Journal of Environmental and Public Health The latest articles from Hindawi Publishing Corporation © 2016 , Hindawi Publishing Corporation . All rights reserved. Airborne Infectious Agents and Other Pollutants in Automobiles for Domestic Use: Potential Health Impacts and Approaches to Risk Mitigation Wed, 30 Nov 2016 12:24:49 +0000 The world total of passenger cars is expected to go from the current one billion to >2.5 billion by 2050. Cars for domestic use account for ~74% of the world’s yearly production of motorized vehicles. In North America, ~80% of the commuters use their own car with another 5.6% travelling as passengers. With the current life-expectancy of 78.6 years, the average North American spends 4.3 years driving a car! This equates to driving 101 minutes/day with a lifetime driving distance of nearly 1.3 million km inside the confined and often shared space of the car with exposure to a mix of potentially harmful pathogens, allergens, endotoxins, particulates, and volatile organics. Such risks may increase in proportion to the unprecedented upsurge in the numbers of family cars globally. Though new technologies may reduce the levels of air pollution from car exhausts and other sources, they are unlikely to impact our in-car exposure to pathogens. Can commercial in-car air decontamination devices reduce the risk from airborne infections and other pollutants? We lack scientifically rigorous protocols to verify the claims of such devices. Here we discuss the essentials of a customized aerobiology facility and test protocols to assess such devices under field-relevant conditions. Syed A. Sattar, Kathryn E. Wright, Bahram Zargar, Joseph R. Rubino, and M. Khalid Ijaz Copyright © 2016 Syed A. Sattar et al. All rights reserved. Estimating Access to Drinking Water Supply, Sanitation, and Hygiene Facilities in Wolaita Sodo Town, Southern Ethiopia, in Reference to National Coverage Tue, 29 Nov 2016 08:42:54 +0000 Introduction. The coverage of sanitation and access to safe drinking water in Ethiopia especially in Wolaita Sodo town are not well studied. Therefore, the main objective of this study was estimating access to drinking water supply, sanitation, and hygiene facilities in Wolaita Sodo town, southern Ethiopia, in reference to national coverage. Methods. A community based cross-sectional study design method was employed in the study in 588 households of Wolaita Sodo town inhabitants. Face-to-face interview to household owners, in-depth interview to key informants, reviewing secondary data, and observational check lists were used to collect data. Districts were selected using simple random sampling techniques, while systematic random sampling technique was applied to select households. Data was analyzed using Epi Info version 3.5.4 and SPSS version 16 statistical software. Bivariate and multivariable logistic regression analysis were carried out. Results. The community has access to improved water supply which was estimated to be 67.9%. The main water sources of the town were tap water within the yard, which was estimated to be 44.7%, and tap water in the community was 40.0% followed by private protected well which was 14.5%. Ninety-one percent of the households had at least one type of latrine in their homes. The most common type of latrine available to households was pit latrine with superstructure which was estimated to be 75.9% followed by a pit without superstructure, 21.3%, and more than half of the respondents had hand washing facilities in their compound. Occupational status, educational status, and training on water, sanitation, and hygiene related topics were significantly associated with use of improved water source, improved sanitation, and hygiene facilities. Conclusion. In order to address the demand of the town, additional water, sanitation, and hygiene programs are required. Amha Admasie and Ashenafi Debebe Copyright © 2016 Amha Admasie and Ashenafi Debebe. All rights reserved. A Citizen-Science Study Documents Environmental Exposures and Asthma Prevalence in Two Communities Thu, 24 Nov 2016 12:45:05 +0000 A citizen-science study was conducted in two low-income, flood-prone communities in Atlanta, Georgia, in order to document environmental exposures and the prevalence of occupant asthma. Teams consisting of a public-health graduate student and a resident from one of the two communities administered a questionnaire, inspected residences for mold growth, and collected a dust sample for quantifying mold contamination. The dust samples were analyzed for the 36 molds that make up the Environmental Relative Moldiness Index (ERMI). Most residents (76%) were renters. The median duration of residence was 2.5 years. Although only 12% of occupants reported a history of flooding, 46% reported at least one water leak. Homes with visible mold (35%) had significantly () higher mean ERMI values compared to homes without (14.0 versus 9.6). The prevalence of self-reported, current asthma among participants was 14%. In logistic regression models controlling for indoor smoking, among participants residing at their current residence for two years or less, a positive association was observed between asthma and the homes’ ERMI values (adjusted odds ratio per unit increase in ERMI = 1.12, 95% confidence intervals (CI): 1.01–1.25; two-tailed ). Documentation of the exposures and asthma prevalence has been presented to the communities and public officials. Community-based organizations have taken responsibility for planning and implementing activities in response to the study findings. Samantha Eiffert, Yomi Noibi, Stephen Vesper, Jonathan Downs, Florence Fulk, Juanita Wallace, Melanie Pearson, and Andrea Winquist Copyright © 2016 Samantha Eiffert et al. All rights reserved. Climate Change Impact: The Experience of the Coastal Areas of Bangladesh Affected by Cyclones Sidr and Aila Thu, 27 Oct 2016 09:09:44 +0000 Bangladesh is considered one of the countries most at risk to the effects of