Journal of Environmental and Public Health The latest articles from Hindawi © 2017 , Hindawi Limited . All rights reserved. Inhalation Dose and Source Term Studies in a Tribal Area of Wayanad, Kerala, India Mon, 22 May 2017 00:00:00 +0000 Among radiation exposure pathways to human beings, inhalation dose is the most prominent one. Radon, thoron, and their progeny contribute more than 50 per cent to the annual effective dose due to natural radioactivity. South west coast of India is classified as a High Natural Background Radioactivity Area and large scale data on natural radioactivity and dosimetry are available from these coastal regions including the Neendakara-Chavara belt in the south of Kerala. However, similar studies and reports from the northern part of Kerala are scarce. The present study involves the data collection and analysis of radon, thoron, and progeny concentration in the Wayanad district of Kerala. The radon concentration was found to be within a range of 12–378 Bq/m3. The thoron concentration varied from 15 to 621 Bq/m3. Progeny concentration of radon and thoron and the diurnal variation of radon were also studied. In order to assess source term, wall and floor exhalation studies have been done for the houses showing elevated concentration of radon and thoron. The average values of radon, thoron, and their progeny are found to be above the Indian average as well as the average values reported from the High Natural Background Radioactivity Areas of Kerala. Exhalation studies of the soil samples collected from the vicinity of the houses show that radon mass exhalation rate varied from below detectable limit (BDL) to a maximum of 80 mBq/kg/h. The thoron surface exhalation rate ranged from BDL to 17470 Bq/m2/h. Reshma Bhaskaran, Ravikumar C. Damodaran, Visnuprasad Ashok Kumar, Jojo Panakal John, Danalakshmi Bangaru, Chitra Natarajan, Bala Sundar Sathiamurthy, Jose Mundiyanikal Thomas, and Rosaline Mishra Copyright © 2017 Reshma Bhaskaran et al. All rights reserved. Examining the Benefits and Barriers of Instructional Gardening Programs to Increase Fruit and Vegetable Intake among Preschool-Age Children Sun, 21 May 2017 00:00:00 +0000 Research exists on using instructional gardening programs with school age children as a means of improving dietary quality and for obesity prevention. This article examines the potential use of instructional gardens in childcare settings to improving fruit and vegetable intake in young children. A qualitative study was conducted with childcare providers. Participants () were recruited via e-mails, letters, and follow-up phone calls. Interviews were recorded, transcribed, and coded to identify themes within two areas childcare providers perceptions of children’s fruit and vegetable consumption and components necessary to initiate or improve instructional gardening programs. Themes associated with provider’s perceptions of child fruit and vegetable consumption included benefits of consumption, willingness to try fruits and vegetables, meeting recommendations, and influence of the home and childcare environments on child eating. Benefits, barriers, and resources needed were identified as themes related to starting or improving instructional gardening programs. Benefits to gardening with preschoolers are consistent with those found in school-age populations. While several barriers exist, resources are available to childcare providers to address these barriers. Increased knowledge and awareness of resources are necessary to improve the success of gardening programs in the childcare setting with the goal of improving child diet quality. Kristen L. Davis and Lynn S. Brann Copyright © 2017 Kristen L. Davis and Lynn S. Brann. All rights reserved. Charting Availability of Processed and Unprocessed Foods in School Neighbourhood Nutrition Environments in an Urban Australian Setting Wed, 03 May 2017 00:00:00 +0000 School Neighbourhood Nutrition Environments (SNNEs) can facilitate or impede healthy eating. This study describes the SNNEs surrounding 6 Good Start Program (GSP) schools in 5 suburbs in Logan, Queensland. Relative density of healthy and unhealthy food outlets was calculated for SNNEs surrounding GSP (6) and non-GSP (10) schools within the 5 suburbs. Relative accessibility of minimally processed and highly processed food and drink in SNNEs of the 6 GSP schools was determined using shelf measurements of snack foods. Unhealthy outlets greatly outnumber healthy outlets (mean relative density 15.6%, median 19.1%). The majority of outlets stock predominantly highly processed food and drink. Study areas are dominated by unhealthy food outlets and highly processed food. Holly Oaken, Lisa Vaughan, Nicola Fa’avale, Robert S. Ware, and Lisa Schubert Copyright © 2017 Holly Oaken et al. All rights reserved. Horizontal and Vertical Distribution of Heavy Metals in Farm Produce and Livestock around Lead-Contaminated Goldmine in Dareta and Abare, Zamfara State, Northern Nigeria Tue, 02 May 2017 08:45:19 +0000 Background. Hitherto studies in response to the June 2010 lead poisoning, Zamfara State, Nigeria, have focused on clinical interventions without information on livestock and other metals. Objective. This study has investigated the distribution of heavy metals in farm produce and livestock around lead-contaminated goldmine in Dareta and Abare, Zamfara State, Nigeria. Methods. Vegetables, soil, water, blood, and different meat samples were harvested from goat, sheep, cattle, and chicken from Dareta, Abare, and Gusau communities. The samples were digested with 10 mL of a mix of nitric and perchloric acids; the mixture was then heated to dryness. Lead, cadmium, zinc, chromium, copper, magnesium, and nickel were analysed using flame Atomic Absorption Spectrophotometer. The daily intake, bioaccumulation factor, and target hazard quotient (THQ) were calculated. Results. Chicken bone-muscles from Dareta had the highest concentrations of lead, zinc, and nickel (28.2750, 16.1650, and 4.2700 mg/kg, resp.), while chicken brain had the highest levels of cadmium, magnesium (0.3800 