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Int. J. Environ. Res. Public Health, Volume 12, Issue 11 (November 2015) , Pages 13662-14957

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Open AccessArticle
Radon Exposure Assessment and Relative Effective Dose Estimation to Inhabitants of Puglia Region, South Italy
Int. J. Environ. Res. Public Health 2015, 12(11), 14948-14957; https://doi.org/10.3390/ijerph121114948 - 23 Nov 2015
Cited by 17 | Viewed by 1843
Abstract
Indoor radon concentrations were measured in dwellings of the Puglia region in Southern Italy using LR-115 passive detectors. The results show that the radon concentrations varied from 15 ± 2 to 2166 ± 133 Bq/m3 with a geometric mean of 114 Bq/m [...] Read more.
Indoor radon concentrations were measured in dwellings of the Puglia region in Southern Italy using LR-115 passive detectors. The results show that the radon concentrations varied from 15 ± 2 to 2166 ± 133 Bq/m3 with a geometric mean of 114 Bq/m3 and a geometric standard deviation of 2.3. An analysis on the factors affecting radon concentration such as age of the dwellings, floors, and stories, was performed. The mean effective dose to inhabitants has been calculated and found to be 8.2 mSv/y. Finally, for estimation of cancer risks, the lifetime risk and lung cancer cases per years per million have been calculated. Full article
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Open AccessArticle
Unintentional Injuries and Psychosocial Correlates among in-School Adolescents in Malaysia
Int. J. Environ. Res. Public Health 2015, 12(11), 14936-14947; https://doi.org/10.3390/ijerph121114936 - 20 Nov 2015
Cited by 10 | Viewed by 2105
Abstract
The study aimed to provide estimates of the prevalence and psychosocial correlates of unintentional injury among school-going adolescents in Malaysia. Cross-sectional data from the Global School-Based Health Survey (GSHS) included 21,699 students (predominantly ≤13 to ≥17 years) that were selected by a two-stage [...] Read more.
The study aimed to provide estimates of the prevalence and psychosocial correlates of unintentional injury among school-going adolescents in Malaysia. Cross-sectional data from the Global School-Based Health Survey (GSHS) included 21,699 students (predominantly ≤13 to ≥17 years) that were selected by a two-stage cluster sample design to represent all secondary school students in Forms 1 to 5. The percentage of school children reporting one or more serious injuries in the past year was 34.9%, 42.1% of boys and 27.8% of girls. The two major causes of the most serious injury were “fall” (9.9%) and motor vehicle accident or being hit by a motor vehicle (5.4%), and the most frequent type of injury sustained was cut, puncture, or stab wound (6.2%) and a broken bone or dislocated joint (4.2%). In multivariable logistic regression analysis, sociodemographic factors (being male and low socioeconomic status), substance use (tobacco and cannabis use), frequent soft drink consumption, attending physical education classes three or more times a week, other risky behavior (truancy, ever having had sex, being bullied), psychological distress, and lack of parental or guardian bonding were associated with annual injury prevalence. Several factors were identified, which could be included in injury prevention promotion programs among secondary school children. Full article
(This article belongs to the Special Issue Child Injury Prevention 2015)
Open AccessArticle
An Examination of Electronic Cigarette Content on Social Media: Analysis of E-Cigarette Flavor Content on Reddit
Int. J. Environ. Res. Public Health 2015, 12(11), 14916-14935; https://doi.org/10.3390/ijerph121114916 - 20 Nov 2015
Cited by 25 | Viewed by 4228
Abstract
In recent years, the emerging electronic cigarette (e-cigarette) marketplace has shown great development prospects all over the world. Reddit, one of the most popular forums in the world, has a very large user group and thus great influence. This study aims to gain [...] Read more.
