Developing and Implementing In-Person and Virtual SoilSHOPs in Atlanta, Georgia, as a Community-Engaged Approach to Screen and Prevent Soil Lead Exposure.

Urban agriculture presents the opportunity for increased availability of local, fresh foods; however, exposure to lead soil contamination can occur through gardening in urban environments. Through a community-engaged partnership, we implemented Soil Screening, Health, Outreach and Partnerships (soilSHOPs), in-person and virtually, to screen soils for lead in Atlanta, Georgia. These soilSHOPs inform best practices for increasing awareness about lead exposure and grounding interventions in residents' lived experiences and also led the US Environmental Protection Agency to identify a Superfund site.

Characteristics Associated with Adults Remembering to Wash Hands in Multiple Situations Before and During the COVID-19 Pandemic - United States, October 2019 and June 2020.

Washing hands often, especially during times when one is likely to acquire and spread pathogens,* is one important measure to help prevent the spread of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), as well as other pathogens spread by respiratory or fecal-oral transmission (1,2). Studies have reported moderate to high levels of self-reported handwashing among adults worldwide during the COVID-19 pandemic (3-5)†; however, little is known about how handwashing behavior among U.S. adults has changed since the start of the pandemic. For this study, survey data from October 2019 (prepandemic) and June 2020 (during pandemic) were compared to assess changes in adults' remembering to wash their hands in six situations.§ Statistically significant increases in reported handwashing were seen in June 2020 compared with October 2019 in four of the six situations; the odds of remembering to wash hands was 2.3 times higher among respondents after coughing, sneezing, or blowing their nose, 2.0 times higher before eating at a restaurant, and 1.7 times higher before eating at home. Men, young adults aged 18-24 years, and non-Hispanic White (White) adults were less likely to remember to wash hands in multiple situations. Strategies to help persons remember to wash their hands frequently and at important times should be identified and implemented, especially among groups reporting low prevalence of remembering to wash their hands.

Knowledge and Practices Regarding Safe Household Cleaning and Disinfection for COVID-19 Prevention - United States, May 2020.

A recent report described a sharp increase in calls to poison centers related to exposures to cleaners and disinfectants since the onset of the coronavirus disease 2019 (COVID-19) pandemic (1). However, data describing cleaning and disinfection practices within household settings in the United States are limited, particularly concerning those practices intended to prevent transmission of SARS-CoV-2, the virus that causes COVID-19. To provide contextual and behavioral insight into the reported increase in poison center calls and to inform timely and relevant prevention strategies, an opt-in Internet panel survey of 502 U.S. adults was conducted in May 2020 to characterize knowledge and practices regarding household cleaning and disinfection during the COVID-19 pandemic. Knowledge gaps were identified in several areas, including safe preparation of cleaning and disinfectant solutions, use of recommended personal protective equipment when using cleaners and disinfectants, and safe storage of hand sanitizers, cleaners, and disinfectants. Thirty-nine percent of respondents reported engaging in nonrecommended high-risk practices with the intent of preventing SARS-CoV-2 transmission, such as washing food products with bleach, applying household cleaning or disinfectant products to bare skin, and intentionally inhaling or ingesting these products. Respondents who engaged in high-risk practices more frequently reported an adverse health effect that they believed was a result of using cleaners or disinfectants than did those who did not report engaging in these practices. Public messaging should continue to emphasize evidence-based, safe practices such as hand hygiene and recommended cleaning and disinfection of high-touch surfaces to prevent transmission of SARS-CoV-2 in household settings (2). Messaging should also emphasize avoidance of high-risk practices such as unsafe preparation of cleaning and disinfectant solutions, use of bleach on food products, application of household cleaning and disinfectant products to skin, and inhalation or ingestion of cleaners and disinfectants.

Vital Signs: Health Care-Associated Legionnaires' Disease Surveillance Data from 20 States and a Large Metropolitan Area - United States, 2015.