and 67.5400 mg/kg), and chromium (6.1650 mg/kg, kidney tissue inclusive). Conclusion. In addition to lead, cadmium may also be of concern in the contaminated mining communities of Zamfara State, Nigeria, given the high levels of cadmium in meat and vegetables samples from these areas. O. E. Orisakwe, O. O. Oladipo, G. C. Ajaezi, and N. A. Udowelle Copyright © 2017 O. E. Orisakwe et al. All rights reserved. Safety Evaluation of Potential Toxic Metals Exposure from Street Foods Consumed in Mid-West Nigeria Wed, 26 Apr 2017 09:45:25 +0000 Objective. Street-vended foods offer numerous advantages to food security; nevertheless, the safety of street food should be considered. This study has investigated the level of potential toxic metal (Pb, Cd, Hg, Sb, Mn, and Al) contamination among street-vended foods in Benin City and Umunede. Methods. Twenty street food samples were purchased from vendors at bus stops. Metals were analyzed with atomic absorption spectrophotometry. The methods developed by the US EPA were employed to evaluate the potential health risk of toxic metals. Results. The concentrations of the toxic metals in mg/kg were in the range of Pb (0.014–1.37), Cd (0.00–0.00017), Hg (0.00–0.00014), Sb (0.00–0.021), Mn (0.00–0.012), and Al (0.00–0.22). All the toxic metals except Pb were below permissible limit set by WHO, EU, and USEPA. The daily intake, hazard quotient, and hazard index of all toxic metals except for Pb in some street foods were below the tolerable daily intake and threshold value of 1, indicating an insignificant health risk. Total cancer risk was within the priority risk level of but higher than the acceptable risk level of . Conclusion. Consumption of some of these street foods is of public health concern. O. C. Ekhator, N. A. Udowelle, S. Igbiri, R. N. Asomugha, Z. N. Igweze, and O. E. Orisakwe Copyright © 2017 O. C. Ekhator et al. All rights reserved. Risk Factors for Road Traffic Injuries among Different Road Users in the Gambia Sun, 23 Apr 2017 00:00:00 +0000 We identified risk factors for road traffic injuries among road users who received treatment at two major trauma hospitals in urban Gambia. The study includes pedestrians, bicyclists, motorcyclists, and drivers/passengers of cars and trucks. We examined distributions of injury by age, gender, collision vehicle types and vehicle category, and driver and environment factors. Two hundred and fifty-four patients were included in the study. Two-thirds were male and one-third female. Two-thirds (67%) of road traffic injuries involved pedestrians, bicyclists, and motorcyclists; and these were more common during weekdays (74%) than weekends. Nearly half (47%) of road traffic injuries involved pedestrians. One-third (34%) of injured patients were students (mean age of students was less than 14 years), more than half (51%) of whom were injured on the roadway as pedestrians. Head/skull injuries were common. Concussion/brain injuries were 3.5 times higher among pedestrians, bicyclists, and motorcyclists than vehicle occupants. Crashes involving pedestrians were more likely to involve young people (<25 years; aOR 6.36, 95% CI: 3.32–12.17) and involve being struck by a motor car (aOR 3.95, 95% CI: 2.09–7.47). Pedestrians contribute the largest proportion of hospitalizations in the Gambia. Young pedestrians are at particularly high risk. Prevention efforts should focus on not only vehicle and driver factors, but also protecting pedestrians, bicyclists, and motorcyclists. Edrisa Sanyang, Corinne Peek-Asa, Paul Bass, Tracy L. Young, Babanding Daffeh, and Laurence J. Fuortes Copyright © 2017 Edrisa Sanyang et al. All rights reserved. Human Papillomavirus Genotype Distribution among Cervical Cancer Patients prior to Brazilian National HPV Immunization Program Sun, 23 Apr 2017 00:00:00 +0000 To evaluate the impact of HPV immunization and possible changes in virus type-specific prevalence associated with cervical cancer, it is important to obtain baseline information based on socioeconomic, educational, and environmental characteristics in human populations. We describe these characteristics and the type-specific HPV distribution in 1,183 women diagnosed with cervical cancer in two Brazilian healthcare institutions located at the Southeastern (Rio de Janeiro/RJ) and the Amazonian (Belém/PA) regions. Large differences were observed between women in these regions regarding economic, educational, and reproductive characteristics. The eight most frequent HPV types found in tumor samples were the following: 16, 18, 31, 33, 35, 45, 52, and 58. Some HPV types classified as unknown or low risk were found in tumor samples with single infections, HPV 83 in RJ and HPV 11, 61, and 69 in PA. The proportion of squamous cervical cancer was lower in RJ than in PA (76.3% versus 87.3%, ). Adenocarcinoma was more frequent in RJ than in PA (13.5% versus 6.9%, ). The frequency of HPV 16 in PA was higher in younger women (). The success of a cervical cancer control program should consider HPV types, local health system organization, and sociodemographic diversity of Brazilian regions. Liz M. de Almeida, Luís Felipe L. Martins, Valéria B. Pontes, Flávia M. Corrêa, Raquel C. Montenegro, Laine C. Pinto, Bruno M. Soares, João Paulo C. B. Vidal, Shayany P. Félix, Neilane Bertoni, Moysés Szklo, and Miguel Angelo M. Moreira Copyright © 2017 Liz M. de Almeida et al. All rights reserved. Geospatial Assessment of Cholera in a Rapidly Urbanizing Environment Tue, 11 Apr 2017 00:00:00 +0000 This study mapped out and investigated the spatial relationship between cholera incidences and environmental risk factors in the study area. The study area was stratified into eight zones. Water samples from each zone were collected and analyzed to determine the colony forming units. GIS layers including housing density, digitized roads, rivers, buildings, and cholera incidence data from hospital archives were also collected and analyzed using ArcGIS 10.1. It was observed that there was an association between the ERFs (). Similarly, 18 out of the 44 waste dump sites, seven out of 18 