climate change and its coastal area is most vulnerable. This study tries to explore the experiences of cyclones Sidr and Aila affected people living in the coastal areas of Bangladesh. This study was conducted in the cyclone Sidr affected Amtali Upazila of Barguna District and in the cyclone Aila affected Koyra Upazila of Khulna District. Primary data collection was done using Focus Group Interview and then a thematic analysis approach was used for analysis. Three core themes emerged from the analysis and they are, firstly, impacts of climate change on the socioeconomic condition of the people, secondly, the impact on the health status of the population, and finally the impact on vulnerable people. Findings show that the effects of climate change have serious consequences on the livelihood patterns of the affected population and on their overall health status. As a result, the unfavorable health condition of these affected people makes them more vulnerable to various emerging diseases. Russell Kabir, Hafiz T. A. Khan, Emma Ball, and Kay Caldwell Copyright © 2016 Russell Kabir et al. All rights reserved. Comparative Analysis of Households Solid Waste Management in Rural and Urban Ghana Tue, 11 Oct 2016 15:20:22 +0000 The comparative analysis of solid waste management between rural and urban Ghana is largely lacking. This study investigated the solid waste situation and the organisation of solid waste management in both urban and rural settings from the perspective of households. The study employed cross-sectional survey covering both rural and urban districts in the Ashanti and Greater Accra Regions of Ghana. The study systematically sampled houses from which 400 households and respondents were randomly selected. Pearson’s Chi square test was used to compare demographic and socioeconomic variables in rural and urban areas. Multivariate Test, Tests of Between-Subjects Effects, and Pair-Wise Comparisons were performed through one-way MANOVA to determine whether or not solid waste situations in rural and urban areas are significantly different. The results revealed that location significantly affects solid waste management in Ghana. Urban communities had lower mean scores than rural communities for poor solid waste situation in homes. However, urban communities had higher mean scores than rural communities for poor solid waste situation in principal streets and dumping sites. The study recommends that the local government authorities implement very comprehensive policies (sanitary inspection, infrastructure development, and community participation) that will take into consideration the specific solid waste management needs of both urban and rural areas. Simon Boateng, Prince Amoako, Divine Odame Appiah, Adjoa Afriyie Poku, and Emmanuel Kofi Garsonu Copyright © 2016 Simon Boateng et al. All rights reserved. Women in Saudi Arabia and the Prevalence of Cardiovascular Risk Factors: A Systematic Review Thu, 29 Sep 2016 06:07:26 +0000 Background. Cardiovascular disease (CVD) is one of the leading causes of death in Saudi Arabia. Saudi women in particular are more susceptible as there are sociocultural restrictions on female physical activities that may lead to high prevalence of CVD risks, especially obesity, and physical inactivity. This study aims to systematically review the published articles related to the prevalence of CVD risk among women in Saudi Arabia. The search strategy covers all published articles that assess the risk factor of CVD in Saudi Arabia from January 2000 to December 2015, using the following sources: Medline, Embase, and PsycINFO. A total of 61 studies were included. Results. Prevalence among Saudi women of smoking ranged from 1.1% to 9.1%, hypertension was 21.8%, diabetes ranged from 9.6% to 27.6%, overweight was 27%, and obesity was 40.23%, and physical inactivity ranged from 53.2% to 98.1%. Hypercholesterolemia prevalence on Saudi women on average was 24.5%, while metabolic syndrome ranged from 13.6% to 40.3%. Conclusion. The prevalence of CVD risk factors is high among women in Saudi Arabia especially in obesity and physical inactivity. Public health authorities must implement solutions from a gender specific aspect to reverse the trend and decrease the prevalence of CVDs among Saudi women. Mashael K. Alshaikh, Filippos T. Filippidis, Juren P. Baldove, Azeem Majeed, and Salman Rawaf Copyright © 2016 Mashael K. Alshaikh et al. All rights reserved. Association of Household Food Insecurity with the Mental and Physical Health of Low-Income Urban Ecuadorian Women with Children Mon, 26 Sep 2016 16:40:36 +0000 Chronic physical and mental health conditions account for a rising proportion of morbidity, mortality, and disability in the Americas region. Household food insecurity (HFI) has been linked to chronic disease in US and Canadian women but it is uncertain if the same is true for low- and middle-income Latin American countries in epidemiologic transition. We conducted a survey to investigate the association of HFI with the physical and mental health of 794 women with children living in low-income Quito, Ecuador, neighborhoods. Data were collected on HFI and health indicators including self-reported health (SF-1), mental health (MHI-5), blood pressure, and self-reported mental and physical health complaints. Fasting blood glucose and lipids were measured in a subsample. The multivariate analyses revealed that HFI was associated with poorer self-rated health, low MHI-5 scores, and mental health complaints including stress, depression, and ethnospecific illnesses. It was also associated with chest tightness/discomfort/pain, dental disease, and gastrointestinal illness but not other conditions. The findings suggest that improving food security in low-income households may help reduce the burden of mental distress in women with children. The hypothesized link with diabetes and hypertension may become more apparent as Ecuador moves further along in the epidemiologic transition. M. Margaret