Journal of Environmental and Public Health The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. Lifestyle Behaviors and Self-Rated Health: The Living for Health Program Tue, 28 Oct 2014 08:06:02 +0000 Background. Lack of adherence to dietary and physical activity guidelines has been linked to an increase in chronic diseases in the United States (US). The aim of this study was to assess the association of lifestyle behaviors with self-rated health (SRH). Methods. This cross-sectional study used self-reported data from Living for Health Program ( 1,701) which was conducted from 2008 to 2012 in 190 health fair events in South Florida, US. Results. Significantly higher percent of females as compared to males were classified as obese (35.4% versus 27.0%), reported poor/fair SRH (23.4% versus 15.0%), and were less physically active (33.9% versus 25.4%). Adjusted logistic regression models indicated that both females and males were more likely to report poor/fair SRH if they consumed 2 servings of fruits and vegetables per day (, 95% CI 1.30–3.54; , 95% CI 1.12–7.35, resp.) and consumed mostly high fat foods (, 95% CI 1.03–2.43; , 95% CI 1.67–2.43, resp.). The association of SRH with less physical activity was only significant in females (, 95% CI 1.17–2.35). Conclusion. Gender differences in health behaviors should be considered in designing and monitoring lifestyle interventions to prevent cardiovascular diseases. Gustavo G. Zarini, Joan A. Vaccaro, Maria A. Canossa Terris, Joel C. Exebio, Laura Tokayer, Janet Antwi, Sahar Ajabshir, Amanpreet Cheema, and Fatma G. Huffman Copyright © 2014 Gustavo G. Zarini et al. All rights reserved. An Approach to Developing Local Climate Change Environmental Public Health Indicators, Vulnerability Assessments, and Projections of Future Impacts Tue, 30 Sep 2014 07:52:12 +0000 Environmental public health indicators (EPHIs) are used by local, state, and federal health agencies to track the status of environmental hazards; exposure to those hazards; health effects of exposure; and public health interventions designed to reduce or prevent the hazard, exposure, or resulting health effect. Climate and health EPHIs have been developed at the state, federal, and international levels. However, they are also needed at the local level to track variations in community vulnerability and to evaluate the effectiveness of interventions designed to enhance community resilience. This review draws on a guidance document developed by the U.S. Council of State and Territorial Epidemiologists’ State Environmental Health Indicators Collaborative climate change working group to present a three-tiered approach to develop local climate change EPHIs. Local climate change EPHIs can assist local health departments (LHDs) in implementing key steps of the 10 essential public health services and the U.S. Centers for Disease Control and Prevention’s Building Resilience Against Climate Effects framework. They also allow LHDs to incorporate climate-related trends into the larger health department planning process and can be used to perform vulnerability assessments which can be leveraged to ensure that interventions designed to address climate change do not exacerbate existing health disparities. Adele Houghton and Paul English Copyright © 2014 Adele Houghton and Paul English. All rights reserved. Estimating the Effectiveness of Health-Risk Communications with Propensity-Score Matching: Application to Arsenic Groundwater Contamination in Four US Locations Tue, 30 Sep 2014 00:00:00 +0000 This paper provides a demonstration of propensity-score matching estimation methods to evaluate the effectiveness of health-risk communication efforts. This study develops a two-stage regression model to investigate household and respondent characteristics as they contribute to aversion behavior to reduce exposure to arsenic-contaminated groundwater. The aversion activity under study is a household-level point-of-use filtration device. Since the acquisition of arsenic contamination information and the engagement in an aversion activity may be codetermined, a two-stage propensity-score model is developed. In the first stage, the propensity for households to acquire arsenic contamination information is estimated. Then, the propensity scores are used to weight observations in a probit regression on the decision to avert the arsenic-related health risk. Of four potential sources of information, utility, media, friend, or others, information received from a friend appears to be the source of information most associated with aversion behavior. Other statistically significant covariates in the household’s decision to avert contamination include reported household income, the presence of children in household, and region-level indicator variables. These findings are primarily illustrative and demonstrate the usefulness of propensity-score methods to estimate health-risk communication effectiveness. They may also be suggestive of areas for future research. Andrew J. Leidner Copyright © 2014 Andrew J. Leidner. All rights reserved. Levels of Heavy Metals in Adolescents Living in the Industrialised Area of Milazzo-Valle del Mela (Northern Sicily) Tue, 23 Sep 2014 04:56:12 +0000 In the Milazzo-Valle del Mela area, the presence of industrial plants and the oil refinery make local residents concerned for their health. For this reason, we evaluated the levels of heavy metals in 226 children aged 12–14 years, living in the 7 municipalities of the area. A control age-matched population living 45 km far from the industrial site was also enrolled. Arsenic, cadmium, chromium, mercury, nickel, and vanadium were analysed in 24 h urine samples, while lead