markets, and two out of 36 abattoirs were found near the historical cholera cases. Similarly, 4 (21.1%) locations were traced to be predominantly close to rivers and waste dump site. All the historical cholera cases were found adjoining to roads and buildings. Highest CFU count was found in the wells and streams of areas with a cluster of all the environmental risk factors and high housing density. This study revealed that waste dump sites and market had the highest predisposing attribute while the least was abattoir. The uniqueness of the study lies in the combination of mapping and microbial analyses to identify and assess the pattern of cholera risk and also to provide clear information for development of strategies for environmental supervision. Olajumoke Esther Olanrewaju and Kayode Adewale Adepoju Copyright © 2017 Olajumoke Esther Olanrewaju and Kayode Adewale Adepoju. All rights reserved. Increased Sensitization to Mold Allergens Measured by Intradermal Skin Testing following Hurricanes Sun, 09 Apr 2017 07:14:39 +0000 Objective. To report on changes in sensitivity to mold allergens determined by changes in intradermal skin testing reactivity, after exposure to two severe hurricanes. Methods. A random, retrospective allergy charts review divided into 2 groups of 100 patients each: Group A, patients tested between 2003 and 2010 prior to hurricanes, and Group B, patients tested in 2014 and 2015 following hurricanes. Reactivity to eighteen molds was determined by intradermal skin testing. Test results, age, and respiratory symptoms were recorded. Chi-square test determined reactivity/sensitivity differences between groups. Results. Posthurricane patients had 34.6 times more positive results () at weaker dilutions, all tested molds were found to be more reactive, and 95% had at least one positive test versus only 62% before the hurricanes (); average mold reactivity was 55% versus 16% while 17% of patients reacted to the entire panel versus none before the hurricanes (). The posthurricane population was younger () and included more patients with asthma or lower respiratory symptoms (). Conclusion. Reactivity and sensitization to mold allergens increased compared to patients before the hurricanes. This supports climatologists’ hypothesis that environmental changes resulting from hurricanes can be a health risk as reflected in increased allergic sensitivities and symptoms and has significant implications for physicians treating patients from affected areas. Diego Saporta and David Hurst Copyright © 2017 Diego Saporta and David Hurst. All rights reserved. Self-Medication in University Students from the City of Mansoura, Egypt Wed, 05 Apr 2017 00:00:00 +0000 Background. Self-medication is a common practice in developed and developing countries. Objectives. To explore the prevalence of self-medication practices among university students, probable reasons, symptoms requiring self-medication, and sources of advice. Methods. A descriptive cross-sectional study was carried out in Mansoura University, Egypt, and included 1st and last year students of both medical and nonmedical faculties. Results. Prevalence of self-medication was 62.9%. Younger age, female, medical, and ever-married students and those having home pharmacy tended to self-medicate more than their peers with significant difference between them. Being medical student, being from urban area, having good current health condition, being careless about health, and having drugs stored at home pharmacy were independently associated with the likelihood of self-medicating. Conclusion. Prevalence of self-medication among university students is high which constitutes a health problem that needs intervention. R. M. Helal and H. S. Abou-ElWafa Copyright © 2017 R. M. Helal and H. S. Abou-ElWafa. All rights reserved. Environmental, Spatial, and Sociodemographic Factors Associated with Nonfatal Injuries in Indonesia Mon, 03 Apr 2017 08:18:06 +0000 Background. The determinants of injuries and their reoccurrence in Indonesia are not well understood, despite their importance in the prevention of injuries. Therefore, this study seeks to investigate the environmental, spatial, and sociodemographic factors associated with the reoccurrence of injuries among Indonesian people. Methods. Data from the 2013 round of the Indonesia Baseline Health Research (IBHR 2013) were analysed using a two-part hurdle regression model. A logit regression model was chosen for the zero-hurdle part, while a zero-truncated negative binomial regression model was selected for the counts part. Odds ratio (OR) and incidence rate ratio (IRR) were the measures of association, respectively. Results. The results suggest that living in a household with distant drinking water source, residing in slum areas, residing in Eastern Indonesia, having low educational attainment, being men, and being poorer are positively related to the likelihood of experiencing injury. Moreover, being a farmer or fishermen, having low educational attainment, and being men are positively associated with the frequency of injuries. Conclusion. This study would be useful to prioritise injury prevention programs in Indonesia based on the environmental, spatial, and sociodemographic characteristics. Sri Irianti and Puguh Prasetyoputra Copyright © 2017 Sri Irianti and Puguh Prasetyoputra. All rights reserved. Epidemic of Vitamin D Deficiency and Its Management: Awareness among Indian Medical Undergraduates Mon, 03 Apr 2017 00:00:00 +0000 Vitamin D deficiency is prevalent across all age groups in epidemic proportions. The purpose of this study was to acquire a baseline assessment and create awareness among medical students regarding vitamin D. A cross-sectional, voluntary survey was conducted among undergraduate medical students. Data were collected using a questionnaire which assessed the level of knowledge students had with regard to where vitamin D comes from, what it does for health, how much is recommended, factors that affect its levels, and deficiency management. Majority of students were unaware that vitamin D deficiency