Weigel, Rodrigo X. Armijos, Marcia Racines, William Cevallos, and Nancy P. Castro Copyright © 2016 M. Margaret Weigel et al. All rights reserved. Sugar Sweetened Beverage Consumption among Primary School Students: Influence of the Schools’ Vicinity Mon, 26 Sep 2016 13:49:13 +0000 The purpose of the research was to explore the associations between the characteristics of schools’ vicinity and the risk of sugar sweetened beverage (SSB) consumption in elementary students. Findings exposed an important variation in student’s SSB consumption between schools. Schools with a lower socioeconomic status or in a densely built environment tend to have higher proportion of regular SSB drinkers. These characteristics of the school’s vicinity partly explained the variation observed between them. We estimated that a student moving to a school with a higher proportion of SSB drinkers may increase his/her chances by 52% of becoming a daily consumer. Important changes in dietary preferences can occur when children are in contact with a new social environment. Findings also support the idea that dietary behaviors among children result from the complex interactions between biological, social, and environmental factors. Alexandre Lebel, Pascale Morin, Éric Robitaille, Benoit Lalonde, Ramona Florina Fratu, and Sherri Bisset Copyright © 2016 Alexandre Lebel et al. All rights reserved. Identifying the Prognosis Factors in Death after Liver Transplantation via Adaptive LASSO in Iran Thu, 25 Aug 2016 16:27:35 +0000 Despite the widespread use of liver transplantation as a routine therapy in liver diseases, the effective factors on its outcomes are still controversial. This study attempted to identify the most effective factors on death after liver transplantation. For this purpose, modified least absolute shrinkage and selection operator (LASSO), called Adaptive LASSO, was utilized. One of the best advantages of this method is considering high number of factors. Therefore, in a historical cohort study from 2008 to 2013, the clinical findings of 680 patients undergoing liver transplant surgery were considered. Ridge and Adaptive LASSO regression methods were then implemented to identify the most effective factors on death. To compare the performance of these two models, receiver operating characteristic (ROC) curve was used. According to the results, 12 factors in Ridge regression and 9 ones in Adaptive LASSO regression were significant. The area under the ROC curve (AUC) of Adaptive LASSO was equal to 89% (95% CI: 86%–91%), which was significantly greater than Ridge regression (64%, 95% CI: 61%–68%) (). As a conclusion, the significant factors and the performance criteria revealed the superiority of Adaptive LASSO method as a penalized model versus traditional regression model in the present study. Hadi Raeisi Shahraki, Saeedeh Pourahmad, and Seyyed Mohammad Taghi Ayatollahi Copyright © 2016 Hadi Raeisi Shahraki et al. All rights reserved. Cross-Sectional Study of Polybrominated Flame Retardants and Self-Reported Attention Deficit Hyperactivity Disorder in US Youth Aged 12–15 (NHANES 2003-2004) Mon, 04 Jul 2016 07:34:18 +0000 Background. Animal toxicity tests and epidemiological studies suggest that exposure to PBDEs can alter attention behavior, yet few studies have examined their association with diagnosis of attention deficit hyperactivity disorder (ADHD) in adolescents. Methods. Logistic regression was used to examine the cross-sectional association between ADHD and lipid and non-lipid adjusted blood serum concentrations of 2′,4-tribromodiphenyl ether (BDE-28), 2,2′,4,4′-tetrabromodiphenylether (BDE-47), 2,2′,4,4′,5-pentabromodiphenyl ether (BDE-99), 2,2′,4,4′,5,5′-pentabromodiphenyl ether (BDE-100), 2,2′,4,4′,5,5′-hexabromodiphenyl ether (BDE-153), serum PBDEs, above/below the 75th percentile of serum PBDEs, and tertiles of serum PBDE in 12–15-year-olds () using the National Health and Nutrition Examination Survey (NHANES) 2003-2004. Results. The ADHD weighted prevalence was 13.57%. The weighted adjusted odds ratios (AOR) and 95% confidence interval (CI) between ADHD diagnosis and lipid adjusted BDE-28, BDE-47, BDE-99, BDE-100, BDE-153, serum total PBDE, serum PBDE concentrations above the 75th percentile, and serum PBDE concentrations in the second or third tertile were 1.16 (95% CI: 0.51, 2.67), 1.36 (95% CI: 0.72, 2.56), 1.51 (95% CI: 0.70, 3.25), 1.53 (95% CI: 0.73, 3.23), 1.43 (95% CI: 0.57, 3.56), 1.41 (0.71, 2.83), 0.59 (0.10, 3.56), 6.16 (1.19, 31.90), and 0.99 (0.23, 4.29). Conclusions. We observed no association between serum PBDE concentrations and ADHD in US youths. Jennifer Przybyla, Molly L. Kile, Ellen Smit, and E. Andres Houseman Copyright © 2016 Jennifer Przybyla et al. All rights reserved. A Coproduction Community Based Approach to Reducing Smoking Prevalence in a Local Community Setting Thu, 30 Jun 2016 13:57:46 +0000 Research highlights that asset-based community development where local residents become equal partners in service development may help promote health and well-being. This paper outlines baseline results of a coproduction evaluation of an asset-based approach to improving health and well-being within a small community through promoting tobacco control. Local residents were recruited and trained as community researchers to deliver a smoking prevalence survey within their local community and became local health champions, promoting health and well-being. The results of the survey will be used to inform health promotion activities within the community. The local smoking prevalence was higher than the regional and national averages. Half of the households surveyed had at least one smoker, and 63.1% of children lived in a smoking household. Nonsmokers reported higher well-being than smokers; however, the differences were not significant. Whilst the community has a high smoking prevalence, more than half of the smokers surveyed would consider quitting. Providing smoking cessation