concentration was evaluated in blood samples. A questionnaire regarding life style and risk perception was also administered. Adolescents from Milazzo-Valle del Mela had cadmium levels significantly higher compared to either controls   or the reference values of the European Germany Environmental Survey (GerES-IV) and the American National Health and Nutrition Examination Survey (NHANES). Furthermore, children had higher perception of living in a high-risk environment. The present data, for the first time, clearly indicate that adolescents living in Milazzo-Valle del Mela have increased body concentration of cadmium, which may be harmful to human health. These results deserve particular attention by the local and regional government to initiate prevention programmes in this susceptible population. Monica Interdonato, Alessandra Bitto, Gabriele Pizzino, Natasha Irrera, Giovanni Pallio, Anna Mecchio, Antonino Cuspilici, Letteria Minutoli, Domenica Altavilla, and Francesco Squadrito Copyright © 2014 Monica Interdonato et al. All rights reserved. Factors Associated with Larval Control Practices in a Dengue Outbreak Prone Area Wed, 17 Sep 2014 08:27:23 +0000 In order to reduce the risk of dengue outbreak recurrence in a dengue outbreak prone area, the members of the community need to sustain certain behavior to prevent mosquito from breeding. Our study aims to identify the factors associated with larval control practices in this particular community. A cross-sectional study involves 322 respondents living in a dengue outbreak prone area who were interviewed using a pretested questionnaire. The level of knowledge about Aedes mosquitoes, dengue transmission, its symptoms, and personal preventive measures ranges from fair to good. The level of attitude towards preventive measures was high. However, reported level of personal larval control practices was low (33.2%). Our multiple logistic regression analysis showed that only those with a good level of attitude towards personal preventive measure and frequent attendance to health campaigns were significantly associated with the good larval control practices. We conclude that, in a dengue outbreak prone area, having a good attitude towards preventive measures and frequent participation in health campaigns are important factors to sustain practices on larval control. Mariam Mohamad, Mohamad Ikhsan Selamat, and Zaliha Ismail Copyright © 2014 Mariam Mohamad et al. All rights reserved. Environmental and Organizational Factors Associated with Elbow/Forearm and Hand/Wrist Disorder among Sewing Machine Operators of Garment Industry in Ethiopia Mon, 15 Sep 2014 00:00:00 +0000 Occupational health problems related to upper limp musculoskeletal disorders were the major issue among sewing machine operators of garment industries in Ethiopia. The aim of this study was to assess the prevalence and associated risk factors of work related elbow and wrist musculoskeletal disorders among sewing machine operators of garment industries in Galan City, Oromia Regional State. A cross-sectional study was conducted from April 1 to 30, 2012. A total of 422 study subjects were included in this study. Standard Nordic Musculoskeletal Questionnaire was used to collect detailed information on musculoskeletal symptom, sociodemographic data, and factors associated with the problems through face to face interview. From a total of 422 sewing machine operators included in the study 370 (87.7%) were females and 306 (72.5%) were in the age group of <30 years. The prevalence of self-reported work related elbow and wrist musculoskeletal disorders was 40% and 37.7%, respectively. In multivariate analysis, those who had >16 years of service were about five times more likely to develop elbow and wrist musculoskeletal disorders than those who had short (1–5 years) year of services [AOR = 4.7, 95% CI: 1.55–13.02], physical activities [AOR = 5.02, 95% CI: 1.57–16.00], and methods of payment [AOR = 2.01, 95% CI: 1.23–3.28], factors significantly associated with this disorders. Work related elbow and wrist musculoskeletal disorders were high among sewing machine operators in selected garment industries. Moreover, personal and environmental factors were identified as the potential risk factors related to elbow and wrist musculoskeletal disorders among the study group. Therefore, government and the owner of the garment industries should give special attention to prevent and control the problems through proper occupational health and safety policy implementation in the country. Wakjira Kebede Deyyas and Ararso Tafese Copyright © 2014 Wakjira Kebede Deyyas and Ararso Tafese. All rights reserved. Sanitary Conditions of Food Vending Sites and Food Handling Practices of Street Food Vendors in Benin City, Nigeria: Implication for Food Hygiene and Safety Wed, 03 Sep 2014 00:00:00 +0000 Objective. To determine the sanitary conditions of vending sites as well as food handling practices of street food vendors in Benin City, Nigeria. Methodology. A descriptive cross-sectional study was done using an observational checklist and researcher-administered questionnaire. 