Beyond the Bench: Tox-in-a-Box

At the New Mexico Center for Environmental Health Sciences (NMCEHS), community concerns and relationships are as much at the center’s foundation as the latest research techniques. According to center director Scott Burchiel, the unique populations of New Mexico—including a high number of Hispanics and Native American tribes, pueblos, and sovereign nations—steer the center’s course. “One of the things we have tried to do is to determine what these populations’ concerns are for environmental health, because we want our center to be focused on environmental public health, and we want to work on basic research projects that address issues that people in this region are particularly interested in,” he says. Based in Albuquerque as a partnership of The University of New Mexico Health Sciences Center and the Lovelace Respiratory Research Institute (LRRI), the NIEHS-funded center comprises major research cores in environmental cancer and oxidative stress, cardiovascular toxicology, environmental lung disease, and population health and epidemiology. The center also includes world-class facility cores (particularly for inhalation toxicology), a pilot project program to provide funding for small innovative research studies, and an unusually strong community outreach and education program (COEP). Community input is essential, as is trust. “We have investigators who may have certain interests for certain kinds of projects and want to work with communities,” says Burchiel. “But when we go to the community, we find out that [the community has] a different agenda, different interests. We’ve been learning how to work with communities since we’ve had this environmental health center.” It’s a process that involves a lot of development of community relationships and trust relationships. Burchiel says that investigating environmental health problems such as asthma requires a broad definition of environment. He says, “In our center, we define the environment quite broadly. It includes nutritional, social, behavioral, economic, and built environment components. . . . We have not only environmental epidemiologists [but] also social epidemiologists who help us look at social factors in assessing economic and poverty factors.”

Background:Environmental health (EH) professionals, one of the largest segments of the public health workforce, are responsible for delivery of essential environmental public health services. The challenges facing these professionals and research needs to improve EH practice are not fully understood, but 26% of EH professionals working in health departments of the United States plan to retire in 5 y, while only 6% of public health students are currently pursuing EH concentrations.Objectives:A groundbreaking initiative was recently launched to understand EH practice in health departments of the United States. This commentary article aims to identify priority EH practice challenges and related research needs for health departments.Methods:A horizon scanning approach was conducted in which challenges facing EH professionals were provided by 1,736 respondents working at health departments who responded to a web-based survey fielded in November 2017. Thematic analyses of the responses and determining the frequency at which respondents reported specific issues and opportunities identified primary EH topic areas. These topic areas and related issues informed focus group discussions at an in-person workshop held in Anaheim, California. The purpose of the in-person workshop was to engage each of the topic areas and issues, through facilitated focus groups, leading to the formation of four to five related problem statements for each EH topic.Discussion:EH professionals are strategically positioned to diagnose, intervene, and prevent public health threats. Focus group engagement resulted in 29 priority problem statements partitioned among 6 EH topic areas: a) drinking water quality, b) wastewater management, c) healthy homes, d) food safety, e) vectors and public health pests, and f) emerging issues. This commentary article identifies priority challenges and related research needs to catalyze effective delivery of essential environmental public health services for common EH program areas in health departments. An unprecedented initiative to revitalize EH practice with timely and strategic recommendations for student and professional training, nontraditional partnerships, and basic and translational research activities is recommended. https://doi.org/10.1289/EHP5161