advice in GP surgeries may help reduce smoking prevalence in this community. Work in the area could be done to reduce children’s exposure to smoking in the home. G. J. McGeechan, D. Woodall, L. Anderson, L. Wilson, G. O’Neill, and D. Newbury-Birch Copyright © 2016 G. J. McGeechan et al. All rights reserved. Pyrolytic Waste Plastic Oil and Its Diesel Blend: Fuel Characterization Tue, 28 Jun 2016 15:30:01 +0000 The authors introduced waste plastic pyrolysis oil (WPPO) as an alternative fuel characterized in detail and compared with conventional diesel. High density polyethylene, HDPE, was pyrolyzed in a self-designed stainless steel laboratory reactor to produce useful fuel products. HDPE waste was completely pyrolyzed at 330–490°C for 2-3 hours to obtain solid residue, liquid fuel oil, and flammable gaseous hydrocarbon products. Comparison of the fuel properties to the petrodiesel fuel standards ASTM D 975 and EN 590 revealed that the synthetic product was within all specifications. Notably, the fuel properties included a kinematic viscosity (40°C) of 1.98 cSt, density of 0.75 gm/cc, sulphur content of 0.25 (wt%), and carbon residue of 0.5 (wt%), and high calorific value represented significant enhancements over those of conventional petroleum diesel fuel. M. Z. H. Khan, M. Sultana, M. R. Al-Mamun, and M. R. Hasan Copyright © 2016 M. Z. H. Khan et al. All rights reserved. Occupational Risks Associated with Solid Waste Management in the Informal Sector of Gweru, Zimbabwe Tue, 21 Jun 2016 07:48:21 +0000 This study identifies and analyses the occupational risks associated with solid waste management practices in the informal enterprises of Gweru. Many concerns have been raised about the potential harm from waste to the environment and the general public, but the risks and consequent costs of occupational hazards in waste management have received little attention in the rush to adopt or adapt technologies such as composting. A multimethods research design that triangulates qualitative and quantitative research paradigms is employed in this study. The quantitative design involves physical characterisation of solid waste through material component separation and measurements as well as a questionnaire survey that investigates the risks associated with waste management. The qualitative component includes interviews, open-ended questionnaires, and field observations. Occupational risks occur at every stage in the waste management process, from the point where workers handle waste in the enterprises for collection or recycling to the point of ultimate disposal. Key findings from the study revealed that solid waste management practices are dominated by manual handling tasks hence the higher incidents of muscular-skeletal disorders. Other safety and health hazards associated with waste management in the informal enterprises of Gweru include incidents of diarrhoea, viral hepatitis, and higher incidents of obstructive and restrictive disorders. Steven Jerie Copyright © 2016 Steven Jerie. All rights reserved. Arsenic in Drinking Water and Lung Cancer Mortality in the United States: An Analysis Based on US Counties and 30 Years of Observation (1950–1979) Mon, 13 Jun 2016 10:47:16 +0000 Background. To examine whether the US EPA (2010) lung cancer risk estimate derived from the high arsenic exposures (10–934 µg/L) in southwest Taiwan accurately predicts the US experience from low arsenic exposures (3–59 µg/L). Methods. Analyses have been limited to US counties solely dependent on underground sources for their drinking water supply with median arsenic levels of ≥3 µg/L. Results. Cancer risks (slopes) were found to be indistinguishable from zero for males and females. The addition of arsenic level did not significantly increase the explanatory power of the models. Stratified, or categorical, analysis yielded relative risks that hover about 1.00. The unit risk estimates were nonpositive and not significantly different from zero, and the maximum (95% UCL) unit risk estimates for lung cancer were lower than those in US EPA (2010). Conclusions. These data do not demonstrate an increased risk of lung cancer associated with median drinking water arsenic levels in the range of 3–59 µg/L. The upper-bound estimates of the risks are lower than the risks predicted from the SW Taiwan data and do not support those predictions. These results are consistent with a recent metaregression that indicated no increased lung cancer risk for arsenic exposures below 100–150 µg/L. Hamid Ferdosi, Elisabeth K. Dissen, Nana Ama Afari-Dwamena, Ji Li, Rusan Chen, Manning Feinleib, and Steven H. Lamm Copyright © 2016 Hamid Ferdosi et al. All rights reserved. Exposures Resulting in Safety and Health Concerns for Child Laborers in Less Developed Countries Sun, 12 Jun 2016 12:21:05 +0000 Objectives. Worldwide, over 200 million children are involved in child labor, with another 20 million children subjected to forced labor, leading to acute and chronic exposures resulting in safety and health (S&H) risks, plus removal from formal education and play. This review summarized S&H issues in child labor, including forced or indentured domestic labor as other sectors of child labor. Specifically, we focused on exposures leading to S&H risks. Methods. We used PubMed, Scopus, Science Direct, and Google Scholar. References were in English, published in 1990–2015, and included data focused on exposures and S&H concerns of child labor. Results. Seventy-six journal articles were identified, 67 met criteria, 57 focused on individual countries, and 10 focused on data from multiple countries (comparing 3–83 countries). Major themes of concern were physical exposures including ergonomic hazards, chemical exposure hazards, and missed education. Childhood labor, especially forced, exploitative labor, created a significant burden on child development, welfare, and S&H. Conclusions. More field researche data emphasizing longitudinal quantitative effects of exposures