ALBERT

Description: IJERPH, Vol. 14, Pages 1354: Pattern of Road Traffic Injuries in Rural Bangladesh: Burden Estimates and Risk Factors International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14111354 Authors: Md. Ul Baset Aminur Rahman Olakunle Alonge Priyanka Agrawal Shirin Wadhwaniya Fazlur Rahman Globally, road traffic injury (RTI) causes 1.3 million deaths annually. Almost 90% of all RTI deaths occur in low- and middle-income countries. RTI is one of the leading causes of death in Bangladesh; the World Health Organization estimated that it kills over 21,000 people in the country annually. This study describes the current magnitude and risk factors of RTI for different age groups in rural Bangladesh. A household census was carried out in 51 unions of seven sub-districts situated in the north and central part of Bangladesh between June and November 2013, covering 1.2 million individuals. Trained data collectors collected information on fatal and nonfatal RTI events through face-to-face interviews using a set of structured pre-tested questionnaires. The recall periods for fatal and non-fatal RTI were one year and six months, respectively. The mortality and morbidity rates due to RTI were 6.8/100,000 population/year and 889/100,000 populations/six months, respectively. RTI mortality and morbidity rates were significantly higher among males compared to females. Deaths and morbidities due to RTI were highest among those in the 25–64 years age group. A higher proportion of morbidity occurred among vehicle passengers (34%) and pedestrians (18%), and more than one-third of the RTI mortality occurred among pedestrians. Twenty percent of all nonfatal RTIs were classified as severe injuries. RTI is a major public health issue in rural Bangladesh. Immediate attention is needed to reduce preventable deaths and morbidities in rural Bangladesh.

Description: Passive houses and other highly energy-efficient buildings need mechanical ventilation. However, ventilation systems in such houses are regarded with a certain degree of skepticism by parts of the public due to alleged negative health effects. Within a quasi-experimental field study, we investigated if occupants of two types of buildings (mechanical vs. natural ventilation) experience different health, wellbeing and housing satisfaction outcomes and if associations with indoor air quality exist. We investigated 123 modern homes (test group: with mechanical ventilation; control group: naturally ventilated) built in the years 2010 to 2012 in the same geographic area and price range. Interviews of occupants based on standardized questionnaires and measurements of indoor air quality parameters were conducted twice (three months after moving in and one year later). In total, 575 interviews were performed (respondents’ mean age 37.9 ± 9 years in the test group, 37.7 ± 9 years in the control group). Occupants of the test group rated their overall health status and that of their children not significantly higher than occupants of the control group at both time points. Adult occupants of the test group reported dry eyes statistically significantly more frequently compared to the control group (19.4% vs. 12.5%). Inhabitants of energy-efficient, mechanically ventilated homes rated the quality of indoor air and climate significantly higher. Self-reported health improved more frequently in the mechanically ventilated new homes (p = 0.005). Almost no other significant differences between housing types and measuring time points were observed concerning health and wellbeing or housing satisfaction. Associations between vegetative symptoms (dizziness, nausea, headaches) and formaldehyde concentrations as well as between CO2 levels and perceived stale air were observed. However, both associations were independent of the type of ventilation. In summary, occupants of the mechanically ventilated homes rated their health status slightly higher and their health improved significantly more frequently than in occupants of the control group. As humidity in homes with mechanical ventilation was lower, it seems plausible that the inhabitants reported dry eyes more frequently.

Description: The epidemiology of malaria, anaemia and malnutrition in children is potentially altered in mining development areas. In a copper extraction project in northwestern Zambia, a health impact assessment (HIA) was commissioned to predict, manage and monitor health impacts. Two cross-sectional surveys were conducted: at baseline prior to project development (2011) and at four years into development (2015). Prevalence of Plasmodium falciparum, anaemia and stunting were assessed in under-five-year-old children, while hookworm infection was assessed in children aged 9–14 years in communities impacted and comparison communities not impacted by the project. P. falciparum prevalence was significantly higher in 2015 compared to 2011 in both impacted and comparison communities (odds ratio (OR) = 2.51 and OR = 6.97, respectively). Stunting was significantly lower in 2015 in impacted communities only (OR = 0.63). Anaemia was slightly lower in 2015 compared to baseline in both impacted and comparison communities. Resettlement due to the project and migration background (i.e., moving into the area within the past five years) were generally associated with better health outcomes in 2015. We conclude that repeated cross-sectional surveys to monitor health in communities impacted by projects should become an integral part of HIA to deepen the understanding of changing patterns of health and support implementation of setting-specific public health measures.

Description: Online social networking sites (SNSs) have gained increasing popularity in the last decade, with individuals engaging in SNSs to connect with others who share similar interests. The perceived need to be online may result in compulsive use of SNSs, which in extreme cases may result in symptoms and consequences traditionally associated with substance-related addictions. In order to present new insights into online social networking and addiction, in this paper, 10 lessons learned concerning online social networking sites and addiction based on the insights derived from recent empirical research will be presented. These are: (i) social networking and social media use are not the same; (ii) social networking is eclectic; (iii) social networking is a way of being; (iv) individuals can become addicted to using social networking sites; (v) Facebook addiction is only one example of SNS addiction; (vi) fear of missing out (FOMO) may be part of SNS addiction; (vii) smartphone addiction may be part of SNS addiction; (viii) nomophobia may be part of SNS addiction; (ix) there are sociodemographic differences in SNS addiction; and (x) there are methodological problems with research to date. These are discussed in turn. Recommendations for research and clinical applications are provided.

Description: Leishmaniasis is the third most common vector-borne disease and a very important protozoan infection. Cutaneous leishmaniasis is one of the most common types of leishmaniasis infectious diseases with up to 1.2 million occurrences of new cases each year worldwide. A dynamic transmission multivariate time series model was applied to the data to account for overdispersion and evaluate the effects of three environmental layers as well as seasonality in the data. Furthermore, ecological niche modeling was used to study the geographically suitable conditions for cutaneous leishmaniasis using temperature, precipitation and altitude as environmental layers, together with the leishmaniasis presence data. A retrospective analysis of the cutaneous leishmaniasis spatial data in Afghanistan between 2003 and 2009 indicates a steady increase from 2003 to 2007, a small decrease in 2008, and then another increase in 2009. An upward trend and regularly repeating patterns of highs and lows were observed related to the months of the year, which suggests seasonality effect in the data. Two peaks were observed in the disease occurrence—January to March and September to December—which coincide with the cold period. Ecological niche modelling indicates that precipitation has the greatest contribution to the potential distribution of leishmaniasis.

Description: Environmental noise is known to cause noise annoyance. Since noise annoyance is a subjective indicator, other mediators—such as noise sensitivity—may influence its perception. However, few studies have thus far been conducted on noise annoyance in South Korea that consider noise sensitivity and noise level simultaneously. The aim of this study was to evaluate the correlations between noise sensitivity or noise level and noise annoyance on a large scale in South Korea. This study estimated the level of noise exposure based on a noise map created in 2014; identified and surveyed 1836 subjects using a questionnaire; and assessed the impact of transportation noise and noise sensitivity on noise annoyance. The result showed that noise exposure level and noise sensitivity simultaneously affect noise annoyance, and noise sensitivity has a relatively larger impact on noise annoyance. In conclusion, when study subjects were exposed to a similar level of noise, the level of noise annoyance differed depending on the noise sensitivity of the individual.

Description: This study systematically reviewed forest therapy programs designed to decrease the level of depression among adults and assessed the methodological rigor and scientific evidence quality of existing research studies to guide future studies. This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The authors independently screened full-text articles from various databases using the following criteria: (1) intervention studies assessing the effects of forest therapy on depressive symptoms in adults aged 18 years and older; (2) studies including at least one control group or condition; (3) peer-reviewed studies; and (4) been published either in English or Korean before July 2016. The Scottish Intercollegiate Guideline Network measurement tool was used to assess the risk of bias in each trial. In the final sample, 28 articles (English: 13, Korean: 15) were included in the systematic review. We concluded that forest therapy is an emerging and effective intervention for decreasing adults’ depression levels. However, the included studies lacked methodological rigor. Future studies assessing the long-term effect of forest therapy on depression using rigorous study designs are needed.

Description: In the absence of pipe-borne water, many people in Africa, especially in rural communities, depend on alternative water sources such as wells, boreholes and rivers for household and personal hygiene. Poor maintenance and nearby pit latrines, however, lead to microbial pollution of these sources. We evaluated the abundance of Escherichia coli and the prevalence of pathogenic E. coli virulence genes in water from wells, boreholes and a river in a South African peri-urban community. Monthly samples were collected between August 2015 and November 2016. In all, 144 water samples were analysed for E. coli using the Colilert 18 system. Virulence genes (eagg, eaeA, stx1, stx2, flichH7, ST, ipaH, ibeA) were investigated using real-time polymerase chain reaction. Mean E. coli counts ranged between 0 and 443.1 Most Probable Number (MPN)/100 mL of water sample. Overall, 99.3% of samples were positive for at least one virulence gene studied, with flicH7 being the most detected gene (81/140; 57.6%) and the stx2 gene the least detected gene (8/140; 5.7%). Both intestinal and extraintestinal pathogenic E. coli genes were detected. The detection of virulence genes in these water sources suggests the presence of potentially pathogenic E. coli strains and is a public health concern.

Description: In the USA, little is known about local variation in retail cigarette prices; price variation explained by taxes, bans, and area-level socio-demographics, and whether taxes and hospitality bans have synergistic effects on smoking prevalence. Cigarette prices 2001–2011 from chain supermarkets and drug stores (n = 2973) were linked to state taxes (n = 41), state and county bar/restaurant smoking bans, and census block group socio-demographics. Hierarchical models explored effects of taxes and bans on retail cigarette prices as well as county smoking prevalence (daily, non-daily). There was wide variation in store-level cigarette prices in part due to differences in state excise taxes. Excise taxes were only partially passed onto consumers (after adjustment, $1 tax associated with $0.90 increase in price, p 〈 0.0001) and the pass-through was slightly higher in areas that had bans but did not differ by area-level socio-demographics. Bans were associated with a slight increase in cigarette price (after adjustment, $0.09 per-pack, p 〈 0.0001). Taxes and bans were associated with reduction in smoking prevalence and taxes had a stronger association when combined with bans, suggesting a synergistic effect. Given wide variation in store-level prices, and uneven state/county implementation of taxes and bans, more federal policies should be considered.

Description: Background: Research has shown that suicide is a phenomenon highly present among the drug dependent population. Different studies have demonstrated an upraised level of comorbidity between personality disorders (PD) and substance use disorders (SUD). This study aimed to describe which PDs are more frequent among those patients with a risk of suicide. Methods: The study was based on a consecutive non-probabilistic convenience sample of 196 bereaved patients attended to in a Public Addiction Center in Girona (Spain). Sociodemographic data, as well as suicide and drug related characteristics were recorded. The risk of suicide was assessed with the Spanish version of “Risk of suicide”. Personality disorders were measured with the Spanish version of Millon Multiaxial Clinical Inventory. Results: The PDs more associated with the presence of risk of suicide were depressive, avoidant, schizotypal and borderline disorders. However, the histrionic, narcissistic and compulsive PDs are inversely associated with risk of suicide even though the narcissistic scale had no statistical correlation. Conclusions: The risk of suicide is a significant factor to take into account related to patients with SUD and especially with the presence of specific PDs. These findings underline the importance of diagnosing and treating rigorously patients with SUD.

Description: Substance use disorders (SUD) and mental health disorders are significant public health issues that co-occur and are associated with high risk for suicide attempts. SUD and mental health disorders are more prevalent among offenders (i.e., prisoners or inmates) than the non-imprisoned population, raising concerns about the risk of self-harm. This cross-sectional study examined the population of a state prison system (10,988 out of 13,079) to identify associations among SUD (alcohol, cannabis, intravenous drugs, narcotics, and tobacco smoking), mental health disorders (anxiety, bipolar, depression, and psychotic disorders), and suicide attempts. The primary aim was to determine which groups (SUD, mental health disorders, and co-occurrences) were strongly association with suicide attempts. Groups with a documented SUD or mental health disorders compared to peers without these issues had 2.0 and 9.2 greater odds, respectively, for attempting suicide, which was significant at p 〈 0.0001 for both conditions. There were also significant differences within SUD and mental health disorders groups in regard to suicide attempts. Groups with the greatest odds for suicide attempts were offenders with comorbid bipolar comorbid and anxiety, alcohol combined with depression, and cannabis co-occurring with depression. Documentation of suicide attempts during imprisonment indicates awareness, but also suggest a need to continue enhancing screening and evaluating environmental settings.

Description: International recommendations for mental health care have advocated for a reduction in the length of stay (LOS) in full-time hospitalization and the development of alternatives to full-time hospitalizations (AFTH) could facilitate alignment with those recommendations. Our objective was therefore to assess whether the development of AFTH in French psychiatric sectors was associated with a reduction in the LOS in full-time hospitalization. Using data from the French national discharge database of psychiatric care, we computed the LOS of patients admitted for full-time hospitalization. The level of development of AFTH was estimated by the share of human resources allocated to those alternatives in the hospital enrolling the staff of each sector. Multi-level modelling was carried out to adjust the analysis on other factors potentially associated with the LOS (patients’, psychiatric sectors’ and environmental characteristics). We observed considerable variations in the LOS between sectors. Although the majority of these variations resulted from patients’ characteristics, a significant negative association was found between the LOS and the development of AFTH, after adjusting for other factors. Our results provide first evidence of the impact of the development of AFTH on mental health care and will provide a lever for policy makers to further develop these alternatives.

Description: Objective: Childhood obesity is a serious concern for developed and developing countries. This study aimed to assess the level of support in Australia for regulation and to assess whether systematic differences occur between individuals who support increased regulation and individuals who oppose it. Methods: An online survey (n = 563) was used to assess parental/caregiver preferences for taxation policy options and nutrition labelling designed to address the incidence of childhood obesity. Participants were parents or caregivers of young children (3 to 7 years) who were actively enrolled in an existing birth cohort study in South-East Queensland, Australia. Results: The majority of the parents (over 80%) strongly agreed or agreed with labelling food and drink with traffic light or teaspoon labelling. Support for taxation was more variable with around one third strongly supporting and a further 40% of participants equivocal about using taxation; however, a quarter strongly rejected this policy. Cluster analysis did not detect any socio-demographic differences between those who strongly supported taxation and those who did not. Conclusions: Better food labelling would be welcomed by parents to enhance food choices for their children. Taxation for health reasons would not be opposed by most parents. Implications for Public Health: Governments should consider taxation of unhealthy drinks and improved labelling to encourage healthy food purchasing.

Description: Given that public transportation networks are less developed in rural than in urban areas, a lack of accessibility to dental care facilities could be a barrier to routine dental checkups. Thus, we hypothesized that the distance to the dental care facilities is a risk factor for tooth loss. The aim of this study was to test whether there is an association between the distance to dental care facilities, estimated by geographic information systems, and number of teeth, assessed by an oral examination, among elderly residents of a rural area in Japan. Data were collected in 2016 from a cross-sectional study conducted in Shimane prefecture, Japan. After excluding participants with missing data (n = 21), we analyzed data from 710 participants. Of them, 40.6% were male and the mean (standard deviation) age was 67.4 (7.4) years. Further, 68.0% (n = 483) had at least 20 teeth. We found that the distance to dental care facilities was significantly associated with the number of teeth (less than 20) (odds ratio = 1.07, 95% confidence interval = 1.01–1.12) after adjustment for potential confounders. This result suggested that individuals without easy access to dental care facilities may be important targets for dental care.

Description: An underrepresentation of stakeholder perspectives within urban health research arguably limits our understanding of what is a multi-dimensional and complex relationship between the built environment and health. By engaging a wide range of stakeholders using a participatory concept mapping approach, this study aimed to achieve a more holistic and nuanced understanding of the built environments shaping disease risk, specifically cardiometabolic risk (CMR). Moreover, this study aimed to ascertain the importance and changeability of identified environments through government action. Through the concept mapping process, community members, researchers, government and non-government stakeholders collectively identified eleven clusters encompassing 102 built environmental domains related to CMR, a number of which are underrepresented within the literature. Among the identified built environments, open space, public transportation and pedestrian environments were highlighted as key targets for policy intervention. Whilst there was substantive convergence in stakeholder groups’ perspectives concerning the built environment and CMR, there were disparities in the level of importance government stakeholders and community members respectively assigned to pedestrian environments and street connectivity. These findings support the role of participatory methods in strengthening how urban health issues are understood and in affording novel insights into points of action for public health and policy intervention.

Description: The increasing health costs of and the risks factors associated with obesity are well documented. From this perspective, it is important that the propensity of individuals towards obesity is analyzed. This paper uses longitudinal data from the Household Income and Labour Dynamics in Australia (HILDA) Survey for 2005 to 2010 to model those variables which condition the probability of being obese. The model estimated is a random effects generalized ordered probit, which exploits two sources of heterogeneity; the individual heterogeneity of panel data models and heterogeneity across body mass index (BMI) categories. The latter is associated with non-parallel thresholds in the generalized ordered model, where the thresholds are functions of the conditioning variables, which comprise economic, social, and demographic and lifestyle variables. To control for potential predisposition to obesity, personality traits augment the empirical model. The results support the view that the probability of obesity is significantly determined by the conditioning variables. Particularly, personality is found to be important and these outcomes reinforce other work examining personality and obesity.