BACKGROUND: Legionnaires' disease, a severe pneumonia, is typically acquired through inhalation of aerosolized water containing Legionella bacteria. Legionella can grow in the complex water systems of buildings, including health care facilities. Effective water management programs could prevent the growth of Legionella in building water systems. METHODS: Using national surveillance data, Legionnaires' disease cases were characterized from the 21 jurisdictions (20 U.S. states and one large metropolitan area) that reported exposure information for ≥90% of 2015 Legionella infections. An assessment of whether cases were health care-associated was completed; definite health care association was defined as hospitalization or long-term care facility residence for the entire 10 days preceding symptom onset, and possible association was defined as any exposure to a health care facility for a portion of the 10 days preceding symptom onset. All other Legionnaires' disease cases were considered unrelated to health care. RESULTS: A total of 2,809 confirmed Legionnaires' disease cases were reported from the 21 jurisdictions, including 85 (3%) definite and 468 (17%) possible health care-associated cases. Among the 21 jurisdictions, 16 (76%) reported 1-21 definite health care-associated cases per jurisdiction. Among definite health care-associated cases, the majority (75, 88%) occurred in persons aged ≥60 years, and exposures occurred at 72 facilities (15 hospitals and 57 long-term care facilities). The case fatality rate was 25% for definite and 10% for possible health care-associated Legionnaires' disease. CONCLUSIONS AND IMPLICATIONS FOR PUBLIC HEALTH PRACTICE: Exposure to Legionella from health care facility water systems can result in Legionnaires' disease. The high case fatality rate of health care-associated Legionnaires' disease highlights the importance of case prevention and response activities, including implementation of effective water management programs and timely case identification.

Calls to Florida Poison Control Centers about mercury: Trends over 2003-2013.

OBJECTIVE: The aim of this analysis was to contrast trends in exposure-report calls and informational queries (a measure of public interest) about mercury to the Florida Poison Control Centers over 2003-2013. MATERIALS AND METHODS: Poison-control specialists coded calls to Florida Poison Control Centers by substance of concern, caller demographics, and whether the call pertained to an exposure event or was an informational query. For the present study, call records regarding mercury were de-identified and provided along with daily total number of calls for statistical analysis. We fit Poisson models using generalized estimating equations to summarize changes across years in counts of daily calls to Florida Poison Control Centers, adjusting for month. In a second stage of analysis, we further adjusted for the total number of calls each day. We also conducted analyses stratified by age of the exposed. RESULTS: There was an overall decrease over 2003-2013 in the number of total calls about mercury [Ratio per year: 0.89, 95% CI: (0.88, 0.90)], and calls about mercury exposure [Ratio per year: 0.84, 95% CI: (0.83, 0.85)], but the number of informational queries about mercury increased over this time [Ratio per year: 1.15 (95% CI: 1.12, 1.18)]. After adjusting for the number of calls of that type each day (e.g., call volume), the associations remained similar: a ratio of 0.88 (95% CI: 0.87, 0.89) per year for total calls, 0.85 (0.83, 0.86) for exposure-related calls, and 1.17 (1.14, 1.21) for informational queries. CONCLUSION: Although, the number of exposure-related calls decreased, informational queries increased over 2003-2013. This might suggest an increased public interest in mercury health risks despite a decrease in reported exposures over this time period.

Racial Disparities in Incidence of Legionnaires' Disease and Social Determinants of Health: A Narrative Review.

OBJECTIVES: Racial and socioeconomic disparities in the incidence of Legionnaires' disease have been documented for the past 2 decades; however, the social determinants of health (SDH) that contribute to these disparities are not well studied. The objective of this narrative review was to characterize SDH to inform efforts to reduce disparities in the incidence of Legionnaires' disease. METHODS: We conducted a narrative review of articles published from January 1979 through October 2019 that focused on disparities in the incidence of Legionnaires' disease and pneumonia (inclusive of bacterial pneumonia and/or community-acquired pneumonia) among adults and children (excluding articles that were limited to people aged <18 years). We identified 220 articles, of which 19 met our criteria: original research, published in English, and examined Legionnaires' disease or pneumonia, health disparities, and SDH. We organized findings using the Healthy People 2030 SDH domains: economic stability, education access and quality, social and community context, health care access and quality, and neighborhood and built environment. RESULTS: Of the 19 articles reviewed, multiple articles examined disparities in incidence of Legionnaires' disease and pneumonia related to economic stability/income (n = 13) and comorbidities (n = 10), and fewer articles incorporated SDH variables related to education (n = 3), social support (none), health care access (n = 1), and neighborhood and built environment (n = 6) in their analyses. CONCLUSIONS: Neighborhood and built-environment factors such as housing, drinking water infrastructure, and pollutant exposures represent critical partnership and research opportunities. More research that incorporates SDH and multilevel, cross-sector interventions is needed to address disparities in Legionnaires' disease incidence.