In recent years, the emerging electronic cigarette (e-cigarette) marketplace has shown great development prospects all over the world. Reddit, one of the most popular forums in the world, has a very large user group and thus great influence. This study aims to gain a systematic understanding of e-cigarette flavors based on data collected from Reddit. Flavor popularity, mixing, characteristics, trends, and brands are analyzed. Fruit flavors were mentioned the most (n = 15,720) among all the posts and were among the most popular flavors (n = 2902) used in mixed blends. Strawberry and vanilla flavors were the most popular for e-juice mixing. The number of posts discussing e-cigarette flavors has increased sharply since 2014. Mt. Baker Vapor and Hangen were the most popular brands discussed among users. Information posted on Reddit about e-cigarette flavors reflected consumers’ interest in a variety of flavors. Our findings suggest that Reddit could be used for data mining and analysis of e-cigarette-related content. Understanding how e-cigarette consumers’ view and utilize flavors within their vaping experience and how producers and marketers use social media to promote flavors and sell products could provide valuable information for regulatory decision-makers. Full article
(This article belongs to the Special Issue Tobacco Control 2015)
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Open AccessArticle
The Effects of the Urban Built Environment on Mental Health: A Cohort Study in a Large Northern Italian City
Int. J. Environ. Res. Public Health 2015, 12(11), 14898-14915; https://doi.org/10.3390/ijerph121114898 - 20 Nov 2015
Cited by 25 | Viewed by 7772
Abstract
Mental health (MH) has a relevant burden on the health of populations. Common MH disorders (anxiety and non-psychotic depression) are well associated to socioeconomic individual and neighborhood characteristics, but little is known about the influence of urban structure. We analyzed among a Turin [...] Read more.
Mental health (MH) has a relevant burden on the health of populations. Common MH disorders (anxiety and non-psychotic depression) are well associated to socioeconomic individual and neighborhood characteristics, but little is known about the influence of urban structure. We analyzed among a Turin (Northwest Italy) urban population the association at area level of different urban structure characteristics (density, accessibility by public transport, accessibility to services, green and public spaces) and consumption of antidepressants. Estimates were adjusted by individual socio-demographic variables (education, housing tenure, employment) and contextual social environment (SE) variables (social and physical disorder, crime rates). Data was extracted from the Turin Longitudinal Study (TLS)—a census-based cohort study following up prospectively the mortality and morbidity of the population. As expected, individual characteristics show the strongest association with antidepressant drug consumption, while among built environment (BE) indicators accessibility by public transport and urban density only are associated to MH, being slightly protective factors. Results from this study, in agreement with previous literature, suggest that BE has a stronger effect on MH for people who spend more time in the neighborhood. Therefore, this research suggests that good accessibility to public transport, as well as a dense urban structure (versus sprawl), could contribute to reduced risk of depression, especially for women and elderly, by increasing opportunities to move around and have an active social life. Full article
(This article belongs to the Special Issue The Impacts of the Built Environment on Public Health)
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Open AccessReview
Air Pollution Exposure and Physical Activity in China: Current Knowledge, Public Health Implications, and Future Research Needs
Int. J. Environ. Res. Public Health 2015, 12(11), 14887-14897; https://doi.org/10.3390/ijerph121114887 - 20 Nov 2015
Cited by 34 | Viewed by 3191
Abstract
Deteriorating air quality in China has created global public health concerns in regard to health and health-related behaviors. Although emerging environmental regulations address ambient air pollution in China, the level of enforcement and long-term impact of these measures remain unknown. Exposure to air [...] Read more.
Deteriorating air quality in China has created global public health concerns in regard to health and health-related behaviors. Although emerging environmental regulations address ambient air pollution in China, the level of enforcement and long-term impact of these measures remain unknown. Exposure to air pollution has been shown to lead to multiple adverse health outcomes, including increased rates of heart disease and mortality. However, a lesser-known but increasingly significant concern is the relationship between air pollution and its effects on outdoor exercise. This is especially important in China, which has a culturally rooted lifestyle that encourages participation in outdoor physical activity. This article evaluates the intersection of air pollution and outdoor exercise and provides a discussion of issues related to its public health impact in China, where efforts to promote a healthy lifestyle may be adversely affected by the ambient air pollution that has accompanied rapid economic development and urbanization. Full article
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Open AccessArticle
Workplace Violence and Job Performance among Community Healthcare Workers in China: The Mediator Role of Quality of Life
Int. J. Environ. Res. Public Health 2015, 12(11), 14872-14886; https://doi.org/10.3390/ijerph121114872 - 20 Nov 2015
Cited by 17 | Viewed by 2711
Abstract
Objective: To explore the impact of workplace violence on job performance and quality of life of community healthcare workers in China, especially the relationship of these three variables. Methods: From December 2013 to April 2014, a total of 1404 healthcare workers [...] Read more.