Description: This paper describes the development of a new artificial turf surrogate surface (ATSS) sampler for use in the measurement of mercury (Hg) dry deposition. In contrast to many existing surrogate surface designs, the ATSS utilizes a three-dimensional deposition surface that may more closely mimic the physical structure of many natural surfaces than traditional flat surrogate surface designs (water, filter, greased Mylar film). The ATSS has been designed to overcome several complicating factors that can impact the integrity of samples with other direct measurement approaches by providing a passive system which can be deployed for both short and extended periods of time (days to weeks), and is not contaminated by precipitation and/or invalidated by strong winds. Performance characteristics including collocated precision, in-field procedural and laboratory blanks were evaluated. The results of these performance evaluations included a mean collocated precision of 9%, low blanks (0.8 ng), high extraction efficiency (97%–103%), and a quantitative matrix spike recovery (100%).

Description: Ultraviolet radiation (UVR) has been associated with various health outcomes, including skin cancers, vitamin D insufficiency, and multiple sclerosis. Measurement of UVR has been difficult, traditionally relying on subject recall. We investigated trends in satellite-derived UVB from 1978 to 2014 within the continental United States (US) to inform UVR exposure assessment and determine the potential magnitude of misclassification bias created by ignoring these trends. Monthly UVB data remotely sensed from various NASA satellites were used to investigate changes over time in the United States using linear regression with a harmonic function. Linear regression models for local geographic areas were used to make inferences across the entire study area using a global field significance test. Temporal trends were investigated across all years and separately for each satellite type due to documented differences in UVB estimation. UVB increased from 1978 to 2014 in 48% of local tests. The largest UVB increase was found in Western Nevada (0.145 kJ/m2 per five-year increment), a total 30-year increase of 0.87 kJ/m2. This largest change only represented 17% of total ambient exposure for an average January and 2% of an average July in Western Nevada. The observed trends represent cumulative UVB changes of less than a month, which are not relevant when attempting to estimate human exposure. The observation of small trends should be interpreted with caution due to measurement of satellite parameter inputs (ozone and climatological factors) that may impact derived satellite UVR nearly 20% compared to ground level sources. If the observed trends hold, satellite-derived UVB data may reasonably estimate ambient UVB exposures even for outcomes with long latency phases that predate the satellite record.

Description: This study was designed to examine the effects of ambient heat on firefighters’ physical task performance, and physiological and perceptual responses when sleep restricted during simulated wildfire conditions. Thirty firefighters were randomly allocated to the sleep restricted (n = 17, SR; 19 °C, 4-h sleep opportunity) or hot and sleep restricted (n = 13, HOT + SR; 33 °C, 4-h sleep opportunity) condition. Firefighters performed two days of simulated, intermittent, self-paced work circuits comprising six firefighting tasks. Heart rate, and core temperature were measured continuously. After each task, firefighters reported their rating of perceived exertion and thermal sensation. Effort sensation was also reported after each work circuit. Fluids were consumed ad libitum. Urine volume and urine specific gravity were analysed. Sleep was monitored using polysomnography. There were no differences between the SR and HOT + SR groups in firefighters’ physiological responses, hydration status, ratings of perceived exertion, motivation, and four of the six firefighting tasks (charged hose advance, rake, hose rolling, static hose hold). Black out hose and lateral repositioning were adversely affected in the HOT + SR group. Working in hot conditions did not appear to consistently impair firefighters work performance, physiology, and perceptual responses. Future research should determine whether such findings remain true when individual tasks are performed over longer durations.

Description: IJERPH, Vol. 14, Pages 908: Why Do People Like Loud Sound? A Qualitative Study International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14080908 Authors: David Welch Guy Fremaux Many people choose to expose themselves to potentially dangerous sounds such as loud music, either via speakers, personal audio systems, or at clubs. The Conditioning, Adaptation and Acculturation to Loud Music (CAALM) Model has proposed a theoretical basis for this behaviour. To compare the model to data, we interviewed a group of people who were either regular nightclub-goers or who controlled the sound levels in nightclubs (bar managers, musicians, DJs, and sound engineers) about loud sound. Results showed four main themes relating to the enjoyment of loud sound: arousal/excitement, facilitation of socialisation, masking of both external sound and unwanted thoughts, and an emphasis and enhancement of personal identity. Furthermore, an interesting incidental finding was that sound levels appeared to increase gradually over the course of the evening until they plateaued at approximately 97 dBA Leq around midnight. Consideration of the data generated by the analysis revealed a complex of influential factors that support people in wanting exposure to loud sound. Findings were considered in terms of the CAALM Model and could be explained in terms of its principles. From a health promotion perspective, the Social Ecological Model was applied to consider how the themes identified might influence behaviour. They were shown to influence people on multiple levels, providing a powerful system which health promotion approaches struggle to address.

Description: IJERPH, Vol. 14, Pages 907: Maintaining Traditions: A Qualitative Study of Early Childhood Caries Risk and Protective Factors in an Indigenous Community International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14080907 Authors: Ana Levin Karen Sokal-Gutierrez Anita Hargrave Elizabeth Funsch Kristin Hoeft In lower middle-income economies (LMIE), the nutrition transition from traditional diets to sugary foods and beverages has contributed to widespread early childhood dental caries. This qualitative study explores perceived risk and protective factors, and overall experiences of early childhood nutrition and oral health in indigenous Ecuadorian families participating in a community-based oral health and nutrition intervention. Dental exams of 698 children age 6 months through 6 years determined each child’s caries burden. A convenience sample of 18 “outlier” families was identified: low-caries children with ≤2 carious teeth vs. high-caries children with ≥10 carious teeth. Semi-structured in-depth interviews with parents/caregivers explored the child’s diet, dental habits, and family factors related to nutrition and oral health. Interviews were transcribed and thematically analyzed using grounded theory. In the high-caries families, proximity to highway and stores, consumption of processed-food, and low parental monitoring of child behavior were identified as risk factors for ECC (early childhood caries). In the low-caries families, protective factors included harvesting and consuming food from the family farm, remote geography, and greater parental monitoring of child behavior. The study results suggest that maintaining traditional family farms and authoritative parenting to avoid processed foods/drinks and ensure tooth brushing could improve early childhood nutrition and oral health.

Description: IJERPH, Vol. 14, Pages 903: Socioeconomic Inequalities in Visits to the Dentist to Receive Professionally Applied Topical Fluoride in a Developing Country International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14080903 Authors: Miriam Herrera Carlo Medina-Solís América Pontigo-Loyola Rubén Rosa-Santillana Leticia Ávila-Burgos Rogelio Scougall-Vilchis Sonia Márquez-Rodríguez Mirna Minaya-Sánchez Alejandro Casanova-Rosado Objective: To determine the frequency and associated factors of visits to the dentist in the last year by Nicaraguan schoolchildren to receive professionally applied topical fluoride (PATF). Material and Methods: A cross-sectional study was designed in children from public schools in the city of León, Nicaragua, were included. A series of socioeconomic, sociodemographic, and behavioural variables were collected through a questionnaire. The dependent variable was the visit to the dentist to receive professionally applied topical fluoride in the last year, which was dichotomised as (0) Did not receive PATF and (1) Yes received PATF. In the statistical analysis, binary logistic regression was used. Results: The mean age of the students included was 9 years, and 49.9% were girls. The prevalence of visits to the dentist in the last year to receive PATF was 3.1%. In the multivariate model, the associated characteristics (p < 0.05) were: female (OR = 2.73, 95% CI = 1.34–4.50); the positive attitude of the mother to the oral health of her child (OR = 2.15, 95% CI = 1.03–4.50); and the best socioeconomic position (OR = 2.68, 95% CI = 1.36—5.31). Conclusions: The prevalence of visits to the dentist in the last year to receive professionally applied topical fluoride was very low (3.1%). The results of the socioeconomic position suggest the existence of certain inequalities in oral health. It is necessary to implement policies and programs aimed at improving this scenario.

Description: IJERPH, Vol. 14, Pages 905: A Randomized Crossover Trial on Acute Stress-Related Physiological Responses to Mountain Hiking International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14080905 Authors: Martin Niedermeier Carina Grafetstätter Arnulf Hartl Martin Kopp Green exercise, defined as physical activity in natural environments, might have positive effects on stress-related physiological measures. Little is known about the acute effects of green exercise bouts lasting longer than 60 min. Therefore, the aim of the present study was to analyze the acute effects of a three-hour green exercise intervention (mountain hiking) on stress-related physiological responses. Using a randomized crossover design, 42 healthy participants were exposed to three different conditions in a field-based experiment: outdoor mountain hiking, indoor treadmill walking, and sedentary control condition (three hours each). At baseline and at follow-up (five minutes after the condition), stress-related physiological responses (salivary cortisol, blood pressure, and heart rate variability) were measured. Salivary cortisol decreased in all conditions, but showed a larger decrease after both mountain hiking and treadmill walking compared to the sedentary control situation (partial η2 = 0.10). No differences were found between mountain hiking and treadmill walking in salivary cortisol. In heart rate variability and blood pressure, changes from baseline to follow-up did not significantly differ between the three conditions. The results indicate that three hours of hiking indoors or outdoors elicits positive effects on salivary cortisol concentration. Environmental effects seem to play a minor role in salivary cortisol, blood pressure, and heart rate variability.

Description: IJERPH, Vol. 14, Pages 913: Effects of Short-Term Set-Aside Management Practices on Soil Microorganism and Enzyme Activity in China International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14080913 Authors: Guangyu Li Cifang Wu Set-aside farmland can effectively improve the self-rehabilitation of arable soil. Long-term set-asides however cannot satisfy provisionment, therefore the use of short-term set-asides to restore cultivated soil is a better option. Few studies have compared short-term set-aside patterns, and the effects of set-asides on soil microbial community and enzyme enzymes. We analyzed the bacterial structure, microbial biomass carbon/nitrogen and enzyme activity of farmland soil under different set-aside regimes in the Yellow River Delta of China. Bacterial alpha diversity was relatively lower under only irrigation, and farmyard manure applications showed clear advantages. Set-asides should consider their influence on soil organic carbon and nitrogen, which were correlated with microbial community structure. Nitrospira (0.47–1.67%), Acidobacteria Gp6 (8.26–15.91%) and unclassified Burkholderiales (1.50–2.81%) were significantly altered (p < 0.01). Based on functions of these genera, some set-aside patterns led to a relative balance in nitrogen and carbon turnover. Partial treatments showed a deficiency in organic matter. In addition, farmyard manure may lead to the increased consumption of organic matter, with the exception of native plants set-asides. Conventional farming (control group) displayed a significant enzyme activity advantage. Set-aside management practices guided soil microbial communities to different states. Integrated soil microbiota and the content of carbon and nitrogen, native plants with farmyard manure showed an equilibrium state relatively, which would be helpful to improve land quality in the short-term.

Description: IJERPH, Vol. 14, Pages 917: Dynamics of Implementation and Maintenance of Organizational Health Interventions International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14080917 Authors: Mohammad Jalali Hazhir Rahmandad Sally Bullock Alice Ammerman In this study, we present case studies to explore the dynamics of implementation and maintenance of health interventions. We analyze how specific interventions are built and eroded, how the building and erosion mechanisms are interconnected, and why we can see significantly different erosion rates across otherwise similar organizations. We use multiple comparative obesity prevention case studies to provide empirical information on the mechanisms of interest, and use qualitative systems modeling to integrate our evolving understanding into an internally consistent and transparent theory of the phenomenon. Our preliminary results identify reinforcing feedback mechanisms, including design of organizational processes, motivation of stakeholders, and communication among stakeholders, which influence implementation and maintenance of intervention components. Over time, these feedback mechanisms may drive a wedge between otherwise similar organizations, leading to distinct configurations of implementation and maintenance processes.

Description: IJERPH, Vol. 14, Pages 916: Socioeconomic Inequalities in Green Space Quality and Accessibility—Evidence from a Southern European City International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14080916 Authors: Elaine Hoffimann Henrique Barros Ana Ribeiro Background: The provision of green spaces is an important health promotion strategy to encourage physical activity and to improve population health. Green space provision has to be based on the principle of equity. This study investigated the presence of socioeconomic inequalities in geographic accessibility and quality of green spaces across Porto neighbourhoods (Portugal). Methods: Accessibility was evaluated using a Geographic Information System and all the green spaces were audited using the Public Open Space Tool. Kendall’s tau-b correlation coefficients and ordinal regression were used to test whether socioeconomic differences in green space quality and accessibility were statistically significant. Results: Although the majority of the neighbourhoods had an accessible green space, mean distance to green space increased with neighbourhood deprivation. Additionally, green spaces in the more deprived neighbourhoods presented significantly more safety concerns, signs of damage, lack of equipment to engage in active leisure activities, and had significantly less amenities such as seating, toilets, cafés, etc. Conclusions: Residents from low socioeconomic positions seem to suffer from a double jeopardy; they lack both individual and community resources. Our results have important planning implications and might contribute to understanding why deprived communities have lower physical activity levels and poorer health.

Description: IJERPH, Vol. 14, Pages 921: Association between Promoter Methylation of Gene ERCC3 and Benzene Hematotoxicity International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14080921 Authors: Min Zheng Feiliang Lin Fenxia Hou Guilan Li Caiying Zhu Peiyu Xu Caihong Xing Qianfei Wang Benzene is a primary industrial chemical and a ubiquitous environmental pollutant. ERCC3 is a key player in nucleotide excision repair. Recent studies suggested that site-specific methylation is a possible mechanism of the transcriptional dysregulation by blocking transcription factors binding. We previously found that the average promoter methylation level of ERCC3 was increased in benzene-exposed workers. In order to test whether specific CpG sites of ERCC3 play an important role in benzene-induced epigenetic changes and whether the specific methylation patterns are associated with benzene hematotoxicity, we analyzed the promoter methylation levels of individual CpG sites, transcription factor binding motif and the correlation between aberrant CpG methylation and hematotoxicity in 76 benzene-exposed workers and 24 unexposed controls in China. Out of all the CpGs analyzed, two CpG units located 43 bp upstream and 99 bp downstream of the transcription start site of ERCC3 (CpG 2–4 and CpG 17–18, respectively), showed the most pronounced increase in methylation levels in benzene-exposed workers, compared with unexposed controls (Mean ± SD: 5.86 ± 2.77% vs. 4.92 ± 1.53%, p = 0.032; 8.45 ± 4.09% vs. 6.79 ± 2.50%, p = 0.024, respectively). Using the JASPAR CORE Database, we found that CpG 2–4 and CpG 17–18 were bound by three putative transcription factors (TFAP2A, E2F4 and MZF1). Furthermore, the methylation levels for CpG 2–4 were correlated negatively with the percentage of neutrophils (β = −0.676, p = 0.005) in benzene-exposed workers. This study demonstrates that CpG-specific DNA methylation in the ERCC3 promoter region may be involved in benzene-induced epigenetic modification and it may contribute to benzene-induced hematotoxicity.

Description: IJERPH, Vol. 14, Pages 922: An Overview of Factors Associated with Adherence to Lifestyle Modification Programs for Weight Management in Adults International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14080922 Authors: Alice W. Y. Leung Ruth S. M. Chan Mandy M. M. Sea Jean Woo This review aims to provide an overview of the factors associated with adherence reported in existing literature on lifestyle modification programs for weight management among the adult population. An electronic search was performed using PubMed, Medline, PsycINFO and PsycARTICLE to identify studies that examined the factors of adherence to lifestyle modification programs with explicit definition of adherence indicators. We identified 19 studies published between 2004 and 2016. The most commonly used indicator of adherence was attrition, followed by attendance, self-monitoring and dietary adherence. A broad array of factors has been studied but only few studies exploring each factor. Limited evidence suggested older age, higher education, healthier eating and physical activity behaviours, higher stage of change at baseline and higher initial weight loss may predict better adherence. On the other hand, having depression, stress, strong body shape concern and full-time job may predict poor adherence. Inconsistent findings were obtained for self-efficacy, motivation, male gender and previous weight loss attempt. This review highlights the need for more rigorous studies to enhance our knowledge on factors related to adherence. Identification of the factors of adherence could provide important implication for program improvement, ultimately improving the effectiveness and the cost-effectiveness of lifestyle modification program.

