Developing a survey instrument to assess flood health beliefs among residents of river flood zones in the Heartland.

INTRODUCTION: Flooding represents a significant health risk to residents of states bordering the Missouri and Missis-sippi Rivers. In Nebraska and Iowa, nearly 280,000 individuals live in floodplains that put them at higher risk for expe-riencing a flood. In Nebraska, 8.60 percent of residents live within floodplains, while in Iowa, 3.83 percent of residents live in floodplains.1 Flooding poses immediate risks including injury and loss of life, but it additionally threatens long-er-term impacts due to increased exposure to environmental health risks and damage to physical and social infrastruc-ture.2,3 Health education interventions depend on risk communication based on accurate knowledge of the health beliefs of at-risk individuals. This paper outlines the development of a survey instrument designed to solicit flooding health beliefs of individuals living in river flood zones. METHODS: This study developed the survey instrument through a series of revisions designed to increase the con-struct validity of the data collected. These steps included item sourcing and modification, expert review, and cognitive interviewing. Content for the initial survey draft was sourced from existing flood risk survey instruments and other standardized demographic surveys.4-8 This study then validated the instrument through sequential expert review and cognitive interviewing, collecting and conducting qualitative analysis of data collected through each phase. RESULTS: Themes from the expert review include (1) improvement of the user experience through revision of re-sponse categories and removal of unnecessary structural elements, (2) improvement of construct representativity through attentiveness to existing flood preparedness policies in the Heartland, and (3) streamlining of data analysis through revision and clarification of item prompts and responses. Themes from the cognitive interviewing include (1) the addition of items soliciting respondents' awareness of their flood risk as well as open-ended items soliciting respond-ents' existing personal flood plan components, (2) revision of existing demographic items to solicit respondents' esti-mated-rather than exact-household income, and (3) clarification of our definition of a flooding event. DISCUSSION: This study adapted existing survey items into an instrument designed to gather data on respondents' flood health beliefs and relevant demographic characteristics, producing a developed instrument that can be used to measure a population's flood health beliefs with reasonable evidence of validity. This instrument may be further tested by gathering baseline data and conducting psychometric testing to determine which items wield significant influence over respondents' decision to develop a personal or household flood plan.9 Additionally, this study provides a model for risk communication professionals seeking to adapt existing survey items to develop instruments designed to gather data on locally relevant health outcomes.10.

Communication strategies to facilitate emergency preparedness for Generation Z and college food pantries: Lessons from the COVID-19 pandemic.

BACKGROUND: There is a paucity of research on college food pantry operations, especially in relation to emergency preparedness and disaster relief. However, there are multiple research studies confirming the efficacy of using social media to communicate with younger adults, especially Generation Z (Gen Z). METHODS: This study examines a college food pantry's social media posts and pantry utilization in a midsize, public university in Texas, prior to and during the COVID-19 pandemic. Collegiate food insecurity was analyzed through the lens of the socioecological model. Social media data during the spring 2019 semester were compared using a two-way ANOVA prior to and following the origination of the COVID-19 pandemic within the state, and pantry utilization over the spring 2019 and fall 2020 semesters was evaluated using a t-test. RESULTS: There were significantly more likes per post on Instagram than other social media outlets, and there were significantly more impressions per post on Twitter as opposed to Facebook, with a trend toward more impressions per posts, after COVID-19. There was no significant difference in food pantry utilization between the fall and spring semester aside from a spike after return following the spring recess, confirmed as Grubb's outlier. Application of the socioecological model emphasized the importance of interdisciplinary collaboration and multitiered interventions during an emergency, including the use of social media. CONCLUSION: This information can help collegiate organizations reach more students through targeted posting on select social media platforms used by their students. Interdisciplinary, inclusive approaches are recommended to reduce food insecurity for Gen Z students.

Factors Associated with Having Ever Considered a Cancer Research Career.

Increasing cancer workforce diversity is a priority for the National Cancer Institute. Cancer research encompasses a wide range of disciplines including basic, clinical, behavioral, and social sciences, but many research development programs are narrowly focused. Our aim was two-fold: to describe undergraduate students' knowledge of and interest in cancer research careers and to identify factors associated with having ever considered a cancer research career. Undergraduate students (n = 857) completed a paper questionnaire. Most students associated cancer careers with bench science and healthcare or public health, but less so for applied fields. Most respondents (69%) received career counseling in high school but only 4% had cancer-specific career counseling. Nearly half the respondents (49%) indicated they or an immediate family member had been diagnosed with cancer, and 17% had attended a cancer appointment. Only 10% of respondents indicated that they had ever considered a career in cancer research. Associated factors included cancer-specific career counseling (odds ratio [OR] 8.05; 95% confidence interval [CI] 3.60, 18.03), attended a cancer appointment (OR 2.37; 95% CI 1.34, 4.20), being slightly (vs. very) worried about developing cancer (OR 0.32; 95% CI 0.15, 0.68), and Other (vs. White) race (OR 2.83; 95% CI 1.34, 5.97). Personal experience with cancer and knowledge of cancer careers appear to be driving factors in career choice for cancer research. Increasing student exposure to cancer careers, possibly in junior high or high school, may be one mechanism for recruiting more underrepresented undergraduate students into cancer-related fields of study.

