allowing marijuana in residential settings. Future work should examine areas of risk regarding household marijuana rules. Carla J. Berg, David B. Buller, Gillian L. Schauer, Michael Windle, Erin Stratton, and Michelle C. Kegler Copyright © 2015 Carla J. Berg et al. All rights reserved. Timing of First Antenatal Care Attendance and Associated Factors among Pregnant Women in Arba Minch Town and Arba Minch District, Gamo Gofa Zone, South Ethiopia Mon, 12 Oct 2015 09:04:13 +0000 Objective. To assess the timing of first antenatal care attendance and associated factors among pregnant women in Arba Minch Town and Arba Minch District, south Ethiopia. Method. Facility based cross-sectional study employing both quantitative and qualitative methods was conducted from February to March, 2014, in Arba Minch Town and Arba Minch District. Data were collected from 409 pregnant women attending antenatal care clinics in nine public health facilities using systematic random sampling. Analysis was done using SPSS version 20. Descriptive statistics and binary and multiple logistic regression analysis were done. Results. The mean (SD±) age of the respondents was 26 ± 5.5 years. The mean gestational age at first antenatal care attendance was 5 ± 1.5 months. This study indicated that pregnant women with low monthly income (AOR = 4.9, CI: 1.71, 14.08), women who did not receive advise on when to start ANC (AOR = 3, CI: 1.48, 6.24), women with household food insecurity (AOR = 4.66, CI: 1.007, 21.59) and women with unplanned pregnancy (AOR = 4.49, CI: 2.16, 9.35) had higher odds of late antenatal care attendance compared with their counterparts. Conclusions. The study showed that majority of the pregnant women attended late for first antenatal care. Hence, providing health education on the timing of antenatal care is important. Feleke Gebremeskel, Yohannes Dibaba, and Bitiya Admassu Copyright © 2015 Feleke Gebremeskel et al. All rights reserved. Are Healthcare Providers Asking about Environmental Exposures? A Community-Based Mixed Methods Study Thu, 08 Oct 2015 13:18:04 +0000 People living near environmental hazards may develop symptoms and health conditions that require specialized monitoring and treatment by healthcare providers. One emerging environmental hazard is coal ash. Coal ash is comprised of small particles containing heavy metals, polycyclic aromatic hydrocarbons, and radioactive elements. The overall purpose of this study was to explore whether healthcare providers ask patients if they live near an environmental hazard like coal ash storage sites and to assess what health conditions prompt a provider inquiry. Focus groups were conducted in 2012 and a cross-sectional survey was administered in 2013. Overall, 61% of survey respondents reported that their healthcare providers never asked if they lived near an environmental hazard. One focus group member stated “No, they don’t ask that. They just always blame stuff on you….” Respondents with asthma and other lung conditions were significantly more likely to be asked by a healthcare provider if they lived near an environmental hazard. Due to the unique exposures from environmental hazards and the low prevalence of patients being asked about environmental hazards, we recommend that healthcare providers take environmental health histories in order to understand patients’ exposures, to monitor symptoms of exposure, and to assist with education about reducing exposure. Kristina M. Zierold and Clara G. Sears Copyright © 2015 Kristina M. Zierold and Clara G. Sears. All rights reserved. Bacteriological and Physical Quality of Locally Packaged Drinking Water in Kampala, Uganda Mon, 05 Oct 2015 14:18:11 +0000 Objective. To assess the bacteriological and physical quality of locally packaged drinking water sold for public consumption. Methods. This was cross-sectional study where a total of 60 samples of bottled water from 10 brands and 30 samples of sachet water from 15 brands purchased randomly were analyzed for bacteriological contamination (total coliform and faecal coliform per 100 mL) using membrane filtrate method and reported in terms of cfu/100 mL. Results. Both bottled water and sachet water were not contaminated with faecal coliform. Majority (70%, 21/30) of the sachet water analyzed exceeded acceptable limits of 0 total coliforms per 100 mL set by WHO and the national drinking water standards. The physical quality (turbidity and pH) of all the packaged water brands analyzed was within the acceptable limits. There was statistically significant difference between the median count of