286 randomly selected vending units were surveyed, and their operators interviewed on their food handling practices. Results. A higher proportion, 259 (90.5%), of the observed vending sites appeared clean. The following sanitary facilities were observed in and around the respective food premises of the respondents: waste bin, 124 (43.4%), refuse dumpsite, 41 (14.3%), wash hand basin, 201 (71.2%), hand towel, 210 (73.4%), and soap, 220 (76.9%). There were also the presence of flies 118, (41.3%), and the presence of rats/cockroaches, 7 (2.4%). Respondents with tertiary education, 5 (38.5%), vended foods in environment with good hygiene status compared to those with secondary, 45 (31.7%), and primary education, 33 (27.3%). There was no statistically significant association between educational status and the hygiene status of food premise (). Conclusion. This study showed that street food vending sites in Benin City were sanitary and that food vendors had good food handling practices. P. W. Okojie and E. C. Isah Copyright © 2014 P. W. Okojie and E. C. Isah. All rights reserved. Antenatal Care Strengthening in Jimma, Ethiopia: A Mixed-Method Needs Assessment Sun, 31 Aug 2014 07:52:19 +0000 Objective. We assessed how health system priorities matched user expectations and what the needs for antenatal care (ANC) strengthening were for improved maternal health in Jimma, Ethiopia. Methods. A questionnaire survey among all recent mothers in the study area was conducted to study the content of ANC and to identify the predictors of low ANC satisfaction. Further, a qualitative approach was applied to understand perceptions, practices, and policies of ANC. Results. There were no national guidelines for ANC in Ethiopia. Within the health system, the teaching of health professional students was given high priority, and that contributed to a lack of continuity and privacy. To the women, poor user-provider interaction was a serious concern hindering the trust in the health care providers. Further, the care provision was compromised by the inadequate laboratory facilities, unstructured health education, and lack of training of health professionals. Conclusions. Health system trials are needed to study the feasibility of ANC strengthening in the study area. Nationally and internationally, the leadership needs to be strengthened with supportive supervision geared towards building trust and mutual respect to protect maternal and infant health. Sarah Fredsted Villadsen, Britt Pinkowski Tersbøl, Dereje Negussie, Abebe GebreMariam, Abebech Tilahun, Henrik Friis, and Vibeke Rasch Copyright © 2014 Sarah Fredsted Villadsen et al. All rights reserved. Religion, Acculturation, and Incarceration: Determinants of Substance Use among Hispanic Adults in the United States Mon, 25 Aug 2014 05:51:59 +0000 Objective. The influence of religion, acculturation, and incarceration on substance abuse has been studied, though predominantly among adolescents. Little research exists on how such factors influence substance use among Hispanic adults. The objective of this study was to assess key determinants of substance use among Hispanic adults. Methods. Public access 2012 National Survey on Drug Use and Health was utilized. Univariate and multivariable logistic regression analyses were conducted while accounting for complex survey design to obtain population-weighted estimates. Receiver operator curve analysis was used to evaluate the relative contribution of each variable. Results. Importance of religious influence in life and Spanish language interview were associated with lower odds of substance use, while history of incarceration increased the likelihood of substance use among Hispanic adults. Other factors associated with lower odds were increasing age, being female, and currently married. Other factors associated with increased odds were high school graduate and some college in addition to living above the 200% federal poverty level. Discussion. Results from this study add to the limited body of the literature on determinants of substance use among Hispanic adults. Health education measures should target acculturated Hispanic adults and those with incarceration history to reduce substance use. Benjamin J. Becerra, Monideepa B. Becerra, Miryam C. Gerdine, and Jim E. Banta Copyright © 2014 Benjamin J. Becerra et al. All rights reserved. Contaminated Turmeric Is a Potential Source of Lead Exposure for Children in Rural Bangladesh Sun, 24 Aug 2014 09:24:19 +0000 Background. During the conduct of a cohort study intended to study the associations between mixed metal exposures and child health outcomes, we found that 78% of 309 children aged 20–40 months evaluated in the Munshiganj District of Bangladesh had blood lead concentrations ≥5 µg/dL and 27% had concentrations ≥10 µg/dL. Hypothesis. Environmental sources such as spices (e.g., turmeric, which has already faced recalls in Bangladesh due to high lead levels) may be a potential route of lead exposure. Methods. We conducted visits to the homes of 28 children randomly selected from among high and low blood lead concentration groups. During the visits, we administered a structured questionnaire and obtained soil, dust, rice, and spice samples. We obtained water samples from community water sources, as well as environmental samples from neighborhood businesses. Results. Lead concentrations in many turmeric samples were elevated, with lead concentrations as high as 483 ppm. Analyses showed high bioaccessibility of lead. Conclusions. Contamination of turmeric powder is a potentially important source of lead exposure in this population. Kelsey Gleason, James P. Shine, Nadia Shobnam, Lisa B. Rokoff, Hafiza Sultana Suchanda, Md Omar Sharif Ibne Hasan, Golam Mostofa, Chitra Amarasiriwardena, Quazi Quamruzzaman, Mahmuder Rahman, Molly L. Kile, David C. Bellinger, David C. Christiani, Robert O. Wright, and Maitreyi Mazumdar Copyright © 2014 Kelsey Gleason et al. All rights reserved. Determination of Lead, Cations, and Anions Concentration in Indoor and Outdoor Air at the Primary Schools in Kuala Lumpur Tue, 22 Jul 2014 10:22:34 +0000 This study was carried out to determine the concentration of lead (Pb), anions, and cations at six primary schools located around Kuala Lumpur. Low volume sampler (MiniVol ) was used to collect the suspended particulates in indoor and outdoor air. Results showed that the concentration of Pb in indoor air was in the range of 5.18 ± 1.08 μg/g–7.01 ± 0.08 μg/g. All the concentrations of Pb in indoor air were higher than in outdoor air at all sampling stations. The concentrations of cations and anions were higher in outdoor air than in indoor air. The concentration of (39.51 ± 5.01 mg/g–65.13 ± 9.42 mg/g) was the highest because the cation existed naturally in soil dusts, while the concentrations of and were higher in outdoor air because there were more sources of exposure for anions in outdoor air, such as highly congested traffic and motor vehicles emissions. In comparison, the concentration of (29.72 ± 0.31 μg/g–32.00 ± 0.75 μg/g) was slightly higher than . The concentrations of most of the parameters in this study, such as , , , , and , were higher in outdoor air than in indoor air at all sampling stations. Normah Awang and Farhana Jamaluddin Copyright © 2014 Normah Awang and Farhana Jamaluddin. All rights reserved. An Overview of Thunderstorm-Associated Asthma Outbreak in Southwest of Iran Sun, 29 Jun 2014 09:00:31 +0000 The aim of this study was to report the characteristics and treatment strategies of all patients with acute bronchospasm who were presented to the emergency departments of Ahvaz, Iran, following the occurrence of a thunderstorm on November 2, 2013. A total of 2000 patients presenting with asthma attacks triggered by thunderstorm were interviewed and an initial questionnaire was completed for each individual. After twenty days, patients were asked to complete a supplementary questionnaire, but only 800 of them accepted to do so. The majority of subjects was aged 20–40 years (60.5%) and had no history of asthma in most cases (60.0%). The symptoms had started outdoors for 60.0% of the participants. In most patients, the onset of the condition was on November 2. Short-acting β2-agonist (salbutamol) and aminophylline were the most commonly prescribed medications in the emergency department. Upon the second interview, 85.3% of the patients were still symptomatic. Overall, 63.6% did not have a follow-up visit after hospital discharge, although all of them were referred to the specialist. The findings of the present study suggest that thunderstorm-associated asthma could affect young adults with no gender priority, with or without asthma history, which put a strain on emergency medical services. Arash Forouzan, Kambiz Masoumi, Maryam Haddadzadeh Shoushtari, Esmaeil Idani, Fatemeh Tirandaz, Maryam Feli, Mohammad Ali Assarehzadegan, and Ali Asgari Darian Copyright © 2014 Arash Forouzan et al. All rights reserved. How Adolescent Subjective Health and Satisfaction with Weight and Body Shape Are Related to Participation in Sports Thu, 12 Jun 2014 00:00:00 +0000 Background. Physical exercise has positive effects on health. However, its associations with self-rated health and body image, which are important predictors for adolescents’ wellbeing and later morbidity, are complex. Methods. Cross-sectional survey among 2527 Norwegian adolescents. We examined the relations between self-reported gender, body size, amount and type of exercise and measures of self-rated health, drive for thinness, and desire to change body, with binary logistic regression analyses. Results. Girls and overweight students reported to a greater extent than their peers impaired self-rated health, weight concerns, and desire to change their body. Increasing amount of time spent on sports was related to improved self-rated health in a dose-response manner. Both girls and boys who engaged in individual sports with an advantage of leanness, but only girls engaged in team sports, reported an increased desire to change the body. However, weight concern was not related to amount or type of sports. Conclusions. Physical exercise is positively related to self-reported health but has negative associations with body image for many adolescents. Health promotion efforts should consider this paradox and stimulate physical activity and sports along with body acceptance. Åse Eriksen Dyremyhr, Esperanza Diaz, and Eivind Meland Copyright © 2014 Åse Eriksen Dyremyhr et al. All rights reserved. The Impact of “Unseasonably” Warm Spring Temperatures on Acute Myocardial Infarction Hospital Admissions in Melbourne, Australia: A City with a Temperate Climate Wed, 04 Jun 2014 11:23:55 +0000 The effects of extreme temperatures on human health have been well described. However, the adverse health effects of warm weather that occurs outside the summer period have had little attention. We used daily anomalous AMI morbidity and daily anomalous temperature to determine the impact of “unseasonable” temperature on human health. The “unseasonably” warm weather was attributed to a slow moving high pressure system to the east of Melbourne. No morbidity displacement was noted during either of these periods suggesting that morbidity due to “unseasonable” temperatures is avoidable. An increase in warmer weather during the cooler months of spring may result in increased morbidity, and an alert system based on summer thresholds may not be appropriate for early season heat health warnings. A straightforward alert system based on calculating anomalous temperature from daily weather forecasts may reduce the public health impact of “unseasonably” warm weather. Margaret Loughnan, Nigel Tapper, and Terence Loughnan Copyright © 2014 Margaret Loughnan et al. All rights reserved. Factors Affecting Parent-Adolescent Discussion on Reproductive Health Issues in Harar, Eastern Ethiopia: A Cross-Sectional Study Thu, 29 May 2014 09:17:00 +0000 Background. Open