A greening theory of change: How neighborhood greening impacts adolescent health disparities.

Neighborhoods are one of the key determinants of health disparities among young people in the United States. While neighborhood deprivation can exacerbate health disparities, amenities such as quality parks and greenspace can support adolescent health. Existing conceptual frameworks of greening-health largely focus on greenspace exposures, rather than greening interventions. In this paper, we develop and propose a Greening Theory of Change that explains how greening initiatives might affect adolescent health in deprived neighborhoods. The theory situates greening activities and possible mechanisms of change in the context of their ability to modify distal social determinants of health factors, stemming from macrostructural and historical processes that lead to resource inequalities, affecting both the social and built environment in which adolescents live and develop. The framework illustrates both short- and long-term health, economic, and security effects of greening. We also describe how the theory informed the development of Project VITAL (Vacant lot Improvement to Transform Adolescent Lives) in Baltimore, MD, which aims to (1) build a citywide sharable database on vacant lot restoration activities, (2) evaluate the impact of greening initiatives on adolescent health outcomes, (3) conduct cost-effectiveness analyses, and (4) develop best practices for greening programs for improved adolescent health.

Perceived Barriers to Climate Change Activism Behaviors in the United States Among Individuals Highly Concerned about Climate Change.

BACKGROUND: There is a tremendous gap between the proportion of the population expressing concern about climate change and those engaged in climate change activism. We examined barriers to climate change activism among respondents stating climate change was an important issue to them. METHODS: Participants in a national online longitudinal study reported on 12 reasons for lack of involvement in climate change actions. Five months later, engagement in six climate change actions was assessed. The primary analyses focused on the 319 respondents who, out of 592 respondents who participated in both surveys, reported that the issue of global warming was extremely or very important to them. RESULTS: Participants showed a range of engagement in climate change activism behaviors: 29.8% donated money to an organization to reduce climate change, 32.3% signed a petition, 69.0% voted for candidates who support measures to reduce climate change, 11.9% wrote letters, e-mailed, or phoned government officials to urge them to take action, and 9.4% volunteered with organizations working to curb climate change. The median number of barriers was 5. The most frequent reasons for lack of involvement in climate change activism were other people are better at it (57.4%), hadn't been trained (56.7%), hadn't been asked (50.8%), not knowing how to get involved (49.8%), activities like letter writing not appealing (49.8%), too busy (38.9%), organizations would ask them for money (39.8%), and not encouraged to become involved (38.2%). Several barriers were associated with engagement in climate change activism five months later. The most consistent association with activism was with talking about climate change in the prior month. CONCLUSION: Most respondents cited several barriers that impeded their involvement in climate change activism. Select barriers were associated with reduced engagement in activism. Organizations that address climate change should acknowledge barriers but emphasize that individuals can engage in climate change activism regardless of barriers.

Building Healthy Community Environments: A Public Health Approach.

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.

Advancing environmental health surveillance in the US through a national human biomonitoring network.

The United States lacks a comprehensive, nationally-coordinated, state-based environmental health surveillance system. This lack of infrastructure leads to: • varying levels of understanding of chemical exposures at the state & local levels • often inefficient public health responses to chemical exposure emergencies (such as those that occurred in the Flint drinking water crisis, the Gold King mine spill, the Elk river spill and the Gulf Coast oil spill) • reduced ability to measure the impact of public health interventions or environmental policies • less efficient use of resources for cleaning up environmental contamination Establishing the National Biomonitoring Network serves as a step toward building a national, state-based environmental health surveillance system. The Network builds upon CDC investments in emergency preparedness and environmental public health tracking, which have created advanced chemical analysis and information sharing capabilities in the state public health systems. The short-term goal of the network is to harmonize approaches to human biomonitoring in the US, thus increasing the comparability of human biomonitoring data across states and communities. The long-term goal is to compile baseline data on exposures at the state level, similar to data found in CDC's National Report on Human Exposure to Environmental Chemicals. Barriers to success for this network include: available resources, effective risk communication strategies, data comparability & sharing, and political will. Anticipated benefits include high quality data on which to base public health and environmental decisions, data with which to assess the success of public health interventions, improved risk assessments for chemicals, and new ways to prioritize environmental health research.

State public health laboratory biomonitoring programs: implementation and early accomplishments.

In 2009, the Centers for Disease Control and Prevention funded three state-based public health laboratory biomonitoring programs. These programs are the foundation for a National Biomonitoring Plan that consists of a larger network of state and local biomonitoring programs. To understand the utility of these programs and plan for the larger network, interviews were conducted with the program officials. The goal was to gather information on the challenges, successes, and lessons learned in program launch and implementation. Representatives of all programs participated. Projects range from statewide efforts to focused community investigations. Each program focuses on specific analytes including metals, pesticides, and other organics. Main accomplishments reported include development of laboratory and field capacity as well as generation of analytical results. Common challenges reported were laboratory setup and operation, sample collection and logistics, and staff recruitment. Respondents made specific recommendations for improving effectiveness of the current programs as well as ways to advance the National Biomonitoring Plan.

Public health laboratories and radiological readiness.

OBJECTIVE: To document the ability of public health laboratories to respond to radiological emergencies. METHODS: The Association of Public Health Laboratories developed, distributed, and analyzed two separate surveys of public health laboratories representing the 50 US states and major nonstate jurisdictions. The 2009 All-Hazards Laboratory Preparedness Survey examined overall laboratory capability and capacity, with a subset of questions on radiation preparedness. A 2011 survey focused exclusively on radiation readiness. RESULTS: The 50 state and District of Columbia public health laboratories responded to the 2009 All-Hazards Laboratory Preparedness Survey, representing a 98% response rate. In addition to the above laboratories, environmental and agricultural laboratories responded to the 2011 Radiation Capabilities Survey, representing a 76% response rate. Twenty-seven percent of the All-Hazards Survey respondents reported the ability to measure radionuclides in clinical specimens; 6% reported that another state agency or department accepted and analyzed these samples via a radioanalytical method. Of the Radiation Capabilities Survey respondents, 60% reported the ability to test environmental samples, such as air, soil, or surface water, for radiation; 48% reported the ability to test nonmilk food samples; 47% reported the ability to test milk; and 56% reported sending data for drinking water to the Environmental Protection Agency. CONCLUSIONS: Survey data reveal serious gaps in US radiological preparedness. In 2007, federal experts estimated it would take more than 4 years to screen 100 000 individuals for radiation exposure and 6 years to test environmental samples from a large-scale radiological emergency, relying on existing laboratory assets. Although some progress has been made since 2007, public health laboratory radiological test capabilities and capacities remain insufficient to respond to a major event. Adequate preparation requires significant new investment to build and enhance laboratory emergency response networks, as well as investments in the broader public health system in which public health laboratories function.

Predictors of blood mercury levels in older urban residents.

OBJECTIVE: The objective of this study was to describe the distribution and predictors of blood mercury levels in an adult population. METHODS: This was a cross-sectional analysis of first-visit data (2001-2002) on a random sample of 474 subjects from the Baltimore Memory Study. RESULTS: After adjustment for race/ethnicity, education, assets, and diabetes, persons in the highest quartile of fish consumption had median mercury levels 1.82 times above the levels in the lowest quartile, while those in the highest education category had median mercury levels 1.57 times higher than levels in the lowest category. Nine percent of subjects were above the reference dose recommended by the Environmental Protection Agency, which is high compared with that found by the Centers for Disease Control and Prevention in women of childbearing age. CONCLUSIONS: These findings offer guidance for targeted education and possible new insights regarding the kinetics of mercury.