A review of data for quantifying human exposures to micro and nanoplastics and potential health risks.

Plastic debris have been shown to degenerate to particle sizes that can be transported in air, water, and food. Small particles are documented to enter and exit our bodies and translocate to and from some internal organs. Health effects on respiratory, hepatic, immune, and gastrointestinal systems have been reported in humans and other mammals in response to elevated particle or fiber exposures. These health effects differed by plastic type and size, and there was evidence of dose response for a few health endpoints. We conducted a systematic word search and reviewed published literature to identify microplastic and nanoplastic studies that quantified exposure via the ingestion, inhalation, and subcutaneous absorption (not dermal) exposure pathways; identified translocation, internal dose, and associations with health effects and markers related to exposures to specific sizes and types of plastics. We identified the data gaps in relating exposure data to health effects and biomarkers, most notably the lack of characterization of plastic particles and fibers smaller than 10 µm in most media.

Safe Use and Storage of Cleaners, Disinfectants, and Hand Sanitizers: Knowledge, Attitudes, and Practices among U.S. Adults during the COVID-19 Pandemic, May 2020.

Cleaning and disinfection of frequently touched surfaces and frequent hand hygiene are recommended measures to prevent transmission of SARS-CoV-2, the virus that causes COVID-19. Since the onset of the COVID-19 pandemic, poison center calls regarding exposures to cleaners, disinfectants, and hand sanitizers have increased as compared with prior years, indicating a need to evaluate household safety precautions. An opt-in Internet panel survey of 502 U.S. adults was conducted in May 2020. Survey items evaluated knowledge regarding use and storage of cleaners, disinfectants, and hand sanitizers; attitudes about household cleaning and disinfection; and safety precautions practiced during the prior month. We assigned a knowledge score to each respondent to quantify knowledge of safety precautions and calculated median scores by demographic characteristics and attitudes. We identified gaps in knowledge regarding safe use and storage of cleaners, disinfectants, and hand sanitizers; the overall median knowledge score was 5.17 (95% CI: 4.85-5.50; maximum 9.00). Knowledge scores were lower among younger than older age-groups and among black non-Hispanic and Hispanic respondents compared with white non-Hispanic respondents. A greater proportion of respondents expressed knowledge of safety precautions than the proportion who engaged in these precautions. Tailored communication strategies should be used to reach populations with lower knowledge of cleaning and disinfection safety. In addition, as knowledge alone did not shape individual engagement in safety precautions, health promotion campaigns may specifically emphasize the health risks of unsafe use and storage of cleaners, disinfectants, and hand sanitizers to address risk perception.

Safe Community Gardening Practices: Focus Groups with Garden Leaders in Atlanta, Georgia.

Although best management practices have been recommended by government agencies and non-profit organizations to reduce community gardeners' potential exposure to soil contaminants such as lead, some gardeners do not perform these practices. Understanding gardeners' beliefs and motivations is critical for effective promotion of safer gardening practices. This study, grounded in the Theory of Planned Behavior (TPB), employed five focus groups to investigate Atlanta community garden leaders' perspectives concerning three gardening practices: composting, hygiene behaviors, and mulching. These general practices are also considered safe gardening practices in that they can reduce exposure to toxicants in urban gardens. Qualitative analysis identified advantages and disadvantages; supporters and non-supporters; and barriers and facilitators that might influence gardeners' opinions regarding these behaviors. Gardeners expressed that more funding, volunteers, and training are needed to promote these behaviors. Gardeners noted that mulch and compost provided advantages such as improving soil quality, but a primary barrier was concern about contamination of source materials. Focus group participants did not directly associate composting and mulching with reduction of exposure to soil contaminants. Behavioral challenges related to hygiene included concerns about decreased exposure to salubrious bacteria, inadequate access to potable water, and limited availability of gloves and wipes. These study findings characterize factors that community garden stakeholders should consider when promoting safe gardening practices and interventions.

