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Environmental Health Literacy and Equity

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Communication and Informatics".

Deadline for manuscript submissions: closed (30 June 2022) | Viewed by 32319

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Special Issue Editors

Dr. Rima E. Rudd

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Guest Editor

Harvard T.H. Chan School of Public Health, Department of Social and Behavioral Sciences, 677 Huntington Avenue, Boston, MA 02115, USA
Interests: health literacy; social determinants

Dr. Cynthia Baur

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Guest Editor

University of Maryland, School of Public Health, Horowitz Center for Health Literacy, 4200 Valley Drive, College Park, MD 20742, USA
Interests: health communication; risk communication; health literacy

Ms. Kathryn Tomsho

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Assistant Guest Editor

Harvard T.H. Chan School of Public Health, Department of Environmental Health. 677 Huntington Avenue, Boston, MA 02115, USA
Interests: environmental health; exposure assessment; health literacy; social justice

Dr. Vanessa Simonds

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Assistant Guest Editor

Department of Health and Human Development, Montana State University, Herrick Hall 316D, Bozeman, MT 59717, USA
Interests: health literacy; community-based participatory research; American Indian populations
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

This Special Issue will be devoted to environmental health literacy inquiries. We call for papers focused on Issues such as inhibiting access to information or establishing barriers to engagement, as well as papers exploring efficacious actions.

Environmental health issues including those related to the climate crisis, natural and anthropogenic disasters, air and water quality, workplace exposures, and increased industrialization require more widespread awareness. If environmental scientific findings, evidence of health consequences of environmental degradation, risk analyses, local and national policy options, and/or emerging issues are “available” but not “accessible” to the general public, then knowledge as well as action is stymied.

Accumulated health literacy studies over the past two decades indicate that, on average, adults’ health-related literacy and numeracy skills are quite limited and that such limitations carry health consequences. Rigorous international surveys of adult literacy indicate that, across all industrialized nations, lower literacy and numeracy skills are more likely to be found among members of minority population groups as compared to those with majority status in their country, among those living in under-resourced areas compared to more affluent areas, those un- or underemployed compared to those fully employed, and those living in poverty compared to those with higher income. These inequities are exacerbated by the overwhelming findings that health materials are generally written at levels of complexity far beyond the reading skills of average high-school graduates. These information inequities are further compounded by other social and environmental inequities related to communities’ and workers’ exposures, hazards, and polluted and degraded spaces.

Scientists, researchers, and health practitioners are being challenged to re-examine their own assumptions, expectations, and communication skills. This is a necessary step in reducing barriers that impede access to information and that constrain risk perceptions, decision making, and healthful action on multiple levels, including individual/family, neighborhood/community, and geo-political. The “translation” of scientific findings into public discourse can support local, national, and international advocacy and policy responses. Citizen science is one approach, for example, that provides opportunities for the general public to collaborate with scientists, gain knowledge, and translate findings into action. Environmental justice is another approach that envisions fair access, involvement, and treatment for all with respect to environmental laws, policies, and regulations (https://www.epa.gov/environmentaljustice).

Submissions should address environmental health literacy—the intersection of health literacy and environmental studies. Papers that document problems as well as interventions and options for equitable and effective engagement and action are welcome.

Dr. Rima E. Rudd
Dr. Cynthia Baur
Ms. Kathryn Tomsho
Dr. Vanessa Simonds
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

Health literacy
Environmental literacy
Inequities
Risk communication
Environmental justice

Published Papers (10 papers)

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Research

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9 pages, 534 KiB

Open AccessCommunication

Differences in Data Trustworthiness and Risk Perception between Bar Graphs and Pictograms

by Munehito Machida, Michio Murakami and Aya Goto

Int. J. Environ. Res. Public Health 2022, 19(8), 4690; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19084690 - 13 Apr 2022

Cited by 2 | Viewed by 1768

Abstract

We investigated whether differences in presentation style affect risk perception, understanding, preference, and trust toward data. One hundred and sixty Fukushima Medical University students were shown the lifetime probability of breast cancer incidence for a 50-year-old woman, presented in both a pictogram and a horizontal bar graph format. Participants rated each of the following on a five-point scale by looking at each figure: risk perception, perceived truth of data, and comparative risk perception. The perceived truth of data was high for pictograms, especially among men and among those defined as having lower health literacy. Women correctly perceived the risk of breast cancer as higher than that of dying in a car accident when the data were presented on a pictogram. There was no difference in risk perception, perceived truth of data, or comparative risk perception arising from being shown the bar graphs and the pictograms in a particular order. There was a 50/50 split on which type of graph was perceived as easier to understand, but the preference was for the pictogram format. It is important to devise a visual method of health communication that considers the purpose of the information and characteristics of the target audience. Full article

