Topics A to Z

As part of NEHA's continuos effort to provide convenient access to information and resources, we have gathered together for you the links in this section. Our mission is "to advance the environmental health and protection professional for the purpose of providing a healthful environment for all,” as well as to educate and inform those outside the profession.


Adequate and appropriate water, sanitation, and hygiene (WaSH) infrastructure is important for reducing pathogen exposures in developing communities. To improve the ability of field practitioners in optimizing WaSH infrastructure within communities, models can provide insight into the complex interactions among WaSH infrastructure, health outcomes, and geographies. This study investigated the significant correlations between WaSH infrastructure variables and three different health outcomes (diarrhea, environmental enteric dysfunction, and stunting) over five geographic regions within Guatemala. Exploratory structural equation modeling was used to build WaSH models from U.S. Agency for International Development (USAID) 2012 Food for Peace Survey data (n = 2,103). The models were then tested using USAID 2013 Western Highlands Integrated Program survey data collected from the same regions (n = 4,633). Our results support that significant WaSH infrastructure variables vary widely over health outcome and geographic region. Improved sanitation had the highest prevalence of significance among all models. The floor transmission route for pathogens was identified as significant across all geographies for child stunting. Additionally, commonalities in potential pathogen transmission routes were identified among environmentally similar geographies. Practitioners and policy makers must account for the specific geography and health outcome to identify which set of WaSH infrastructure interventions are most appropriate at the correct scale.


July 2019
July/August 2019
82.1 | 20-28
Lee E. Voth-Gaeddert, MS, PhD, EIT, Missouri University of Science and Technology, Daniel B. Oerther, MS, PhD, PE, BCEE, CEng, FAAN, Missouri University of Science and Technology
Additional Topics A to Z: General Environmental Health


In Arizona, opioid-related deaths have increased by 74% since 2012. In addition, the reported number of opioid-related deaths, inpatient incidences, and emergency department incidences increased 310% from 2008–2016 among the American Indian/Alaska Native (AI/AN) service population within the Phoenix Area Indian Health Service (PAIHS). Using the Strategy to Combat Opioid Abuse, Misuse, and Overdose: A Framework Based on the Five Point Strategy as a template (U.S. Department of Health and Human Services, 2017), the Division of Environmental Health Services (DEHS) within PAIHS was able to identify several community-based actions to assist in addressing this crisis in the AI/AN communities it serves. These actions included improving opioid-related poisonings data, identifying methods to safeguard medication in the home environment, advocating for community-based prescription medication disposal programs, facilitating medical-assisted treatment training for tribal healthcare professionals, and identifying resources for naloxone to be used by tribal first responders. DEHS staff members worked collaboratively with federal, state, and tribal partners on the design, development, implementation, and evaluation of community-based activities to ensure they are effective and culturally appropriate.


June 2021
June 2021
83.10 | 22-25
CDR Robert Morones, MPH, RS/REHS, CPH, U.S. Public Health Service, Division of Environmental Health Services, Phoenix Area Indian Health Service, LT Andrea Tsatoke, MPH, RS/REHS, CPH, U.S. Public Health Service, Division of Environmental Health Services, Phoenix Area Indian Health Service, LCDR Isaac Ampadu, MEHS, RS/REHS, CPH, U.S. Public Health Service, Division of Environmental Health Services, Phoenix Area Indian Health Service, LCDR Martin Stephens, MPH, RS/REHS, CPH, U.S. Public Health Service, Division of Environmental Health Services, Phoenix Area Indian Health Service


