Graduate proficiency assessment using a competency-based learning model.

OBJECTIVE: The goal of this study was to evaluate and compare occupational health and safety graduates' perceptions of the value of and their proficiency in 29 educational competencies. METHODS: A survey was mailed to 159 students graduating between 1992 and 2005. RESULTS: Ninety-eight graduates (62% response) ranked all 29 competencies as valuable or very valuable. Graduates reported high proficiency in the competencies they most highly valued. The greatest discrepancy between value and proficiency occurred in competencies related to managing resources, programs, and personnel. Results were similar to those of a 2001 survey. Competencies identified by occupational health and safety professionals in 49 countries were very similar to those included in our set. CONCLUSIONS: We made changes in the curriculum to address graduates' reports of low proficiency in resource, program, and personnel management.

Small business owners' opinions about written health and safety information.

Owners of small manufacturing businesses from twelve industrial sectors (n=40) participated in focus groups. They most frequently read trade and local business publications; few regularly read or receive health and safety materials. They select business-related materials that are specific to their business, give them new ideas, or have information that is easy to use. Insurance companies and business associations are the most frequently mentioned sources of health and safety information. The most important aspects of a prototype newsletter are sponsorship, color and graphics, length and relevance. Most are positive about a university logo, because it indicates a trusted source. The front page should have a table of contents with short descriptions of articles and catchy headlines. A newsletter should take no more than ten minutes to read. Owners did not like articles that were written in first person, used quotes, were too personal or gave no solutions. Owners think a newsletter will be successful if it is targeted to their industry, shows costs, includes case studies about local businesses, isn't too academic, focuses on a different topic with each issue, and gives readers an opportunity to provide feedback.

Asthma, atopy, and lung function among racially diverse, poor inner-urban Minneapolis schoolchildren.

As part of an assessment of schoolchildren's environmental exposures and health, a probability sample of 136 children from diverse racial/ethnic backgrounds was drawn from grades 2-5 of two inner-urban Minneapolis schools (Whittier, Lyndale). Questionnaires were administered to a parent/guardian; blood samples for IgE and lung function tests were obtained. Overall adjusted rates for lifetime asthma (15.4%; 95%CI 9.3-21.5%), asthma in the last 12 months (13.6%; 7.8-19.4%), and current asthma medication use (10.5%; 5.3-15.7%) were higher than reported US national rates. Adjusted rates for lifetime physician-diagnosed asthma differed significantly among racial/ethnic groups (P<0.01): African-Americans (25.9%), White/Others (25.8%), Hispanics (9.3%), Somalis (1.8%), Asians (0%). Corresponding rates for atopy (total IgE>100 IU/mL or an allergen-specific IgE>0.35 IU/mL) were: African-Americans (66.6%), White/Others (100%), Hispanics (77.2%), Somalis (78.1%), Asians (81.8%). Lung function (FEV1, FVC) was analyzed by linear regression using log-transformed data: significant race-specific differences in lung function were found relative to White/Others (P<0.001 for each racial/ethnic group): African-Americans (FEV1 -16.5%, FVC -16.9%), Somalis (-22.7%, -26.8%), Hispanics (-12.2%, -11.4%) and Asians (-11.1%, -12.4%). Females had significantly lower FEV1 (-8.8%) and FVC (-11.0%) than males. An unexplained, significant difference in children's lung function was found between the two schools. A history of physician-diagnosed asthma was not associated with decreased lung function. Factors other than poverty, inner-urban living, and IgE levels (atopy) need to be considered in the development of childhood asthma.

Competencies most valued by employers--Implications for master's-prepared occupational health nurses.

Educational institutions seek to prepare students to compete for positions in the workplace with a competency-based education. Employers are important stakeholders in the preparation of occupational health nurses. Competencies considered most valuable by employers will affect their hiring decisions. This study identifies competencies valued by employers in the workplace.

Using biologic markers in blood to assess exposure to multiple environmental chemicals for inner-city children 3-6 years of age.