total coliform in both sachet water and bottled water brands (, ). Conclusion. Both bottled water and sachet water were not contaminated with faecal coliforms; majority of sachet water was contaminated with total coliform above acceptable limits. Government and other stakeholders should consider intensifying surveillance activities and enforcing strict hygienic measures in this rapidly expanding industry to improve packaged water quality. Abdullah Ali Halage, Charles Ssemugabo, David K. Ssemwanga, David Musoke, Richard K. Mugambe, David Guwatudde, and John C. Ssempebwa Copyright © 2015 Abdullah Ali Halage et al. All rights reserved. Phenotypic and Molecular Characterisation of Extended-Spectrum Beta-Lactamase Producing Escherichia coli Obtained from Animal Fecal Samples in Ado Ekiti, Nigeria Mon, 31 Aug 2015 11:51:09 +0000 Production of extended-spectrum β-lactamases (ESBLs) producing E. coli in animals and different methods of identifications from Ado Ekiti, Ekiti State, Nigeria, were investigated. Three hundred and fifty fecal samples, collected from apparently healthy cattle and pigs, were cultured and identified following standard procedures. ESBL phenotypic detection was carried out using combination disc test, double disc synergism test, and ESBL brilliance agar screening. Molecular detection of TEM, SHV, and CTX-M genes was carried out using standard molecular method. One hundred and fourteen E. coli isolates were recovered from the 350 samples processed, out of which 72 (63.2%) isolates were positive for ESBLs with multiple resistance to the antibiotics used. Eighty-one (71%) isolates were positive for ESBL by combination disc test, 90 (78.9%) were positive for double disc synergism test, and 93 (81.6%) were positive for ESBL brilliance agar. TEM and CTX-M genes were detected in 48 (42.1%) and 51 (44.7%) isolates, respectively. SHV gene was not detected in any of the isolates while TEM and CTX-M were detected in 33 (28.9%) isolates. This study showed high resistance of E. coli to antibiotics, particularly to the third generation cephalosporins. Regular monitoring and regulated use of antibiotics in livestock should be encouraged. Olugbenga Adekunle Olowe, Olufunmilayo Adewumi, Gbolabo Odewale, Olusola Ojurongbe, and Olusolabomi Jose Adefioye Copyright © 2015 Olugbenga Adekunle Olowe et al. All rights reserved. The Social Determinants of Health in Military Forces of Iran: A Qualitative Study Mon, 24 Aug 2015 07:13:48 +0000 Providing effective health interventions and achieving equity in health need to apply the community-based approaches such as social determinants of health. In the military organizations, these determinants have received less attention from the military health researchers and policymakers. Therefore, this study aimed to identify and explain the social determinants affecting the health of military forces in Iran. This was a qualitative study which was conducted in 2014. The required data were collected through semistructured interviews and analyzed through Conventional Content Analysis. The studied sample consisted of 22 military health experts, policymakers, and senior managers selected using purposeful sampling method with maximum variation sampling. MAXQDA.2007 was used to analyze the collected data. After analyzing the collected data, two main contents, that is, “general social determinants of health” and “military social determinants of health,” with 22 themes and 90 subthemes were identified as the social determinants of military forces’ health. Main themes were religious rule, spirituality promotion policies, international military factors, military command, and so forth. Given the role and importance of social factors determining the military forces’ health, it can be recommended that the military organizations should pay more attention to these determinants in making policies and creating social, economic, and cultural structures for their forces. Mohammadkarim Bahadori, Hormoz Sanaeinasab, Mostafa Ghanei, Ali Mehrabi Tavana, Ramin Ravangard, and Mazyar Karamali Copyright © 2015 Mohammadkarim Bahadori et al. All rights reserved. Organic Compounds Detected in Deciduous Teeth: A Replication Study from Children with Autism in Two Samples Tue, 28 Jul 2015 13:31:52 +0000 Biological samples are an important part of investigating toxic exposures and disease outcomes. However, blood, urine, saliva, or hair can only reflect relatively recent exposures. Alternatively, deciduous teeth have served as a biomarker of early developmental exposure to heavy metals, but little has been done to