Objective: To explore the impact of workplace violence on job performance and quality of life of community healthcare workers in China, especially the relationship of these three variables. Methods: From December 2013 to April 2014, a total of 1404 healthcare workers were recruited by using the random cluster sampling method from Community Health Centers in Guangzhou and Shenzhen. The workplace violence scale, the job performance scale and the quality of life scale (SF-36) were self-administered. The structural equation model constructed by Amos 17.0 was employed to assess the relationship among these variables. Results: Our study found that 51.64% of the respondents had an experience of workplace violence. It was found that both job performance and quality of life had a negative correlation with workplace violence. A positive association was identified between job performance and quality of life. The path analysis showed the total effect (β = −0.243) of workplace violence on job performance consisted of a direct effect (β = −0.113) and an indirect effect (β = −0.130), which was mediated by quality of life. Conclusions: Workplace violence among community healthcare workers is prevalent in China. The workplace violence had negative effects on the job performance and quality of life of CHCs’ workers. The study suggests that improvement in the quality of life may lead to an effective reduction of the damages in job performance caused by workplace violence. Full article
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Open AccessArticle
The Association between Health Behaviours and Academic Performance in Canadian Elementary School Students: A Cross-Sectional Study
Int. J. Environ. Res. Public Health 2015, 12(11), 14857-14871; https://doi.org/10.3390/ijerph121114857 - 20 Nov 2015
Cited by 12 | Viewed by 3629
Abstract
Background: Establishing early healthy eating and physical activity behaviours is critical in supporting children’s long-term health and well-being. The objective of the current paper was to examine the association between health behaviours and academic performance in elementary school students in a school [...] Read more.
Background: Establishing early healthy eating and physical activity behaviours is critical in supporting children’s long-term health and well-being. The objective of the current paper was to examine the association between health behaviours and academic performance in elementary school students in a school board in Nova Scotia, Canada. Methods: Our population-based study included students in grades 4–6 across 18 schools in a rural school board. Diet and physical activity were assessed through validated instruments. Academic performance measures were obtained from the school board for Mathematics and English Language Arts (ELA). Associations between health behaviours and academic performance were assessed using multilevel logistic regression. Results: Students with unhealthy lifestyle behaviours were more likely to have poor academic performance for both ELA and Mathematics compared to students with healthy lifestyle behaviours; associations were statistically significant for diet quality, physical activity, sugar-sweetened beverage consumption for ELA; and breakfast skipping, not being physically active at morning recess, and not being physically active after school for Mathematics. The effects of diet and physical activity were independent of each other and there was no interaction between the two exposures. Conclusions: Our findings suggest that support for healthy behaviours may help to improve academic outcomes of students. Full article
Open AccessArticle
Factors Associated with Suicidal Ideation and Suicide Attempt among School-Going Urban Adolescents in Peru
Int. J. Environ. Res. Public Health 2015, 12(11), 14842-14856; https://doi.org/10.3390/ijerph121114842 - 20 Nov 2015
Cited by 28 | Viewed by 2605
Abstract
The study examines the prevalence of suicidal ideation and suicide attempt, and associated factors among school-going urban adolescents in Peru. A cross-sectional survey was conducted in a sample of 916 secondary school adolescents in 2014. A structured questionnaire adapted from Global School-based Student [...] Read more.