We assessed concurrent exposure to a mixture of > 50 environmental chemicals by measuring the chemicals or their metabolites in the blood of 43 ethnically diverse children (3-6 years of age) from a socioeconomically disadvantaged neighborhood in Minneapolis. Over a 2-year period, additional samples were collected every 6-12 months from as many children as possible. We analyzed blood samples for 11 volatile organic compounds (VOCs), 2 heavy metals (lead and mercury, 11 organochlorine (OC) pesticides or related compounds, and 30 polychlorinated biphenyl (PCB) congeners. The evidence suggests that numerous VOCs originated from common sources, as did many PCBs. Longitudinal measurements indicate that between-child variance was greater than within-child variance for two VOCs (benzene, toluene), for both heavy metals (Pb, Hg), for all detectable OC pesticides, and for 15 of the measured PCB congeners (74, 99, 101, 118, 138-158, 146, 153, 156, 170, 178, 180, 187, 189, 194, 195). Despite the relatively small sample size, highest measured blood levels of 1,4-dichlorobenzene, styrene, m-/p-xylene, Pb, Hg, heptachlor epoxide, oxychlordane, dichlorodiphenyldichloroethene (p,p -DDE), trans-nonachlor, and PCB congeners 74, 99, 105, 118, 138, 146, 153, 156, 170, and 180 were comparable with or higher than 95th percentile measurements of older children and adults from national surveys. Results demonstrate that cumulative exposures to multiple environmental carcinogens and neurotoxins can be comparatively high for children from a poor inner-city neighborhood.

Crosscutting competencies for occupational health and safety professionals.

A change from a quarter system to a semester system presented a convenient opportunity for faculty at the Midwest Center for Occupational Health and Safety (a 27-year-old National Institute for Occupational Safety and Health-sponsored education and research center) to evaluate the current curriculum. As part of this process faculty identified both individual and crosscutting competencies for four programs: Occupational Medicine, Occupational Health Nursing, Industrial Hygiene, and Occupational Injury Epidemiology and Control. Faculty identified potential competency sets using published literature, course objectives, and content summaries. Common themes, termed crosscutting competencies, were identified. Seventy program graduates (58%) responded to a survey designed to assess the value of, and proficiency in, these competencies based on their postgraduation job experience. All 29 crosscutting competencies were rated as valuable or very valuable by respondents in each of the four programs. There was less agreement between respondents in proficiency ratings, with 24 of 29 competencies rated either proficient or very proficient. Comparing value and proficiency provided an opportunity to further refine the curriculum and a model for enhancing the skills, knowledge, and attitudes of future environmental and occupational health professionals. With further testing, we propose this set of crosscutting competencies be considered for adoption as a set of interdisciplinary core competencies for Occupational Health and Safety professionals.

Children's exposure to volatile organic compounds as determined by longitudinal measurements in blood.

Blood concentrations of 11 volatile organic compounds (VOCs) were measured up to four times over 2 years in a probability sample of more than 150 children from two poor, minority neighborhoods in Minneapolis, Minnesota. Blood levels of benzene, carbon tetrachloride, trichloroethene, and m-/p-xylene were comparable with those measured in selected adults from the Third National Health and Nutrition Examination Survey (NHANES III), whereas concentrations of ethylbenzene, tetrachloroethylene, toluene, 1,1,1-trichloroethane, and o-xylene were two or more times lower in the children. Blood levels of styrene were more than twice as high, and for about 10% of the children 1,4-dichlorobenzene levels were greater than or equal to 10 times higher compared with NHANES III subjects. We observed strong statistical associations between numerous pairwise combinations of individual VOCs in blood (e.g., benzene and m-/p-xylene, m-/p-xylene and o-xylene, 1,1,1-trichloroethane and m-/p-xylene, and 1,1,1-trichloroethane and trichloroethene). Between-child variability was higher than within-child variability for 1,4-dichlorobenzene and tetrachloroethylene. Between- and within-child variability were approximately the same for ethylbenzene and 1,1,1-trichloroethane, and between-child was lower than within-child variability for the other seven compounds. Two-day, integrated personal air measurements explained almost 79% of the variance in blood levels for 1,4-dichlorobenzene and approximately 20% for tetrachloroethylene, toluene, m-/p-xylene, and o-xylene. Personal air measurements explained much less of the variance (between 0.5 and 8%) for trichloroethene, styrene, benzene, and ethylbenzene. We observed no significant statistical associations between total urinary cotinine (a biomarker for exposure to environmental tobacco smoke) and blood VOC concentrations. For siblings living in the same household, we found strong statistical associations between measured blood VOC concentrations.