Description: IJERPH, Vol. 14, Pages 927: Drinking Water Uranium and Potential Health Effects in the German Federal State of Bavaria International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14080927 Authors: Andre Banning Mira Benfer Mainly due to its nephrotoxic and osteotoxic potential, uranium (U) increasingly finds itself in the spotlight of environmental and health-related research. Germany decided on a binding U guideline value in drinking water of 10 µg/L, valid since 2011. It is yet widely unknown if and how public health was affected by elevated U concentrations before that. In this ecological study we summarized available drinking water U data for the German federal state of Bavaria (703 analyses in total for 553 different municipalities) at county level (for 76 out of 96 Bavarian counties, representing about 83% of Bavaria’s and about 13% of Germany’s total population) in terms of mean and maximum U concentration. Bavaria is known to regionally exhibit mainly geogenically elevated groundwater U with a maximum value of 40 µg/L in the database used here. Public health data were obtained from federal statistical authorities at county resolution. These included incidence rates of diagnosed diseases suspected to be potentially associated with chronic U uptake, e.g., diseases of the skeleton, the liver or the thyroid as well as tumor and genito-urinary diseases. The datasets were analyzed for interrelations and mutual spatial occurrence using statistical approaches and GIS as well as odds ratios and relative risks calculations. Weak but significant positive associations between maximum U concentrations and aggregated ICD-10 diagnose groups for growths/tumors as well as liver diseases were observed, elevated incidence rates of thyroid diseases seem to occur where mean drinking water U concentrations exceed 2 µg/L. Here, we discuss obtained results and their implications for potential impacts of hydrochemistry on public health in southeast Germany.

Description: IJERPH, Vol. 14, Pages 936: I Walk My Dog Because It Makes Me Happy: A Qualitative Study to Understand Why Dogs Motivate Walking and Improved Health International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14080936 Authors: Carri Westgarth Robert Christley Garry Marvin Elizabeth Perkins Dog walking is a popular everyday physical activity. Dog owners are generally more active than non-owners, but some rarely walk with their dog. The strength of the dog–owner relationship is known to be correlated with dog walking, and this qualitative study investigates why. Twenty-six interviews were combined with autoethnography of dog walking experiences. Dog walking was constructed as “for the dog”, however, owners represented their dog’s needs in a way which aligned with their own. Central to the construction of need was perceptions of dog personality and behaviour. Owners reported deriving positive outcomes from dog walking, most notably, feelings of “happiness”, but these were “contingent” on the perception that their dogs were enjoying the experience. Owner physical activity and social interaction were secondary bonuses but rarely motivating. Perceptions and beliefs of owners about dog walking were continually negotiated, depending on how the needs of the owner and dog were constructed at that time. Complex social interactions with the “significant other” of a pet can strongly motivate human health behaviour. Potential interventions to promote dog walking need to account for this complexity and the effect of the dog-owner relationship on owner mental wellbeing.

Description: IJERPH, Vol. 14, Pages 947: Surface Sampling Collection and Culture Methods for Escherichia coli in Household Environments with High Fecal Contamination International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14080947 Authors: Natalie Exum Margaret Kosek Meghan Davis Kellogg Schwab Empiric quantification of environmental fecal contamination is an important step toward understanding the impact that water, sanitation, and hygiene interventions have on reducing enteric infections. There is a need to standardize the methods used for surface sampling in field studies that examine fecal contamination in low-income settings. The dry cloth method presented in this manuscript improves upon the more commonly used swabbing technique that has been shown in the literature to have a low sampling efficiency. The recovery efficiency of a dry electrostatic cloth sampling method was evaluated using Escherichia coli and then applied to household surfaces in Iquitos, Peru, where there is high fecal contamination and enteric infection. Side-by-side measurements were taken from various floor locations within a household at the same time over a three-month period to compare for consistency of quantification of E. coli bacteria. The dry cloth sampling method in the laboratory setting showed 105% (95% Confidence Interval: 98%, 113%) E. coli recovery efficiency off of the cloths. The field application demonstrated strong agreement of side-by-side results (Pearson correlation coefficient for dirt surfaces was 0.83 (p < 0.0001) and 0.91 (p < 0.0001) for cement surfaces) and moderate agreement for results between entrance and kitchen samples (Pearson (0.53, p < 0.0001) and weighted Kappa statistic (0.54, p < 0.0001)). Our findings suggest that this method can be utilized in households with high bacterial loads using either continuous (quantitative) or categorical (semi-quantitative) data. The standardization of this low-cost, dry electrostatic cloth sampling method can be used to measure differences between households in intervention and non-intervention arms of randomized trials.

Description: IJERPH, Vol. 14, Pages 949: Exposure Modelling of Extremely Low-Frequency Magnetic Fields from Overhead Power Lines and Its Validation by Measurements International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14090949 Authors: Alfred Bürgi Sanjay Sagar Benjamin Struchen Stefan Joss Martin Röösli A three-dimensional model for calculating long term exposure to extremely low-frequency magnetic fields from high-voltage overhead power lines is presented, as well as its validation by measurements. For the validation, the model was applied to two different high-voltage overhead power lines in Iffwil and Wiler (Switzerland). In order to capture the daily and seasonal variations, each measurement was taken for 48 h and the measurements were carried out six times at each site, at intervals of approximately two months, between January and December 2015. During each measurement, a lateral transect of the magnetic flux density was determined in the middle of a span from nine measurement points in the range of ±80 m. The technical data of both the lines as well as the load flow data during the measurement periods were provided by the grid operators. These data were used to calculate 48 h averages of the absolute value of the magnetic flux density and compared with modelled values. The highest 48 h average was 1.66 µT (centre of the line in Iffwil); the lowest 48 h average was 22 nT (80 m distance from the centre line in Iffwil). On average, the magnetic flux density was overestimated by 2% (standard deviation: 9%) in Iffwil and underestimated by 1% (8%) in Wiler. Sensitivity analyses showed that the uncertainty is mainly driven by errors in the coordinates and height data. In particular, for predictions near the centre of the line, an accurate digital terrain model is critical.

Description: IJERPH, Vol. 14, Pages 960: Social Environment of Older People during the First Year in Senior Housing and Its Association with Physical Performance International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14090960 Authors: Sinikka Lotvonen Helvi Kyngäs Pentti Koistinen Risto Bloigu Satu Elo Increasing numbers of older people relocate into senior housing when their physical performance declines. The change in social environment is known to affect their wellbeing, providing both challenges and opportunities, but more information on the relations between social and physical parameters is required. Thus, we elicited perceptions of the social environment of 81 older people (aged 59–93 years, living in northern Finland) and changes in it 3 and 12 months after relocation to senior housing. We also measured their physical performance, then analysed associations between the social and physical variables. Participants reported that they had freedom to do whatever they liked and generally had enough contact with close people (which have recognized importance for older people’s wellbeing), but changes in their physical condition limited their social activity. Moreover, their usual walking speed, dominant hand’s grip strength and instrumental activities of daily living (IADL) significantly decreased. The pleasantness of the residential community, peer support, constraints on social activity imposed by changes in physical condition, meaningful activity at home and meeting close people all affected these physical performance parameters. Clearly, in addition to assessing physical performance and encouraging regular exercise, the complex interactions among social factors, physical performance and wellbeing should be considered when addressing individuals’ needs.

Description: IJERPH, Vol. 14, Pages 961: Contaminations, Sources, and Health Risks of Trace Metal(loid)s in Street Dust of a Small City Impacted by Artisanal Zn Smelting Activities International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14090961 Authors: Tingting Wu Xiangyang Bi Zhonggen Li Guangyi Sun Xinbin Feng Lihai Shang Hua Zhang Tianrong He Ji Chen To investigate the impact of artisanal zinc smelting activities (AZSA) on the distribution and enrichment of trace metal(loid)s in street dust of a small city in Guizhou province, SW China, street dust samples were collected and analyzed for 10 trace metal(loid)s (Cr, Co, Ni, Cu, Zn, As, Cd, Sb, Pb, and Hg). Meanwhile, the health risks of local resident exposed to street dust were assessed. The result showed that the average concentrations of 10 elements were Zn (1039 mg kg−1), Pb (423 mg kg−1), Cr (119 mg kg−1), Cu (99 mg kg−1), As (55 mg kg−1), Ni (39 mg kg−1), Co (18 mg kg−1), Sb (7.6 mg kg−1), Cd (2.6 mg kg−1), and Hg (0.22 mg kg−1). Except Ni, Co, and Cr, other elements in street dust were obviously elevated compared to the provincial soil background. Pb, Zn, Cd, Sb, and Cu were at heavy to moderate contamination status, especially Pb and Zn, with maximums of 1723 and 708 mg kg−1, respectively; As and Hg were slightly contaminated; while Cr, Ni, and Co were at un-contaminated levels. Multivariate statistical analysis revealed AZSA contributed to the increase of Pb, Zn, Cd, Sb, As, and Hg, while, natural sources introduced Ni, Co, Cr, and Cu. The health risk assessment disclosed that children had higher non-carcinogenic risk than those found in adults, and As has hazardous index (HI) higher than 1 both for children and adults, while Pb and Cr only had HIs higher than 1 for children, other elements were relatively safe. For carcinogenic risks, the major concern was As, then a lesser concern for Cr. The study showed that although the scale of AZSA was small, the contamination of heavy metal(loid)s in street dust and associated health risks were severe.

Description: IJERPH, Vol. 14, Pages 962: Relationships between Safe Pesticide Practice and Perceived Benefits and Subjective Norm, and the Moderation Role of Information Acquisition: Evidence from 971 Farmers in China International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14090962 Authors: Jianhua Wang Yuanyuan Deng Yuting Ma Improper use of pesticides among farmers has caused food safety issues which are serious threats to public health in China. A central question concerns how to motivate farmers to self-regulate their pesticide usage. The paper aims to identify the influence of an internal driving factor, i.e., perceived benefits, and an external driving factor, i.e., subjective norm, on farmers’ safe pesticide behaviors, and whether the two factors are moderated by the exposure to information on government policies and the market, based on a sample of 971 farmers selected from 5 Chinese provinces. The results revealed that farmers’ safe pesticide usage was predominately driven by perceived benefits whereas external pressure or subjective norm did not play much of a role. Interaction effects were found between the exposure to market information and perceived benefits, and also between subjective norm and exposure to government policy. Extensions agencies are recommended to effectively convey to farmers the benefits to follow safe pesticide practices. Meanwhile, surveillance and monitoring systems should be established so that the prices of their agricultural products are reflected by the quality of the products.

Description: IJERPH, Vol. 14, Pages 966: Effect of Water Supplementation on Cognitive Performances and Mood among Male College Students in Cangzhou, China: Study Protocol of a Randomized Controlled Trial International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14090966 Authors: Na Zhang Songming Du Zhenchuang Tang Mengqi Zheng Guansheng Ma Introduction: Water accounts for about 75% of brain mass. Cognitive performances and mood may be impaired by hypohydration and improved by water supplementation. Two surveys conducted in China demonstrated that a large proportion of adults and children drank less fluid than the amounts recommended by the Chinese Nutrition Society. The association between hypohydration and cognitive performance has not been reported in China. The purpose of this study is to explore the effect of water supplementation on cognitive performances and mood among male college students in Cangzhou, China. Methods and Analysis: A randomized controlled trial is designed to test the hypothesis. A total of 68 male college students aged 18–25 years will be recruited and randomly assigned into water-supplementation group (WS group, n = 34) and no water-supplementation group (NW group, n = 34) after an overnight fasting, i.e., without eating foods and drinking fluid for 12 h. The first morning urine will be collected to determine urine osmolality on the water supplementation day. Cognitive performances and mood will be performed before water supplementation by researchers with questionnaire. Subjects in the WS group will drink 400 mL purified water within 5 min, while those in NW group will not drink any fluid. One hour later, urine will be collected and urine osmolality, cognitive performances and mood will be measured again. Mixed model of repeated measures ANOVA will be used to investigate the effect of water supplementation on cognitive performances. The study would provide information about the benefit of water supplementation on cognitive performances. Ethics and Dissemination: The study protocol is reviewed and approved by the Ethical Review Committee of the Chinese Nutrition Society. Ethical approval project identification code is CNS-2015-001. Results will be published according to the CONSORT statement and will be reported in peer-reviewed journals. Trial registration: Chinese clinical trial registry. Identifier: ChiCTR-IOR-15007020. Registry name “The effect of hydration on cognitive performance”.

Description: IJERPH, Vol. 14, Pages 970: Occurrence, Distribution, and Risk Assessment of Perfluoroalkyl Acids (PFAAs) in Muscle and Liver of Cattle in Xinjiang, China International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14090970 Authors: Gehui Wang Jianjiang Lu Zhenni Xing Shanman Li Zilong Liu Yanbin Tong Despite risks associated with perfluoroalkyl acids (PFAAs) in many regions, little is known about their prevalence in Xinjiang. We determined the presence of 13 PFAAs in 293 beef muscle and liver samples collected in 22 cities covering northern, southern, and eastern Xinjiang using liquid chromatography, coupled with tandem mass spectrometry. Overall, the average values for PFAAs were relatively low compared with previous studies. Liver presented higher mean levels of total PFAAs at 1.632 ng/g, which was over 60-fold higher than in muscle (0.026 ng/g). Among the PFAAs analyzed, medium-chain compounds were dominant, accounting for more than 70% of the total. Perfluorooctane sulfonate (PFOS) was highly prevalent in the liver with the highest mean concentration (0.617 ng/g) and detection frequency (80%). When comparing the three regions of Xinjiang, we found differences in PFAA profiles, with the northern region showing the highest levels. Furthermore, the average daily intake and hazard ratios of PFOS and perfluorooctanoic acid varied by region, urban/rural environment, gender, ethnicity, and age. The highest risk value of 13 PFAAs was estimated to be 0.837 × 10−3, which is far below 1, indicating that there is no health risk posed by eating beef muscle and liver in Xinjiang.

Description: IJERPH, Vol. 14, Pages 979: Investigation on Indoor Air Pollution and Childhood Allergies in Households in Six Chinese Cities by Subjective Survey and Field Measurements International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14090979 Authors: Jinhua Hu Nianping Li Yang Lv Jing Liu Jingchao Xie Huibo Zhang Greater attention is currently being paid to the relationship between indoor environment and childhood allergies, however, the lack of reliable data and the disparity among different areas hinders reliable assessment of the relationship. This study focuses on the effect of indoor pollution on Chinese schoolchildren and the relationship between specific household and health problems suffered. The epidemiological questionnaire survey and the field measurement of the indoor thermal environment and primary air pollutants including CO2, fine particulate matter (PM2.5), chemical pollutants and fungi were performed in six Chinese cities. A total of 912 questionnaires were eligible for statistical analyses and sixty houses with schoolchildren aged 9–12 were selected for field investigation. Compared with Chinese national standards, inappropriate indoor relative humidity (<30% or >70%), CO2 concentration exceeding 1000 ppm and high PM2.5 levels were found in some monitored houses. Di(2-ethylhexyl) phthalate (DEHP) and dibutyl phthalate (DBP) were the most frequently detected semi-volatile organic compounds (SVOCs) in house dust. Cladosporium, Aspergillus and Penicillium were detected in both indoor air and house dust. This study indicates that a thermal environment with CO2 exceeding 1000 ppm, DEHP and DBP exceeding 1000 μg/g, and high level of PM2.5, Cladosporium, Aspergillus and Penicillium increases the risk of children’s allergies.

Description: IJERPH, Vol. 14, Pages 977: Bioaccessibility and Human Exposure Assessment of Cadmium and Arsenic in Pakchoi Genotypes Grown in Co-Contaminated Soils International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14090977 Authors: Yanyan Wei Xiaoman Zheng Md. Shohag Minghua Gu In many countries cadmium (Cd) and arsenic (As) commonly coexist in soils contaminated by mining activities, and can easily enter the human body via consumption of leafy vegetables, like the popularly consumed pakchoi (Brassica chinensis L.), causing major health concerns. In the present study, bioaccessibility and human exposure of Cd and As were assessed in twenty genotypes of pakchoi cultured at two different levels of co-contamination to identify low health risk genotypes. The bioaccessibilities of Cd and As represent a fraction of the total metals content could be bioaccessible for human, in the present study, significant differences in pakchoi Cd and As bioaccessibility were observed among all tested genotypes and co-contaminated levels. Cd and As bioaccessibility of pakchoi were in the ranges of 24.0–87.6% and 20.1–82.5%, respectively, for in the high level co-contaminated soils, which was significantly higher than for low level co-contaminated soils with 7.9–71.8% for Cd bioaccessibility and 16.1–59.0% for As bioaccessibility. The values of bioaccessible established daily intakes (BEDI) and the total bioaccessible target hazard quotients (TBTHQ) of Cd and As were also considerably higher in high level co-contaminated soils than in low level co-contaminated soils. Two genotypes (Meiguanqinggengcai and Zhenqing60F1) contained relatively low concentrations and bioaccessible Cd and As and, their BEDI and TBTHQ for Cd and As ranged below the tolerable limits set by the FAO/WHO (BEDI of Cd < 0.83 μg kg−1 bw day−1, BEDI of As < 3 μg kg−1 bw day−1) and United States Environmental Protection Agency (TBTHQ for Cd and As < 1), this applied for both levels of co-contaminated soils for adults and children. Consequently, these findings suggest identification of safe genotypes in leafy vegetable with low health risk via genotypic screening and breeding methods could be a useful strategy to ensure the safety of food crops grown in those Cd and As co-contaminated fields due to mining activities.