(This article belongs to the Special Issue Environmental Health Literacy and Equity)

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15 pages, 1828 KiB

Open AccessArticle

Empowering Children as Agents of Change to Foster Resilience in Community: Implementing “Creative Health” in Primary Schools after the Fukushima Nuclear Disaster

by Aya Goto, Alison Lloyd Williams, Satoko Okabe, Yohei Koyama, Chihaya Koriyama, Michio Murakami, Yumiya Yui and Kenneth E. Nollet

Int. J. Environ. Res. Public Health 2022, 19(6), 3417; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19063417 - 14 Mar 2022

Cited by 5 | Viewed by 2917

Abstract

The “Creative Heath” project, a participatory school activity to foster community resilience, was implemented in Fukushima, Japan, and children’s experiences of the project were assessed both quantitatively and qualitatively. The project consists of three workshops: BODY, FOOD, and ACT, with activities to facilitate students’ scientific and creative thinking, working in teams, presenting, and expressing their opinions. The first two schools participated with 105 students aged 9–11 years old. Before and after each workshop, students were given questionnaires to rate their satisfaction with their own health (BODY), local foods (FOOD), and the community at large (ACT) on a five-level scale, with space to add free comments. Ratings for BODY and FOOD changed significantly, and the proportion of students who increased their rating of an evaluation indicator after each workshop was 25% for BODY, 28% for FOOD, and 25% for ACT. Text analysis of free comments showed that students in the “increased” group appreciated presenting, measuring, learning connections between nutrition and health, and working collaboratively with peers. Children perceived their health and the foods in their community more positively after participating. Moreover, the Creative Health project could be a way to enhance children’s creativity and autonomy as agents of change in the community. Full article

(This article belongs to the Special Issue Environmental Health Literacy and Equity)

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17 pages, 359 KiB

Open AccessArticle

Environmental Health Literacy as Knowing, Feeling, and Believing: Analyzing Linkages between Race, Ethnicity, and Socioeconomic Status and Willingness to Engage in Protective Behaviors against Health Threats

by Andrew R. Binder, Katlyn May, John Murphy, Anna Gross and Elise Carlsten

Int. J. Environ. Res. Public Health 2022, 19(5), 2701; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19052701 - 25 Feb 2022

Cited by 8 | Viewed by 3866

Abstract

This study investigates the relationships between environmental health literacy, the characteristics of people (race, ethnicity, and socioeconomic status) associated with health disparities, and people’s willingness to engage in protective behaviors against environmental health threats. Environmental health literacy is a framework for capturing the continuum between the knowledge of environmental impacts on public health, and the skills and decisions needed to take health-protective actions. We pay particular attention to three dimensions of environmental health literacy: factual knowledge (knowing the facts), knowledge sufficiency (feeling ready to decide what to do), and response efficacy (believing that protective behaviors work). In June 2020, we collected survey data from North Carolina residents on two topics: the viral infection COVID-19 and industrial contaminants called per- and polyfluoroalkyl substances (PFAS). We used their responses to test stepwise regression models with willingness to engage in protective behaviors as a dependent variable and other characteristics as independent variables, including environmental health literacy. For both topics, our results indicated that no disparities emerged according to socioeconomic factors (level of education, household income, or renting one’s residence). We observed disparities in willingness according to race, comparing Black to White participants, but not when comparing White to American Indian, Alaska Native, Asian, Native Hawaiian, or Pacific Islander participants nor Hispanic to non-Hispanic participants. The disparities in willingness between Black and White participants persisted until we introduced the variables of environmental health literacy, when the difference between these groups was no longer significant in the final regression models. The findings suggest that focusing on environmental health literacy could bridge a gap in willingness to protect oneself based on factors such as race/ethnicity and socioeconomic status, which have been identified in the environmental health literature as resulting in health disparities. Full article

(This article belongs to the Special Issue Environmental Health Literacy and Equity)

16 pages, 862 KiB

Open AccessArticle

Characterizing the Environmental Health Literacy and Sensemaking of Indoor Air Quality of Research Participants

by Kathryn S. Tomsho, Erin Polka, Stacey Chacker, David Queeley, Marty Alvarez, Madeleine K. Scammell, Karen M. Emmons, Rima E. Rudd and Gary Adamkiewicz

Int. J. Environ. Res. Public Health 2022, 19(4), 2227; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19042227 - 16 Feb 2022