Vol. 113, No. 1 EnvironewsOpen AccessBeyond the Bench: Building Blocks of Learningis corrected byErrata Amy Fitzgerald Amy Fitzgerald Search for more papers by this author Published:1 January 2005https://doi.org/10.1289/ehp.113-a33Cited by:2AboutSectionsPDF ToolsDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InReddit Playing with blocks has long been a favorite pastime of children and one that parents often encourage as a means of developing reasoning, spatial acuity, and other skills. A program developed by the Community Outreach and Education Program (COEP) of the Massachusetts Institute of Technology (MIT) Center for Environmental Health Studies turns this childhood pastime into an effective method for teaching students about DNA and cellular processes by building models out of LEGO blocks.Now a commercial product, the LEGO Life Science kits contain different-colored blocks representing the basic structural elements of DNA. So far, the kit series includes models of DNA, chromosomes, and photosynthesis. The kits were developed by Lexington public school teacher Kathleen Vandiver to bring the form and function of the double helix alive for middle-school students. Vandiver later joined the staff of the MIT COEP and has worked with the program to design a learning activity for students based on the kits called “The Shape of Life: From Helix to Chromosome.”The activity begins with students identifying LEGOs that represent molecules of sugar, phosphates, and nucleotide bases. Using these pieces, they construct their own twisting model of the DNA ladder, with careful attention to base pairing. A brief overview of DNA replication follows, using the LEGO DNA structure as a simulation aid. Students then have individual exploration time to answer questions and investigate variations of their DNA model. Teachers may also add a mutation lesson.Next, the students learn how DNA’s complex sequence is replicated prior to mitosis, and the lesson scales up to the LEGO Chromosomes kit to model the process of mitosis. The activity concludes with the study of structural components of chromosomes, including a discussion of genes and traits. With the Chromosomes kit, students can build a LEGO fish as a model to demonstrate how genes can be expressed in a living creature. The fish has only 3 chromosome pairs, rather than a human’s 23 pairs, so it’s easier to understand the relationship between genes and traits. Chromosomes, cell membranes, and spindle fibers are modeled in LEGOs as the students move through the stages of interphase, prophase, metaphase, anaphase, and telophase.The kits can be used to teach many levels of students. Although originally designed for middle schoolers, they can be reassembled into a more advanced version for use at the college level. Several introductory biology classes at MIT have used the sets. Says Vandiver, “It is important to realize that many people need to be taught the basics in order to understand the issues in environmental health.” And what could be more basic—or fun—than playing with blocks?The LEGO Life Science kits are available for purchase at http://www.legoeducationstore.com/.Constructive thinking. COEP researcher Luke Higgins (second from left) helps students build a DNA double helix from LEGOs.FiguresReferencesRelatedDetailsCited by Weaver H (2010) Native Americans and Cancer Risks: Moving Toward Multifaceted Solutions, Social Work in Public Health, 10.1080/19371910903240621, 25:3-4, (272-285), Online publication date: 28-Apr-2010. Petersen M, Halling J, Damkier P, Nielsen F, Grandjean P, Weihe P and Brøsen K (2006) Caffeine N3-demethylation (CYP1A2) in a population with an increased exposure to polychlorinated biphenyls, European Journal of Clinical Pharmacology, 10.1007/s00228-006-0205-0, 62:12, (1041-1048), Online publication date: 17-Nov-2006. Related articlesErrata1 April 2005Environmental Health Perspectives Vol. 113, No. 1 January 2005Metrics About Article Metrics Publication History Originally published1 January 2005Published in print1 January 2005 Financial disclosuresPDF download License information EHP is an open-access journal published with support from the National Institute of Environmental Health Sciences, National Institutes of Health. All content is public domain unless otherwise noted. Note to readers with disabilities EHP strives to ensure that all journal content is accessible to all readers. However, some figures and Supplemental Material published in EHP articles may not conform to 508 standards due to the complexity of the information being presented. If you need assistance accessing journal content, please contact [email protected]. Our staff will work with you to assess and meet your accessibility needs within 3 working days.

Injury prevention: A strategic priority for environmental health?

Environmental quality has a profound effect on health and the burden of disease. In the United States, the environment-related burden of disease is increasingly dominated by chronic diseases. At the local level, public health practitioners realize that many policy decisions affecting environmental quality and health transcend the authorities of traditional health department programs. Healthy decisions about the built environment, including housing, transportation, and energy, require broad collaborative efforts. Environmental health professionals have an opportunity to address the shift in public health burden toward chronic diseases and play an important role in the design of healthy communities by bringing data and tools to decision makers. This article provides a guide for community leaders to consider the public health effects of decisions about the built environment. We present a conceptual framework that represents a shift from compartmentalized solutions toward an inclusive systems approach that encourages partnership across disciplines and sectors. We discuss practical tools to assist with environmental decision making, such as Health Impact Assessments, environmental public health tracking, and cumulative risk assessment. We also identify priorities in research, practice, and education to advance the role of public health in decision making to improve health, such as the Health Impact Assessment, as a core competency for environmental health practitioners. We encourage cross-disciplinary communication, research, and education that bring the fields of planning, transportation, and energy in closer collaboration with public health to jointly advance the systems approach to today's environmental challenges.