Description: IJERPH, Vol. 14, Pages 975: Transnational Research Networks in Chinese Scientific Production. An Investigation on Health-Industry Related Sectors International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14090975 Authors: Lauretta Rubini Chiara Pollio Marco Di Tommaso Transnational research networks (TRN) are becoming increasingly complex. Such complexity may have both positive and negative effects on the quality of research. Our work studies the evolution over time of Chinese TRN and the role of complexity on the quality of Chinese research, given the leading role this country has recently acquired in international science. We focus on the fields of geriatrics and gerontology. We build an original dataset of all scientific publications of China in these areas in 2009, 2012 and 2015, starting from the ISI Web of Knowledge (ISI WoK) database. Using Social Network Analysis (SNA), we analyze the change in scientific network structure across time. Second, we design indices to control for the different aspects of networks complexity (number of authors, country heterogeneity and institutional heterogeneity) and we perform negative binomial regressions to identify the main determinants of research quality. Our analysis shows that research networks in the field of geriatrics and gerontology have gradually become wider in terms of countries and have become more balanced. Furthermore, our results identify that different forms of complexity have different impacts on quality, including a reciprocal moderating effect. In particular, according to our analysis, research quality benefits from complex research networks both in terms of countries and of types of institutions involved, but that such networks should be “compact” in terms of number of authors. Eventually, we suggest that complexity should be carefully taken into account when designing policies aimed at enhancing the quality of research.

Description: IJERPH, Vol. 14, Pages 1001: Antimicrobial Susceptibility of Staphylococcus aureus Isolated from Recreational Waters and Beach Sand in Eastern Cape Province of South Africa International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14091001 Authors: Olufemi Emmanuel Akanbi Henry Akum Njom Justine Fri Anthony C. Otigbu Anna M. Clarke Background: Resistance of Staphylococcus aureus to commonly used antibiotics is linked to their ability to acquire and disseminate antimicrobial-resistant determinants in nature, and the marine environment may serve as a reservoir for antibiotic-resistant bacteria. This study determined the antibiotic sensitivity profile of S. aureus isolated from selected beach water and intertidal beach sand in the Eastern Cape Province of South Africa. Methods: Two hundred and forty-nine beach sand and water samples were obtained from 10 beaches from April 2015 to April 2016. Staphylococcus aureus was isolated from the samples using standard microbiological methods and subjected to susceptibility testing to 15 antibiotics. Methicillin-resistant Staphylococcus aureus (MRSA) was detected by susceptibility to oxacillin and growth on Brilliance MRSA II agar. Antibiotic resistance genes including mecA, femA rpoB, blaZ, ermB, ermA, ermC, vanA, vanB, tetK and tetM were screened. Results: Thirty isolates (12.3%) were positive for S. aureus by PCR with over 50% showing phenotypic resistance to methicillin. Resistance of S. aureus to antibiotics varied considerably with the highest resistance recorded to ampicillin and penicillin (96.7%), rifampicin and clindamycin (80%), oxacillin (73.3%) and erythromycin (70%). S. aureus revealed varying susceptibility to imipenem (96.7%), levofloxacin (86.7%), chloramphenicol (83.3%), cefoxitin (76.7%), ciprofloxacin (66.7%), gentamycin (63.3%), tetracycline and sulfamethoxazole-trimethoprim (56.7%), and vancomycin and doxycycline (50%). All 30 (100%) S. aureus isolates showed multiple antibiotic-resistant patterns (resistant to three or more antibiotics). The mecA, femA, rpoB, blaZ, ermB and tetM genes were detected in 5 (22.7%), 16 (53.3%), 11 (45.8%), 16 (55.2%), 15 (71.4%), and 8 (72.7%) isolates respectively; Conclusions: Results from this study indicate that beach water and sand from the Eastern Cape Province of South Africa may be potential reservoirs of antibiotic-resistant S. aureus which could be transmitted to exposed humans and animals.

Description: IJERPH, Vol. 14, Pages 1000: The Effect of Taichi Practice on Attenuating Bone Mineral Density Loss: A Systematic Review and Meta-Analysis of Randomized Controlled Trials International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14091000 Authors: Liye Zou Chaoyi Wang Kevin Chen Yankai Shu Xiaoan Chen Lin Luo Xitang Zhao Objective: The purpose of this study was to determine the effects of practicing Taichi on attenuating bone mineral density (BMD) loss. Methods: Both electronic and manual searches were performed for randomized controlled trials (RCTs) examining Taichi for bone health. Two review authors independently performed study selection and data extraction according to inclusion criteria. A third party (Lin Luo) emerged to discuss with the two review authors and resolve a disagreement. Results: Twenty RCTs were found to meet the inclusion criteria and used for meta-analysis with a total effective sample of 1604. The aggregated results from this systematic review have shown significant benefits in favour of Taichi on BMD at lumbar spine (Standard Mean Difference, SMD) = 0.29; 95% CI 0.15 to 0.43; p < 0.0001), femur neck (SMD = 0.56; 95% CI 0.38 to 0.75; p < 0.00001), femur trochanter (SMD = 0.04; 95% CI 0.01 to 0.07; p = 0.007), total hip BMD (SMD = 0.46; 95% CI 0.16 to 0.76; p = 0.003). Conclusions: The aggregated results from this systematic review suggests that Taichi is effective on attenuating BMD loss at the regions of lumbar spine and proximal femur neck in special populations (e.g., older adults, perimenopausal and postmenopausal women, people with osteoarthritis, and cancer survivors). Researchers should further examine the effect of Taichi on the proximal femur trochanter and total hip so that a more definitive claim can be made regarding the beneficial effects for attenuating BMD loss in these musculoskeletal regions.

Description: IJERPH, Vol. 14, Pages 1006: Gene Drive for Mosquito Control: Where Did It Come from and Where Are We Headed? International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14091006 Authors: Vanessa Macias Johanna Ohm Jason Rasgon Mosquito-borne pathogens place an enormous burden on human health. The existing toolkit is insufficient to support ongoing vector-control efforts towards meeting disease elimination and eradication goals. The perspective that genetic approaches can potentially add a significant set of tools toward mosquito control is not new, but the recent improvements in site-specific gene editing with CRISPR/Cas9 systems have enhanced our ability to both study mosquito biology using reverse genetics and produce genetics-based tools. Cas9-mediated gene-editing is an efficient and adaptable platform for gene drive strategies, which have advantages over innundative release strategies for introgressing desirable suppression and pathogen-blocking genotypes into wild mosquito populations; until recently, an effective gene drive has been largely out of reach. Many considerations will inform the effective use of new genetic tools, including gene drives. Here we review the lengthy history of genetic advances in mosquito biology and discuss both the impact of efficient site-specific gene editing on vector biology and the resulting potential to deploy new genetic tools for the abatement of mosquito-borne disease.

Description: IJERPH, Vol. 14, Pages 1010: Association between Functional Movements Skills and Health Indicators in Children Aged between 9 and 12 Years Old International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14091010 Authors: Megan Comeau Danielle Bouchard Cindy Levesque Michel Jonhson Brittany Rioux Andrea Mayo Martin Sénéchal Background: Children’s health is a current concern and data suggests that poor fundamental movement skills (FMS) could be associated with poor health, which may or may not be mediated by low physical activity level. However, tools to assess FMS have not been standardized, and could consequently lead to different associations between FMS and health indicators. Objective: The primary objective of this study was to evaluate the associations between FMS and health indicators using two different FMS measurement tools often used in Canada. Methods: A total of 145 children between the ages of 9 to 12 were recruited from schools, after school programs, and summer camps in 2016. FMS were evaluated using the Passport for Life (bound, plank, run, kick, throw) and the PLAYbasic (run, hop, throw, kick, and balance). The association between each test and an average score for each tool were tests with health indicators including anthropometric measures, grip strength, cardiorespiratory fitness, and percent body fat. Results: Participants were composed of 54.2% boys aged 10.4 ± 1.2 years with an average body mass index of 18.8 ± 3.8 kg/m2. The association between the average score of both tools was 0.77 (p < 0.01), body mass index was significantly associated with 67% of FMS elements using the Passport for Life (r ranging from −0.18 to −0.32; p < 0.05), and 60% of FMS using the PLAYbasic (r ranging from −0.15 to −0.30; p < 0.05). There were no significant differences between the associations of the health indicators with FMS and either FMS assessment tool (Passport for Life and PLAYbasic) (p = 0.05). Average score of FMS was significantly associated with all health indicators using both PLAYbasic and Passport for Life (all p < 0.05). Conclusions: Health indicators in children are associated with FMS regardless of whether the Passport for Life or the PLAYbasic was used as the assessment tool. It is worth investigating if interventions that improve FMS lead to improvements in these health indicators.

Description: IJERPH, Vol. 14, Pages 1013: Barriers to Effective Municipal Solid Waste Management in a Rapidly Urbanizing Area in Thailand International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14091013 Authors: Nachalida Yukalang Beverley Clarke Kirstin Ross This study focused on determining the barriers to effective municipal solid waste management (MSWM) in a rapidly urbanizing area in Thailand. The Tha Khon Yang Subdistrict Municipality is a representative example of many local governments in Thailand that have been facing MSWM issues. In-depth interviews with individuals and focus groups were conducted with key informants including the municipality staff, residents, and external organizations. The major influences affecting waste management were categorized into six areas: social-cultural, technical, financial, organizational, and legal-political barriers and population growth. SWOT analysis shows both internal and external factors are playing a role in MSWM: There is good policy and a reasonably sufficient budget. However, there is insufficient infrastructure, weak strategic planning, registration, staff capacity, information systems, engagement with programs; and unorganized waste management and fee collection systems. The location of flood prone areas has impacted on location and operation of landfill sites. There is also poor communication between the municipality and residents and a lack of participation in waste separation programs. However, external support from government and the nearby university could provide opportunities to improve the situation. These findings will help inform municipal decision makers, leading to better municipal solid waste management in newly urbanized areas.

Description: IJERPH, Vol. 14, Pages 1027: Sedentary and Physical Activity Patterns in Adults with Intellectual Disability International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14091027 Authors: Guillermo Oviedo Noémie Travier Myriam Guerra-Balic Little is known about the patterns of sedentary time (ST) and physical activity (PA) levels throughout the week among adults and older adults with Intellectual Disability (ID). We analyzed ST and PA patterns of adults and older adults with ID. Forty-two adults and 42 older adults with mild to severe ID participated in this study. Height and weight were obtained to calculate Body Mass Index (BMI). Body fat and fat-free mass percentages were also obtained. Patterns of PA levels and ST were assessed with GT3X Actigraph accelerometers. Adults performed higher amounts of total PA and moderate to vigorous PA than older adults during the week, on weekdays and in center time (all p > 0.05). No differences between males and females were found for either PA levels or ST. Only 10.7% of the participants met the global recommendations on PA for health. The participants of the current study showed low PA levels and a high prevalence of ST. Interestingly, when comparing age and/or sex groups, no differences were observed for ST. Our findings provide novel and valuable information to be considered in future interventions aiming to increase PA levels and reduce ST.

Description: IJERPH, Vol. 14, Pages 1025: Risk Assessment of Metals in Urban Soils from a Typical Industrial City, Suzhou, Eastern China International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14091025 Authors: Gang Wang Hou-Qi Liu Yu Gong Yang Wei Ai-Jun Miao Liu-Yan Yang Huan Zhong Risk of metals in urban soils is less studied, compared to that in other types of soils, hindering accurate assessment of human exposure to metals. In this study, the concentrations of five metals (As, Cd, Cr, Pb, and Hg) were analyzed in 167 surface soil samples collected from Suzhou city and their potential ecological and human health risks were assessed. The mean concentrations of As, Cd, Pb, and Hg except Cr, were higher than the background values in Jiangsu Province. Metal concentrations varied among districts, where sites of high contamination showed a punctate distribution. Principal components and correlation analyses revealed that As, Pb, and Cd could originate from the same sources. The geo-accumulation (Igeo) and potential ecological risk indices (RI) were calculated and the relatively low values of Igeo (<0) and RI (<150) suggested generally low ecological risk. The noncarcinogenic risks of the metals were relatively low for Suzhou residents (i.e., average hazard index or HI: 0.1199 for adults and 0.5935 for children, <1), while the total carcinogenic risks (TCR) of Cr and As were acceptable (TCR in the range of 1.0 × 10−6 to 1.0 × 10−4). Children faced a higher threat than adults. Results of Monte-Carlo simulations were lower than those obtained from models using deterministic parameters. Of all the uncertain parameters, the ingestion rate and body weight were the most sensitive for adults and children, respectively, while As was an important factor for both. The results as well as the factors controlling risks of metals could help better understand the risks of metals in urban soils of industrial cities in China.

Description: IJERPH, Vol. 14, Pages 1032: The Burden of Suicide in Rural Bangladesh: Magnitude and Risk Factors International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14091032 Authors: Shumona Sharmin Salam Olakunle Alonge Md Islam Dewan Hoque Shirin Wadhwaniya Md Ul Baset Saidur Mashreky Shams El Arifeen The aim of the paper is to quantify the burden and risk factors of fatal and non-fatal suicidal behaviors in rural Bangladesh. A census was carried out in seven sub-districts encompassing 1.16 million people. Face-to-face interviews were conducted at the household level. Descriptive analyses were done to quantify the burden and Poisson regression was run to determine on risk factors. The estimated rates of fatal and non-fatal suicide were 3.29 and 9.86 per 100,000 person years (PY) observed, respectively. The risk of suicide was significantly higher by 6.31 times among 15–17 and 4.04 times among 18–24 olds compared to 25–64 years old. Married adolescents were 22 times more likely to commit suicide compared to never-married people. Compared to Chandpur/Comilla district, the risk of suicide was significantly higher in Narshingdi. Students had significantly lower risk of non-fatal suicidal behavior compared to skilled laborers. The risk of non-fatal suicidal behavior was lower in Sherpur compared to Chandpur/Comilla. Among adolescents, unskilled laborers were 16 times more likely to attempt suicide than students. The common methods for fatal and non-fatal suicidal behaviors were hanging and poisoning. Suicide is a major public health problem in Bangladesh that needs to be addressed with targeted interventions.

Description: IJERPH, Vol. 14, Pages 1044: The Effect of Bisphenol A on Puberty: A Critical Review of the Medical Literature International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14091044 Authors: Alberto Leonardi Marta Cofini Donato Rigante Laura Lucchetti Clelia Cipolla Laura Penta Susanna Esposito Many scientific studies have revealed a trend towards an earlier onset of puberty and have disclosed an increasing number of children that display precocious puberty. As an explanation, some authors have considered the global socio-economic improvement across different populations, and other authors have considered the action of endocrine disrupting chemicals (EDCs). Among these, bisphenol A (BPA), an aromatic compound largely used worldwide as a precursor of some plastics and chemical additives, is well known for its molecular oestrogen-like and obesogenic actions. We reviewed the medical literature of the previous 20 years that examined associations between BPA exposure and the age of puberty in humans, considering only those referring to clinical or epidemiological data. Of 19 studies, only 7 showed a correlation between BPA and puberty. In particular, the possible disruptive role of BPA on puberty may be seen in those with central precocious puberty or isolated premature breast development aged 2 months to 4 years old, even if the mechanism is undefined. Some studies also found a close relationship between urinary BPA, body weight, and early puberty, which can be explained by the obesogenic effect of BPA itself. The currently available data do not allow establishment of a clear role for BPA in pubertal development because of the conflicting results among all clinical and epidemiological studies examined. Further research is needed to fully understand the potential role of exposure to EDCs and their adverse endocrine health outcomes.

Description: IJERPH, Vol. 14, Pages 1041: Lipid Profiles, Glycated Hemoglobin, and Diabetes in People Living at High Altitude in Nepal International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14091041 Authors: Nirmal Aryal Mark Weatherall Yadav Bhatta Stewart Mann This study aimed to describe lipid profiles and the distribution of glycated hemoglobin (HbA1c) in a sample of a high altitude population of Nepal and to explore associations between these metabolic risk variables and altitude. A cross-sectional survey of cardiovascular disease and associated risk factors was conducted among 521 people living at four different altitude levels, all above 2800 m, in the Mustang and Humla districts of Nepal. Urban participants (residents at 2800 m and 3620 m) had higher total cholesterol (TC) and triglyceride (TG) than rural participants. A high ratio of TC to high-density lipoprotein-cholesterol (HDL) (TC/HDL ≥ 5.0) was found in 23.7% (95% CI 19.6, 28.2) and high TG (≥1.7 mmol/L) in 43.3% (95% CI 38.4, 48.3) of participants overall. Mean HbA1c levels were similar at all altitude levels although urban participants had a higher prevalence of diabetes. Overall, 6.9% (95% CI 4.7, 9.8) of participants had diabetes or were on hypoglycaemic treatment. There was no clear association between lipid profiles or HbA1c and altitude in a multivariate analysis adjusted for possible confounding variables. Residential settings and associated lifestyle practices are more strongly associated with lipid profiles and HbA1c than altitude amongst high altitude residents in Nepal.