The study examines the prevalence of suicidal ideation and suicide attempt, and associated factors among school-going urban adolescents in Peru. A cross-sectional survey was conducted in a sample of 916 secondary school adolescents in 2014. A structured questionnaire adapted from Global School-based Student Health Survey was used to obtain information. Data were analyzed using logistic regression models at 5% level of significance. Overall, 26.3% reported having suicidal ideation, and 17.5% reported having attempted suicide during the past 12 months. Multivariate logistic regression analysis showed that female sex, being in a fight, being insulted, being attacked, perceived unhappiness, smoking and sexual intercourse initiation were significantly associated with increased risk of suicidal ideation, while female sex, being in a fight, being insulted, being attacked, perceived unhappiness, alcohol and illicit drug use were related to suicide attempt. The prevalence of suicidal ideation and suicide attempts observed in the survey area is relatively high. Female adolescents are particularly vulnerable to report suicidal ideation and suicide attempt. Interventions that address the issue of violence against adolescents, fighting with peers, health risk behaviors particularly initiation of smoking, alcohol and illicit drug use and encourage supportive role of parents may reduce the risk of suicidal behaviors. Full article
Open AccessConcept Paper
Harm Reduction as “Continuum Care” in Alcohol Abuse Disorder
Int. J. Environ. Res. Public Health 2015, 12(11), 14828-14841; https://doi.org/10.3390/ijerph121114828 - 19 Nov 2015
Cited by 8 | Viewed by 2551
Abstract
Alcohol abuse is one of the most important risk factors for health and is a major cause of death and morbidity. Despite this, only about one-tenth of individuals with alcohol abuse disorders receive therapeutic intervention and specific rehabilitation. Among the various dichotomies that [...] Read more.
Alcohol abuse is one of the most important risk factors for health and is a major cause of death and morbidity. Despite this, only about one-tenth of individuals with alcohol abuse disorders receive therapeutic intervention and specific rehabilitation. Among the various dichotomies that limit an effective approach to the problem of alcohol use disorder treatment, one of the most prominent is integrated treatment versus harm reduction. For years, these two divergent strategies have been considered to be opposite poles of different philosophies of intervention. One is bound to the search for methods that aim to lead the subject to complete abstinence; the other prioritizes a progressive decline in substance use, with maximum reduction in the damage that is correlated with curtailing that use. Reduction of alcohol intake does not require any particular setting, but does require close collaboration between the general practitioner, specialized services for addiction, alcohology services and psychiatry. In patients who reach that target, significant savings in terms of health and social costs can be achieved. Harm reduction is a desirable target, even from an economic point of view. At the present state of neuroscientific knowledge, it is possible to go one step further in the logic that led to the integration of psychosocial and pharmacological approaches, by attempting to remove the shadows of social judgment that, at present, are aiming for a course of treatment that is directed towards absolute abstention. Full article
(This article belongs to the Special Issue Treating Alcoholism between Harm Reduction and Immediate Abstinence)
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Open AccessArticle
Prolonged Sitting is Associated with Attenuated Heart Rate Variability during Sleep in Blue-Collar Workers
Int. J. Environ. Res. Public Health 2015, 12(11), 14811-14827; https://doi.org/10.3390/ijerph121114811 - 19 Nov 2015
Cited by 14 | Viewed by 2853
Abstract
Prolonged sitting is associated with increased risk for cardiovascular diseases and mortality. However, research into the physiological determinants underlying this relationship is still in its infancy. The aim of the study was to determine the extent to which occupational and leisure-time sitting are [...] Read more.
Prolonged sitting is associated with increased risk for cardiovascular diseases and mortality. However, research into the physiological determinants underlying this relationship is still in its infancy. The aim of the study was to determine the extent to which occupational and leisure-time sitting are associated with nocturnal heart rate variability (HRV) in blue-collar workers. The study included 138 blue-collar workers (mean age 45.5 (SD 9.4) years). Sitting-time was measured objectively for four days using tri-axial accelerometers (Actigraph GT3X+) worn on the thigh and trunk. During the same period, a heart rate monitor (Actiheart) was used to sample R-R intervals from the electrocardiogram. Time and frequency domain indices of HRV were only derived during nighttime sleep, and used as markers of cardiac autonomic modulation. Regression analyses with multiple adjustments (age, gender, body mass index, smoking, job-seniority, physical work-load, influence at work, and moderate-to-vigorous physical activity) were used to investigate the association between sitting time and nocturnal HRV. We found that occupational sitting-time was negatively associated (p < 0.05) with time and frequency domain HRV indices. Sitting-time explained up to 6% of the variance in HRV, independent of the covariates. Leisure-time sitting was not significantly associated with any HRV indices (p > 0.05). In conclusion, objectively measured occupational sitting-time was associated with reduced nocturnal HRV in blue-collar workers. This indicates an attenuated cardiac autonomic regulation with increasing sitting-time at work regardless of moderate-to-vigorous physical activity. The implications of this association for cardiovascular disease risk warrant further investigation via long-term prospective studies and intervention studies. Full article
Open AccessArticle
Predicting the Incidence of Human Cataract through Retinal Imaging Technology
Int. J. Environ. Res. Public Health 2015, 12(11), 14800-14810; https://doi.org/10.3390/ijerph121114800 - 19 Nov 2015
Cited by 4 | Viewed by 1920
Abstract
With the progress of science, technology and medicine, the proportion of elderly people in society has gradually increased over the years. Thus, the medical care and health issues of this population have drawn increasing attention. In particular, among the common medical problems of [...] Read more.