ObjectiveTo increase the availability and accessibility of standardized environmental health data for public health surveillance and decision-making.IntroductionIn 2002, the United States (US) Centers for Disease Control and Prevention (CDC) launched the National Environmental Public Health Tracking Program (Tracking Program) to address the challenges in environmental health surveillance described by the Pew Environmental Commission (1). The report cited gaps in our understanding of how the environment affects our health and attributed these gaps to a dearth of surveillance data for environmental hazards, human exposures, and health effects. The Tracking Program’s mission is to provide information from a nationwide network of integrated health and environmental data that drives actions to improve the health of communities. Accomplishing this mission requires a range of expertise from environmental health scientists to programmers to communicators employing the best practices and latest technical advances of their disciplines. Critical to this mission, the Tracking Program must identify and prioritize what data are needed, address any gaps found, and integrate the data into the network for ongoing surveillance.MethodsThe Tracking Program identifies important environmental health topics with data challenges based on the recommendations in the Pew Commission report as well as input from federal, state, territorial, tribal, and local partners. For each topic, the first step is to formulate the key surveillance question, which includes identifying the decision-maker or end user. Next, available data are evaluated to determine if the data can answer the question and, if not, what enhancements or new data are needed. Standards are developed to establish data requirements and to ensure consistency and comparability. Standardized data are then integrated into the network at national, state, and local levels. Standardized measures are calculated to translate the data into the information needed. These measures are then publically disseminated via national, state, and local web-based portals. Data are updated annually or as they are available and new data are added regularly. All data undergo a multi-step validation process that is semi-automated, routinized, and reproducible.ResultsThe first set of nationally consistent data and measures (NCDM) was released in 2008 and covered 8 environmental health topics. Since then the NCDM have grown to cover 14 topics. Additional standardized data and measures are integrated into the national network resulting in 23 topics with standardized 450 measures (Figure). On the national network, measures can be queried via the Data Explorer, viewed in the info-by-location application, or connected to via the network’s Application Program Interface (API). On average, 15,000 and 3300 queries are run every month on the Data Explorer and the API respectfully. Additional locally relevant data are available on state and local tracking networks.Gaps in data have been addressed through standards for new data collections, models to extend available data, new methodologies for using existing data, and expansion of the utility of non-traditional public health data. For example, the program has collaborated with the Environmental Protection Agency to develop daily estimates of fine particulate matter and ozone for every county in the conterminous US and to develop the first national database of standardized radon testing data. The program also collaborated with the National Aeronautics and Space Administration and its academic partners to transform satellite data into data products for public health.The Tracking Program has analyzed the data to address important gaps in our understanding of the relationship between negative health outcomes and environmental hazards. Data have been used in epidemiologic studies to better quantify the association between fine particulate matter, ozone, wildfire smoke, and extreme heat on emergency department visits and hospitalizations. Results are translated into measures of health burden for public dissemination and can be used to inform regulatory standards and public health interventions.ConclusionsThe scope of the Tracking Program’s mission and the volume of data within the network requires the program to merge traditional public health expertise and practices with current technical and scientific advances. Data integrated into the network can be used to (1) describe temporal and spatial trends in health outcomes and potential environmental exposures, (2) identify populations most affected, (3) generate hypotheses about associations between health and environmental exposures, and (4) develop, guide, and assess the environmental public health policies and interventions aimed at reducing or eliminating health outcomes associated with environmental factors. The program continues to expand the data within the network and the applications deployed for others to access the data. Current data challenges include the need for more temporally and spatially resolved data to better understand the complex relationships between environmental hazards, health outcomes, and risk factors at a local level. National standards are in development for systematically generating, analyzing, and disseminating small area data and real-time data that will allow for comparisons between different datasets over geography and time.