and S&H risks are needed. Findings warranted developing policies and educational interventions with proper monitoring and evaluation data collection, plus multiple governmental, international organization and global economic reform efforts, particularly in lower-income, less developed countries. Derek G. Shendell, Saisattha Noomnual, Shumaila Chishti, MaryAnn Sorensen Allacci, and Jaime Madrigano Copyright © 2016 Derek G. Shendell et al. All rights reserved. Impact on the Quality of Life When Living Close to a Municipal Wastewater Treatment Plant Tue, 07 Jun 2016 06:17:30 +0000 The objective of the study was to investigate the impact on the quality of life of people living close to a municipal wastewater treatment plant. A case control study, including 235 inhabitants living within a 500 m radius by a municipal wastewater treatment plant (cases) and 97 inhabitants living in a different area (controls), was conducted. A standardized questionnaire was self-completed by the participants which examined the general health perception and the overall life satisfaction. Also, the concentration of airborne pathogenic microorganisms in aerosol samples collected around the wastewater treatment plant was investigated. Significant risk for symptoms such as headache, unusual tiredness, and concentration difficulties was recorded and an increased possibility for respiratory and skin diseases was reported. A high rate of the cases being irritable and moody was noticed. Significantly higher gastrointestinal symptoms were also reported among the cases in relation to the controls. The prevalence of pathogenic airborne microorganisms originating from the wastewater treatment plant was reported in high numbers in sampling points close to the wastewater treatment plant. More analytical epidemiological investigations are needed to determine the cause as well as the burden of the diseases to inhabitants living surrounding the wastewater treatment plant. A. Vantarakis, S. Paparrodopoulos, P. Kokkinos, G. Vantarakis, K. Fragou, and I. Detorakis Copyright © 2016 A. Vantarakis et al. All rights reserved. Valuing the Economic Costs of Allergic Rhinitis, Acute Bronchitis, and Asthma from Exposure to Indoor Dampness and Mold in the US Sun, 29 May 2016 12:28:40 +0000 Two foundational methods for estimating the total economic burden of disease are cost of illness (COI) and willingness to pay (WTP). WTP measures the full cost to society, but WTP estimates are difficult to compute and rarely available. COI methods are more often used but less likely to reflect full costs. This paper attempts to estimate the full economic cost (2014$) of illnesses resulting from exposure to dampness and mold using COI methods and WTP where the data is available. A limited sensitivity analysis of alternative methods and assumptions demonstrates a wide potential range of estimates. In the final estimates, the total annual cost to society attributable to dampness and mold is estimated to be $3.7 (2.3–4.7) billion for allergic rhinitis, $1.9 (1.1–2.3) billion for acute bronchitis, $15.1 (9.4–20.6) billion for asthma morbidity, and $1.7 (0.4–4.5) billion for asthma mortality. The corresponding costs from all causes, not limited to dampness and mold, using the same approach would be $24.8 billion for allergic rhinitis, $13.5 billion for acute bronchitis, $94.5 billion for asthma morbidity, and $10.8 billion for asthma mortality. David H. Mudarri Copyright © 2016 David H. Mudarri. All rights reserved. The LINA Study: Higher Sensitivity of Infant Compared to Maternal Eosinophil/Basophil Progenitors to Indoor Chemical Exposures Thu, 26 May 2016 12:57:28 +0000 Purpose. Enhanced eosinophil/basophil (Eo/B) progenitor cell levels are known to be associated with allergic inflammation and atopy risk. The aim of the present study was to investigate the influence of different indoor exposures on the recruitment and differentiation of Eo/B progenitors in mother-child pairs. Methods. In 68 mother-child pairs of the LINA study peripheral blood mononuclear cells were used to assess Eo/B colony forming units (CFUs). Information about disease outcomes and indoor exposures was obtained from questionnaires. Indoor concentrations of volatile organic compounds (VOCs) were measured by passive sampling. Results. Infant’s Eo/B CFUs were positively associated with exposure to tobacco smoke, disinfectants, or VOCs. In contrast, for maternal Eo/B CFUs, only a few associations were seen. Higher numbers of infant Eo/B CFUs were observed in children with wheezing symptoms within the second year of life. Conclusions. We demonstrate that infant’s hematopoietic cells seem to respond with more sensitivity to environmental exposure compared to maternal cells. At least in infants, an activation of these hematopoietic cells by environmental exposure could contribute to an enhanced risk for the development of respiratory outcomes. Friederike Hörnig, Tibor Kohajda, Stefan Röder, Gunda Herberth, Martin von Bergen, Michael Borte, Ulrike Diez, Ulrike Rolle-Kampczyk, Jan-C. Simon, Judah A. Denburg, Irina Lehmann, and Kristin M. Junge Copyright © 2016 Friederike Hörnig et al. All rights reserved. The Impact of General Strike on Government Healthcare Delivery in Kerala State in India Tue, 03 May 2016 09:16:40 +0000 General strike (also known as hartal) is used as a mode of protest by organizations and political parties in India. It is generally thought that hartals negatively impact the healthcare delivery in a society. We used the Right to Information Act to obtain data from government health centers in Kerala state in India for four hartal days (H-day) and two control days (A-day and B-day) for each H-day, from sixteen health centers including 6 Community Health Center (CHC), 6 Secondary Health Center (SHC), and 4 Tertiary Health Center (THC). Data on emergency room visits was available for six HCs. 15 HCs had a statistically significant decrease in the number of outpatient visits on