family discussion on reproductive health (RH) issues often leads to increased awareness on RH matters and reduces risky behaviors among adolescents. This study was conducted to assess factors affecting parent-adolescent discussion on RH issues in Harar, Ethiopia. Methods. A cross-sectional survey using face to face interview supplemented with focus group discussion (FGD) was conducted on 751 randomly selected parents of 10–19-year-old adolescents. Data was analyzed using SPSS version 15. Results. More than one-fourth (28.76%) of parents reported discussing RH issues with their adolescents during the last six months. In the logistic regression, parents who have demonstrated good RH knowledge and positive attitude towards RH were almost six times and seventy percent (AOR 5.69, 95% CI: 3.67–8.82; AOR 1.70, 95% CI: 1.08–2.68) higher in discussing RH with their adolescents than their counterparts, respectively. Conclusion. Parent-adolescent discussion about RH issues rarely occurs and is bounded by lack of knowledge, sociocultural norms, and parental concern that discussion would encourage premarital sex. Reproductive health programs should target on improving awareness of parents and addressing sociocultural norms surrounding reproductive health issues. Tesfaye Assebe Yadeta, Haji Kedir Bedane, and Abera Kenay Tura Copyright © 2014 Tesfaye Assebe Yadeta et al. All rights reserved. Early Childhood Nutritional Status in CARICOM Countries: An Overview with respect to Five Nutrition Related Millennium Development Goals Thu, 08 May 2014 13:10:54 +0000 Previous reviews of nutritional status in children under 5 years describe the Caribbean grouped with Latin America. This paper focuses specifically on the Caribbean and the goals and targets of the Millennium Declaration that have bearing on childhood development. The results indicate that CARICOM countries have made progress in terms of child health as assessed by gross health indicators. Yet, the millennium generation experiences coexistence of undernutrition and overweight in early childhood. The associations of GNI with markers such as poverty indices are somewhat inconsistent with traditional findings and highlight a need to reassess the causes of infant mortality and low birth weight. However, a lack of systematic local data has hampered progress on an individual country basis. Interventions that deal more pointedly with country specific needs are required including those targeting obesity if the MDGs are to be attained by all member states. Pamela S. Gaskin, Anders L. Nielsen, Douladel Willie, and Tara C. Durant Copyright © 2014 Pamela S. Gaskin et al. All rights reserved. Relationship between Objectively Measured Walkability and Exercise Walking among Adults with Diabetes Wed, 26 Mar 2014 09:53:23 +0000 Little is known about the relationship between objectively measured walkability and walking for exercise among adults with diabetes. Information regarding walking behavior of adults with diabetes residing in 3 Upstate New York counties was collected through an interview survey. Walkability measures were collected through an environmental audit of a sample of street segments. Overall walkability and 4 subgroup measures of walkability were aggregated at the ZIP level. Multivariate logistic regression was used for analysis. Study participants were 61.0% female, 56.7% non-Hispanic White, and 35.1% African-American, with a mean age of 62.0 years. 108 participants (51.9%) walked for exercise on community streets, and 62 (29.8%) met the expert-recommended level of walking for ≥150 minutes/week. After adjustment for age, gender, race/ethnicity, education, BMI, physical impairment, and social support for exercise, walking any minutes/week was associated with traffic safety (OR 1.34, 95% CI 1.15–1.65). Walking ≥150 minutes/week was associated with overall walkability of the community (2.65, 1.22, and 5.74), as well as sidewalks (1.73, 1.12–2.67), street amenity (2.04, 1.12–3.71), and traffic safety (1.92, 1.02–3.72). This study suggests that walkability of the community should be an integral part of the socioecologic approach to increase physical activity among adults with diabetes. Akiko S. Hosler, Mary P. Gallant, Mary Riley-Jacome, and Deepa T. Rajulu Copyright © 2014 Akiko S. Hosler et al. All rights reserved. Risk Factors of Domestic Violence in Iran Tue, 25 Mar 2014 13:36:52 +0000 Objectives. In this study, we have evaluated the lifetime and past-year prevalence of exposure to physical violence among married women in the city of Tehran and urban and rural areas of Hashtgerd. Methods. The target population were noninstitutionalized female citizens, aged 15 years or older, who have at least one history of marriage and who resided in the capital city of Tehran or Hashtgerd County from the summer of 2008 to fall of 2010. We used a multistage sampling method. Tehran’s District Six, a central district in Tehran, was selected as a representative cluster of all municipal districts in Tehran. A total of fifty blocks were randomly selected from this district, from which 1,000 married women aged 15 years or older were interviewed using a cross-sectional design. Data was gathered face-to-face using a structured questionnaire. The lifetime prevalence, past-year prevalence, and related factors of domestic violence were measured. SPSS version 11.5 was used for the analyses. Results. Figures for lifetime prevalence and past-year prevalence were measured to be 38.7% and 6.6%, respectively. The independent effects of marital status and location and type of residency for women, along with education and smoking habits of their spouses, were statistically significant in multivariate logistic