has attained epidemic proportions. Though bone and skeletal disorders as a complication of vitamin D deficiency were known, a large number were unaware of systemic consequences (diabetes mellitus, cardiovascular diseases, and cancers). Only one-third of respondents were aware of duration and timing of sun exposure required for adequate serum vitamin D levels. However, we observed lack of awareness among students regarding the various biochemical forms, dose, and duration of vitamin D supplementation for treatment of nutritional deficiency. Our study highlighted a lack of knowledge about the importance of vitamin D, worldwide prevalence of vitamin D deficiency, and its management among medical students. Promoting vitamin D health awareness, if replicated across populations, could lead to positive health outcomes globally. Yangshen Lhamo, Preeta Kaur Chugh, Sandhya R. Gautam, and C. D. Tripathi Copyright © 2017 Yangshen Lhamo et al. All rights reserved. Understanding Public Views about Air Quality and Air Pollution Sources in the San Joaquin Valley, California Sun, 02 Apr 2017 08:44:21 +0000 The San Joaquin Valley of California has poor air quality and high rates of asthma. Surveys were collected from 744 residents of the San Joaquin Valley from November 2014 to January 2015 to examine the public’s views about air quality. The results of this study suggest that participants exposed to high PM2.5 (particulate matter less than 2.5 microns in size) concentrations perceived air pollution to be of the worst quality. Air quality in the San Joaquin Valley was primarily perceived as either moderate or unhealthy for sensitive groups. Females perceived air pollution to be of worse quality compared to males. Participants perceived unemployment, crime, and obesity to be the top three most serious community problems in the San Joaquin Valley. Participants viewed cars and trucks, windblown dust, and factories as the principle contributors to air pollution in the area. There is a need to continue studying public perceptions of air quality in the San Joaquin Valley with a more robust survey with more participants over several years and seasons. Ricardo Cisneros, Paul Brown, Linda Cameron, Erin Gaab, Mariaelena Gonzalez, Steven Ramondt, David Veloz, Anna Song, and Don Schweizer Copyright © 2017 Ricardo Cisneros et al. All rights reserved. Social, Environmental, and Health Vulnerability to Climate Change: The Case of the Municipalities of Minas Gerais, Brazil Wed, 29 Mar 2017 00:00:00 +0000 Vulnerability to climate change is a complex and dynamic phenomenon involving both social and physical/environmental aspects. It is presented as a method for the quantification of the vulnerability of all municipalities of Minas Gerais, a state in southeastern Brazil. It is based on the aggregation of different kinds of environmental, climatic, social, institutional, and epidemiological variables, to form a composite index. This was named “Index of Human Vulnerability” and was calculated using a software (SisVuClima®) specifically developed for this purpose. Social, environmental, and health data were combined with the climatic scenarios RCP 4.5 and 8.5, downscaled from ETA-HadGEM2-ES for each municipality. The Index of Human Vulnerability associated with the RCP 8.5 has shown a higher vulnerability for municipalities in the southern and eastern parts of the state of Minas Gerais. Ana Flávia Quintão, Isabela Brito, Frederico Oliveira, Ana Paula Madureira, and Ulisses Confalonieri Copyright © 2017 Ana Flávia Quintão et al. All rights reserved. Socioeconomic and Racial/Ethnic Disparities in Cancer Mortality, Incidence, and Survival in the United States, 1950–2014: Over Six Decades of Changing Patterns and Widening Inequalities Mon, 20 Mar 2017 00:00:00 +0000 We analyzed socioeconomic and racial/ethnic disparities in US mortality, incidence, and survival rates from all-cancers combined and major cancers from 1950 to 2014. Census-based deprivation indices were linked to national mortality and cancer data for area-based socioeconomic patterns in mortality, incidence, and survival. The National Longitudinal Mortality Study was used to analyze individual-level socioeconomic and racial/ethnic patterns in mortality. Rates, risk-ratios, least squares, log-linear, and Cox regression were used to examine trends and differentials. Socioeconomic patterns in all-cancer, lung, and colorectal cancer mortality changed dramatically over time. Individuals in more deprived areas or lower education and income groups had higher mortality and incidence rates than their more affluent counterparts, with excess risk being particularly marked for lung, colorectal, cervical, stomach, and liver cancer. Education and income inequalities in mortality from all-cancers, lung, prostate, and cervical cancer increased during 1979–2011. Socioeconomic inequalities in cancer mortality widened as mortality in lower socioeconomic groups/areas declined more slowly. Mortality was higher among Blacks and lower among Asian/Pacific Islanders and Hispanics than Whites. Cancer patient survival was significantly lower in more deprived neighborhoods and among most ethnic-minority groups. Cancer mortality and incidence disparities may reflect inequalities in smoking, obesity, physical inactivity, diet, alcohol use, screening, and treatment. Gopal K. Singh and Ahmedin Jemal Copyright © 2017 Gopal K. Singh and Ahmedin Jemal. All rights reserved. Household Food Insecurity and Its Association with Nutritional Status of Children 6–59 Months of Age in East Badawacho District, South Ethiopia Thu, 16 Mar 2017 00:00:00 +0000 Background. Ethiopia has one of the highest child malnutrition rates in the world. Food insecurity is one of the determinant factors of malnutrition in developing countries; however its role remains unclear. Objective. To assess household food insecurity and its association with the nutritional status of children 6–59 months of age in East Badawacho District, South Ethiopia. Methods. A community based cross-sectional study was conducted from February 20 to 30, 2014 