Outdoor, indoor, and personal exposure to VOCs in children.

We measured volatile organic compound (VOC) exposures in multiple locations for a diverse population of children who attended two inner-city schools in Minneapolis, Minnesota. Fifteen common VOCs were measured at four locations: outdoors (O), indoors at school (S), indoors at home (H), and in personal samples (P). Concentrations of most VOCs followed the general pattern O approximately equal to S < P less than or equal to H across the measured microenvironments. The S and O environments had the smallest and H the largest influence on personal exposure to most compounds. A time-weighted model of P exposure using all measured microenvironments and time-activity data provided little additional explanatory power beyond that provided by using the H measurement alone. Although H and P concentrations of most VOCs measured in this study were similar to or lower than levels measured in recent personal monitoring studies of adults and children in the United States, p-dichlorobenzene was the notable exception to this pattern, with upper-bound exposures more than 100 times greater than those found in other studies of children. Median and upper-bound H and P exposures were well above health benchmarks for several compounds, so outdoor measurements likely underestimate long-term health risks from children's exposure to these compounds.

Children's exposure to environmental tobacco smoke: using diverse exposure metrics to document ethnic/racial differences.

Four metrics were used to assess exposure to environmental tobacco smoke (ETS) for a probability sample (n = 152) of elementary school-age children in two economically disadvantaged neighborhoods: a) caregiver responses to a baseline questionnaire (BQ) about smoking status and behavior; b) 48-hr time-activity (T-A) data on location and time spent by children in the presence of tobacco smoke; c) total urinary cotinine as a marker for nicotine uptake; and d) urinary NNAL [4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol] + NNAL-Gluc [4-(methylnitrosamino)-1- (3-pyridyl)-1-(O-beta-D-glucopyranuronosyl)butane] as a marker for uptake of the tobacco-specific lung carcinogen 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK). Consistent differences in ETS exposure by ethnicity and race were observed. Although data were insufficient to determine differences for NNAL + NNAL-Gluc, BQ responses, T-A data, and cotinine levels all indicated that average ETS exposure was highest for African-American children, moderately high for those designated "other" (white, Southeast Asian, Native American), moderately low for Hispanic children, and lowest for Somali immigrant children. For example, in February 2000, mean cotinine levels were 14.1 ng/mL for African Americans, 12.2 ng/mL for other, 4.8 ng/mL for Hispanics, and 4.4 ng/mL for Somalis. The BQ and T-A data together were reasonably good predictors of total cotinine levels (adjusted r2 = 0.69), and based on limited data, measured total cotinine values were a relatively good predictor of NNAL + NNAL-Gluc (adjusted r2 = 0.73). The results suggest that when children are exposed to ETS primarily in their homes, questionnaires and T-A logs might be effective screening tools for identifying those likely to experience higher uptake of nicotine.

Recruitment, retention, and compliance results from a probability study of children's environmental health in economically disadvantaged neighborhoods.

The School Health Initiative: Environment, Learning, and Disease (SHIELD) study used a probability sample of children (second through fifth grades) from two low-income and racially mixed neighborhoods of Minneapolis, Minnesota, to assess childhood environmental health. Children were eligible to participate in SHIELD regardless of whether they or their families spoke a foreign language, their household had a telephone, or they were enrolled in a special education program. The overall enrollment rate in year 1 was 57%, with a substantial disparity between children from English-speaking (42%) versus non-English-speaking (71%) families. At the end of year 1, 85% were retained in the study. A relatively high percentage of children provided the two requested blood (82%) and urine (86%) samples in year 1, and 90% provided a valid spirometry sample. Eighty-two percent provided both requested volatile organic chemical badge samples, and both time-activity logs were obtained from 66%. However, only 32% provided both peak flow measurements. All percentages increased for those participating in the second year of the study. Results indicate that a school-based research design makes it feasible and practical to conduct probability-based assessments of children's environmental health in economically disadvantaged and ethnically diverse neighborhoods. There is an ongoing need, however, to improve understanding of the cultural, economic, psychologic, and social determinants of study participation among this population.