With the progress of science, technology and medicine, the proportion of elderly people in society has gradually increased over the years. Thus, the medical care and health issues of this population have drawn increasing attention. In particular, among the common medical problems of the elderly, the occurrence of cataracts has been widely observed. In this study, we developed retinal imaging technology by establishing a human eye module with ray tracing. Periodic hole arrays with different degrees were constructed on the anterior surface of the lens to emulate the eyesight decline caused by cataracts. Then, we successfully predicted the incidence of cataracts among people with myopia ranging from −3.0 D to −9.0 D. Results show that periodic hole arrays cause severe eyesight decline when they are centralized in the visual center. However, the wide distribution of these arrays on the anterior surface of the lens would not significantly affect one’s eyesight. Full article
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Open AccessArticle
Pooling Bio-Specimens in the Presence of Measurement Error and Non-Linearity in Dose-Response: Simulation Study in the Context of a Birth Cohort Investigating Risk Factors for Autism Spectrum Disorders
Int. J. Environ. Res. Public Health 2015, 12(11), 14780-14799; https://doi.org/10.3390/ijerph121114780 - 19 Nov 2015
Viewed by 2107
Abstract
We sought to determine the potential effects of pooling on power, false positive rate (FPR), and bias of the estimated associations between hypothetical environmental exposures and dichotomous autism spectrum disorders (ASD) status. Simulated birth cohorts in which ASD outcome was assumed to have [...] Read more.
We sought to determine the potential effects of pooling on power, false positive rate (FPR), and bias of the estimated associations between hypothetical environmental exposures and dichotomous autism spectrum disorders (ASD) status. Simulated birth cohorts in which ASD outcome was assumed to have been ascertained with uncertainty were created. We investigated the impact on the power of the analysis (using logistic regression) to detect true associations with exposure (X1) and the FPR for a non-causal correlate of exposure (X2, r = 0.7) for a dichotomized ASD measure when the pool size, sample size, degree of measurement error variance in exposure, strength of the true association, and shape of the exposure-response curve varied. We found that there was minimal change (bias) in the measures of association for the main effect (X1). There is some loss of power but there is less chance of detecting a false positive result for pooled compared to individual level models. The number of pools had more effect on the power and FPR than the overall sample size. This study supports the use of pooling to reduce laboratory costs while maintaining statistical efficiency in scenarios similar to the simulated prospective risk-enriched ASD cohort. Full article
(This article belongs to the Special Issue Methodological Innovations and Reflections-1)
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Open AccessArticle
Prevalence of Diabetes and Impaired Fasting Glucose in Hypertensive Adults in Rural China: Far from Leveling-Off
Int. J. Environ. Res. Public Health 2015, 12(11), 14764-14779; https://doi.org/10.3390/ijerph121114764 - 19 Nov 2015
Cited by 8 | Viewed by 2281
Abstract
In recent years data from many investigations has shown a leveling–off trend in diabetes incidence. In order to explain the diabetes epidemic in rural China during the past ten years, we conducted a survey from July 2012 to August 2013. Data from comprehensive [...] Read more.