on a sample of 508 mother/child pairs of 6–59-month-old children. Sample households with eligible children were selected using systematic random sampling technique. Both bivariate and multivariate analysis were used to identify factors associated with nutritional status of children. value of <0.05 was considered as statistically significant. Result. The prevalence of household food insecurity was 75.8%. The prevalence rates of stunting, underweight, and wasting among children were 45.6%, 26.3%, and 14.6%, respectively. Household food insecurity was significantly associated with underweight (AOR = 3.82; CI = 1.78–8.19) and stunting (AOR = 6.7; CI = 3.71–12.1) but not with wasting. Conclusion and Recommendation. Household food insecurity and the prevalence rates of stunting, underweight, and wasting, among children 6 to 59 months, were high. Intervention programs should focus on improving household food insecurity and nutritional status of children. Bealu Betebo, Tekle Ejajo, Fissahaye Alemseged, and Desalegn Massa Copyright © 2017 Bealu Betebo et al. All rights reserved. Land Use Land Cover Changes in Detection of Water Quality: A Study Based on Remote Sensing and Multivariate Statistics Thu, 09 Mar 2017 10:50:45 +0000 Malacca River water quality is affected due to rapid urbanization development. The present study applied LULC changes towards water quality detection in Malacca River. The method uses LULC, PCA, CCA, HCA, NHCA, and ANOVA. PCA confirmed DS, EC, salinity, turbidity, TSS, DO, BOD, COD, As, Hg, Zn, Fe, E. coli, and total coliform. CCA confirmed 14 variables into two variates; first variate involves residential and industrial activities; and second variate involves agriculture, sewage treatment plant, and animal husbandry. HCA and NHCA emphasize that cluster 1 occurs in urban area with Hg, Fe, total coliform, and DO pollution; cluster 3 occurs in suburban area with salinity, EC, and DS; and cluster 2 occurs in rural area with salinity and EC. ANOVA between LULC and water quality data indicates that built-up area significantly polluted the water quality through E. coli, total coliform, EC, BOD, COD, TSS, Hg, Zn, and Fe, while agriculture activities cause EC, TSS, salinity, E. coli, total coliform, arsenic, and iron pollution; and open space causes contamination of turbidity, salinity, EC, and TSS. Research finding provided useful information in identifying pollution sources and understanding LULC with river water quality as references to policy maker for proper management of Land Use area. Ang Kean Hua Copyright © 2017 Ang Kean Hua. All rights reserved. Effect of a 12-Week Summer Break on School Day Physical Activity and Health-Related Fitness in Low-Income Children from CSPAP Schools Thu, 09 Mar 2017 00:00:00 +0000 Background. The purpose of this study was to examine the effect of a 12-week summer break on school day physical activity and health-related fitness (HRF) in children from schools receiving a Comprehensive School Physical Activity Program (CSPAP). Methods. Participants were school-aged children (; 624 girls and 608 boys; years) recruited from three low-income schools receiving a CSPAP. Physical activity and HRF levels were collected during the end of spring semester 2015 and again during the beginning of fall semester 2015. Physical activity was assessed using the Yamax DigiWalker CW600 pedometer. HRF measures consisted of body mass index (BMI) and the Progressive Aerobic Cardiovascular Endurance Run (PACER). Results. Results from a doubly MANCOVA analysis indicated that pedometer step counts decreased from 4,929 steps in the spring to 4,445 steps in the fall (mean difference = 484 steps; ; Cohen’s d = 0.30) and PACER laps decreased from 31.2 laps in the spring to 25.8 laps in the fall (mean difference = 5.4 laps; ; Cohen’s d = 0.33). Conclusions. Children from schools receiving a CSPAP intervention had lower levels of school day physical activity and cardiorespiratory endurance following a 12-week summer break. You Fu, Timothy A. Brusseau, James C. Hannon, and Ryan D. Burns Copyright © 2017 You Fu et al. All rights reserved. An Approach to Developing Local Climate Change Environmental Public Health Indicators in a Rural District Thu, 02 Mar 2017 08:13:21 +0000 Climate change represents a significant and growing threat to population health. Rural areas face unique challenges, such as high rates of vulnerable populations; economic uncertainty due to their reliance on industries that are vulnerable to climate change; less resilient infrastructure; and lower levels of access to community and emergency services than urban areas. This article fills a gap in public health practice by developing climate and health environmental public health indicators for a local public health department in a rural area. We adapted the National Environmental Public Health Tracking Network’s framework for climate and health indicators to a seven-county health department in Western Kentucky. Using a three-step review process, we identified primary climate-related environmental public health hazards for the region (extreme heat, drought, and flooding) and a suite of related exposure, health outcome, population vulnerability, and environmental vulnerability indicators. Indicators that performed more poorly at the county level than at the state and national level were defined as “high vulnerability.” Six to eight high vulnerability indicators were identified for each county. The local health department plans to use the results to enhance three key areas of existing services: epidemiology, public health preparedness, and community health assessment. Adele Houghton, Jessica Austin, Abby Beerman, and Clayton Horton Copyright © 2017 Adele Houghton et al. All rights reserved. Long-Term Body Weight Maintenance among StrongWomen–Healthy Hearts Program Participants Thu, 02 Mar 2017 00:00:00 +0000 Background. The repeated loss and regain of body weight, referred to as weight cycling, may be associated with negative health complications. Given today’s obesity epidemic and related interventions to address obesity, it