Atlanta Residents' Knowledge Regarding Heavy Metal Exposures and Remediation in Urban Agriculture.

Urban agriculture and gardening provide many health benefits, but the soil is sometimes at risk of heavy metal and metalloid (HMM) contamination. HMM, such as lead and arsenic, can result in adverse health effects for humans. Gardeners may face exposure to these contaminants because of their regular contact with soil and consumption of produce grown in urban areas. However, there is a lack of research regarding whether differential exposure to HMM may be attributed to differential knowledge of exposure sources. In 2018, industrial slag and hazardous levels of soil contamination were detected in West Atlanta. We conducted community-engaged research through surveys and follow-up interviews to understand awareness of slag, HMM in soil, and potential remediation options. Home gardeners were more likely to recognize HMM health effects and to cite health as a significant benefit of gardening than community gardeners. In terms of knowledge, participants were concerned about the potential health effects of contaminants in soil yet unconcerned with produce in their gardens. Gardeners' knowledge on sources of HMM exposure and methods for remediation were low and varied based on racial group.

A Scoping Review of Capacity-Building Efforts to Address Environmental Justice Concerns.

Environmental justice (EJ) efforts aimed at capacity building are essential to addressing environmental health disparities; however, limited attention has been given to describing these efforts. This study reports findings from a scoping review of community-academic partnerships and community-led efforts to address environmental inequities related to air, water, and land pollution in the United States. Literature published in peer-reviewed journals from January 1986 through March 2018 were included, and community capacity theory was applied as a framework for understanding the scope of capacity-building and community change strategies to address EJ concerns. Paired teams of independent analysts conducted a search for relevant articles (n = 8452 citations identified), filtered records for content abstraction and possible inclusion (n = 163) and characterized selected studies (n = 58). Most articles implemented activities that were aligned with community capacity dimensions of citizen participation (96.4%, n = 53), community power (78%, n = 45), leadership (78%, n = 45), and networks (81%, n = 47); few articles identified a direct policy change (22%, n = 13), and many articles discussed the policy implications of findings for future work (62%, n = 36). This review synthesizes three decades of efforts to reduce environmental inequities and identifies strategic approaches used for strengthening community capacity.

Perspectives on Heavy Metal Soil Testing Among Community Gardeners in the United States: A Mixed Methods Approach.

Community gardens offer numerous benefits, but there are also potential risks from exposure to chemical contaminants in the soil. Through the lens of the Theory of Planned Behavior, this mixed methods study examined community gardeners' beliefs and intentions to conduct heavy metal soil testing. The qualitative component involved five focus groups of community garden leaders in Atlanta, Georgia. Qualitative analysis of the focus group data revealed that heavy metal soil contamination was not frequently identified as a common gardening hazard and several barriers limited soil testing in community gardens. The focus group results informed the development of a questionnaire that was administered to 500 community gardeners across the United States. Logistic regression analysis revealed that the soil testing intention was associated with attitude (aOR = 2.46, 95% CI: 1.34, 4.53), subjective norms (aOR = 3.39 95% CI: 2.07, 5.57), and perceived behavioral control (aOR = 1.81, 95% CI: 1.10, 2.99). Study findings have implications for interventions involving community garden risk mitigation, particularly gardens that engage children and vulnerable populations.

Reducing Legionnaires' Disease in Public Spas.

Data from the Centers for Disease Control and Prevention (CDC) shows improper maintenance of public spas increases risk for Legionnaires' disease. Legionnaires' disease affects thousands of individuals each year and represents a signifcant public health burden, with a 10% case fatality rate and an estimated annual hospitalization cost burden of $433 million.1,2 CDC's Model Aquatic Health Code (MAHC) offers critical guidance for reducing the risk of Legionnaires' disease in public aquatic facilities.