regression analysis. Conclusion. Domestic violence is a public health concern in Iran. Based on our findings, we propose that empowering women through education, and improving their ability to find employment and income, along with increasing public awareness of human rights issues through education could lower the prevalence of domestic violence. M. Rasoulian, S. Habib, J. Bolhari, M. Hakim Shooshtari, M. Nojomi, and Sh. Abedi Copyright © 2014 M. Rasoulian et al. All rights reserved. Hydraulic Fracturing: Paving the Way for a Sustainable Future? Tue, 25 Mar 2014 08:32:42 +0000 With the introduction of hydraulic fracturing technology, the United States has become the largest natural gas producer in the world with a substantial portion of the production coming from shale plays. In this review, we examined current hydraulic fracturing literature including associated wastewater management on quantity and quality of groundwater. We conclude that proper documentation/reporting systems for wastewater discharge and spills need to be enforced at the federal, state, and industrial level. Furthermore, Underground Injection Control (UIC) requirements under SDWA should be extended to hydraulic fracturing operations regardless if diesel fuel is used as a fracturing fluid or not. One of the biggest barriers that hinder the advancement of our knowledge on the hydraulic fracturing process is the lack of transparency of chemicals used in the practice. Federal laws mandating hydraulic companies to disclose fracturing fluid composition and concentration not only to federal and state regulatory agencies but also to health care professionals would encourage this practice. The full disclosure of fracturing chemicals will allow future research to fill knowledge gaps for a better understanding of the impacts of hydraulic fracturing on human health and the environment. Jiangang Chen, Mohammed H. Al-Wadei, Rebekah C. M. Kennedy, and Paul D. Terry Copyright © 2014 Jiangang Chen et al. All rights reserved. Residential Relocation by Older Adults in Response to Incident Cardiovascular Health Events: A Case-Crossover Analysis Sun, 23 Mar 2014 08:54:30 +0000 Objective. We use a case-crossover analysis to explore the association between incident cardiovascular events and residential relocation to a new home address. Methods. We conducted an ambidirectional case-crossover analysis to explore the association between incident cardiovascular events and residential relocation to a new address using data from the Cardiovascular Health Study (CHS), a community-based prospective cohort study of 5,888 older adults from four U.S. sites beginning in 1989. Relocation was assessed twice a year during follow-up. Event occurrences were classified as present or absent for the period preceding the first reported move, as compared with an equal length of time immediately prior to and following this period. Results. Older adults (65+) that experience incident cardiovascular disease had an increased probability of reporting a change of residence during the following year (OR 1.6, 95% confidence interval (CI) = 1.2–2.1). Clinical conditions associated with relocation included stroke (OR: 2.0, 95% CI: 1.2–3.3), angina (OR: 1.6, 95% CI: 1.0–2.6), and congestive heart failure (OR: 1.5, 95% CI: 1.0–2.1). Conclusions. Major incident cardiovascular disease may increase the probability of residential relocation in older adults. Case-crossover analyses represent an opportunity to investigate triggering events, but finer temporal resolution would be crucial for future research on residential relocations. Gina S. Lovasi, John M. Richardson, Carlos J. Rodriguez, Willem J. Kop, Ali Ahmed, Arleen F. Brown, Heather Greenlee, and David S. Siscovick Copyright © 2014 Gina S. Lovasi et al. All rights reserved. PFAAs in Fish and Other Seafood Products from Icelandic Waters Thu, 20 Mar 2014 17:41:32 +0000 Perfluorinatedalkyl acids (PFAAs) are of growing concern due to possible health effects on humans. Exposure assessments indicate that fish consumption is one of the major sources of perfluorooctane sulfonate (PFOS) exposure to humans, one of the major PFASs, whereas concerns of overestimation of this exposure source have been raised. Therefore, PFAAs concentrations in fish from the North Atlantic (Icelandic fishing grounds) in the flesh of different fish species were investigated along with more detailed analyses of tissue concentrations in cod (Gadus morhua) and lumpfish (Cyclopterus lumpus). Further, fish feed was investigated as a possible source of PFAAs in aquaculture by examining fish meal as feed ingredient. No PFAAs were detected in the edible part of all fish samples, except for PFOS in pollock (Pollachius virens, 0,05 ng/g wet weight). PFOS was the only PFAA detected in the fish meal samples with the exception of PFOSA in blue whiting (Micromesistius poutassou) meal (0,45 ng/g dry weight (d.w.)), where the PFOS concentration was 1,3–13 ng/g d.w. in the capelin (Mallotus villosus) and mackerel (Scomber scombrus) meal samples. The conclusions of the study are that fish commonly consumed from the Icelandic fishing grounds are unlikely to be an important source of PFAAs exposure. Hrönn Jörundsdóttir, Thorhallur I. Halldorsson, and Helga Gunnlaugsdottir Copyright © 2014 Hrönn Jörundsdóttir et al. All rights reserved. Evaluation of Trace Metal Content by ICP-MS Using Closed Vessel Microwave Digestion in Fresh Water Fish Thu, 13 Mar 2014 12:00:02 +0000 The objective of the present study was to investigate trace metal levels of different varieties of fresh water fish using Inductively Coupled Plasma Mass Spectrophotometer after microwave digestion (MD-ICPMS). Fish samples were collected