is increasingly important to understand contexts and factors associated with weight loss maintenance. This study examined BMI among individuals who had previously participated in a 12-week, evidence-based, nationally disseminated nutrition and physical activity program designed for overweight and obese middle-aged and older women. Methods. Data were collected using follow-up surveys. Complete height and weight data were available for baseline, 12-week program completion (post-program) and follow-up (approximately 3 years later) for 154 women (response rate = 27.5%; BMI characteristics did not differ between responders and nonresponders). Results. Mean BMI decreased significantly from baseline to post-program (−0.5, ) and post-program to follow-up (−0.7, ). Seventy-five percent of survey respondents maintained or decreased BMI post-program to follow-up. Self-efficacy and social support for healthy eating behaviors (but not physical activity) were associated with BMI maintenance or additional weight loss. Conclusions. These findings support the durability of weight loss following participation in a relatively short-term intervention. Rebecca A. Seguin, Sara C. Folta, Miriam E. Nelson, Karla L. Hanson, and Andrea Z. LaCroix Copyright © 2017 Rebecca A. Seguin et al. All rights reserved. A Simulation Study on Hypothetical Ebola Virus Transmission in India Using Spatiotemporal Epidemiological Modeler (STEM): A Way towards Precision Public Health Mon, 27 Feb 2017 09:45:58 +0000 Background. Precision public health is a state-of-the-art concept in public health research and its application in health care. Application of information technology in field of epidemiology paves the way to its transformation to digital epidemiology. A geospatial epidemiological model was simulated to estimate the spread of Ebola virus disease after a hypothetical outbreak in India. Methods. It was a simulation study based on SEIR (Susceptible-Exposed-Infectious-Recovered) compartmental model. Simulation was done in Spatiotemporal Epidemiological Modeler (STEM). Epidemiological profile of Ebola virus, that transmitted throughout the Sierra Leon in 2014–2016, was fitted into the SEIR deterministic compartment model designed for India. Result. Spatiotemporal distribution of EVD exposed, infectious, and recovered population at 4-month interval represented by different figures. It is estimated that if no intervention is taken to stop the spread, within 2 years, almost half of the country will be effected by EVD and cumulative number of exposed individuals, infectious persons, and deaths will be 106947760, 30651674, and 18391005, respectively. Conclusion. Precision public health may play the key role to achieve the health related targets in the Sustainable Development Goals. Policy makers, public health specialists, and data scientists need to put their hands together to make precision public health a reality. Arkaprabha Sau Copyright © 2017 Arkaprabha Sau. All rights reserved. Role Performance of Community Health Volunteers and Its Associated Factors in Kuching District, Sarawak Mon, 13 Feb 2017 00:00:00 +0000 The objective of this study was to assess the role performance among KOSPEN community health volunteer in Kuching district and its associated factors. This was a cross-sectional study, conducted in 21 localities in Kuching with a total of 210 respondents. Data were collected using validated interviewer-administered questionnaires and analyzed using SPSS version 22.0. The respondents comprised 55.2% females, 81.9% married, and 41.4% aged above 45 and above and 72.4% completed their education up to secondary school. The result revealed that 59.0% of the respondents agreed and understood their role performances. Multiple Logistics analysis revealed that factors associated with role performance were age group (), education level (), marital status (), prestige and respect (), being seen as “doctor” in community (), job aids (), training location (), and supervision by community (). To increase and maintain the work performance of CHVs, commitment from the government, policy makers, stakeholders, and the communities is required. Melvin Hsien Liang Chung, Helmy Hazmi, and Whye Lian Cheah Copyright © 2017 Melvin Hsien Liang Chung et al. All rights reserved. Compliance with Standard Precautions and Associated Factors among Healthcare Workers in Gondar University Comprehensive Specialized Hospital, Northwest Ethiopia Mon, 16 Jan 2017 00:00:00 +0000 Background. In many studies, compliance with standard precautions among healthcare workers was reported to be inadequate. Objective. The aim of this study was to assess compliance with standard precautions and associated factors among healthcare workers in northwest Ethiopia. Methods. An institution-based cross-sectional study was conducted from March 01 to April 30, 2014. Simple random sampling technique was used to select participants. Data were entered into Epi info 3.5.1 and were exported to SPSS version 20.0 for statistical analysis. Multivariate logistic regression analyses were computed and adjusted odds ratio with 95% confidence interval was calculated to identify associated factors. Results. The proportion of healthcare workers who always comply with standard precautions was found to be 12%. Being a female healthcare worker (AOR [95% CI] 2.18 [1.12–4.23]), higher infection risk perception (AOR [95% CI] 3.46 [1.67–7.18]), training on standard precautions (AOR [95% CI] 2.90 [1.20–7.02]), accessibility of personal protective equipment (AOR [95% CI] 2.87 [1.41–5.86]), and management support (AOR [95% CI] 2.23 [1.11–4.53]) were found to be statistically significant. Conclusion and Recommendation. Compliance with standard precautions among the healthcare workers is very low. Interventions which include training of healthcare workers on standard precautions and consistent management support are recommended. Tariku Gebre Haile, Eshetu Haileselassie Engeda, and Abdella Amano Abdo Copyright © 2017 Tariku Gebre Haile et al. All rights reserved. Bioaerosols, Noise, and Ultraviolet Radiation