Description: IJERPH, Vol. 14, Pages 1043: The Effect of Vitamin A on Fracture Risk: A Meta-Analysis of Cohort Studies International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14091043 Authors: Xinge Zhang Rui Zhang Justin Moore Yueqiao Wang Hanyi Yan Yingru Wu Anran Tan Jialin Fu Ziqiong Shen Guiyu Qin Rui Li Guoxun Chen This meta-analysis evaluated the influence of dietary intake and blood level of vitamin A (total vitamin A, retinol or β-carotene) on total and hip fracture risk. Cohort studies published before July 2017 were selected through English-language literature searches in several databases. Relative risk (RR) with corresponding 95% confidence interval (CI) was used to evaluate the risk. Heterogeneity was checked by Chi-square and I2 test. Sensitivity analysis and publication bias were also performed. For the association between retinol intake and total fracture risk, we performed subgroup analysis by sex, region, case ascertainment, education level, age at menopause and vitamin D intake. R software was used to complete all statistical analyses. A total of 319,077 participants over the age of 20 years were included. Higher dietary intake of retinol and total vitamin A may slightly decrease total fracture risk (RR with 95% CI: 0.95 (0.91, 1.00) and 0.94 (0.88, 0.99), respectively), and increase hip fracture risk (RR with 95% CI: 1.40 (1.02, 1.91) and 1.29 (1.06, 1.57), respectively). Lower blood level of retinol may slightly increase total fracture risk (RR with 95% CI: 1.11 (0.94, 1.30)) and hip fracture risk (RR with 95% CI: 1.27 (1.05, 1.53)). In addition, higher β-carotene intake was weakly associated with the increased risk of total fracture (RR with 95% CI: 1.07 (0.97, 1.17)). Our data suggest that vitamin A intake and level may differentially influence the risks of total and hip fractures. Clinical trials are warranted to confirm these results and assess the clinical applicability.

Description: IJERPH, Vol. 14, Pages 1051: Applying Nonparametric Methods to Analyses of Short-Term Fine Particulate Matter Exposure and Hospital Admissions for Cardiovascular Diseases among Older Adults International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14091051 Authors: Louis Cox Xiaobin Liu Liuhua Shi Ke Zu Julie Goodman Short-term exposure to fine particulate matter (PM2.5) has been associated with increased risks of cardiovascular diseases (CVDs), but whether such associations are supportive of a causal relationship is unclear, and few studies have employed formal causal analysis methods to address this. We employed nonparametric methods to examine the associations between daily concentrations of PM2.5 and hospital admissions (HAs) for CVD among adults aged 75 years and older in Texas, USA. We first quantified the associations in partial dependence plots generated using the random forest approach. We next used a Bayesian network learning algorithm to identify conditional dependencies between CVD HAs of older men and women and several predictor variables. We found that geographic location (county), time (e.g., month and year), and temperature satisfied necessary information conditions for being causes of CVD HAs among older men and women, but daily PM2.5 concentrations did not. We also found that CVD HAs of disjoint subpopulations were strongly predictive of CVD HAs among older men and women, indicating the presence of unmeasured confounders. Our findings from nonparametric analyses do not support PM2.5 as a direct cause of CVD HAs among older adults.

Description: IJERPH, Vol. 14, Pages 1055: Effects of Heat Stress on Construction Labor Productivity in Hong Kong: A Case Study of Rebar Workers International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14091055 Authors: Wen Yi Albert Chan Global warming is bringing more frequent and severe heat waves, and the result will be serious for vulnerable populations such as construction workers. Excessive heat stress has profound effects on physiological responses, which cause occupational injuries, fatalities and low productivity. Construction workers are particularly affected by heat stress, because of the body heat production caused by physically demanding tasks, and hot and humid working conditions. Field studies were conducted between August and September 2016 at two construction training grounds in Hong Kong. Onsite wet-bulb globe temperature (WBGT), workers’ heart rate (HR), and labor productivity were measured and monitored. Based on the 378 data sets of synchronized environmental, physiological, construction labor productivity (CLP), and personal variables, a CLP-heat stress model was established. It was found that WBGT, percentage of maximum HR, age, work duration, and alcohol drinking habits were determining factors for predicting the CLP (adjusted R2 = 0.68, p < 0.05). The model revealed that heat stress reduces CLP, with the percentage of direct work time decreasing by 0.33% when the WBGT increased by 1 °C. The findings in this study extend the existing practice notes by providing scientific data that may be of benefit to the industry in producing solid guidelines for working in hot weather.

Description: IJERPH, Vol. 14, Pages 1048: Health Effects of Ambient Air Pollution in Developing Countries International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14091048 Authors: Pier Mannucci Massimo Franchini The deleterious effects of ambient air pollution on human health have been consistently documented by many epidemiologic studies worldwide, and it has been calculated that globally at least seven million deaths are annually attributable to the effects of air pollution. The major air pollutants emitted into the atmosphere by a number of natural processes and human activities include nitrogen oxides, volatile organic compounds, and particulate matter. In addition to the poor ambient air quality, there is increasing evidence that indoor air pollution also poses a serious threat to human health, especially in low-income countries that still use biomass fuels as an energy resource. This review summarizes the current knowledge on ambient air pollution in financially deprived populations.

Description: IJERPH, Vol. 14, Pages 1058: Community Capacity Building for Physical Activity Promotion among Older Adults—A Literature Review International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14091058 Authors: Tobias Ubert Sarah Forberger Dirk Gansefort Hajo Zeeb Tilman Brand Community-based interventions to promote physical activity (PA) among older adults are of high interest in health promotion since they promise to be effective strategies to reach this population group. Community capacity building, that is, the local promotion of knowledge, skills, commitment, structures, and leadership, is among the recommended core strategies. However, little guidance is provided on how to achieve a high degree of community capacity. This study aims to identify practical strategies to enhance community capacities for PA promotion among older adults (50 years or older) and to evaluate their success. A literature review was conducted using scientific databases (PsycInfo and Web of Sciences) and grey literature (national and international project databases), and 14 studies (16 articles) were identified. Five groups of capacity building strategies emerged from the literature: (1) building community coalitions and networks, (2) training of professionals, (3) training of laypersons, (4) strengthening competence and awareness in the target population, and (5) allocation of financial resources. All studies used more than one strategy. Coalition building and strengthening competence and awareness were most frequently used. Feasibility and acceptability of the capacity building strategies were demonstrated. However, intervention effects on PA behavior and other relevant outcomes were inconsistent. The one study that systematically compared different capacity building approaches did not find any evidence for beneficial effects of intensified capacity building. More rigorous research evaluating the efficacy of specific strategies to enhance community capacities for PA promotion is needed.

Description: IJERPH, Vol. 14, Pages 1059: Distribution of Non-Persistent Endocrine Disruptors in Two Different Regions of the Human Brain International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14091059 Authors: Thomas P. van der Meer Francisco Artacho-Cordón Dick F. Swaab Dicky Struik Konstantinos C. Makris Bruce H. R. Wolffenbuttel Hanne Frederiksen Jana V. van Vliet-Ostaptchouk Non-persistent endocrine disrupting chemicals (npEDCs) can affect multiple organs and systems in the body. Whether npEDCs can accumulate in the human brain is largely unknown. The major aim of this pilot study was to examine the presence of environmental phenols and parabens in two distinct brain regions: the hypothalamus and white-matter tissue. In addition, a potential association between these npEDCs concentrations and obesity was investigated. Post-mortem brain material was obtained from 24 individuals, made up of 12 obese and 12 normal-weight subjects (defined as body mass index (BMI) > 30 and BMI < 25 kg/m2, respectively). Nine phenols and seven parabens were measured by isotope dilution TurboFlow-LC-MS/MS. In the hypothalamus, seven suspect npEDCs (bisphenol A, triclosan, triclocarban and methyl-, ethyl-, n-propyl-, and benzyl paraben) were detected, while five npEDCs (bisphenol A, benzophenone-3, triclocarban, methyl-, and n-propyl paraben) were found in the white-matter brain tissue. We observed higher levels of methylparaben (MeP) in the hypothalamic tissue of obese subjects as compared to controls (p = 0.008). Our findings indicate that some suspected npEDCs are able to cross the blood–brain barrier. Whether the presence of npEDCs can adversely affect brain function and to which extent the detected concentrations are physiologically relevant needs to be further investigated.

Description: IJERPH, Vol. 14, Pages 1065: Use of Principal Components Analysis and Kriging to Predict Groundwater-Sourced Rural Drinking Water Quality in Saskatchewan International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14091065 Authors: Lianne McLeod Lalita Bharadwaj Tasha Epp Cheryl Waldner Groundwater drinking water supply surveillance data were accessed to summarize water quality delivered as public and private water supplies in southern Saskatchewan as part of an exposure assessment for epidemiologic analyses of associations between water quality and type 2 diabetes or cardiovascular disease. Arsenic in drinking water has been linked to a variety of chronic diseases and previous studies have identified multiple wells with arsenic above the drinking water standard of 0.01 mg/L; therefore, arsenic concentrations were of specific interest. Principal components analysis was applied to obtain principal component (PC) scores to summarize mixtures of correlated parameters identified as health standards and those identified as aesthetic objectives in the Saskatchewan Drinking Water Quality Standards and Objective. Ordinary, universal, and empirical Bayesian kriging were used to interpolate arsenic concentrations and PC scores in southern Saskatchewan, and the results were compared. Empirical Bayesian kriging performed best across all analyses, based on having the greatest number of variables for which the root mean square error was lowest. While all of the kriging methods appeared to underestimate high values of arsenic and PC scores, empirical Bayesian kriging was chosen to summarize large scale geographic trends in groundwater-sourced drinking water quality and assess exposure to mixtures of trace metals and ions.

Description: IJERPH, Vol. 14, Pages 1076: Poverty Dynamics and Academic Trajectories of Children of Immigrants International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14091076 Authors: Liwei Zhang Wen-Jui Han Using Early Childhood Longitudinal Study, Kindergarten Class of 1998–1999 (ECLS-K), we investigated the relationship between poverty and academic trajectories for children in immigrant families in the United States. We used family socioeconomic status (SES) which considers parental education, parental occupation, and family income to define poverty in correspondence with the U.S. federal poverty threshold. Three dimensions of poverty were examined including depth (i.e., not-poor, near-poor, poor or extreme poor), stability (i.e., continuously or intermittently), and duration (i.e., for how many times in poverty). Our results indicated that living in poverty, particularly when it was extreme, volatile, and for long spell could compromise children’s reading and math achievements during the first nine schooling years. Children of immigrants were doing as well as, if not better than, children of native-borns in certain areas (i.e., math) or in facing of certain pattern of poverty (i.e., long-spell). However, deep poverty and volatile changes in family SES could compromise academic achievements for children of immigrants throughout their first nine years of schooling, a period holds important key to their future success. Implications to practice and policy as well as future directions were discussed.

Description: Healthcare facilities (HF) represent an at-risk environment for legionellosis transmission occurring after inhalation of contaminated aerosols. In general, the control of water is preferred to that of air because, to date, there are no standardized sampling protocols. Legionella air contamination was investigated in the bathrooms of 11 HF by active sampling (Surface Air System and Coriolis®μ) and passive sampling using settling plates. During the 8-hour sampling, hot tap water was sampled three times. All air samples were evaluated using culture-based methods, whereas liquid samples collected using the Coriolis®μ were also analyzed by real-time PCR. Legionella presence in the air and water was then compared by sequence-based typing (SBT) methods. Air contamination was found in four HF (36.4%) by at least one of the culturable methods. The culturable investigation by Coriolis®μ did not yield Legionella in any enrolled HF. However, molecular investigation using Coriolis®μ resulted in eight HF testing positive for Legionella in the air. Comparison of Legionella air and water contamination indicated that Legionella water concentration could be predictive of its presence in the air. Furthermore, a molecular study of 12 L. pneumophila strains confirmed a match between the Legionella strains from air and water samples by SBT for three out of four HF that tested positive for Legionella by at least one of the culturable methods. Overall, our study shows that Legionella air detection cannot replace water sampling because the absence of microorganisms from the air does not necessarily represent their absence from water; nevertheless, air sampling may provide useful information for risk assessment. The liquid impingement technique appears to have the greatest capacity for collecting airborne Legionella if combined with molecular investigations.

Description: Todays children spend a large amount of their time sedentary. There is limited evidence on the determinants of sedentary behavior in children, and qualitative studies are especially lacking. Therefore, this study aimed to explore determinants of children’s sedentary behavior from the child- and parent perspective. Qualitative data were collected during concept mapping sessions with four groups of 11–13 years old children (n = 38) and two online sessions with parents (n = 21). Children and parents generated sedentary behavior motives, sorted related motives, and rated their importance in influencing children’s sedentary time. Next, multidimensional scaling and hierarchical cluster analysis was performed to create clusters of motives resulting in a concept map. Finally, the researchers named the clusters in the concept map. Concept maps of children yielded eight to ten perceived determinants, and concept maps of parents six to seven. Children and parents identified six similar potential determinants, and both rated as important: Sitting because… “it is the norm (I have to)”, and “I can work/play better that way”. In addition, children rated “there is nobody to play with” as an important potential determinant for engaging in sedentary behavior. The most important child- and parent perceived determinants were related to the social/cultural and physical environment, indicating that these are promising targets for future interventions.

Description: IJERPH, Vol. 14, Pages 914: Assessment of Typical Heavy Metals in Human Hair of Different Age Groups and Foodstuffs in Beijing, China International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14080914 Authors: Gang Liang Ligang Pan Xinhui Liu Human hair of different age groups and foodstuff samples were collected in Beijing, China. The concerned metals—Cd, Cr, Pb, As, and Hg—were analyzed, and the metal levels in relation to age, gender, and dietary intake were further assessed. Results showed the highest level of the metals was shown by Pb, with an average concentration of 1.557 ± 0.779 mg/kg, followed by Cr (0.782 ± 0.394), Hg (0.284 ± 0.094), As (0.127 ± 0.078), and Cd (0.071 ± 0.032), following a decreasing order of Pb > Cr > Hg > As > Cd, which were all below the upper limit of normal values in China. The heavy metal concentrations varied greatly among different age groups, and higher concentrations for Cd, Cr, Pb, and As appeared in female hair, whereas higher Hg concentration were found in male hair, suggesting that age and gender were not crucial factors for assessing metal concentrations in human hair. The ingestion of cereals and vegetables were the main route by which heavy metals in the environment create hazardous health effects for local inhabitants, but the estimated metal intakes through food consumption were all lower than the proposed limit of Provisional Tolerable Weekly Intake (PTWI), indicating that heavy metals posed no health risks for the inhabitants. Furthermore, little relationship was found between metal intakes and the corresponding metal levels in hair. Nevertheless, the results of this study can be used to analyze the internal heavy metal burden in the resident population of Beijing area and can also serve as reference for further studies.

Description: IJERPH, Vol. 14, Pages 915: Pricing of Staple Foods at Supermarkets versus Small Food Stores International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14080915 Authors: Caitlin Caspi Jennifer Pelletier Lisa Harnack Darin Erickson Kathleen Lenk Melissa Laska Prices affect food purchase decisions, particularly in lower-income communities, where access to a range of food retailers (including supermarkets) is limited. The aim of this study was to examine differences in staple food pricing between small urban food stores and the closest supermarkets, as well as whether pricing differentials varied based on proximity between small stores and larger retailers. In 2014, prices were measured for 15 staple foods during store visits in 140 smaller stores (corner stores, gas-marts, dollar stores, and pharmacies) in Minneapolis/St. Paul, MN and their closest supermarket. Mixed models controlling for store type were used to estimate the average price differential between: (a) smaller stores and supermarkets; (b) isolated smaller stores (>1 mile to closest supermarket) and non-isolated smaller stores; and (c) isolated smaller stores inside versus outside USDA-identified food deserts. On average, all items except white bread were 10–54% more expensive in smaller stores than in supermarkets (p < 0.001). Prices were generally not significantly different in isolated stores compared with non-isolated stores for most items. Among isolated stores, there were no price differences inside versus outside food deserts. We conclude that smaller food stores have higher prices for most staple foods compared to their closest supermarket, regardless of proximity. More research is needed to examine staple food prices in different retail spaces.