In recent years data from many investigations has shown a leveling–off trend in diabetes incidence. In order to explain the diabetes epidemic in rural China during the past ten years, we conducted a survey from July 2012 to August 2013. Data from comprehensive questionnaires, physical examinations, and blood tests were obtained from 5919 residents with hypertension, aged ≥ 35 years. Diabetes and impaired fasting glucose (IFG) were defined according to the American Diabetes Association (ADA) criteria. The overall prevalence of diabetes and IFG were 15.3% (13.6% in men, 16.8% in women) and 40.7% (44.1% in men, 34.7% in women) in the hypertensive rural Chinese population. The prevalence of previously diagnosed diabetes was 6.5% (4.6% in men, 8.4% in women). The prevalence of undiagnosed diabetes was 8.7% (9.0% in men, 8.5% in women). Multivariate logistic regression revealed that increasing age, drinking, overweight or obesity, systolic blood pressure, low HDL-C, high total cholesterol and triglycerides increased the risk of diabetes (p < 0.05). Diabetes is thus still prevalent in rural areas of China and is manifesting an accelerating trend. It remains an important public health problem in China, especially in rural areas and routine assessment for the early detection and treatment of diabetes should be emphasized. Full article
(This article belongs to the collection Health Care and Diabetes)
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Open AccessArticle
Travel Behavior Change in Older Travelers: Understanding Critical Reactions to Incidents Encountered in Public Transport
Int. J. Environ. Res. Public Health 2015, 12(11), 14741-14763; https://doi.org/10.3390/ijerph121114741 - 18 Nov 2015
Cited by 3 | Viewed by 2246
Abstract
Accessibility of travel may be better understood if psychological factors underlying change in travel behavior are known. This paper examines older (65+) travelers’ motives for changing their travel behavior. These changes are grounded in critical incidents earlier encountered in public-transport travel. A scientific [...] Read more.
Accessibility of travel may be better understood if psychological factors underlying change in travel behavior are known. This paper examines older (65+) travelers’ motives for changing their travel behavior. These changes are grounded in critical incidents earlier encountered in public-transport travel. A scientific framework is developed based on cognitive and behavioral theory. In 29 individual interviews, travelers’ critical reactions (i.e., cognitive, emotional, and/or behavioral) to 77 critical incidents were examined. By applying critical incident technique (CIT), five reaction themes were identified that had generated travel-behavior change: firm restrictions, unpredictability, unfair treatment, complicated trips, and earlier adverse experiences. To improve older travelers’ access to public transport, key findings were: (a) service must be designed so as to strengthen the feeling of being in control throughout the journey; (b) extended personal service would increase predictability in the travel chain and decrease travel complexity; consequently, (c) when designing new services and making effective accessibility interventions, policy makers should consider and utilize underlying psychological factors that could direct traveler behavior. Full article
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Open AccessArticle
A Discriminant Function Approach to Adjust for Processing and Measurement Error When a Biomarker is Assayed in Pooled Samples
Int. J. Environ. Res. Public Health 2015, 12(11), 14723-14740; https://doi.org/10.3390/ijerph121114723 - 18 Nov 2015
Cited by 3 | Viewed by 1744
Abstract
Pooling biological specimens prior to performing expensive laboratory assays has been shown to be a cost effective approach for estimating parameters of interest. In addition to requiring specialized statistical techniques, however, the pooling of samples can introduce assay errors due to processing, possibly [...] Read more.
Pooling biological specimens prior to performing expensive laboratory assays has been shown to be a cost effective approach for estimating parameters of interest. In addition to requiring specialized statistical techniques, however, the pooling of samples can introduce assay errors due to processing, possibly in addition to measurement error that may be present when the assay is applied to individual samples. Failure to account for these sources of error can result in biased parameter estimates and ultimately faulty inference. Prior research addressing biomarker mean and variance estimation advocates hybrid designs consisting of individual as well as pooled samples to account for measurement and processing (or pooling) error. We consider adapting this approach to the problem of estimating a covariate-adjusted odds ratio (OR) relating a binary outcome to a continuous exposure or biomarker level assessed in pools. In particular, we explore the applicability of a discriminant function-based analysis that assumes normal residual, processing, and measurement errors. A potential advantage of this method is that maximum likelihood estimation of the desired adjusted log OR is straightforward and computationally convenient. Moreover, in the absence of measurement and processing error, the method yields an efficient unbiased estimator for the parameter of interest assuming normal residual errors. We illustrate the approach using real data from an ancillary study of the Collaborative Perinatal Project, and we use simulations to demonstrate the ability of the proposed estimators to alleviate bias due to measurement and processing error. Full article
(This article belongs to the Special Issue Methodological Innovations and Reflections-1)
Open AccessArticle
Economic, Environmental and Health Implications of Enhanced Ventilation in Office Buildings
Int. J. Environ. Res. Public Health 2015, 12(11), 14709-14722; https://doi.org/10.3390/ijerph121114709 - 18 Nov 2015
Cited by 17 | Viewed by 6972
Abstract
Introduction: Current building ventilation standards are based on acceptable minimums. Three decades of research demonstrates the human health benefits of increased ventilation above these minimums. Recent research also shows the benefits on human decision-making performance in office workers, which translates to increased productivity. [...] Read more.