H-day. There was no difference in the number of outpatient visits between the two control days (A and B) in 15 HCs, suggesting the lack of a posthartal surge in visits. Median decrease in outpatient visits in CHCs, SHCs, and THCs was 50.4%, 59.5%, and 47.4%, respectively. Hartal did not impact the number of emergency room visits in 6 out of 7 health centers assessed. Our study identified a significant harmful impact on government healthcare delivery due to hartals in Kerala. These findings have major public health implications. Aasems Jacob, Heidi Weiss, and Aju Mathew Copyright © 2016 Aasems Jacob et al. All rights reserved. Determinants of Early Marriage from Married Girls’ Perspectives in Iranian Setting: A Qualitative Study Wed, 30 Mar 2016 07:49:10 +0000 Early marriage is a worldwide problem associated with a range of health and social consequences for teenage girls. Designing effective health interventions for managing early marriage needs to apply the community-based approaches. However, it has received less attention from policymakers and health researchers in Iran. Therefore, the current study aimed to explore determinants of early marriage from married girls’ perspectives. The study was conducted from May 2013 to January 2015 in Ahvaz, Iran. A purposeful sampling method was used to select fifteen eligible participants. Data were collected through face-to-face, semistructured interviews and were analyzed using the conventional content analysis approach. Three categories emerged from the qualitative data including “family structure,” “Low autonomy in decision-making,” and “response to needs.” According to the results, although the participants were not ready to get married and intended to postpone their marriage, multiple factors such as individual and contextual factors propelled them to early marriage. Given that early marriage is a multifactorial problem, health care providers should consider a multidimensional approach to support and empower these vulnerable girls. Simin Montazeri, Maryam Gharacheh, Nooredin Mohammadi, Javad Alaghband Rad, and Hassan Eftekhar Ardabili Copyright © 2016 Simin Montazeri et al. All rights reserved. Food Insecurity Is Associated with Undernutrition but Not Overnutrition in Ecuadorian Women from Low-Income Urban Neighborhoods Wed, 23 Mar 2016 12:36:38 +0000 Household food insecurity (HFI) is becoming an increasingly important issue in Latin America and other regions undergoing rapid urbanization and nutrition transition. The survey investigated the association of HFI with the nutritional status of 794 adult women living in households with children in low-income neighborhoods in Quito, Ecuador. Data were collected on sociodemographic characteristics, household food security status, and nutritional status indicators (dietary intake, anthropometry, and blood hemoglobin). Data were analyzed using multivariate methods. The findings identified revealed a high HFI prevalence (81%) among the urban households that was associated with lower per capita income and maternal education; long-term neighborhood residency appeared protective. HFI was associated with lower dietary quality and diversity and an increased likelihood of anemia and short stature but not increased high-calorie food intake or generalized or abdominal obesity. Although significant progress has been made in recent years, low dietary diversity, anemia, and growth stunting/short stature in the Ecuadorian maternal-child population continue to be major public health challenges. The study findings suggest that improving urban food security may help to improve these nutritional outcomes. They also underscore the need for food security policies and targeted interventions for urban households and systematic surveillance to assess their impact. M. Margaret Weigel, Rodrigo X. Armijos, Marcia Racines, and William Cevallos Copyright © 2016 M. Margaret Weigel et al. All rights reserved. Factors Influencing Attitude, Safety Behavior, and Knowledge regarding Household Waste Management in Guinea: A Cross-Sectional Study Tue, 22 Mar 2016 16:02:09 +0000 Waste indiscriminate disposal is recognized as an important cause of environmental pollution and is associated with health problems. Safe management and disposal of household waste are an important problem to the capital city of Guinea (Conakry). The objective of this study was to identify socioeconomic and demographic factors associated with practice, knowledge, and safety behavior of family members regarding household waste management and to produce a remedial action plan. I found that no education background, income, and female individuals were independently associated with indiscriminate waste disposal. Unplanned residential area was an additional factor associated with indiscriminate waste disposal. I also found that the community residents had poor knowledge and unsafe behavior in relation to waste management. The promotion of environmental information and public education and implementation of community action programs on disease prevention and health promotion will enhance environmental friendliness and safety of the community. Keita Mamady Copyright © 2016 Keita Mamady. All rights reserved. Practices, Concerns, and Willingness to Participate in Solid Waste Management in Two Urban Slums in Central Uganda Mon, 14 Mar 2016 07:02:08 +0000 Poor solid waste management is among the major challenges facing urban slums in developing countries including Uganda. Understanding community concerns and willingness towards involvement in solid waste management improvement initiatives is critical for informing interventions in slums. Methods. We used a cross-sectional study to collect quantitative data from 435 residents in two urban slums in central Uganda. A semistructured questionnaire was used which assessed waste collection practices, separation and disposal methods, concerns regarding solid wastes, and willingness to participate in waste separation and composting. Data