Description: IJERPH, Vol. 14, Pages 924: Quality of Vegetables Based on Total Phenolic Concentration Is Lower in More Rural Consumer Food Environments in a Rural American State International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14080924 Authors: Selena Ahmed Carmen Byker Shanks While daily consumption of fruits and vegetables (FVs) is widely recognized to be associated with supporting nutrition and health, disparities exist in consumer food environments regarding access to high-quality produce based on location. The purpose of this study was to evaluate FV quality using total phenolic (TP) scores (a phytochemical measure for health-promoting attributes, flavor, appearance, and shelf-life) in consumer food environments along a rural to urban continuum in the rural state of Montana, United States. Significant differences were found in the means of the FV TP scores (p < 0.0001) and vegetable TP scores (p < 0.0001) on the basis of rurality, while no significant difference was found for fruit TP scores by rurality (p < 0.2158). Specifically, FV TP scores and vegetable TP scores were highest for the least rural stores and lowest for the most rural stores. Results indicate an access gap to high-quality vegetables in more rural and more health-disparate consumer food environments of Montana compared to urban food environments. Findings highlight that food and nutrition interventions should aim to increase vegetable quality in rural consumer food environments in the state of Montana towards enhancing dietary quality and food choices. Future studies are called for that examine TP scores of a wide range of FVs in diverse food environments globally. Studies are further needed that examine linkages between FV quality, food choices, diets, and health outcomes towards enhancing food environments for public health.

Description: IJERPH, Vol. 14, Pages 923: A Youth-Led, Social Marketing Intervention Run by Adolescents to Encourage Healthy Lifestyles among Younger School Peers (EYTO-Kids Project): A Protocol for Pilot Cluster Randomized Controlled Trial (Spain) International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14080923 Authors: Lucia Tarro Magaly Aceves-Martins Ignasi Papell-Garcia Lluís Arola Montse Giralt Elisabet Llauradó Rosa Solà Introduction: The EYTO-kids (European Youth Tackling Obesity in Adolescents and Children) study aims to increase fruit and/or vegetable consumption and physical activity, decrease sedentary lifestyles, and reduce the intake of sugary drinks and fast food using an innovative methodology based on social marketing and youth involvement. Methods: This study is a pilot school-based cluster randomized controlled 10-month intervention spanning two academic years (2015–2016 and 2016–2017), with eight primary schools and three high schools randomized into and designated the control group and eight primary schools and four high schools designated the intervention group in Reus, Spain. At least 301 younger school peers per group should be included. At the intervention high schools, the adolescent creators (ACs) receive an initial 16-h training session. In total, 26–32 high school ACs (12–14 years) from the four high schools will design and implement four health-promotion activities (1 h/each) for their younger (8–10 years), primary school peers. The control group will not receive any intervention. The outcomes (fruit, vegetable, fast food and sugary drink consumption; physical activity; and sedentary behaviors) of the control and intervention groups will be measured pre- and post-intervention. Conclusion: This study describes a protocol for pilot, peer-led, social marketing and youth-involved intervention, where adolescents design and implement activities for their younger peers to promote healthy lifestyles.

Description: IJERPH, Vol. 14, Pages 929: Beverage Intake among Children: Associations with Parent and Home-Related Factors International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14080929 Authors: Arwa Zahid Cynthia Davey Marla Reicks Beverage intake can influence child diet quality in a positive or negative manner depending on the beverage type and amounts consumed. Parenting practices such as role modeling and control of home beverage availability have been associated with child beverage intake, whereas examination of the influence of parental beverage nutrition knowledge has been more limited. The purpose of this study was to examine the relationships between sugar-sweetened and dairy beverage intake among children (9–12 years) and home and parental factors. A questionnaire was administered among a convenience sample of parents (n = 194) to assess beverage nutrition knowledge, beverage intake and home availability of beverages. Children completed a questionnaire to estimate usual beverage intake. Daily sugar-sweetened beverage intake by children ranged from 0.4 to 48 oz. Logistic regression analysis was used to examine relationships. Parents were mostly female, white, well educated, and employed. Home availability of sugar-sweetened and dairy beverages was positively associated with child sugar-sweetened (OR = 1.48, p = 0.03) and dairy beverage intake (OR = 1.34, p = 0.03), respectively. Parent dairy beverage intake was associated with child dairy beverage intake (OR = 1.06, p = 0.01). Parent knowledge about sugar in beverages was related to child dairy beverage intake (OR = 1.46, p = 0.02), whereas calcium/dairy knowledge and general beverage nutrition knowledge were not related to child beverage intake. Parenting practices and knowledge may play a role in determining child beverage intake.

Description: IJERPH, Vol. 14, Pages 931: Population-Based Study on the Effect of a Forest Environment on Salivary Cortisol Concentration International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14080931 Authors: Hiromitsu Kobayashi Chorong Song Harumi Ikei Bum-Jin Park Juyoung Lee Takahide Kagawa Yoshifumi Miyazaki The purpose of this study was to evaluate the effect of a forest environment on salivary cortisol concentration, particularly on the characteristics of its distribution. The participants were 348 young male subjects. The experimental sites were 34 forests and 34 urban areas across Japan. The subjects viewed the landscape (forest or urban environment) for a period of 15 min while sitting in a chair. Saliva was sampled from the participants at the end of this 15-min period and then analyzed for cortisol concentration. Differences in the skewness and kurtosis of the distributions between the two environments were tested by performing a permutation test. The cortisol concentrations exhibited larger skewness (0.76) and kurtosis (3.23) in a forest environment than in an urban environment (skewness = 0.49; kurtosis = 2.47), and these differences were statistically significant. The cortisol distribution exhibited a more peaked and longer right-tailed curve in a forest environment than in an urban environment.

Description: IJERPH, Vol. 14, Pages 928: Personal Hygiene Practices among Urban Homeless Persons in Boston, MA International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14080928 Authors: Jessica Leibler Daniel Nguyen Casey León Jessie Gaeta Debora Perez Persons experiencing homelessness in the United States experience significant barriers to self-care and personal hygiene, including limited access to clean showers, laundry and hand washing facilities. While the obstacles to personal hygiene associated with homelessness may increase risk of infectious disease, hygiene-related behaviors among people experiencing homelessness has received limited attention. We conducted a cross-sectional study of individuals experiencing homelessness in Boston, MA (n = 194) to identify hygiene-related self-care practices and risk factors for reduced hygiene in this population. Most participants (72%) reported taking a daily shower. More than 60% reported hand washing with soap five or more times each day, and use of hand sanitizer was widespread (89% reported using sanitizer in the last week). A majority (86%) used a laundromat or laundry machine to wash clothing, while 14% reported washing clothing in the sink. Heavy drinking, injection drug use, and sleeping outdoors were identified as significant risk factors for reduced hygiene practices. People experiencing homelessness who also engage in these activities may be among the most difficult to reach for intervention, yet targeted efforts may decrease illness risk associated with reduced hygiene. Housed friends and family play a critical role in assisting homeless individuals maintain hygiene by providing showers and laundry facilities.

Description: IJERPH, Vol. 14, Pages 941: Grip Strength and Its Relationship to Police Recruit Task Performance and Injury Risk: A Retrospective Cohort Study International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14080941 Authors: Robin Orr Rodney Pope Michael Stierli Benjamin Hinton Suitable grip strength is a police occupational requirement. The aim of this study was to investigate the association between grip strength, task performance and injury risk in a police population. Retrospective data of police recruits (n = 169) who had undergone basic recruit training were provided, including handgrip strength results, occupational task performance measures (consisting of police task simulations [SIM], tactical options [TACOPS] and marksmanship assessments) and injury records. Left hand grip strength (41.91 ± 8.29 kg) measures showed a stronger correlation than right hand grip strength (42.15 ± 8.53 kg) with all outcome measures. Recruits whose grip strength scores were lower were significantly more susceptible to failing the TACOPS occupational task assessment than those with greater grip strength scores, with significant (p ≤ 0.003) weak to moderate, positive correlations found between grip strength and TACOPS performance. A significant (p < 0.0001) correlation was found between grip strength, most notably of the left hand, and marksmanship performance, with those performing better in marksmanship having higher grip strength. Left hand grip strength was significantly associated with injury risk (r = −0.181, p = 0.018) but right hand grip strength was not. A positive association exists between handgrip strength and police recruit task performance (notably TACOPS and marksmanship) with recruits who scored poorly on grip strength being at greatest risk of occupational assessment task failure.

Description: IJERPH, Vol. 14, Pages 944: Biometeorological Assessment of Mortality Related to Extreme Temperatures in Helsinki Region, Finland, 1972–2014 International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14080944 Authors: Reija Ruuhela Kirsti Jylhä Timo Lanki Pekka Tiittanen Andreas Matzarakis Climate change is expected to increase heat-related and decrease cold-related mortality. The extent of acclimatization of the population to gradually-changing thermal conditions is not well understood. We aimed to define the relationship between mortality and temperature extremes in different age groups in the Helsinki-Uusimaa hospital district in Southern Finland, and changes in sensitivity of the population to temperature extremes over the period of 1972–2014. Time series of mortality were made stationary with a method that utilizes 365-day Gaussian smoothing, removes trends and seasonality, and gives relative mortality as the result. We used generalized additive models to examine the association of relative mortality to physiologically equivalent temperature (PET) and to air temperature in the 43-year study period and in two 21-year long sub-periods (1972–1992 and 1994–2014). We calculated the mean values of relative mortality in percentile-based categories of thermal indices. Relative mortality increases more in the hot than in the cold tail of the thermal distribution. The increase is strongest among those aged 75 years and older, but is somewhat elevated even among those younger than 65 years. Above the 99th percentile of the PET distribution, the all-aged relative mortality decreased in time from 18.3 to 8.6%. Among those ≥75 years old, the decrease in relative mortality between the sub-periods were found to be above the 90th percentile. The dependence of relative mortality on cold extremes was negligible, except among those ≥75 years old, in the latter period. Thus, heat-related mortality is also remarkable in Finland, but the sensitivity to heat stress has decreased over the decades.

Description: IJERPH, Vol. 14, Pages 945: “You Think You’re Helping Them, But They’re Helping You Too”: Experiences of Scottish Male Young Offenders Participating in a Dog Training Program International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14080945 Authors: Rebecca Leonardi Hannah Buchanan-Smith Gill McIvor Sarah-Jane Vick Interaction with animals can be beneficial to humans and animal-assisted interventions (AAIs) are increasingly popular in a range of contexts. Dog training programs (DTPs) are the most popular form of AAI in custodial contexts; prisoners often have multiple needs and DTPs seem to facilitate a diverse range of positive outcomes, including improvements in well-being, behavior, and offending behavior. However, evidence on the efficacy of prison-based DTPs is still limited and these evaluations often lack detail or methodological rigor. We examined the experiences of male young offenders (N = 70) using thematic analysis of semi-structured interviews conducted following completion of a DTP. The themes that emerged indicated a broad range of inter-related experiences and positive outcomes. The most prevalent theme related to their experiences with Dogs (including feelings and attitudes), and there were perceived improvements categorized as: Positive Effects (including mood and well-being), Motivation, Charitable Purpose, Self-Efficacy, Improved Skills, Impulsivity, and Emotional Management. These themes mapped well onto outcomes previously identified in research on DTPs, and to the program’s core aims of improving behavior, educational engagement, employability, and well-being. The diversity and nature of these themes indicates that DTPs have considerable potential to engage and benefit those individuals with multiple needs, such as young offenders, and ultimately to achieve positive long-term outcomes with significant social, health, and economic impact.

Description: IJERPH, Vol. 14, Pages 953: Does Physical Activity Mediate the Associations Between Local-Area Descriptive Norms, Built Environment Walkability, and Glycosylated Hemoglobin? International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14090953 Authors: Suzanne J. Carroll Theo Niyonsenga Neil T. Coffee Anne W. Taylor Mark Daniel Associations between local-area residential features and glycosylated hemoglobin (HbA1c) may be mediated by individual-level health behaviors. Such indirect effects have rarely been tested. This study assessed whether individual-level self-reported physical activity mediated the influence of local-area descriptive norms and objectively expressed walkability on 10-year change in HbA1c. HbA1c was assessed three times for adults in a 10-year population-based biomedical cohort (n = 4056). Local-area norms specific to each participant were calculated, aggregating responses from a separate statewide surveillance survey for 1600 m road-network buffers centered on participant addresses (local prevalence of overweight/obesity (body mass index ≥25 kg/m2) and physical inactivity (<150 min/week)). Separate latent growth models estimated direct and indirect (through physical activity) effects of local-area exposures on change in HbA1c, accounting for spatial clustering and covariates (individual-level age, sex, smoking status, marital status, employment and education, and area-level median household income). HbA1c worsened over time. Local-area norms directly and indirectly predicted worsening HbA1c trajectories. Walkability was directly and indirectly protective of worsening HbA1c. Local-area descriptive norms and walkability influence cardiometabolic risk trajectory through individual-level physical activity. Efforts to reduce population cardiometabolic risk should consider the extent of local-area unhealthful behavioral norms and walkability in tailoring strategies to improve physical activity.

Description: IJERPH, Vol. 14, Pages 964: Improved Housing Accessibility for Older People in Sweden and Germany: Short Term Costs and Long-Term Gains International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14090964 Authors: Björn Slaug Carlos Chiatti Frank Oswald Roman Kaspar Steven Schmidt The physical housing environment is important to facilitate activities of daily living (ADL) for older people. A hindering environment may lead to ADL dependence and thus increase the need for home services, which is individually restricting and a growing societal burden. This study presents simulations of policy changes with regard to housing accessibility that estimates the potential impact specifically on instrumental activities of daily living (I-ADL), usage of home services, and related costs. The models integrate empirical data to test the hypothesis that a policy providing funding to remove the five most severe environmental barriers in the homes of older people who are at risk of developing dependence in I-ADL, can maintain independence and reduce the need for home services. In addition to official statistics from state agencies in Sweden and Germany, we utilized published results from the ENABLE-AGE and other scientific studies to generate the simulations. The simulations predicted that new policies that remove potentially hindering housing features would improve I-ADL performance among older people and reduce the need for home services. Our findings suggest that a policy change can contribute to positive effects with regard to I-ADL independence among older people and to a reduction of societal burden.

Description: IJERPH, Vol. 14, Pages 967: Assessing Knowledge and Attitudes towards Cervical Cancer Screening among Rural Women in Eastern China International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14090967 Authors: Tongtong Liu Shunping Li Julie Ratcliffe Gang Chen There is a heavy burden of cervical cancer in China. Although the Chinese government provides free cervical cancer screening for rural women aged 35 to 59 years, the screening rate remains low even in the more developed regions of eastern China. This study aimed to assess knowledge and attitudes about cervical cancer and its screening among rural women aged 30 to 65 years in eastern China. A cross-sectional study was conducted in four counties of Jining Prefecture in Shandong Province during August 2015. In total, 420 rural women were randomly recruited. Each woman participated in a face-to-face interview in which a questionnaire was administered by a trained interviewer. A total of 405 rural women (mean age 49 years old) were included in the final study. Among them, 210 (51.9%) participants had high knowledge levels. An overwhelming majority, 389 (96.0%) expressed positive attitudes, whilst only 258 (63.7%) had undergone screening for cervical cancer. Related knowledge was higher amongst the screened group relative to the unscreened group. Age, education and income were significantly associated with a higher knowledge level. Education was the only significant factor associated with a positive attitude. In addition, women who were older, or who had received a formal education were more likely to participate in cervical cancer screening. The knowledge of cervical cancer among rural women in eastern China was found to be poor, and the screening uptake was not high albeit a free cervical cancer screening program was provided. Government led initiatives to improve public awareness, knowledge, and participation in cervical cancer screening programs would likely be highly beneficial in reducing cervical cancer incidence and mortality for rural women.

Description: IJERPH, Vol. 14, Pages 956: Positive Rates and Factors Associated with Abnormal Lung Function of Greenhouse Workers in China: A Cross-Sectional Study International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14090956 Authors: Xiaojun Zhu Panjun Gao Yishuo Gu Pei Xiao Mengxuan Liu Juan Chen Yacai Cen Wenjun Ma Tao Li Since the number of greenhouse workers are increasing in China, this observational cross-sectional study was designed to evaluate lung function and discuss the potential risk factors, to provide evidence in the surveillance of greenhouse workers’ health. 678 greenhouse workers in Gansu Province, China were enrolled. A questionnaire which included demographic and occupational information was used. Vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), and FEV1:FVC ratios (FEV1/FVC), maximal expiratory flow after 50% of the FVC has not been exhaled (MEF50), maximal expiratory flow after 25% of the FVC has not been exhaled (MEF25) and maximal mid-expiratory flow curve (MMEF) were measured as lung function indicators. The mean values and standard deviations (SDs) of VC% predicted, FVC% predicted, FEV1% predicted and FEV1/FVC ratio were 106.07 ± 13.36, 107.60 ± 13.95, 97.19 ± 14.80 and 89.76 ± 10.78 respectively. The positive rates of above four and abnormal lung ventilation function were 2.9%, 2.8%, 11.2%, 4.6% and 6.5% respectively. Gender, age, BMI and number of greenhouses owned were influence factors of lung ventilation function (p < 0.05). The mean values and SDs of MEF50% predicted, MEF25% predicted and MMEF% predicted were 69.63 ± 24.95, 54.04 ± 24.94 and 66.81 ± 24.53. The positive rates of above three and abnormal small airway function were 45.0%, 72.1%, 47.2% and 49.4% respectively. Age, education and number of greenhouses owned were influence factors for small airway function (p < 0.05). Working in a greenhouse might influence lung function of the workers. Small airway function indicators could be used as priority indicators for the surveillance of greenhouse workers’ health.