from the outlets of twin cities of Hyderabad and Secunderabad. The trace metal content in different varieties of analyzed fish were ranged from 0.24 to 1.68 mg/kg for Chromium in Cyprinus carpio and Masto symbollon, 0.20 to 7.52 mg/kg for Manganese in Labeo rohita and Masto symbollon, 0.006 to 0.07 mg/kg for Cobalt in Rastrelliger kanagurta and Pampus argenteus, 0.31 to 2.24 mg/kg for Copper in Labeo rohita and Penaeus monodon, 3.25 to 14.56 mg/kg for Zinc in Cyprinus carpio and Macrobrachium rosenbergii, and 0.01 to 2.05 mg/kg for Selenium in Rastrelliger kanagurta and Pampus argenteus, respectively. Proximate composition data for the different fishes were also tabulated. Since the available data for different trace elements for fish is scanty, here an effort is made to present a precise data for the same as estimated on ICP-MS. Results were in accordance with recommended daily intake allowance by WHO/FAO. Sreenivasa Rao Jarapala, Bhaskarachary Kandlakunta, and Longvah Thingnganing Copyright © 2014 Sreenivasa Rao Jarapala et al. All rights reserved. Industrially Contaminated Sites and Health Tue, 11 Mar 2014 12:43:37 +0000 Marco Martuzzi, Roberto Pasetto, and Piedad Martin-Olmedo Copyright © 2014 World Health Organization. All rights reserved. Neonates in Ahmedabad, India, during the 2010 Heat Wave: A Climate Change Adaptation Study Mon, 10 Mar 2014 16:09:44 +0000 Health effects from climate change are an international concern with urban areas at particular risk due to urban heat island effects. The burden of disease on vulnerable populations in non-climate-controlled settings has not been well studied. This study compared neonatal morbidity in a non-air-conditioned hospital during the 2010 heat wave in Ahmedabad to morbidity in the prior and subsequent years. The outcome of interest was neonatal intensive care unit (NICU) admissions for heat. During the months of April, May, and June of 2010, 24 NICU admissions were for heat versus 8 and 4 in 2009 and 2011, respectively. Both the effect of moving the maternity ward and the effect of high temperatures were statistically significant, controlling for each other. Above 42 degrees Celsius, each daily maximum temperature increase of a degree was associated with 43% increase in heat-related admissions (95% CI 9.2–88%). Lower floor location of the maternity ward within hospital which occurred after the 2010 heat wave showed a protective effect. These findings demonstrate the importance of simple surveillance measures in motivating a hospital policy change for climate change adaptation—here relocating one ward—and the potential increasing health burden of heat in non-climate-controlled institutions on vulnerable populations. Khyati Kakkad, Michelle L. Barzaga, Sylvan Wallenstein, Gulrez Shah Azhar, and Perry E. Sheffield Copyright © 2014 Khyati Kakkad et al. All rights reserved. Workplace-Related Traumatic Injuries: Insights from a Rapidly Developing Middle Eastern Country Wed, 05 Mar 2014 15:22:26 +0000 Traumatic workplace-related injuries (WRIs) carry a substantial negative impact on the public health worldwide. We aimed to study the incidence and outcomes of WRIs in Qatar. We conducted occupational injury surveillance for all WRI patients between 2010 and 2012. A total of 5152 patients were admitted to the level 1 trauma unit in Qatar, of which 1496 (29%) sustained WRI with a mean age of . Fall from height (FFH) (51%) followed by being struck by heavy objects (FHO) (18%) and motor vehicle crashes (MVC) (17%) was the commonest mechanism of injury (MOI). WRI patients were mainly laborers involved in industrial work (43%), transportation (18%), installation/repair (12%), carpentry (9%), and housekeeping (3%). Use of protective device was not observed in 64% of cases. The mean ISS was , median ICU stay was 3 days (1–64), and total hospital stay was 6 days (1–192). The overall case fatality was 3.7%. Although the incidence of WRI in Qatar is quite substantial, its mortality rate is relatively low in comparison to other countries of similar socioeconomic status. Prolonged hospital stay and treatment exert a significant socioeconomic burden on the nation’s and families’ resources. Focused and efficient injury prevention strategies are mandatory to prevent future WRI. Hassan Al-Thani, Ayman El-Menyar, Husham Abdelrahman, Ahmad Zarour, Rafael Consunji, Ruben Peralta, Mohammad Asim, Hany El-Hennawy, Ashok Parchani, and Rifat Latifi Copyright © 2014 Hassan Al-Thani et al. All rights reserved. Ambient Particulate Matter Air Pollution in Mpererwe District, Kampala, Uganda: A Pilot Study Mon, 17 Feb 2014 15:30:09 +0000 Air quality in Kampala, the capital of Uganda, has deteriorated significantly in the past two decades. We made spot measurements in Mpererwe district for airborne particulate matter PM2.5 (fine particles) and coarse particles. PM was collected on Teflon-membrane filters and analyzed for mass, 51 elements, 3 anions, and 5 cations. Both fine and coarse particle concentrations were above 100 µg/m3 in all the samples collected. Markers for crustal/soil (e.g., Si and Al) were the most abundant in the PM2.5 fraction, followed by primary combustion products from biomass burning and incinerator emissions (e.g., K and Cl). Over 90% of the measured PM2.5 mass can be explained by crustal species (41% and 59%) and carbonaceous aerosol (33%–55%). Crustal elements dominated the coarse particles collected from Kampala. The results of this pilot study are indicative of unhealthy air and suggest that exposure to ambient air in Kampala may increase the burden of environmentally induced cardiovascular, metabolic, and respiratory diseases including infections. Greater awareness and more