was analysed using STATA 12. Results. Food remains (38%) and plastics (37%) formed the biggest proportion of wastes generated in households. Most households (35.9%) disposed of general wastes by open dumping while 27% disposed of plastics by burning. Only 8.8% of households conducted composting while 55% carried out separation for some decomposable wastes. Separation was carried out for only banana peelings and leftover foods for feeding animals. Respondents expressed high willingness to separate (76.6%) and compost (54.9%) solid wastes. Conclusion. Practices in waste disposal and separation were poor despite high willingness to participate in initiatives to improve waste management, highlighting a need for authorities to engage residents of slums to improve their practices. Trasias Mukama, Rawlance Ndejjo, David Musoke, Geofrey Musinguzi, Abdullah Ali Halage, David O. Carpenter, and John C. Ssempebwa Copyright © 2016 Trasias Mukama et al. All rights reserved. Revisiting Nonresidential Environmental Exposures and Childhood Lead Poisoning in the US: Findings from Kansas, 2000–2005 Wed, 02 Mar 2016 08:56:12 +0000 Although blood lead levels (BLLs) in US children have dramatically declined over the past 40 years, there remain pockets of children living in areas with elevated BLLs. While some increases (≥10 μg/dL) may be associated with legacy lead paint, ambient air lead may be contributing to the problem. A deidentified dataset of information on over 60,000 Kansas children under 3 years of age who were tested for BLL was provided through the Kansas Environmental Public Health Tracking Network for the period 2000–2005. Using ArcGIS, we calculated distance (in miles) from a lead-emitting industry referred to as a toxic release inventory (TRI) site. The USEPA TRI database tracks the management of certain toxic chemicals that may pose a threat to human health. US facilities in different industry sectors must report annually amount of substances like lead into the environment including their exact location. Distance from a TRI site was inversely related to BLL after controlling for area-level poverty and pre-1950 housing. The results of our evaluation indicate there is a significant relationship between proximity to lead industry and childhood BLLs. Proximity to sources of lead emissions should be evaluated as a possible factor when identifying children for targeted BLL testing. Lu Ann Brink, Evelyn O. Talbott, Gary M. Marsh, Ravi Sharma, Stacey Benson, Wen Chi Wu, and Chunzhe Duan Copyright © 2016 Lu Ann Brink et al. All rights reserved. Heavy Metal Contamination of Soils around a Hospital Waste Incinerator Bottom Ash Dumps Site Mon, 29 Feb 2016 18:51:20 +0000 Waste incineration is the main waste management strategy used in treating hospital waste in many developing countries. However, the release of dioxins, POPs, and heavy metals in fly and bottom ash poses environmental and public health concerns. To determine heavy metal (Hg, Pb, Cd, Cr, and Ag) in levels in incinerator bottom ash and soils 100 m around the incinerator bottom ash dump site, ash samples and surrounding soil samples were collected at 20 m, 40 m, 60 m, 80 m, 100 m, and 1,200 m from incinerator. These were analyzed using the absorption spectrophotometer method. The geoaccumulation () and pollution load indices (PLI) were used to assess the level of heavy metal contamination of surrounding soils. The study revealed high concentrations in mg/kg for, Zn (16417.69), Pb (143.80), Cr (99.30), and Cd (7.54) in bottom ash and these were above allowable limits for disposal in landfill. The study also found soils within 60 m radius of the incinerator to be polluted with the metals. It is recommended that health care waste managers be educated on the implication of improper management of incinerator bottom ash and regulators monitor hospital waste incinerator sites. M. Adama, R. Esena, B. Fosu-Mensah, and D. Yirenya-Tawiah Copyright © 2016 M. Adama et al. All rights reserved. Body Mass Index Trajectories among Middle-Aged and Elderly Canadians and Associated Health Outcomes Wed, 27 Jan 2016 12:54:59 +0000 Background. Whether there is heterogeneity in the development of BMI from middle-age onward is still unknown. The primary aim of this study is to analyze long-term obesity and how BMI trajectories are associated with health outcomes in midlife. Methods. Latent Class Growth Modelling was used to capture the changes in BMI over time. In this study, 3070 individuals from the National Population Health Survey (NPHS), aged 40–55 years at baseline, were included. Results. Four BMI trajectory groups, “Normal-Stable” (N-S), “Overweight-Stable” (OV-S), “Obese I-Stable” (OB I-S), and “Obese II-Stable” (OB II-S), were identified. Men, persons of White ancestry, and individuals who had no postsecondary education had higher odds of being in the latter three groups. Moreover, members of the OV-S, OB I-S, and OB II-S groups experienced more asthma, arthritis, hypertension, diabetes, heart disease, cognitive impairment, and reduced self-rated overall health. Individuals in the OB II-S group were at greater risk for back problems, chronic bronchitis or emphysema, and emotional issues when compared to the N-S group. Conclusion. Understanding different BMI trajectories is important in order to identify people who are at the highest risk of developing comorbidities due to obesity and to establish programs to intervene appropriately. Meng Wang, Yanqing Yi, Barbara Roebothan, Jennifer Colbourne, Victor Maddalena, Peizhong Peter Wang, and Guang Sun Copyright © 2016 Meng Wang et al. All rights reserved. Consumption Frequency of Foods Away from Home Linked with Higher Body Mass Index and Lower Fruit and Vegetable Intake among Adults: A Cross-Sectional Study Tue, 26 Jan 2016 06:57:04 +0000 Introduction. Consumption of foods prepared away from home (FAFH) has grown steadily since the 1970s. We examined the relationship between FAFH and body mass index (BMI) and