Cited by 6 | Viewed by 2718

Abstract

This study is based on in-depth semi-structured interviews with the participants of an indoor air quality monitoring study. The purpose of the interviews was to capture participants’ perceptions of indoor air quality and engage them in a discussion of those factors that influenced their behavior. Interview study participants (n = 20) noted the importance of family health concerns and their own sensory awareness of possible contaminants. They discussed their level of personal control over their home environment as well as their access to needed resources. This study is based on grounded theory and applies interpretivist epistemological methods. Study findings offer insights into how people perceive their home environment and what influences their decision making and action. Analyses indicate that perceived agency, risk perception, access to resources, and information all influenced participants’ sense of ability to take action as well as their interest in taking action. These insights serve to challenge some of the current work in environmental health literacy which tends to focus on and measure an individual’s knowledge or skills. Our analysis suggests that consideration be given to a number of factors that include perceived agency, access to resources, and the quality of information provided. Full article

(This article belongs to the Special Issue Environmental Health Literacy and Equity)

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15 pages, 1205 KiB

Open AccessArticle

Developing a Short Assessment of Environmental Health Literacy (SA-EHL)

by Diana Rohlman, Molly L. Kile and Veronica L. Irvin

Int. J. Environ. Res. Public Health 2022, 19(4), 2062; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19042062 - 12 Feb 2022

Cited by 4 | Viewed by 2463

Abstract

Environmental health literacy (EHL) is defined as the understanding of how the environment can impact human health, yet there are few tools to quantify EHL. We adapted the Short Assessment of Health Literacy (SAHL) to create the Short Assessment of Environmental Health Literacy (SA-EHL). Using the Amazon mTurk platform, users (n = 864) completed the 18-item SAHL and the 17-item SA-EHL. The SA-EHL was originally tested with 30 items; 13 items were removed because they were outside the acceptable difficulty parameters (DIFF: −0.4–4.0) or because of limited variance (>90% correct or incorrect), resulting in the final 17 items. Overall, participants scored highly on the SAHL, with 89.9% exhibiting high literacy. In contrast, the majority had low EHL (<1.0% high literacy, 99.2% low literacy) measured by the SA-EHL. The two scales were not correlated with each other (R² = 0.013) as measured via linear regression and dichotomous variables. Scores on the SAHL and the SA-EHL were positively correlated with education. The SAHL was positively correlated with age, gender and marital status, whereas the SA-EHL was not. The SA-EHL can be used to gauge EHL for communities, and the results used to improve interventions and research translation materials. Full article

(This article belongs to the Special Issue Environmental Health Literacy and Equity)

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19 pages, 4877 KiB

Open AccessArticle

Raising Ecological Awareness and Digital Literacy in Primary School Children through Gamification

by María-Carmen Ricoy and Cristina Sánchez-Martínez

Int. J. Environ. Res. Public Health 2022, 19(3), 1149; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19031149 - 20 Jan 2022

Cited by 8 | Viewed by 4945

Abstract

Environmental education, at least in northwest Spain, is often overlooked in the education system from infant schooling onwards and interventions are needed to raise the profile of this subject. The aim of this study was to examine the impact of a learning program designed for primary school students to broaden their ecological awareness and improve digital literacy using gamification tools. The research was developed using a qualitative approach, with data obtained from 156 subjects, including teachers, students and families. The results show that the children assimilated new habits on the better usage of water and electricity and recycling paper and plastic. Moreover, they acquired more efficient strategies for finding information online, by using apps and developing content with digital tools. Gaming dynamics and resources were the key to students’ learning, with the tablet proving an essential tool for boosting motivation, interaction and problem solving. Full article

(This article belongs to the Special Issue Environmental Health Literacy and Equity)

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14 pages, 2034 KiB

Open AccessArticle

Knowledge and Beliefs Associated with Environmental Health Literacy: A Case Study Focused on Toxic Metals Contamination of Well Water

by Kathleen M. Gray, Victoria Triana, Marti Lindsey, Benjamin Richmond, Anna Goodman Hoover and Chris Wiesen

Int. J. Environ. Res. Public Health 2021, 18(17), 9298; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18179298 - 03 Sep 2021

Cited by 9 | Viewed by 3361

Abstract

Environmental health literacy (EHL) is developing as a framework that can inform educational interventions designed to facilitate individual and collective action to protect health, yet EHL measurement poses several challenges. While some studies have measured environmental health knowledge resulting from interventions, few have incorporated skills and self-efficacy. In this study, a process-focused EHL instrument was developed, using the Newest Vital Sign (NVS) health literacy instrument as a model and tailoring it for the context of private well contamination with toxic metals. Forty-seven (47) participants, including undergraduate students and residents of communities with contaminated well water, piloted a prototype EHL instrument alongside NVS. Results suggested a moderate degree of correlation between NVS and the EHL prototype, and significant differences in scores were observed between students and residents. Responses to a self-efficacy survey, tailored for drinking water contaminated with arsenic, revealed significant differences between students and residents on items related to cost and distance. In response to open-ended questions, participants identified a range of potential environmental contaminants in drinking water and deemed varied information sources as reliable. This study highlights differences in knowledge and self-efficacy among students and residents and raises questions about the adequacy of EHL assessments that mimic formal education approaches. Full article