An innovative course for teaching communication and interpersonal relationships was delivered to 29 environmental and occupational health professionals. This course aimed to highlight interpersonal and emotional aspects in the professional-client interaction and incumbent communication aspects when consulting team members, colleagues, and nonprofessionals in the occupational arena. Various experiential and other teaching techniques were used. Assessment showed that participants reported the positive features of such a course although few changes in either psychosocial abilities or awareness were evident. Possible ramifications of the findings are discussed.

This essay poses a novel integrative environmental health promotion (EHP) framework inclusive of spiritual tenets to increase interdisciplinary science as well as public engagement for improved people, place, and planetary (3P) health outcomes. Environmental public health professionals have typically relied upon quantitative scientific evidence related to negative human health outcomes from toxic exposures. Environmental health lags behind more progressive mixed-methods research frameworks leveraging health promotion and 3P health initiatives. This essay argues for a novel integrative EHP framework to encourage more mixed-methods research based on merging an integrative health (body-mind-spirit) perspective and the public health ecological model. Using a three-dimensional Cartesian Coordinate System, the author developed a visual integrative EHP framework with the future ability to record, interpret, and report data with units of measure in three dimensions rather than the traditional x- and y-axis variable relationships. The long-term goal is to engage researchers, study participants, and the general public in exploring new 3P health research and outcomes inclusive of the spiritual axis to leverage more scientific evidence for the care and nurturing of our common home as a basic tenet of civil society.

NIEHS Supports Partnerships in Environmental Public Health Linda S. Birnbaum, PhD I would like to start by thanking the journal for inviting me to write an editorial to accompany Dr. Juliana van Olphen and her colleagues’ thoughtful evaluation that focuses on the important topic of community health partnerships.1 As the new director of the National Institute of Environmental Health Sciences (NIEHS) and the National Toxicology Program, I am pleased to take on this role during a time when both the environment and health are top priorities for our country. I am a big supporter of community-based participatory research (CBPR) that ensures community members have an active role in planning, implementing, translating and disseminating research that addresses local environmental health concerns. NIEHS has been a long-standing leader in fostering partnerships between community groups and researchers to better understand environmental causes of disease. Our commitment is demonstrated in a number of ways. For example, NIEHS, in cooperation with the National Cancer Institute, requires that a Community Outreach and Translation Core (COTC) is established in each of our four Breast Cancer and the Environment Research Centers—one of which was the subject of Dr. van Olphen’s independent analysis published in this issue. COTCs conduct essential work to ensure that the views and concerns of the breast cancer advocacy community are heard and that the research findings are disseminated to the public. Developing educational materials for children and adults about breast cancer and the environment, holding public awareness forums and town meetings, and exploring areas of concern or interest to the community are all essential activities led by the COTC to create community participation in environmental health issues such as breast cancer. What van Olphen’s article demonstrates is that COTCs can further advance and promote CBPR principles within research-intensive Centers. NIEHS grantees employing CBPR approaches are contributing to our understanding about breast cancer and the environment. There is a growing body of literature showing that early-life exposures to endocrine disruptors—particularly during gestation and childhood, but also continuing through puberty, first childbirth, and breastfeeding—are critical to later-life breast cancer risk. As researchers learn more about what causes and how to prevent breast cancer, grantees such as those we support through our environmental justice program are spreading the word and empowering communities to take action. Breast cancer advocates in two communities that differ in racial/ethnic and economic character are working in partnership with researchers to assess household exposures to endocrine disrupting compounds, and to develop communication tools for reporting results to affected individuals and communities.2 These research findings are being used by community groups and advocates to affect public health and lead to policy changes. Congress recently recognized the contributions of NIEHS and the National Institutes of Health as a whole for their outstanding work in the breast cancer and environment area, when it passed the “Breast Cancer and Environment Research Act of 2008.”3 The Act looks to NIH to take a lead role in defining the future research agenda for collaborative research efforts related to breast cancer and the environment. NIEHS’ leadership role in translating research on breast cancer and the environment is the outgrowth of the Institute’s commitment to CBPR approaches that promote having the community actively involved in shaping and conducting research and intervention strategies. Since 1995, through its CBPR activities, the Institute has supported principles that have been developed and shared by leaders in the field such as those developed by Barbara Israel et al. 4 and Lawrence Green et al.5 Principles that call for building on the strengths and resources within the community; focusing on the local relevance of public health problems; and disseminating results to all partners are endorsed by NIEHS and are evident in work supported by NIEHS. Recognizing the [End Page 195] continuum of CBPR, the Institute promotes these principles throughout a variety of programs from traditional outreach and education efforts to more complex biomedical, hypothesis-driven research questions that address environmental justice and health disparities issues. To build upon our past accomplishments and to progress our research agenda in this area, we recently sought input from research grantees and members of advocacy...