fruit and vegetable (FV) consumption. Methods. Frequency of FAFH, daily FV intake, height and weight, and sociodemographic data were collected using a telephone survey in 2008-2009. Participants included a representative sample of 2,001 adult men and women (mean age years) residing in King County, WA, with an analytical sample of 1,570. Frequency of FAFH was categorized as 0-1, 2–4, or 5+ times per week. BMI was calculated from self-reported height and weight. We examined the relationship between FAFH with FV consumption and BMI using multivariate models. Results. Higher frequency of FAFH was associated with higher BMI, after adjusting for age, income, education, race, smoking, marital status, and physical activity (women: ; men: ). There was a negative association between frequency of FAFH and FV consumption. FAFH frequency was significantly () higher among males than females (43.1% versus 54.0% eating out 0-1 meal per week, resp.). Females reported eating significantly () more FV than males. Conclusion. Among adults, higher frequency of FAFH was related to higher BMI and less FV consumption. Rebecca A. Seguin, Anju Aggarwal, Francoise Vermeylen, and Adam Drewnowski Copyright © 2016 Rebecca A. Seguin et al. All rights reserved. Noise Exposure and Hearing Capabilities of Quarry Workers in Ghana: A Cross-Sectional Study Thu, 21 Jan 2016 11:20:11 +0000 Introduction. Although quarry operations have high economic significance, the effects they cause to the workers in terms of excessive noise production cannot be overlooked. This cross-sectional study assessed the extent of noise exposure and its influence on hearing capabilities among quarry workers in Ashanti region. Methods. The study involved 400 workers randomly selected from five quarries in Ashanti region from April to June 2012. Data was collected using structured questionnaires, physical examination, and audiological assessments. A logistic regression model was fitted to assess independent predictors of hearing loss. Results. All the machines used at the various quarries produced noise that exceeded the minimum threshold with levels ranging from 85.5 dBA to 102.7 dBA. 176 (44%) of study respondents had hearing threshold higher than 25 dBA. 18% and 2% of these were moderately (41–55 dBA) and severely (71–90 dBA) impaired, respectively. Age, duration of work, and use of earplugs independently predicted the development of hearing loss. Use of earplugs showed a protective effect on the development of hearing loss (OR = 0.45; 95% CI = 0.25, 0.84). Conclusion. This study provides empirical evidence on the extent of damage caused to quarry workers as a result of excessive noise exposure. This will support the institution of appropriate protective measures to minimize this threat. Charles Kwame R. Gyamfi, Isaac Amankwaa, Frank Owusu Sekyere, and Daniel Boateng Copyright © 2016 Charles Kwame R. Gyamfi et al. All rights reserved. Compliance with Iron-Folate Supplement and Associated Factors among Antenatal Care Attendant Mothers in Misha District, South Ethiopia: Community Based Cross-Sectional Study Tue, 29 Dec 2015 13:45:00 +0000 Background. In Ethiopia, higher proportions of pregnant women are anemic. Despite the efforts to reduce iron deficiency anemia during pregnancy, only few women took an iron supplement as recommended. Thus, this study aimed to assess compliance with iron-folate supplement and associated factors among antenatal care attendant mothers in Misha district, South Ethiopia. Method. Community based cross-sectional study supported with in-depth interview was conducted from March 1 to March 30, 2015. The sample size was determined using single population proportion to 303. Simple random sampling technique was used to select the study participants. Bivariate and multivariable logistic regression analyses were employed to identify factors associated with compliance to iron-folate supplement. Results. The compliance rate was found to be 39.2%. Mothers knowledge of anemia (AOR = 4.451, 95% CI = ()), knowledge of iron-folate supplement (AOR = 3.509, 95% CI = ()), and counseling on iron-folate supplement (AOR = 4.093, 95% CI = ()) were significantly associated with compliance to iron-folate supplement. Conclusions. Compliance rate of iron-folate supplementation during pregnancy remains very low. This study showed that providing women with clear instructions about iron-folate tablet intake and educating them on the health benefits of the iron-folate tablets can increase compliance with iron-folate supplementation. Abinet Arega Sadore, Lakew Abebe Gebretsadik, and Mamusha Aman Hussen Copyright © 2015 Abinet Arega Sadore et al. All rights reserved. Regional Variation in Human Exposure to Persistent Organic Pollutants in the United States, NHANES Tue, 29 Dec 2015 11:02:57 +0000 We examined serum levels of persistent organic pollutants (POPs) among geographical regions of the United States as defined by the US Census Bureau. National Health and Nutrition Examination Survey (NHANES) data for adults aged 20 years and older are presented for selected survey periods between 1999 and 2010. From NHANES 1999 through 2004, dichlorodiphenyldichloroethylene (DDE) concentration levels were consistently higher among people living in the West than in the Midwest, Northeast, or South. In 2003–2010, perfluorinated compound concentrations tended to be highest in the South. The sum of 35 polychlorinated biphenyls (PCBs) congeners was significantly higher in the Northeast [GM: 189; 95% CI: 173–204 ng/g lipid] than the remaining regions. The regional differences in higher body burdens of exposure to particular POPs could be attributed to a variety of activities, including region-specific patterns of land use and industrial and agricultural chemical applications, as well as different levels of regulatory activity. Wendy A. Wattigney, Elizabeth Irvin-Barnwell, Marian Pavuk, and Angela Ragin-Wilson Copyright © 2015 Wendy A. Wattigney et al. All rights reserved.