(This article belongs to the Special Issue Environmental Health Literacy and Equity)

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19 pages, 2537 KiB

Open AccessArticle

Mercury Exposure among E-Waste Recycling Workers in Colombia: Perceptions of Safety, Risk, and Access to Health Information

by Maria Jensen, David Andrés Combariza Bayona and Kam Sripada

Int. J. Environ. Res. Public Health 2021, 18(17), 9295; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18179295 - 03 Sep 2021

Cited by 5 | Viewed by 3778

Abstract

Exposures to the toxic element mercury (Hg) are exceptionally high among recycling workers globally. Recycling is a growing sector in Colombia, yet workers who directly handle e-waste are often unaware of the risks of exposure to mercury from post-consumer lighting products (e.g., fluorescent lamps). This qualitative study aimed to understand how recycling workers perceive their own risks from mercury exposure and how they find information about these risks, through interviews (n = 35) at the three largest formal recycling facilities in Colombia. Workers’ risk perception was generally disconnected from their likely actual exposure to mercury, instead often seen juxtaposed to co-workers who worked more directly with hazardous waste. Recycling workers, who were predominantly men from lower-income socioeconomic backgrounds, had limited knowledge of health risks due to mercury exposure and were more likely to receive health-related information from informal sources. Over a third of interviewees had searched online for information about occupational health risks of mercury, but these searches were perceived as unsatisfactory due to information being difficult to find, not available in Spanish, or related to mercury exposure via seafood or mining rather than recycling. Workers expressed (over)confidence in personal protective equipment and concern about frequent employee turnover. This study points to weaknesses in environmental health literacy and public health communication around toxic exposures to mercury in the workplace. Stronger regulation and enforcement are needed to prevent toxic exposures and promote worker health equity. Full article

(This article belongs to the Special Issue Environmental Health Literacy and Equity)

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11 pages, 310 KiB

Open AccessArticle

What Do Childcare Providers Know about Environmental Influences on Children’s Health? Implications for Environmental Health Literacy Efforts

by Brenda D. Koester, Stephanie Sloane, Elinor M. Fujimoto, Barbara H. Fiese and Leona Yi-Fan Su

Int. J. Environ. Res. Public Health 2021, 18(10), 5489; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18105489 - 20 May 2021

Cited by 8 | Viewed by 2818

Abstract

Children are uniquely vulnerable to toxicant exposures in their environment, which can have long-lasting impacts on their health. Childcare providers are an important population to target for environmental health literacy, as most children in the United States under five years of age spend a significant number of waking hours in non-parental care. There is an increasing body of evidence that children are exposed to toxicants in the childcare environment, and yet little is known about what childcare providers know about environmental influences on the health of children in their care. We conducted semi-structured interviews with 36 home- and center-based Illinois childcare providers to better understand their knowledge, attitudes, and behaviors as they relate to environmental influences on children’s health. We found that the majority of providers had a low level of understanding of potential sources of exposure in the childcare environment, and they did not feel that environmental exposures posed a significant risk to children. Future efforts to increase environmental health literacy should focus on raising awareness and knowledge of environmental health issues for childcare providers before addressing ways that providers can reduce or prevent toxicant exposures to children in their care. Full article

(This article belongs to the Special Issue Environmental Health Literacy and Equity)

Other

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7 pages, 261 KiB

Open AccessPerspective

A Call for More Rigor in Science and Health Communication

by Rima E. Rudd

Int. J. Environ. Res. Public Health 2022, 19(3), 1825; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19031825 - 05 Feb 2022

Cited by 4 | Viewed by 1678

Abstract

Successful dissemination of scientific knowledge relies on the ability of the writer, speaker, and designer to provide information and data that is both available and accessible to the audience for whom it is intended. Scientific rigor, uniformly applied to the development of medicines, products, and devices must be applied, as well, to communications—spoken, written, posted, or displayed. Rigorous development and design protocols call for formative research data gathering, careful pilot testing with members of the intended audience, needed revisions, and rigorous assessments. Guidelines and tools developed for health literacy applications can be adopted and adapted for environmental health research and educational efforts in the design of questionnaires, instructions, education and report back materials, as well as for public discourse. Full article

(This article belongs to the Special Issue Environmental Health Literacy and Equity)

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