Introduction:Environmental health (EH) services have a long history in Ethiopia, but data on environmental health services quality and the magnitude of environmental health professionals’ engagement has never been addressed. This study was conducted to assess the quality of environmental health services in different sectors and professionals’ level of engagement in Eastern Ethiopia.Methods:Institution based cross-sectional mixed study design was implemented. A cluster sampling technique was employed to select 83 participants. Data were collected using a pretested questionnaire and an interview guide. Descriptive, bivariate, multivariate, and thematic analysis was carried out.Results:Professionals’ performance in most services were reported to be average or low. Only 19.5% of participants responded as having good satisfaction in their job. The multiple logistic regression analysis showed factors associated with selected environmental health services. The odds of identifying environmental problems was associated with profession (adjusted odds ratio (AOR): 4.1; 95% confidence interval (CI): 1.3-7.6) and level of education (AOR: 3.1; 95%CI: 0.9-5.9). The factors contributing to introducing innovative solutions to EH problems were type of institution (AOR: 3.1, 95%CI = 1.6-9.3), profession (AOR: 3.4, 95%CI = 1.1-12.2), and level of support and emphasis offered (OR: 5.6, 95% CI = 2.2-11.9). Level of job satisfaction was also associated with the above-mentioned independent variables.Conclusion:The current study showed low level of professionals’ engagement and factors associated with the quality of environmental health services in different sectors. Therefore, Ethiopian Federal Ministry of Health and other concerned ministries, agencies, and authorities should intervene accordingly to improve the service and level of professionals’ engagement.

Moving from awareness to action on preventing patient exposure to toxic environmental chemicals

Over the past three years (2006–2008), the medical/health and public health communities have shown a growing interest in using online 3D virtual worlds like Second Life® (http://secondlife.com/) for health education, community outreach, training and simulations purposes. 3D virtual worlds are seen as the precursors of ‘Web 3D’, the next major iteration of the Internet that will follow in the coming years. This paper provides a tour of several flagship Web 3D experiences in Second Life®, including Play2Train Islands (emergency preparedness training), the US Centers for Disease Control and Prevention—CDC Island (public health), Karuna Island (AIDS support and information), Tox Town at Virtual NLM Island (US National Library of Medicine - environmental health), and Jefferson’s Occupational Therapy Center. We also discuss the potential and future of Web 3D. These are still early days of 3D virtual worlds, and there are still many more untapped potentials and affordances of 3D virtual worlds that are yet to be explored, as the technology matures further and improves over the coming months and years.

Jenny Pronczuk de Garbino: A Global Champion for Children’s Health

The COVID-19 pandemic has highlighted how society is naturally reactive to issues that could have been prevented or minimized in hindsight. Environmental public health professionals (EPHPs) take a proactive approach to health and safety to prevent the occurrence of adverse events that can negatively impact the health of individuals. The Canadian healthcare system largely invests in hospitals and acute care compared to public health. EPHPs have been actively mobilized to assist with the pandemic response and have demonstrated their versatility in skillset—EPHPs have performed a variety of activities, such as enforcement action, education, and contact tracing. Despite EPHPs proving to be a valuable resource during the pandemic, there remains a sense of under-recognition and underappreciation for the work being done. Indeed, the nature of public health work relies on efforts occurring behind-the-scenes—trends over time will reveal the outcomes of health initiatives. Although it is challenging to obtain timely health evidence to justify investment into public health, a continued passive approach to prevention will be harmful to society. Greater acknowledgement and investment of resources into the health protection field can help establish a proactive attitude to thereby lessen the economic and health burdens our communities may face in the future.