Description: IJERPH, Vol. 14, Pages 971: Surveillance Bias in Child Maltreatment: A Tempest in a Teapot International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14090971 Authors: Brett Drake Melissa Jonson-Reid Hyunil Kim Background: Children are believed to be more likely to be reported for maltreatment while they are working with mental health or social service professionals. This “surveillance bias” has been claimed to inflate reporting by fifty percent or more, and has been used to explain why interventions such as home visiting fail to reduce official maltreatment reporting rates. Methods: We use national child abuse reporting data (n = 825,763), supplemented by more detailed regional data from a multi-agency administrative data study (n = 7185). We determine the percentage of all re-reports made uniquely by mental health and social service providers within and across generations, the report sources which could be subject to surveillance bias. Results: At three years after the initial Child protective services (CPS) report, the total percentage of national reports uniquely made by mental health or social service providers is less than 10%, making it impossible that surveillance bias could massively inflate CPS reporting in this sample. Analysis of national data find evidence of a very small (+4.54%) initial surveillance bias “bump” among served cases which decays to +1.84% within three years. Our analysis of regional data showed similar or weaker effects. Conclusions: Surveillance bias effects appear to exist, but are very small.

Description: IJERPH, Vol. 14, Pages 985: Determinants of FDI Localization in China: A County-Level Analysis for the Pharmaceutical Industry International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14090985 Authors: Su Li Antonio Angelino Haitao Yin Francesca Spigarelli Foreign direct investments (FDIs) have been widely recognized as a crucial feature of the Chinese industrial development process. Over the past decades, China has been attracting huge amounts of inward FDIs as a consequence of both spontaneous market dynamics and place-based preferential policies at the sub-national level. However, the Chinese market exhibits large dissimilarities in terms of FDI localization across territories that are worth investigating at a more disaggregated level. In this regards, our study explores the determinants of attraction of inward FDIs in China, at the county level. It focuses on the pharmaceutical industry and attempts to assess whether factors related to location advantages, agglomeration dynamics, information cost effects and environmental regulation costs affect foreign firms’ localization choices as well as invested amounts in that location. By means of discrete choice models, our paper confirms the findings of the prevalent literature about the positive effects of location advantages on pharmaceutical FDI attraction. Different from our expectations, a higher proportion of foreign enterprises do not stimulate significant effects on FDI localization, while preferential policies and sectoral agglomeration are positively correlated with the localization of pharmaceutical foreign firms. Finally, our results suggest that investing firms tend to avoid areas with strict environment regulation.

Description: IJERPH, Vol. 14, Pages 981: Poverty and Child Behavioral Problems: The Mediating Role of Parenting and Parental Well-Being International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14090981 Authors: Till Kaiser Jianghong Li Matthias Pollmann-Schult Anne Song The detrimental impact of poverty on child behavioral problems is well-established, but the mechanisms that explain this relationship are less well-known. Using data from the Families in Germany Study on parents and their children at ages 9–10 (middle childhood), this study extends previous research by examining whether or not and to what extent different parenting styles and parents’ subjective well-being explain the relationship between poverty and child behavior problems. The results show that certain parenting styles, such as psychological control, as well as mothers’ life satisfaction partially mediate the correlation between poverty and child behavioral problems.

Description: IJERPH, Vol. 14, Pages 990: Arsenic Speciation and Extraction and the Significance of Biodegradable Acid on Arsenic Removal—An Approach for Remediation of Arsenic-Contaminated Soil International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14090990 Authors: Thinh Nguyen Van Yasuhito Osanai Hai Do Nguyen Kiyoshi Kurosawa A series of arsenic remediation tests were conducted using a washing method with biodegradable organic acids, including oxalic, citric and ascorbic acids. Approximately 80% of the arsenic in one sample was removed under the effect of the ascorbic and oxalic acid combination, which was roughly twice higher than the effectiveness of the ascorbic and citric acid combination under the same conditions. The soils treated using biodegradable acids had low remaining concentrations of arsenic that are primarily contained in the crystalline iron oxides and organic matter fractions. The close correlation between extracted arsenic and extracted iron/aluminum suggested that arsenic was removed via the dissolution of Fe/Al oxides in soils. The fractionation of arsenic in four contaminated soils was investigated using a modified sequential extraction method. Regarding fractionation, we found that most of the soil contained high proportions of arsenic (As) in exchangeable fractions with phosphorus, amorphous oxides, and crystalline iron oxides, while a small amount of the arsenic fraction was organic matter-bound. This study indicated that biodegradable organic acids can be considered as a means for arsenic-contaminated soil remediation.

Description: IJERPH, Vol. 14, Pages 988: Thyroid Cancer Incidence around the Belgian Nuclear Sites, 2000–2014 International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14090988 Authors: Claire Demoury Tom De Smedt Harlinde De Schutter Michel Sonck Nancy Van Damme Kaatje Bollaerts Geert Molenberghs Lodewijk Van Bladel An Van Nieuwenhuyse The present study investigates whether there is an excess incidence of thyroid cancer among people living in the vicinity of the nuclear sites in Belgium. Adjusted Rate Ratios were obtained from Poisson regressions for proximity areas of varying sizes. In addition, focused hypothesis tests and generalized additive models were performed to test the hypothesis of a gradient in thyroid cancer incidence with increasing levels of surrogate exposures. Residential proximity to the nuclear site, prevailing dominant winds frequency from the site, and simulated radioactive discharges were used as surrogate exposures. No excess incidence of thyroid cancer was observed around the nuclear power plants of Doel or Tihange. In contrast, increases in thyroid cancer incidence were found around the nuclear sites of Mol-Dessel and Fleurus; risk ratios were borderline not significant. For Mol-Dessel, there was evidence for a gradient in thyroid cancer incidence with increased proximity, prevailing winds, and simulated radioactive discharges. For Fleurus, a gradient was observed with increasing prevailing winds and, to a lesser extent, with increasing simulated radioactive discharges. This study strengthens earlier findings and suggests increased incidences in thyroid cancer around two of the four Belgian nuclear sites. Further analyses will be performed at a more detailed geographical level.

Description: IJERPH, Vol. 14, Pages 995: Fitness, Fatness and Active School Commuting among Liverpool Schoolchildren International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14090995 Authors: Robert J. Noonan Lynne M. Boddy Zoe R. Knowles Stuart J. Fairclough This study investigated differences in health outcomes between active and passive school commuters, and examined associations between parent perceptions of the neighborhood environment and active school commuting (ASC). One hundred-ninety-four children (107 girls), aged 9–10 years from ten primary schools in Liverpool, England, participated in this cross-sectional study. Measures of stature, body mass, waist circumference and cardiorespiratory fitness (CRF) were taken. School commute mode (active/passive) was self-reported and parents completed the neighborhood environment walkability scale for youth. Fifty-three percent of children commuted to school actively. Schoolchildren who lived in more deprived neighborhoods perceived by parents as being highly connected, unaesthetic and having mixed land-use were more likely to commute to school actively (p < 0.05). These children were at greatest risk of being obese and aerobically unfit(p < 0.01). Our results suggest that deprivation may explain the counterintuitive relationship between obesity, CRF and ASC in Liverpool schoolchildren. These findings encourage researchers and policy makers to be equally mindful of the social determinants of health when advocating behavioral and environmental health interventions. Further research exploring contextual factors to ASC, and examining the concurrent effect of ASC and diet on weight status by deprivation is needed.

Description: IJERPH, Vol. 14, Pages 989: Erratum: Haraux, E., et al. Maternal Exposure to Domestic Hair Cosmetics and Occupational Endocrine Disruptors Is Associated with a Higher Risk of Hypospadias in the Offspring. Int. J. Environ. Res. Public Health 2016, 14, 27 International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14090989 Authors: Elodie Haraux Karine Braun Philippe Buisson Erwan Stéphan-Blanchard Camille Devauchelle Jannick Ricard Bernard Boudailliez Pierre Tourneux Richard Gouron Karen Chardon Due to an error during production, some data presented in Table 1 in the Experimental section of the published paper [1] were incorrect.[...]

Description: IJERPH, Vol. 14, Pages 993: Relationship between Social Support Networks and Physical Functioning in Older Community-Dwelling Mexicans International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14090993 Authors: Víctor Mendoza-Núñez Fabiola González-Mantilla Elsa Correa-Muñoz Raquel Retana-Ugalde Some studies have demonstrated the relationship between social support networks (SSNs) and health status. In this sense, it has been considered that physical and mental functioning is a key indicator of the health in the age people. The aim of this study was to determine the association between social support networks and physical functioning. A cross-sectional study was carried out including a convenience sample of 150 older community-dwelling Mexicans. We assessed the familial, extra-familial and institutional SSNs; social contacts; the activities of daily living (ADL); the instrumental activities of daily living (IADLs); and physical functioning task (PFT) performance among study participants. Of the 150 older subjects, 53 reported living alone (35%), 113 (75%) reported having few SSNs, and 37 (25%) reported having enough SSNs. Persons with few familial SSNs were at increased odds of demonstrating dependence in at least one of the ADL (OR = 3.25, 95% CI 1.06–9.92, p < 0.05). Likewise, persons with few institutional SSNs and few social contacts were at increased odds of demonstrating dependence in at least one of the IADL (OR = 6.96, 95% CI 1.57–30.7, p < 0.01; OR = 5.02, 95% CI 1.44–17.5, p < 0.01, respectively). We also observed that having few extra-familial SSNs and few social contacts were the main risk factors for PFT dependence, with ORs of 3.70 (95% CI 1.21–11.2, p < 0.05) and 3.85 (95% CI 1.10–13.5, p < 0.05), respectively. Our findings suggest that having few SSNs could be a significant risk factor for reduced physical functioning in older adults.

Description: IJERPH, Vol. 14, Pages 1015: Changes in Daily Steps and Body Mass Index and Waist to Height Ratio during Four Year Follow-Up in Adults: Cardiovascular Risk in Young Finns Study International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14091015 Authors: Kasper Salin Mirja Hirvensalo Costan Magnussen Risto Telama Nina Hutri-Kähönen Jorma Viikari Olli Raitakari Tuija Tammelin Aims: Over the study years, there was a significant increase in body mass index (BMI) and waist-to-height ratio (WtHR) in middle aged Finnish adults. Methods: Data were obtained from 1033 Finnish adults from the Cardiovascular Risk in Young Finns Study in 2007 and 2011. Cohort study participants wore an Omron Walking Style One (HJ-152R-E) pedometer for five days and were grouped into those who increased, maintained and decreased their steps between 2007 and 2011. Paired samples t-test was used to compare body mass index (BMI) and waist-to-height ratio (WtHR) change values between the change groups in study years. Results: Among study population BMI and WtHR increase between study years was statistically significant (p < 0.001). Only those, who increased their total steps for at least 2000 steps, maintained their BMI in the same level, while people who decreased or maintained their total steps in the same level, BMI and WtHR increased during four years follow-up. Conclusions: This data suggests that increasing steps in middle age is associated with maintaining BMI at the same level.

Description: IJERPH, Vol. 14, Pages 1014: Active Transportation on a Complete Street: Perceived and Audited Walkability Correlates International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14091014 Authors: Wyatt Jensen Barbara Brown Ken Smith Simon Brewer Jonathan Amburgey Brett McIff Few studies of walkability include both perceived and audited walkability measures. We examined perceived walkability (Neighborhood Environment Walkability Scale—Abbreviated, NEWS-A) and audited walkability (Irvine–Minnesota Inventory, IMI) measures for residents living within 2 km of a “complete street”—one renovated with light rail, bike lanes, and sidewalks. For perceived walkability, we found some differences but substantial similarity between our final scales and those in a prior published confirmatory factor analysis. Perceived walkability, in interaction with distance, was related to complete street active transportation. Residents were likely to have active transportation on the street when they lived nearby and perceived good aesthetics, crime safety, and traffic safety. Audited walkability, analyzed with decision trees, showed three general clusters of walkability areas, with 12 specific subtypes. A subset of walkability items (n = 11), including sidewalks, zebra-striped crosswalks, decorative sidewalks, pedestrian signals, and blank walls combined to cluster street segments. The 12 subtypes yielded 81% correct classification of residents’ active transportation. Both perceived and audited walkability were important predictors of active transportation. For audited walkability, we recommend more exploration of decision tree approaches, given their predictive utility and ease of translation into walkability interventions.

Description: IJERPH, Vol. 14, Pages 1023: Variations in Obesity Rates between US Counties: Impacts of Activity Access, Food Environments, and Settlement Patterns International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14091023 Authors: Peter Congdon There is much ongoing research about the effect of the urban environment as compared with individual behaviour on growing obesity levels, including food environment, settlement patterns (e.g., sprawl, walkability, commuting patterns), and activity access. This paper considers obesity variations between US counties, and delineates the main dimensions of geographic variation in obesity between counties: by urban-rural status, by region, by area poverty status, and by majority ethnic group. Available measures of activity access, food environment, and settlement patterns are then assessed in terms of how far they can account for geographic variation. A county level regression analysis uses a Bayesian methodology that controls for spatial correlation in unmeasured area risk factors. It is found that environmental measures do play a significant role in explaining geographic contrasts in obesity.

Description: IJERPH, Vol. 14, Pages 1028: Analysis of Baseline Computerized Neurocognitive Testing Results among 5–11-Year-Old Male and Female Children Playing Sports in Recreational Leagues in Florida International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14091028 Authors: Karen Liller Barbara Morris Jessica Fillion Yingwei Yang Omonigho Bubu There is a paucity of data related to sports injuries, concussions, and computerized neurocognitive testing (CNT) among very young athletes playing sports in recreational settings. The purpose of this study was to report baseline CNT results among male and female children, ages 5–11, playing sports in Hillsborough County, Florida using ImPACT Pediatric, which is specifically designed for this population. Data were collected from 2016 to 2017. The results show that 657 baseline tests were conducted and t-tests and linear regression were used to assess mean significant differences in composite scores with sex and age. Results showed that females scored better on visual memory and in general as age increased, baseline scores improved. The results can be used to build further studies on the use of CNT in recreational settings and their role in concussion treatment, management, and interventions.

Description: IJERPH, Vol. 14, Pages 1022: Is the Effect of Body Mass Index on Hypertension Modified by the Elevation? A Cross-Sectional Study of Rural Areas in Japan International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14091022 Authors: Tsuyoshi Hamano Yoshiya Shiotani Miwako Takeda Takafumi Abe Kristina Sundquist Toru Nabika Obesity is an established independent risk factor for developing hypertension. A recent study showed that the effect of obesity on hypertension varies by the elevation of the residence area. Thus, we hypothesized that the interaction effect of body mass index (BMI) and elevation has a significant association with hypertension. The first aim of this cross-sectional study was to examine whether BMI was associated with hypertension, after adjustment for covariates. The second aim was to examine whether the interaction term between BMI and elevation was associated with hypertension, after adjustment for covariates. Data were collected from a cross-sectional study conducted in a rural area of Japan in 2016. After excluding participants with missing data (n = 2), data from 729 participants were analyzed. We found that BMI was significantly associated with hypertension. In addition, the interaction term between BMI and elevation had a significant association with hypertension. The findings of the present study support the recent evidence that high BMI is an independent risk factor for hypertension, but its effect varies by elevation. Thus, context-specific interventions could be an effective approach to prevent hypertension in this area.

Description: IJERPH, Vol. 14, Pages 1037: Family Social Environment and Parenting Predictors of Alcohol Use among Adolescents in Lithuania International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14091037 Authors: Linas Šumskas Apolinaras Zaborskis The role of the family as the social environment in shaping adolescent lifestyle has recently received substantial attention. This study was focused on investigating the association between familial and parenting predictors and alcohol use in school-aged children. Adolescents aged 13- and 15-year from a representative sample (N = 3715) of schools in Lithuania were surveyed during the spring of 2014. The methodology of the cross-national Health Behaviour in School-aged Children (HBSC) study was applied. HBSC international questionnaires were completed in the classroom anonymously for obtaining information about drinking of alcoholic beverages and family characteristics—family’s affluence and structure, style of communication in the family, parenting style, parental monitoring, family time together, etc. Univariate and multivariate logistic regression analysis was applied for assessment of the association between familial variables and weekly alcohol use. Analysis has demonstrated that adolescents from non-intact families tended to show significantly higher risk of being weekly drinkers (OR = 1.69; 95% CI: 1.30–2.19). The following parenting factors were associated with weekly use of alcohol: father’s and mother’s low monitoring, father’s authoritarian-repressive and mother’s permissive-neglectful parenting style. Frequent family time together and frequent electronic media communication with parents showed an inverse negative effect than was predicted. The study suggests that alcohol misuse among adolescents could be associated with a non-intact family structure as well as with complex family and parenting determinants which should be investigated more thoroughly by further studies.