assess organic toxic exposures such as pesticides, plastics, or medications. The purpose of our study was to determine if organic chemicals previously detected in a sample of typically developing children could be detected in teeth from a sample of children with autism. Eighty-three deciduous teeth from children with autism spectrum disorders (ASD) were chosen from our tooth repository. Organic compounds were assessed using liquid chromatography tandem mass spectrometry and gas chromatography methods. Consistent with a prior report from Camann et al., (2013), we have demonstrated that specific semivolatile organic chemicals relevant to autism etiology can be detected in deciduous teeth. This report provides evidence that teeth can be useful biomarkers of early life exposure for use in epidemiologic case-control studies seeking to identify differential unbiased exposures during development between those with and without specific disorders such as autism. Raymond F. Palmer, Lynne Heilbrun, David Camann, Alice Yau, Stephen Schultz, Viola Elisco, Beatriz Tapia, Noe Garza, and Claudia Miller Copyright © 2015 Raymond F. Palmer et al. All rights reserved. A Survey of Residents’ Perceptions of the Effect of Large-Scale Economic Developments on Perceived Safety, Violence, and Economic Benefits Mon, 27 Jul 2015 06:18:40 +0000 Background. Emerging research highlights the promise of community- and policy-level strategies in preventing youth violence. Large-scale economic developments, such as sports and entertainment arenas and casinos, may improve the living conditions, economics, public health, and overall wellbeing of area residents and may influence rates of violence within communities. Objective. To assess the effect of community economic development efforts on neighborhood residents’ perceptions on violence, safety, and economic benefits. Methods. Telephone survey in 2011 using a listed sample of randomly selected numbers in six Pittsburgh neighborhoods. Descriptive analyses examined measures of perceived violence and safety and economic benefit. Responses were compared across neighborhoods using chi-square tests for multiple comparisons. Survey results were compared to census and police data. Results. Residents in neighborhoods with the large-scale economic developments reported more casino-specific and arena-specific economic benefits. However, 42% of participants in the neighborhood with the entertainment arena felt there was an increase in crime, and 29% of respondents from the neighborhood with the casino felt there was an increase. In contrast, crime decreased in both neighborhoods. Conclusions. Large-scale economic developments have a direct influence on the perception of violence, despite actual violence rates. Anthony Fabio, Ruth Geller, Michael Bazaco, Todd M. Bear, Abigail L. Foulds, Jessica Duell, and Ravi Sharma Copyright © 2015 Anthony Fabio et al. All rights reserved. Coal Mine Air Pollution and Number of Children Hospitalizations because of Respiratory Tract Infection: A Time Series Analysis Sun, 12 Jul 2015 12:30:36 +0000 To analyze the relationship between levels of air pollution and number of children hospitalizations because of respiratory tract infection in Shenmu County, the data regarding meteorological factors, environmental pollutants, that is SO2 and NO2, Particulate Matter 10 (PM10), and hospitalizations of children less than 16 years of age was collected during the time duration of November 2009 to October 2012. Using SAS 9.3, descriptive data analysis for meteorological and environmental factors and hospital admissions were performed along with main air pollutants determination. Using the statistical software R 3.0.1, a generalized additive Poisson regression model was established, the linear fitting models of the air pollutant concentrations and meteorological factors were introduced considering the lag effect, and the relative risk of the main atmospheric pollutants on children hospitalization was evaluated. The results showed that the primary air pollutant in Shenmu County is PM10 and its Pearson correlation coefficient with Air Pollution Index (API) is 0.917. After control of long term climate trend, “week day effect,” meteorological factors, and impact of other contaminants, it was found that, on the same day and during the lag of 1 to 10 days, PM10 concentrations had no significant effect on children hospitalization rate. Yonglin Liu, Juan Liu, Fenglian Chen, Shamsi Bilal Haider, Qiang Wang, Fuyong Jiao, Yanmei Qiao, and Yanhua Shi Copyright © 2015 Yonglin Liu et al. All rights reserved.