Francis Collins, director of the National Human Genome Research Institute (NHGRI), picked up a guitar and sang to close out the Seattle community genetics forum. To the tune of the 1961 rock-and-roll song “Runaway” and enthusiastic audience response, he imagined the thoughts of a person in 2015 upon seeing their personal genomic data for the first time: “As I walk the bases/in all three billion places/I wonder/am I built for strong endurance or loss of health insurance?” Ethical, legal, and social issues were a primary focus of the 21 May 2005 community forum, held at the University of Washington (UW). “This is a historic time for our species,” said Collins during his keynote address. “We have, for the first time, the ability to read our own instruction book. We have the responsibility to do so in ways that don’t injure people.” About 300 students, teachers, and community members attended the event, which was organized by the UW Center for Genomics and Health Care Equality (with funding from NHGRI) and the UW Center for Ecogenetics and Environmental Health (with funding from the NIEHS). The centers were assisted by an advisory committee of UW genomics experts. Advances in genomic science—such as genetic testing to determine optimal medication dosing—are making “personalized medicine” a reality, said Collins. At the same time, the increasing ability to collect genetic information about individuals raises concerns about how that knowledge may be used, perhaps by potential employers. Collins also raised larger issues: “Will knowledge of human variations reduce prejudice or increase it? Will we succumb to genetic determinism, neglecting the role of the environment and undervaluing the human spirit?” High school students at the forum included winners from the 18 March 2005 Student Biotech Expo, sponsored by the nonprofit Washington Biotechnology and Biomedical Foundation. Several students reprised prize-winning performances. A rap called “Doggin’ Genes,” written and performed by Heather Earp and Hana Fallisgaard of Shorecrest High School, described the sequencing the dog genome. A two-person play about genetic testing, written and performed by Maya Sugarman and Rhiannon Bronstein of Garfield High School, explored the quandaries of undergoing genetic testing for a disease for which there is no cure. Staff from throughout NHGRI attended the forum to hear community concerns and take them back to institute programs, said Vence Bonham, chief of the NHGRI Education and Community Involvement Branch. Forum presentations and breakout sessions focused on topics including medical uses of genetic information, racial profiling and DNA evidence, behavior and genetics, and genetic discrimination related to employment and insurability. Panel discussions covered a wide range of additional topics including the cost and availability of genomic medicine. “Most Native American people don’t have access to available treatments that could make them better,” said speaker Ralph Forquera, executive director of the Seattle Indian Health Board. Until access to basic care is improved, he said, advances such as genome-based personalized medicine are “fluff,” and will benefit only affluent people. Makani Themba-Nixon, executive director of the nonprofit Praxis Project, wondered if an overemphasis on genomic research could obscure the importance of sociopolitical considerations such as links between environmental pollutants and health. Collins said that large-scale studies that include data on environmental exposures as well as genetics are needed to better understand genetic effects on health. “It would be expensive,” he said. “It would have to be a political priority.” Speakers and meeting participants also discussed the need for better understanding of genomic science among community members and health care providers. Sharon Terry, president of the nonprofit Genetic Alliance, commented that, until her sons were diagnosed with a genetic disorder, she “didn’t know a gene from a hubcap.” Added Forquera, “We need to find a way to make genomic information interesting, engaging, and accessible.” Presenters gave several examples of effective nonlecture formats for conveying genomic information, including the use of individual case studies in discussing genetic testing. Elaine Armstrong, a high school teacher from Battle Ground, Washington, said case studies are useful in the classroom, because they grab the students’ attention. “I was pleased to talk with such a diverse range of participants representing many different communities,” said Collins after the meeting. “What I am most excited about is to see what happens next, and to find ways to continue to actively engage members of the public in this dialogue.”