The growth in the number of pools to more than 7.4 million in the U.S. has been accompanied by a rise in recreational water illnesses (RWIs). Effective pool management, though, can mitigate RWI risks. Inadequate management presumably occurs more frequently where training is less formalized and/or pool operation is a minor aspect of the job of the responsible pool manager(s). During summer 2018, weekly evaluations were performed at public venues in Louisville, Kentucky. Disinfectant levels and other items were monitored and compared with venue-specific (pool or spa) criteria. Among 1,312 venue surveys, 1,173 (89.4%) met criteria and 139 (10.6%) did not meet criteria. Overall, multivariable logistic regression showed a significant association between the likelihood of a venue meeting criteria and setting type. Specifically, hotels had 120% increased odds of not meeting criteria (adjusted odds ratio = 2.2; 95% confidence interval [1.3, 3.8]) compared with other settings. Despite spas having an 80% elevated odds of not meeting criteria compared with pools in a univariate analysis, upon adjusting for setting, spas were not associated with an increased risk of not meeting criteria. Research identifying reasons for these differences in meeting criteria between settings would be beneficial for informing public health interventions for aquatic environments.


July 2020
July/August 2020
83.1 | 18-24
Thomas Gerding, MPH, Department of Environmental Health Science, Eastern Kentucky University, Tim Wilder, RS, Department of Public Health and Wellness, City of Louisville, Jason W. Marion, MS, PhD, Department of Environmental Health Science, Eastern Kentucky University
Additional Topics A to Z: Recreational Waters


The widespread use of hydraulic fracturing (HF) has enabled a dramatic expansion of unconventional natural gas extraction in the U.S. While life cycle greenhouse gas (LC-GHG) emissions associated with HF have gained attention in recent years, little focus has been devoted to upstream LC-GHG impacts of HF natural gas (Clark, Burnham, Harto, & Horner, 2013; Verrastro, 2012). Focusing on 1,921 wells in Pennsylvania from 2012 to 2013, we used the Economic Input-Output Life Cycle Assessment model to assess LC-GHG emissions associated with production and transportation of chemicals and sand mining. Ton-miles from the transportation of sand and water were assessed with life cycle transportation emissions factors to generate LC-GHG emissions. LC-GHG emissions from upstream inputs assessed in this study equaled 1,374 tons of CO2e per well, but account for only 0.63% of the total LC-GHG emissions of HF natural gas. LC-GHG emissions from sand, water, and chemicals are quite small when compared with gas combustion, methane leakage, venting, and flaring from the other phases of the HF process.

November 2016
November 2016
79.4 | 8-15
Christopher Sibrizzi, MPH, Peter LaPuma, PhD, PE, CIH
Additional Topics A to Z: Hazardous Materials


The health burden and resultant economic burden of foodborne norovirus disease among school-age children in the U.S. is unknown but believed to be significant. The economic burden encompasses not only direct medical costs associated with medical care but also indirect costs such as loss of work days and direct nonmedical costs. National passive surveillance data from norovirus outbreaks spanning 2009–2013 were used to identify cases, health outcomes, interventions, and healthcare resource utilization among the school-age population. The cost of supportive care was $2,483,379, outpatient healthcare was $57,672, hospitalization was $48,670, and emergency care was $38,336. The cost of providing supportive care (direct nonmedical costs) was relatively low. When indirect costs were factored in, however, the total cost of care escalated, which illustrates the high burden of loss of productivity. It is important to incorporate the indirect and direct nonmedical costs of disease to more accurately characterize the total economic burden of a disease.

March 2018
March 2018
80.7 | 12-18
Margaret M. Venuto, MA, MPH, DrPH, University of Texas School of Public Health, San Antonio Regional Campus, Sharon P. Cooper, PhD, University of Texas School of Public Health, San Antonio Regional Campus, Hasanat Alamgir, PhD, University of Texas School of Public Health, San Antonio Regional Campus
Additional Topics A to Z: Children's Environmental Health


Entomological surveillance is an essential component for integrated vector management (IVM), the current best practice for West Nile virus (WNV) prevention and control. The significance of vector mosquito surveillance, however, is not always recognized by the public, which increases vulnerability of IVM programs to elimination or downsizing when virus activities are low, particularly during interepidemics of WNV. In order to increase public recognition, the unrecognized contribution of mosquito surveillance with gravid (egg-carrying) mosquito trapping to WNV vector control was estimated using a novel approach. This approach includes development of a quantitative model to estimate the number of female progeny from a gravid mosquito and application of the model with mosquito surveillance data to estimate the potential vector control effect of gravid mosquito trapping. Applying this approach, the potential WNV vector control effect of 2013 surveillance activities in Fort Worth, Texas, was estimated to almost 1,590,000 female mosquitoes by capturing 44,654 females. 