Exposures for Municipal Solid Waste Handlers Thu, 12 Jan 2017 00:00:00 +0000 Few studies have investigated the occupational hazards of municipal solid waste workers, particularly in developing countries. Resultantly these workers are currently exposed to unknown and unabated occupational hazards that may endanger their health. We determined municipal solid waste workers’ work related hazards and associated adverse health endpoints. A multifaceted approach was utilised comprising bioaerosols sampling, occupational noise, thermal conditions measurement, and field based waste compositional analysis. Results from our current study showed highest exposure concentrations for Gram-negative bacteria (6.8 × 103 cfu/m3) and fungi (12.8 × 103 cfu/m3), in the truck cabins. Significant proportions of toxic, infectious, and surgical waste were observed. Conclusively, municipal solid waste workers are exposed to diverse work related risks requiring urgent sound interventions. A framework for assessing occupational risks of these workers must prioritize performance of exposure assessment with regard to the physical, biological, and chemical hazards of the job. France Ncube, Esper Jacobeth Ncube, and Kuku Voyi Copyright © 2017 France Ncube et al. All rights reserved. Health Care Waste Segregation Behavior among Health Workers in Uganda: An Application of the Theory of Planned Behavior Tue, 27 Dec 2016 12:45:31 +0000 Objective. The goal of this study was to assess the appropriateness of the theory of planned behavior in predicting health care waste segregation behaviors and to examine the factors that influence waste segregation behaviors. Methodology. One hundred and sixty-three health workers completed a self-administered questionnaire in a cross-sectional survey that examined the theory of planned behavior constructs (attitudes, subjective norms, perceived behavioral control, and intention) and external variables (sociodemographic factors, personal characteristics, organizational characteristics, professional characteristics, and moral obligation). Results. For their most recent client 21.5% of the health workers reported that they most definitely segregated health care waste while 5.5% did not segregate. All the theory of planned behavior constructs were significant predictors of health workers’ segregation behavior, but intention emerged as the strongest and most significant (, ). The theory of planned behavior model explained 52.5% of the variance in health workers’ segregation behavior. When external variables were added, the new model explained 66.7% of the variance in behavior. Conclusion. Generally, health workers’ health care waste segregation behavior was high. The theory of planned behavior significantly predicted health workers’ health care waste segregation behaviors. Martha Akulume and Suzanne N. Kiwanuka Copyright © 2016 Martha Akulume and Suzanne N. Kiwanuka. All rights reserved. Birth Preparedness and Its Association with Skilled Birth Attendance and Postpartum Checkups among Mothers in Gibe Wereda, Hadiya Zone, South Ethiopia Tue, 27 Dec 2016 09:58:46 +0000 Background. Birth preparedness program was designed to enhance skilled birth attendance and postpartum checkups of women in a developing country to reduce the three delays that lead women and neonates to death and disability. However, the relationship between birth preparedness with skilled birth attendance and postpartum checkups among mothers is not well studied. Therefore this study is intended to assess the association between birth preparedness and skilled birth attendance and postpartum checkups. Methods. A community based cross-sectional study was conducted from March to April 2014. Eight out of 22 Kebeles were selected using probability proportional to size sampling method. Seven hundred and forty-five mothers were selected randomly from the sampling frame, generated from family folders obtained from health posts. Data was collected using pretested questionnaire by face-to-face interview. Data was entered into EpiData version 3.1 database and analyzed by SPSS version 16. Result. Out of 745 sampled mothers 728 (97.7%) participated in the study. One hundred and twelve (15.4%) and 128 (17.6%) mothers got skilled birth attendance and received postpartum checkups for their last child, respectively. Birth preparedness, educational status of women and their husbands, and antenatal care visits of mothers were found to be predictor of skilled birth attendance and postpartum checkups. Mothers well prepared for child birth were 6.7 times more likely to attend skilled birth attendance [AOR = 6.7 (2.7–16.4)] and 3 times more likely to follow postpartum checkups [AOR = 3.0 (1.5–5.9)] than poorly prepared mothers, respectively. Travel time to reach the nearest health facility was found as predictor for postpartum checkups of mothers; mothers who travel ≤ 2 hours were three times more likely to follow postpartum checkups than mothers who travel > 2 hours (AOR (95% CI) = 3.4 (1.5–7.9)). Conclusion and Recommendation. Skilled birth attendance and postpartum checkups were low. Encouraging women to attend recommended antenatal care visits and providing advice and education on birth preparedness and obstetric danger signs are important interventions to increase skilled birth attendance and postpartum checkups. Yohannes Lakew, Fasil Tessema, and Chernet Hailu Copyright © 2016 Yohannes Lakew et al. All rights reserved. Levels of Urinary Metabolites of Organophosphate Flame Retardants, TDCIPP, and TPHP, in Pregnant Women in Shanghai Sun, 25 Dec 2016 07:12:32 +0000 Flame retardants are widely used in consumer products to reduce their flammability. Previously used flame retardants have been sequentially banned due to their environmental and human toxicity. Currently, tris(1,3-dichloropropyl) phosphate (TDCIPP) and triphenyl phosphate (TPHP) are among the most commonly used flame retardants. TDCIPP and TPHP are reproductive toxins and have carcinogenic, neurotoxic, and endocrine-disrupting properties. Although high levels of TDCIPP and TPHP have been found in