Resiliency in burn recovery: a qualitative analysis.

This phenomenological study engaged an availability sample of eight, long-term, adult burn survivors living a primarily rural burn center catchment area of the U.S. in face-to-face interviews focused on their holistic health since their burn injuries occurred. Criteria for the primary study involved females (n = 1) and males (n = 7) with an age range of 18 to 65 years and a minimum of 20% total body surface area (TBSA) injuries that required hospitalization in a specialized burn center. The mean age of participants at the time of interviews was 54.38 years. Burns ranged between 20% and 98% TBSA and one to 22 years since burn injuries occurred. Thematic data analysis revealed resilient protective factors as contributing to participants' post-burn health and recoveries. Resilient factors included resourcefulness, achievement motivation, optimism, spirituality, and empathy. Increased understanding of resilient protective factors and how they impacted long-term burn recovery in this sample may aid social workers in development and implementation community-based interventions in rural communities that promote resilience, health/mental health and long-term recovery for this population and others who have experienced trauma.

Adult survivors' lived experience of burns and post-burn health: A qualitative analysis.

INTRODUCTION: The individual implications of major burns are likely to affect the full spectrum of patients' physical, emotional, psychological, social, environmental, spiritual and vocational health. Yet, not all of the post-burn health implications are inevitably negative. Utilizing a qualitative approach, this heuristic phenomenological study explores the experiences and perceptions early (ages 18-35) and midlife (ages 36-64) adults providing insight for how participants perceived their burns in relationship to their post-burn health. METHODS: Participants were interviewed using semi-structured interview questions framed around seven domains of health. Interview recordings were transcribed verbatim then coded line by line, identifying dominant categories related to health. Categories were analyzed identifying shared themes among the study sample. RESULTS: Participants were Caucasian, seven males and one female. Mean age at time of interviews was 54.38 and 42.38 at time of burns. Mean time since burns occurred was 9.38 years with a minimum of (20%) total body surface area (TBSA) burns. Qualitative content analysis rendered three emergent health-related categories and associated themes that represented shared meanings within the participant sample. The category of "Physical Health" reflected the theme physical limitations, pain and sensitivity to temperature. Within the category of "Intellectual Health" were themes of insight, goal setting and self-efficacy, optimism and humor and within "Emotional Health" were the themes empathy and gratitude. CONCLUSIONS: By exploring subjective experiences and perceptions of health shared through dialog with experienced burned persons, there are opportunities to develop a more complete picture of how holistic health may be affected by major burns that in turn could support future long-term rehabilitative trajectories of early and midlife adult burn patients.

What does the public know about environmental health? A qualitative approach to refining an environmental health awareness instrument.

Despite an increased level of interest in environmental health concerns among the American public, awareness of the risks associated with environmental hazards is generally lacking. Assessing population awareness is typically performed through surveys, yet a comprehensive national environmental health questionnaire is currently unavailable. In 2009, a Delphi study using environmental health experts from federal, state, and local government and academia identified 11 core areas of environmental health (air, water, radiation, food safety, emergency preparedness, healthy housing, infectious disease and vector control, toxicology, injury prevention, waste and sanitation, and weather and climate change) and provided content validity for 443 questions covering 25 specific topics for possible inclusion on a national instrument. The authors' study described in this article used the qualitative approach of focus groups to refine the questions. Questions were divided into four sections and randomly assigned to a focus group location; 32 individuals participated. Results indicated that many perceptions are based on misinformation (or lack of information), which may lead to poor environmental health decision making.

2012 NEHA/UL sabbatical report: vulnerability to potential impacts of climate change: adaptation and risk communication strategies for environmental health practitioners in the United Kingdom.

Climate change risk assessment, adaptation, and mitigation planning have become increasingly important to environmental health practitioners (EHPs). The NEHA/UL Sabbatical Exchange Award allowed me to investigate how EHPs in the UK are incorporating climate change planning and communication strategies into their work. Projected climate change risks in the UK include flooding, extreme heat, water shortages, severe weather, decreased air quality, and changes in vectors. Despite public perception and funding challenges, all the local government representatives with whom I met incorporated climate change risk assessment, adaptation, and mitigation planning into their work. The mandated Community Risk Register serves as a key planning document developed by each local government authority and is a meaningful way to look at potential climate change health risks. Adaptation and sustainability were common threads in my meetings. These often took the form of "going green" with transportation, energy efficiency, conserving resources, and building design because the efforts made sense monetarily as future cost savings. Communication strategies targeted a variety of audiences (EHPs, non-EHP government employees, politicians, and the general public) using a broad range of communication channels (professional training, lobbying, conferences and fairs, publications, print materials, Internet resources, social media, billboards, etc).

Preschool children's environmental exposures: a case-control epidemiological study of the presence of asthma-like symptoms.