July 2016
July/August 2016
79.1 | 14-19
Joon-hak Lee, PhD, Brandon Bennett, MPA, Elmer DePaula, RS

This article characterizes the patterns of environmental health literature from 1993 to 2012 by using bibliometric techniques based on databases of the Science Citation Index and the Social Science Citation Index. “Research article” was the most widely used document type, accounting for 71.7% of the total records (5,053), and 94.9% of these articles were published in English. The number of environmental health publications is growing along with an increasing level of communication. The U.S. was the largest contributing country with the highest h-index (85) and the most publications (1,854), followed by the UK and Canada. Environmental Health Perspectives and the Journal of Environmental Health were the top two most productive journals. The most cited article in each main research area is also listed. The authors’ study not only identifies global characteristics in environmental health research, but also influences researchers’ selection of future studies and publications.

January 2016
January/February 2016
78.6 | 54-61
Guozhu Mao, Xi Liu, Huibin Du, Jian Zuo
Additional Topics A to Z: General Environmental Health

Article Abstract

Since 2000, resurgence in bed bugs has occurred in the U.S. Reports of infestations of homes, hospitals, hotels, and offices have been described. On September 1, 2011, complaints of itching and bites among workers in an office were reported to the Tennessee Department of Health. A retrospective cohort study and environmental assessments were performed in response to the complaints. Canines certified to detect live bed bugs were used to inspect the office and arthropod samples were collected. Of 76 office workers, 61 (80%) were interviewed; 39 (64%) met the case definition. Pruritic maculopapular lesions were consistent with arthropod bites. One collected arthropod sample was identified as a bed bug by three entomologists. Exposures associated with symptoms included working in a cubicle in which a canine identified bed bugs (risk ratio [RR]: 1.8; 95% confidence interval [CI]: 1.3–3.6), and self-reported seasonal allergies (RR: 1.6, 95% CI: 1.0–2.4). Bed bugs represent a reemerging and challenging environmental problem with clinical, psychological, and financial impacts.

April 2014
76.8 | 16-18
Jane A. Gwira Baumblatt, MD, John R. Dunn, DVM, PhD, William Schaffner, MD, Abelardo C. Moncayo, PhD
Additional Topics A to Z: Vectors and Pests


Though local health department performance of restaurant inspections plays an important role in preventing foodborne illness, restaurant inspection quality and uniformity often varies across local health department jurisdictions and among employees. In 2012, the Cincinnati Health Department initiated a food safety staff quality improvement initiative. This initiative, part of a Food and Drug Administration national training standards grant initiative, featured standardized training and food safety workforce practices, defined food safety program data collection standards, and refined reporting protocols. The aim of this article was to explore the relationship between the Ohio food safety code violations incurred and the risk classifications to which a Cincinnati food service operation belongs (ranked I–IV based upon potential threat to public safety). A random intercept model was selected to quantify the difference in odds between risk classification categories of incurring violations. Additionally, longitudinal data analysis tracked violation trends across the three years of the study. Main findings were 1) the odds of receiving a food safety violation increased with each year and 2) food establishments categorized as risk class IV had a higher odds of receiving a food safety violation compared with the other risk classifications.


January 2018
January/February 2018
80.6 | 14-18
Patrick Chang, MPH, Department of Biostatistics, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Haresh Rochani, DrPH, Department of Biostatistics, Jiann-Ping Hsu College of Public Health, Georgia Southern University, William A. Mase, DrPH, Department of Health Policy and Management, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Jeffery A. Jones, PhD, Department of Health Policy and Management, Jiann-Ping Hsu College of Public Health, Georgia Southern University