Building Environmental Health and Genomics Literacy among Healthcare Providers Serving Vulnerable Communities: An Innovative Educational Framework

This study addresses healthcare providers’ knowledge deficits in environmental health and genetics, and primarily focuses on student nurses and nurses serving marginalized, low-income communities frequently exposed to environmental toxicants. Our approach to improve public health is unique, combining hands-on modeling exercises with case-based lessons in addition to three targeted 40 min lectures on toxicology. These lectures included the team’s community-based environmental health research among Indigenous peoples of the U.S. The hands-on approach employed DNA and protein molecular models designed to demonstrate normal and dysfunctional molecules, as well as genetic variants in world populations. The models provided learners with visuals and an experience of “learning by doing.” Increased awareness of the effects of environmental toxicants is the first step toward improving health care for exposed communities. We measured knowledge gains by pre- and post-tests among student nurses and nurses serving Native Americans living both in urban and rural areas of the U.S. (n = 116). The modeling lessons illustrated genetic variants in liver proteins common in Native peoples and their resulting health vulnerabilities. Participants were engaged and enthusiastic; and pre- and post-test results reported substantial knowledge gains and a greater understanding of genetic susceptibility (p < 0.0001). Our study demonstrates the utility of this framework across diverse populations and remote communities.

Co-creating a local environmental epidemiology study: the case of citizen science for investigating air pollution and related health risks in Barcelona, Spain

Background While the health risks of air pollution attract considerable attention, both scholarly and within the general population, citizens are rarely involved in environmental health research, beyond participating as data subjects. Co-created citizen science is an approach that fosters collaboration between scientists and lay people to engage the latter in all phases of research. Currently, this approach is rare in environmental epidemiology and when co-creation processes do take place, they are often not documented. This paper describes the first stages of an ongoing co-created citizen science epidemiological project in Barcelona (Spain), that included identifying topics that citizens wish to investigate as regards air pollution and health, formulating their concerns into research questions and co-designing the study protocol. This paper also reflects key trade-offs between scientific rigor and public engagement and provides suggestions to consider when applying citizen science to environmental health studies. Methods Experts created an online survey and analyzed responses with descriptive statistics and qualitative coding. A pop-up intervention was held to discuss with citizens their concerns about air pollution and health. Later on, a community meeting was organized to narrow down the research topics and list potential research questions. In an online survey, citizens were asked to vote for the research question they would like to investigate with the experts. A workshop was held to choose a study design in which citizens would like to partake to answer their preferred research question. Results According to 488 respondents from the first survey, cognitive and mental health were the main priorities of investigation. Based on the second survey, with 27% of the votes from 556 citizens, the most popular research question was, “How does air pollution together with noise and green/blue spaces affect mental health?”. The study design selected was an observational study in which citizens provide daily repeated measures of different cognitive and mental health outcomes and relate them to the air pollution concentrations. Conclusions Based on the co-creation activities and the results obtained, we conclude that applying citizen science in an environmental health project is valuable for researchers despite some challenges such as engaging citizens and maximizing representativity.

The Future of Food to Tackle Climate and Health – Reflections from COP26

A shift in how we obtain protein from our diets, away from intensive farming and fishing, towards cleaner sources, be they animal or plant-based, will form an essential part of the solution to achieving the pledges formalised following COP26. This can be achieved through many different approaches including reduction, substitution, reducing the frequency of consumption, blending into hybrid products, and without the necessity of a complete eschewal of animal-based products. The new paradigm of ‘planetary health’, which focuses on the interdependence of human health, animal health and environmental health, will greatly facilitate meeting the ambitious and near-term targets set. This commentary discusses these issues in depth, with a focus on solutions to promote both planetary and human health in unison.

Towards a paradigm shift in environmental health decision-making: a case study of oxybenzone

Background Technological advancements make lives safer and more convenient. Unfortunately, many of these advances come with costs to susceptible individuals and public health, the environment, and other species and ecosystems. Synthetic chemicals in consumer products represent a quintessential example of the complexity of both the benefits and burdens of modern living. How we navigate this complexity is a matter of a society’s values and corresponding principles. Objectives We aimed to develop a series of ethical principles to guide decision-making within the landscape of environmental health, and then apply these principles to a specific environmental chemical, oxybenzone. Oxybenzone is a widely used ultraviolet (UV) filter added to personal care products and other consumer goods to prevent UV damage, but potentially poses harm to humans, wildlife, and ecosystems. It provides an excellent example of a chemical that is widely used for the alleged purpose of protecting human health and product safety, but with costs to human health and the environment that are often ignored by stakeholders. Discussion We propose six ethical principles to guide environmental health decision-making: principles of sustainability, beneficence, non-maleficence, justice, community, and precautionary substitution. We apply these principles to the case of oxybenzone to demonstrate the complex but imperative decision-making required if we are to address the limits of the biosphere’s regenerative rates. We conclude that both ethical and practical considerations should be included in decisions about the commercial, pervasive application of synthetic compounds and that the current flawed practice of cost-benefit analysis be recognized for what it is: a technocratic approach to support corporate interests.

A qualitative study of barriers and facilitators to adequate environmental health conditions and infection control for healthcare workers in Malawi

The burden of healthcare-associated infections (HAIs) is greater in low- and middle-income countries than in high-income countries. Inadequate environmental health (EH) conditions and work systems contribute to HAIs in countries like Malawi. We collected qualitative data from 48 semi-structured interviews with healthcare workers (HCWs) from 45 healthcare facilities (HCFs) across Malawi and conducted a thematic analysis. The facilitators of infection prevention and control (IPC) practices in HCFs included disinfection practices, patient education, and waste management procedures. HCWs reported barriers such as lack of IPC training, bottlenecks in maintenance and repair, hand hygiene infrastructure, water provision, and personal protective equipment. This is one of the most comprehensive assessments to date of IPC practices and environmental conditions in Malawian HCFs in relation to HCWs. A comprehensive understanding of barriers and facilitators to IPC practices will help decision-makers craft better interventions and policies to support HCWs to protect themselves and their patients.

Profile of Environmental Chemicals in the Korean Population—Results of the Korean National Environmental Health Survey (KoNEHS) Cycle 3, 2015–2017

The Korean National Environmental Health Survey (KoNEHS) program provides useful information on chemical exposure, serves as the basis for environmental health policies, and suggests appropriate measures to protect public health. Initiated on a three-year cycle in 2009, it reports the concentrations of major environmental chemicals among the representative Korean population. KoNEHS Cycle 3 introduced children and adolescents into the analysis, where the blood and urine samples of 6167 participants were measured for major metals, phthalates, phenolics, and other organic compounds. Lead, mercury, cadmium, metabolites of DEHP and DnBP, and 3-phenoxybenzoic acid levels of the Korean adult population tended to decrease compared to previous survey cycles but remained higher than those observed in the US or Canada. Both bisphenol A (BPA) and trans,trans-muconic acid concentrations have increased over time. Heavy metal concentrations (blood lead, and cadmium) in children and adolescents were approximately half that of adults, while some organic substances (e.g., phthalates and BPA) were high. BPA showed higher levels than in the US or Canada, whereas BPF and BPS showed lower detection rates in this cycle; however, as these are increasingly used as a substitute for BPA, further research is necessary. As environmental chemicals may affect childhood health and development, additional analyses should assess exposure sources and routes through continuous observations.