drinking water, seawater, and office air in China, data regarding human exposure are lacking. In this study, we assessed the level of urinary TPHP and TDCIPP metabolites (DPHP and BDCIPP, resp.) in a cohort of pregnant women () from Shanghai, China, using liquid chromatography-tandem mass spectrometry. DPHP were detected in 100% urine samples, while only four urine samples had detectable level of BDCIPP in this cohort (17% detected). Geometric means of DPHP and BDCIPP concentrations were 1.1 ng/mL (interquartile range [IQR]: 0.6, 1.5 ng/mL) and 1.2 ng/mL (IQR: 0.6, 2.2 ng/mL), respectively. In this small cohort, urinary DPHP and BDCIPP levels were not significantly correlated with miscarriages, neonatal birthweight, gestational diabetes, or maternal age. These data suggest that exposure to TPHP is widespread, and they demonstrate the feasibility of using urinary biomarkers to measure exposures to modern flame-retardant chemicals. Liping Feng, Fengxiu Ouyang, Liangpo Liu, Xu Wang, Xia Wang, Yi-Ju Li, Amy Murtha, Heqing Shen, Junfeng Zhang, and Jun Jim Zhang Copyright © 2016 Liping Feng et al. All rights reserved. Increase in the Risk of Respiratory Disorders in Adults and Children Related to Crop-Growing in Niger Wed, 21 Dec 2016 08:15:08 +0000 Background and Objective. Environmental factors are an increasing concern for respiratory health in developing countries. The objective of this study was to investigate whether Nigerien people living in cultivated areas have more respiratory symptoms than those living in pastoral areas. Method. A cross-sectional study was conducted in 2013 in two populations during the rainy season when land is cultivated. Environmental factors including pesticide use and respiratory symptoms were collected in adults and children during face-to-face interviews. Multivariate analysis between exposures and symptoms was performed in children and in adults separately. Results. The study included 471 adults and 229 children. Overall, none of the households reported the use of pesticides for agricultural purposes. However, 87.2% reported the use of insecticides at home. Multivariate analysis showed that people living in agricultural areas compared to those in pastoral areas had an increased risk of respiratory symptoms in adults (wheezing, dyspnea, sudden shortness of breath, and cough without fever) and in children (cough without fever). The use of insecticides showed no effect on respiratory symptoms after adjustment. Conclusion. This first epidemiological study on the environment and respiratory health conducted in Niger demonstrates a significant relationship between respiratory manifestations and the agricultural characteristics of the living area. However only the effect of insecticides in the home on respiratory health was observed. Ali Mamane, Jean-François Tessier, Ghislaine Bouvier, Roger Salamon, Pierre Lebailly, Chantal Raherison, and Isabelle Baldi Copyright © 2016 Ali Mamane et al. All rights reserved. Association between Asian Dust-Borne Air Pollutants and Daily Symptoms on Healthy Subjects: A Web-Based Pilot Study in Yonago, Japan Thu, 08 Dec 2016 07:58:57 +0000 During the spring, Asian dust (AD) repeatedly makes its way to Japan, originating from drylands. We evaluated the association between AD-borne air pollutants and daily reported subjective symptoms in healthy subjects. We constructed an Internet questionnaire on daily ocular, nasal, respiratory, and skin symptoms. Forty-two healthy volunteers residents of Yonago (mean age, 33.57) were selected from the self-reporting web-based survey and recorded their symptoms between 1 and 31 of March 2013. We also collected information on levels of suspended particulate matter (SPM), particulate matter < 2.5 µm (PM2.5), sulfur dioxide (SO2), and nitrogen oxide () per hour on each of those days. SPM and PM2.5 were the dominant pollutants recorded throughout the month. A positive correlation was observed between SPM and ocular (, ), nasal (, ), and skin (, ) symptoms. PM2.5 correlations were significant for ocular (, ), nasal (, ), and skin (, ) symptoms. Our findings provide introductory evidence of AD-borne air pollutants and their association with several bodily symptoms in healthy subjects with the implementation of a self-administrated web-based survey application. Abir Majbauddin, Kazunari Onishi, Shinji Otani, Yasunori Kurosaki, and Youichi Kurozawa Copyright © 2016 Abir Majbauddin et al. All rights reserved. The Association between Residence Floor Level and Cardiovascular Disease: The Health and Environment in Oslo Study Wed, 07 Dec 2016 14:41:31 +0000 Background. Increasingly more people live in tall buildings and on higher floor levels. Factors relating to floor level may protect against or cause cardiovascular disease (CVD). Only one previous study has investigated the association between floor level and CVD. Methods. We studied associations between floor of bedroom and self-reported history of stroke, venous thromboembolism (VTE), and intermittent claudication (IC) among 12.525 inhabitants in Oslo, Norway. We fitted multivariate logistic regression models and adjusted for sociodemographic variables, socioeconomic status (SES), and health behaviors. Additionally, we investigated block apartment residents () separately. Results. Trend analyses showed that disease prevalence increased by floor level, for all three outcomes. When we investigated block apartment residents alone, the trends disappeared, but one association remained: higher odds of VTE history on 6th floor or higher, compared to basement and 1st floor (OR: 1.504; 95% CI: 1.007–2.247). Conclusion. Floor level is positively associated with CVD, in Oslo. The best-supported explanation may be residual confounding by building height and SES. Another explanation, about the impact of atmospheric electricity, is also presented. The results underline a need to better understand the associations between residence floor level and CVD and multistory housing and CVD. Mads K. Rohde and Geir Aamodt Copyright © 2016 Mads K. Rohde and Geir Aamodt. All rights reserved.