The heterogeneity of asthma and asthma-like symptoms results in difficulty defining, diagnosing, and therefore estimating environmental exposures and associations with wheezing or asthma-like symptoms. Determining the disease burden for young children is particularly challenging. In the study described in this article, counter-matched sampling design was used to select participants from the Woman, Infants, and Children (WIC) program for this nested case-control study (N = 691, with 412 controls). Data were collected through structured interviews. Exposure to wood or oil smoke, soot, or exhaust was significantly associated with early-life asthma, as was exposure to cockroaches. Multivariate analyses showed that increasing age, male gender, presence of allergies (although not the type of allergies), and the presence of eczema at birth predicted wheezing behaviors in the authors' study. The authors estimated the prevalence of wheezing behavior in a population of low-income preschool children was 31% with prevalence rates higher among African-American children as compared to other races/ethnicities. Fifty-one percent of those children whose caregivers reported wheezing, however, had not received a diagnosis of asthma. Further study is recommended to compare the differences in the wheezing experiences between those diagnosed with asthma and those who are undiagnosed, with the intent of designing primary prevention interventions tailored to parents and caregivers of young children.

Mercury, lead, and cadmium in umbilical cord blood.

The study described in this article aimed to determine if measurable levels of mercury, lead, and cadmium are detected in the umbilical cord blood specimens collected in a community hospital in Rhode Island and if prenatal exposure correlates with prematurity or fetal growth indicators. Total mercury, lead, and cadmium concentrations were measured in 538 specimens of cord blood and correlated with demographic characteristics and pregnancy outcomes for each mother-infant pair. Lead concentrations determined in the cord blood of Rhode Island women (geometric mean 0.99 microg/dL) were similar to those reported in U.S. biomonitoring studies. The overall geometric mean for mercury concentration (0.52 microg/L) was slightly lower than in other comparable studies. Cadmium concentrations were generally below the limit of detection. A statistically significant correlation was detected between elevated mercury concentrations and racial and ethnic characteristics of the study participants. Non-Hispanic African-American mothers were 9.6 times more likely to have a mercury concentration > or = 5.8 microg/L compared to women of other racial/ethnic backgrounds. No association was detected between elevated mercury levels and adverse birth outcomes.

The 2011 Japanese earthquake: an overview of environmental health impacts.

A magnitude 9.0 earthquake rupturing the Earth's crust nearly 130 km off the east coast of Japan on March 11, 2011, triggered a tsunami that reached the Japanese coast approximately 30 minutes later. The combined effects of the earthquake and tsunami (known as the Tohoku event) devastated the area of northeast Japan, resulting in widespread infrastructure destruction, loss of life, and environmental contamination. Perhaps the longest-lasting impact of the Tohoku event will result from the damage to the nuclear power plants along the coast and the subsequent release of radioactive elements into the environment. This article describes the environmental impacts of the disaster and highlights the interconnectedness among the core areas of environmental health including air quality, water quality, weather/climate change, food safety, healthy housing, waste/sanitation, infectious disease/vector control, radiation, injury prevention, emergency preparedness, and toxicology. The purpose of this article is to provide an overview of the spectrum of the natural disaster and its environmental health impact to the human population. Future scientific analysis may confirm or challenge the information presented here.

Food safety education: child-to-parent instruction in an immigrant population.

A quasi-experimental pretest-posttest design was used to examine increases in food handling knowledge among eastern European refugee restaurant candidates as a result of educational material taught either by the employee's child or the Salt Lake Valley Health Department. Participants were nonrandomly assigned to a study (n = 15) or control group (n = 17). The study group was taught by their children in their native language. The control group was taught by an SLVHD instructor in English. All participants completed pre- and posttests that measured four areas of food handling knowledge: personal hygiene and hand washing (PHHW), cooking and holding time/temperature (COOKTT), cooling and holding time/temperature (COOLTT), and cross-contamination (CC). Both groups demonstrated a significant increase in knowledge of PHHW, but only the study group demonstrated significant improvements in COOKTT and CC knowledge. These study results suggest that food handling education programs are effective in increasing knowledge and mode of delivery may be an important factor.

Assessing consumer awareness about mercury in fish.

The study discussed in this article was conducted to determine if a retail-based educational campaign would be an effective tool to inform consumers about mercury in fish. In 2005, the Rhode Island (RI) Department of Health, in conjunction with the RI Food Dealers Association, conducted surveys in eight supermarkets to assess consumers' knowledge and awareness of mercury in fish. A presurvey was administered to 523 respondents as they prepared to exit the store June 17-19. During the week of July 11-17, a "Fish Week" educational program was conducted. An identical postsurvey to evaluate the effectiveness of "Fish Week" was administered to 556 customers exiting participating supermarkets on July 21-24. A significant (p < .05) increase occurred in the number of respondents who identified brochures as an information source about mercury in fish. Small, but significant, decreases in awareness and knowledge about mercury in fish issues, however, were unexpected findings that were likely due to factors discussed.