extensive research are required to confirm our findings, to identify personal exposure and pollution sources, and to develop air quality management plans and policies to protect public health. Stephan Schwander, Clement D. Okello, Juergen Freers, Judith C. Chow, John G. Watson, Melody Corry, and Qingyu Meng Copyright © 2014 Stephan Schwander et al. All rights reserved. Comprehensive Planning for Classification and Disposal of Solid Waste at the Industrial Parks regarding Health and Environmental Impacts Thu, 13 Feb 2014 16:04:44 +0000 The aim of this study is the comprehensive planning for integrated management of solid waste at the industrial parks. The share of each industrial group including food, metal, chemical, non-metallic minerals, textile, electrical and electronical, and cellulose industries were 48.2, 14.9, 6.7, 22, 0.9, 0.6, and 6.5 percent, respectively. The results showed that nearly half of total industrial waste produced from the range of biological materials are biodegradable and discharging them without observing environmental regulations leads to short-term pollution and nuisance in the acceptor environment. Also some parts of case study waste were recyclable which is considerable from viewpoint of economical and environmental pollution. Long-term impacts will appear due to improper site selection of disposal from the spatial standpoint. In this way, an approach for site selection using several socioeconomic, physical, and environmental criteria based on multicriteria decision making model (MCDM) is introduced. Health risks and environment pollution such as soil and surface water may be done. It is essential to revise the studied industries layout, particularly those units which produce special waste which should be more cautious. Also stricter enforcement is required as an effective step in reducing the harmful impacts of it. Hassan Hashemi, Hamidreza Pourzamani, and Bahareh Rahmani Samani Copyright © 2014 Hassan Hashemi et al. All rights reserved. Blood Politics, Ethnic Identity, and Racial Misclassification among American Indians and Alaska Natives Mon, 10 Feb 2014 12:48:41 +0000 Misclassification of race in medical and mortality records has long been documented as an issue in American Indian/Alaska Native data. Yet, little has been shared in a cohesive narrative which outlines why misclassification of American Indian/Alaska Native identity occurs. The purpose of this paper is to provide a summary of the current state of the science in racial misclassification among American Indians and Alaska Natives. We also provide a historical context on the importance of this problem and describe the ongoing political processes that both affect racial misclassification and contribute to the context of American Indian and Alaska Native identity. Emily A. Haozous, Carolyn J. Strickland, Janelle F. Palacios, and Teshia G. Arambula Solomon Copyright © 2014 Emily A. Haozous et al. All rights reserved. Agent Orange Footprint Still Visible in Rural Areas of Central Vietnam Mon, 03 Feb 2014 14:28:29 +0000 Levels of polychlorinated dioxins/furans (PCDD/PCDF) in selected environmental samples (soils, sediments, fish, and farm animals) were analyzed from the area of Phong My commune (Thua Thien-Hue province, Vietnam). This area was affected by Agent Orange spraying during the Vietnam war (1968–1971). Whereas PCDD/PCDF content in soil and sediment samples is relatively low and ranges between 0.05 and 5.1 pg WHO-TEQ/g for soils and between 0.7 and 6.4 pg WHO-TEQ/g for sediments, the PCDD/PCDF content in poultry muscle and liver in most cases exceeded the maximum permissible limit of dioxin content per unit fat mass. In some cases of soil and sediments samples, 2,3,7,8-TCDD represented more than 90% of the total PCDD/PCDF, which indicates Agent Orange as the main source. Jan Banout, Ondrej Urban, Vojtech Musil, Jirina Szakova, and Jiri Balik Copyright © 2014 Jan Banout et al. All rights reserved. Urinary Polycyclic Aromatic Hydrocarbon Metabolites and Attention/Deficit Hyperactivity Disorder, Learning Disability, and Special Education in U.S. Children Aged 6 to 15 Thu, 30 Jan 2014 10:04:36 +0000 Exposure to polycyclic aromatic hydrocarbons (PAHs) adversely affects child neurodevelopment, but little is known about the relationship between PAHs and clinically significant developmental disorders. We examined the relationship between childhood measures of PAH exposure and prevalence of attention deficit/hyperactivity disorder (ADHD), learning disability (LD), and special education (SE) in a nationally representative sample of 1,257 U.S. children 6–15 years of age. Data were obtained from the National Health and Nutrition Examination Survey (NHANES) 2001–2004. PAH exposure was measured by urinary metabolite concentrations. Outcomes were defined by parental report of (1) ever doctor-diagnosed ADHD, (2) ever doctor- or school representative-identified LD, and (3) receipt of SE or early intervention services. Multivariate logistic regression accounting for survey sampling was used to determine the associations between PAH metabolites and ADHD, LD, and SE. Children exposed to higher levels of fluorine metabolites had a 2-fold increased odds (95% C.I. 1.1, 3.8) of SE, and this association was more apparent in males (OR 2.3; 95% C.I. 1.2, 4.1) than in females (OR 1.8; 95% C.I. 0.6, 5.4). No other consistent pattern of developmental disorders was associated with urinary PAH metabolites. However, concurrent exposure to PAH fluorine metabolites may increase use of special education services among U.S. children. Zaynah Abid, Ananya Roy, Julie B. Herbstman, and Adrienne S. Ettinger Copyright © 2014 Zaynah Abid et al. All rights reserved.