Description: IJERPH, Vol. 14, Pages 1057: Implementing Low-Cost, Community-Based Exercise Programs for Middle-Aged and Older Patients with Type 2 Diabetes: What Are the Benefits for Glycemic Control and Cardiovascular Risk? International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14091057 Authors: Romeu Mendes Nelson Sousa Victor Reis Jose Themudo-Barata Background: The purpose of this study was to analyze the effects of a long-term, community-based, combined exercise program developed with low-cost exercise strategies on glycemic control and cardiovascular risk factors in middle-aged and older patients with type 2 diabetes. Methods: Participants (n = 124; 63.25 ± 7.20 years old) engaged in either a 9-month supervised exercise program (n = 39; consisting of combined aerobic, resistance, agility/balance, and flexibility exercise; three sessions per week; 70 min per session) or a control group (n = 85) who maintained their usual care. Glycemic control, lipid profile, blood pressure, anthropometric profile, and the 10-year risk of coronary artery disease were assessed before and after the 9-month intervention. Results: A significant time * group interaction effect (p < 0.001) was identified in the values of the glycated hemoglobin, fasting plasma glucose, total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, systolic blood pressure, diastolic blood pressure, body mass index, waist circumference, and the 10-year risk of coronary artery disease. Conclusions: A long-term, community-based, combined exercise program developed with low-cost exercise strategies was effective in inducing significant benefits on glycemic control, lipid profile, blood pressure, anthropometric profile, and the 10-year risk of coronary artery disease in middle-aged and older patients with type 2 diabetes. Clinical Trial Identification Number: ISRCTN09240628.

Description: IJERPH, Vol. 14, Pages 1081: China’s Air Quality and Respiratory Disease Mortality Based on the Spatial Panel Model International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14091081 Authors: Qilong Cao Ying Liang Xueting Niu Background: Air pollution has become an important factor restricting China’s economic development and has subsequently brought a series of social problems, including the impact of air pollution on the health of residents, which is a topical issue in China. Methods: Taking into account this spatial imbalance, the paper is based on the spatial panel data model PM2.5. Respiratory disease mortality in 31 Chinese provinces from 2004 to 2008 is taken as the main variable to study the spatial effect and impact of air quality and respiratory disease mortality on a large scale. Results: It was found that there is a spatial correlation between the mortality of respiratory diseases in Chinese provinces. The spatial correlation can be explained by the spatial effect of PM2.5 pollutions in the control of other variables. Conclusions: Compared with the traditional non-spatial model, the spatial model is better for describing the spatial relationship between variables, ensuring the conclusions are scientific and can measure the spatial effect between variables.

Description: IJERPH, Vol. 14, Pages 1083: Green Space and Depression during Pregnancy: Results from the Growing Up in New Zealand Study International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14091083 Authors: Vikram Nichani Kim Dirks Bruce Burns Amy Bird Cameron Grant Background: Antenatal depression is an important contributor to poor maternal health experienced by some women. This study aimed to determine whether exposure to green space during pregnancy is associated with less depression, and whether this association is moderated by relevant factors, such as age, education, self-identified ethnicity, physical activity, residential rurality, and socioeconomic status. Methods: Health data were sourced from the cohort study “Growing Up in New Zealand” comprised of 6772 participants. Green space was estimated based on the proportion of green space within the Census Area Unit. Adjusted logistic mixed effect models were used to investigate the association between green space and antenatal depression after controlling for confounding variables. Results: Maternal exposure to green space were not associated with lower odds of antenatal depression. Indications of effect modifications due to relevant factors were not observed. Conclusions: This study did not determine an association between access to green space (measured based on the distance to the nearest green space) and antenatal depression. Therefore, a link between green space and antenatal depression was not established. For that reason, ensuring residential areas contain adequate green space may or may not be helpful in preventing antenatal depression and adverse health outcomes associated with this depression. More studies focusing on pregnant women in a range of social contexts, and considering both exposure and access to green space, are warranted to determine the relationships between green space and antenatal depression.

Description: IJERPH, Vol. 14, Pages 1080: Depression and Risk of Unintentional Injury in Rural Communities—A Longitudinal Analysis of the Australian Rural Mental Health Study International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14091080 Authors: Kerry Inder Elizabeth Holliday Tonelle Handley Lyn Fragar Tony Lower Angela Booth Terry Lewin Brian Kelly Limited longitudinal research has examined relationships between depression and injury, particularly in rural contexts. This paper reports cross-sectional and longitudinal analyses from the Australian Rural Mental Health Study (ARMHS) exploring relationships between “probable depression” episodes and unintentional injury. Participants completed four surveys over five years. Multivariate logistic regressions were employed to assess the causal effect of prior depression episodes on subsequent injury risk. Of 2621 baseline participants, 23.3% experienced a probable depression episode recently and 15.9% reported a serious injury during the previous 12 months. Factors associated with a 12-month injury at baseline included male gender, being unemployed or unable to work, being involved in a serious incident, hazardous alcohol use, and having experienced a recent depression episode. Longitudinal analyses revealed that probable depression was significantly associated with subsequent unintentional injury (OR 1.68, 99%CI 1.20–2.35), as was male gender (OR 1.39, 99%CI 1.06–1.82), while alcohol consumption did not mediate these relationships. Campaigns to reduce the impact of mental illness should consider unintentional injuries as a contributor, while injury prevention initiatives may benefit from addressing mental health issues. Such strategies are particularly important in rural and remote areas where injuries are more common and mental health services are less readily available.

Description: IJERPH, Vol. 14, Pages 1082: Mothers’ Perceived Neighbourhood Environment and Outdoor Play of 2- to 3.5-Year-Old Children: Findings from the Healthy Beginnings Trial International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14091082 Authors: Huilan Xu Li Wen Louise Hardy Chris Rissel Background: This study aims to investigate whether mothers’ perceived neighbourhood environment is associated with outdoor playtime of 2- to 3.5-year-old children. Methods: Cross-sectional analyses were conducted using data from the Healthy Beginnings Trial (HBT). Data on children’s outdoor playtime and mothers’ perceived neighbourhood environment were collected through face-to-face interviews with mothers when their children were 2 and 3.5 years old. Walk score was obtained from a publicly available website and population density data were obtained from Australian Census data. Multiple logistic regression models were built to investigate these associations. Results: A total of 497 and 415 mother-child dyads were retained at 2 years and 3.5 years. After adjusting for intervention group allocation and other confounding factors, at 2 years, mothers’ perceptions that ‘the neighbourhood is a good place to bring up children’, ‘it is safe to play outside during the day’, and ‘there are good parks or playgrounds in neighbourhood’ were positively associated with children’s outdoor playtime. At 3.5 years, living in a free-standing house was associated with more children’s outdoor playtime. Conclusions: Children may benefit from living in a neighbourhood that supports active lifestyle. Improving social and physical environments in neighbourhoods could be an important strategy for improving young children’s physical activity.

Description: IJERPH, Vol. 14, Pages 910: Study on the Status of Health Service Utilization among Caregivers of Left-Behind Children in Poor Rural Areas of Hunan Province: A Baseline Survey International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14080910 Authors: Meimei Ji Yefu Zhang Jiaojiao Zou Tong Yuan Amber Tang Jing Deng Lina Yang Mingzhi Li Jihua Chen Hong Qin Qian Lin Background: The caregivers of left-behind children (CLBC) in China’s poor, rural areas are mostly elderly and women. Their health status and access to health services have not been previously characterized. This study aims to explore the status of CLBC in terms of their health service utilization and to provide a scientific basis for guiding effective implementation of health policy in rural Hunan. Methods: Random cluster sampling was used to survey CLBC in two rural counties. Face-to-face interviews and questionnaires were used to collect data, including socioeconomic status and health service utilization. The two-week prevalence rate was used to reflect health service needs, while the two-week visiting rate, annual hospitalization rate and participation in basic public health services were used to evaluate health service utilization. Results: Of the 518 respondents in the study, 95.9% were farmers and 88.4% were over 40 years old. The two-week prevalence rate was 36.1%. Furthermore, 40.1% of ill caregivers’ activities were partly restricted by illness and 3.7% needed to be on bed rest. The two-week visiting rate was 21.0%. The main reasons for not seeing a doctor were “self-medication” (39.1%) or “financial difficulties” (32.6%). The annual hospitalization rate of the CLBC was 22.6% and the non-hospitalization rate of those who needed hospitalization was 41.5%. “Lack of time” (22.3%) and “financial difficulties” (50.5%) were the major factors affecting the utilization of hospitalization services. In terms of participation in basic public health services, only 35.1% CLBC clearly knew that township hospitals have established health records for them. Only 50.6% of caregivers received free health examinations in village clinics or township hospitals and 81.3% of the caregivers did not participate in health education or lectures organized by local health institutions in 2014. Conclusions: The utilization rate of health services was extremely low, which may affect the quality of care for left-behind children. Better public health education through multi-sector cooperation is urgently needed to improve health cognition among CLBC in rural China.

Description: IJERPH, Vol. 14, Pages 918: Well-Being and the Social Environment of Work: A Systematic Review of Intervention Studies International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14080918 Authors: Kevin Daniels David Watson Cigdem Gedikli There is consistent evidence that a good social environment in the workplace is associated with employee well-being. However, there has been no specific review of interventions to improve well-being through improving social environments at work. We conducted a systematic review of such interventions, and also considered performance as an outcome. We found eight studies of interventions. Six studies were of interventions that were based on introducing shared social activities into workgroups. Six out of the six studies demonstrated improvements in well-being across the sample (five studies), or for an identifiable sub-group (one study). Four out of the five studies demonstrated improvements in social environments, and four out of the five studies demonstrated improvements in indicators of performance. Analysis of implementation factors indicated that the interventions based on shared activities require some external facilitation, favorable worker attitudes prior to the intervention, and several different components. We found two studies that focused on improving fairness perceptions in the workplace. There were no consistent effects of these interventions on well-being or performance. We conclude that there is some evidence that interventions that increase the frequency of shared activities between workers can improve worker well-being and performance. We offer suggestions for improving the evidence base.

Description: IJERPH, Vol. 14, Pages 920: Impact of Orientation on the Vitamin D Weighted Exposure of a Human in an Urban Environment International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14080920 Authors: Michael Schrempf Nadine Thuns Kezia Lange Gunther Seckmeyer The vitamin D3-weighted UV exposure of a human with vertical posture was calculated for urban locations to investigate the impact of orientation and obstructions on the exposure. Human exposure was calculated by using the 3D geometry of a human and integrating the radiance, i.e., the radiant energy from the direct solar beam and the diffuse sky radiation from different incident and azimuth angles. Obstructions of the sky are derived from hemispherical images, which are recorded by a digital camera with a fisheye lens. Due to the low reflectivity of most surfaces in the UV range, the radiance from obstructed sky regions was neglected. For spring equinox (21 March), the exposure of a human model with winter clothing in an environment where obstructions cover 40% of the sky varies by up to 25%, depending on the orientation of the human model to the sun. The calculation of the accumulated vitamin D3-weighted exposure of a human with winter clothing walking during lunch break shows that human exposure is reduced by the obstruction of buildings and vegetation by 40%.

Description: IJERPH, Vol. 14, Pages 925: Forecasting the Incidence of Mumps in Zibo City Based on a SARIMA Model International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14080925 Authors: Qinqin Xu Runzi Li Yafei Liu Cheng Luo Aiqiang Xu Fuzhong Xue Qing Xu Xiujun Li This study aimed to predict the incidence of mumps using a seasonal autoregressive integrated moving average (SARIMA) model, and provide theoretical evidence for early warning prevention and control in Zibo City, Shandong Province, China. Monthly mumps data from Zibo City gathered between 2005 and 2013 were used as a training set to construct a SARIMA model, and the monthly mumps in 2014 were defined as a test set for the model. From 2005 to 2014, a total of 8722 cases of mumps were reported in Zibo City; the male-to-female ratio of cases was 1.85:1, the age group of 1–20 years old accounted for 94.05% of all reported cases, and students made up the largest proportion (65.89%). The main serious endemic areas of mumps were located in Huantai County, Linzi District, and Boshan District of Zibo City. There were two epidemic peaks from April to July and from October to January in next year. The fitted model SARIMA (0, 1, 1) (0, 1, 1)12 was established (AIC = 157.528), which has high validity and reasonability. The SARIMA model fitted dynamic changes of mumps in Zibo City well. It can be used for short-term forecasting and early warning of mumps.

Description: IJERPH, Vol. 14, Pages 930: Cycle Tracks and Parking Environments in China: Learning from College Students at Peking University International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14080930 Authors: Changzheng Yuan Yangbo Sun Jun Lv Anne Lusk China has a historic system of wide cycle tracks, many of which are now encroached by cars, buses and bus stops. Even with these conditions, college students still bicycle. On campuses, students park their bikes on facilities ranging from kick-stand-plazas to caged sheds with racks, pumps and an attendant. In other countries, including Canada, some of the newer cycle tracks need to be wider to accommodate an increasing number of bicyclists. Other countries will also need to improve their bike parking, which includes garage-basement cages and two-tiered racks. China could provide lessons about cycle tracks and bike parking. This study applied the Maslow Transportation Level of Service (LOS) theory, i.e., for cycle tracks and bike parking, only after the basic needs of safety and security are met for both vehicle occupants and bicyclists can the higher needs of convenience and comfort be met. With random clustering, a self-administered questionnaire was collected from 410 students in six dormitory buildings at Peking University in Beijing and an environmental scan of bicycle parking conducted in school/office and living areas. Cycle tracks (1 = very safe/5 = very unsafe) shared with moving cars were most unsafe (mean = 4.6), followed by sharing with parked cars (4.1) or bus stop users (4.1) (p < 0.001). Close to half thought campus bike parking lacked order. The most suggested parking facilities were sheds, security (guard or camera), bicycle racks and bicycle parking services (pumps, etc.). If parking were improved, three quarters indicated they would bicycle more. While caged sheds were preferred, in living areas with 1597 parked bikes, caged sheds were only 74.4% occupied. For the future of China’s wide cycle tracks, perhaps a fence-separated bus lane beside a cycle track might be considered or, with China’s recent increase in bike riding, shared bikes and E-bikes, perhaps cars/buses could be banned from the wide cycle tracks. In other countries, a widened cycle track entrance should deter cars. Everywhere, bike parking sheds could be built and redesigned with painted lines to offer more space and order, similar to car parking.

Description: IJERPH, Vol. 14, Pages 932: Urinary Levels of 4-Nonylphenol and 4-t-Octylphenol in a Representative Sample of the Korean Adult Population International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14080932 Authors: Hyejin Park Kisok Kim 4-Nonylphenol (4-NP) and 4-t-octylphenol (4-t-OP) are xenoestrogen compounds to which humans are exposed via contaminated food, water, and air. This study assessed the body burden of 4-NP and 4-t-OP in Koreans aged 18–69 years using data from the Korean National Human Biomonitoring Survey conducted in 2009. Based on data from 1865 representative Koreans, 83.2% and 91.8% had urinary 4-NP and 4-t-OP concentrations >0.05 ng/mL (limit of detection). Of the Korean adult population, the geometric mean urinary concentrations of 4-NP and 4-t-OP were 3.70 ng/mL (95% confidence interval (CI) = 3.20–4.27) and 0.60 ng/mL (95% CI = 0.55–0.66), respectively. Urine 4-NP concentrations were significantly associated with place of residence and smoking status, whereas urine 4-t-OP concentrations were not correlated with any of the demographic factors. These findings suggest that most Koreans have detectable levels of 4-NP and 4-t-OP in their urine and that the body burden of 4-NP, but not 4-t-OP, varies according to some demographic factors.

Description: IJERPH, Vol. 14, Pages 935: Changes in Urinary Phthalate Metabolite Levels Before and After the Phthalate Contamination Event and Identification of Exposure Sources in a Cohort of Taiwanese Children International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14080935 Authors: Chian-Feng Huang I-Jen Wang In 2011, the Taiwan Food and Drug Administration inadvertently discovered that, for decades, manufacturers had replaced expensive natural emulsifiers in food products with diethylhexyl phthalate (DEHP). We wanted to compare urinary phthalate metabolite levels of children before and after the DEHP food contamination event and identify source(s) of phthalate exposure in addition to the illegal food additives. In the present study, morning urine samples were collected from a cohort of 453 children in 2010 in Taipei. After the DEHP food contamination event, there were 200 cohort children left at follow-up in 2013. The geometric means (GMs) of urinary mono(2-ethyl-5-hydroxyhexyl) phthalate (5OH-MEHP) levels before and after the event were 9.39 and 13.34 µg/g of creatinine, respectively, with no significant difference (p = 0.093). After the DEHP food contamination event, we found that urinary phthalate metabolite levels were significantly higher in people who frequently consumed microwave-heated food and used fragrance-containing products (p < 0.05). In addition, children who did not frequently wash hands before eating had significantly higher urinary phthalate metabolite levels than those who did (p < 0.05). These results demonstrate that urinary phthalate metabolite levels did not decrease after the DEHP food contamination event, thus, other sources must contribute to phthalate exposure in daily life. Public awareness of approaches to reducing phthalate exposure is necessary.