Introduction: Current building ventilation standards are based on acceptable minimums. Three decades of research demonstrates the human health benefits of increased ventilation above these minimums. Recent research also shows the benefits on human decision-making performance in office workers, which translates to increased productivity. However, adoption of enhanced ventilation strategies is lagging. We sought to evaluate two of the perceived potential barriers to more widespread adoption—Economic and environmental costs. Methods: We estimated the energy consumption and associated per building occupant costs for office buildings in seven U.S. cities, representing different climate zones for three ventilation scenarios (standard practice (20 cfm/person), 30% enhanced ventilation, and 40 cfm/person) and four different heating, ventilation and air conditioning (HVAC) system strategies (Variable Air Volume (VAV) with reheat and a Fan Coil Unit (FCU), both with and without an energy recovery ventilator). We also estimated emissions of greenhouse gases associated with this increased energy usage, and, for comparison, converted this to the equivalent number of vehicles using greenhouse gas equivalencies. Lastly, we paired results from our previous research on cognitive function and ventilation with labor statistics to estimate the economic benefit of increased productivity associated with increasing ventilation rates. Results: Doubling the ventilation rate from the American Society of Heating, Refrigeration and Air-Conditioning Engineers minimum cost less than $40 per person per year in all climate zones investigated. Using an energy recovery ventilation system significantly reduced energy costs, and in some scenarios led to a net savings. At the highest ventilation rate, adding an ERV essentially neutralized the environmental impact of enhanced ventilation (0.03 additional cars on the road per building across all cities). The same change in ventilation improved the performance of workers by 8%, equivalent to a $6500 increase in employee productivity each year. Reduced absenteeism and improved health are also seen with enhanced ventilation. Conclusions: The health benefits associated with enhanced ventilation rates far exceed the per-person energy costs relative to salary costs. Environmental impacts can be mitigated at regional, building, and individual-level scales through the transition to renewable energy sources, adoption of energy efficient systems and ventilation strategies, and promotion of other sustainable policies. Full article
(This article belongs to the Special Issue Indoor Environmental Quality: Exposures and Occupant Health)
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Open AccessArticle
Caesarean Section—A Density-Equalizing Mapping Study to Depict Its Global Research Architecture
Int. J. Environ. Res. Public Health 2015, 12(11), 14690-14708; https://doi.org/10.3390/ijerph121114690 - 17 Nov 2015
Cited by 13 | Viewed by 2183
Abstract
Caesarean section (CS) is a common surgical procedure. Although it has been performed in a modern context for about 100 years, there is no concise analysis of the international architecture of caesarean section research output available so far. Therefore, the present study characterizes [...] Read more.
Caesarean section (CS) is a common surgical procedure. Although it has been performed in a modern context for about 100 years, there is no concise analysis of the international architecture of caesarean section research output available so far. Therefore, the present study characterizes the global pattern of the related publications by using the NewQIS (New Quality and Quantity Indices in Science) platform, which combines scientometric methods with density equalizing mapping algorithms. The Web of Science was used as a database. 12,608 publications were identified that originated from 131 countries. The leading nations concerning research activity, overall citations and country-specific h-Index were the USA and the United Kingdom. Relation of the research activity to epidemiologic data indicated that Scandinavian countries including Sweden and Finland were leading the field, whereas, in relation to economic data, countries such as Israel and Ireland led. Semi-qualitative indices such as country-specific citation rates ranked Sweden, Norway and Finland in the top positions. International caesarean section research output continues to grow annually in an era where caesarean section rates increased dramatically over the past decades. With regard to increasing employment of scientometric indicators in performance assessment, these findings should provide useful information for those tasked with the improvement of scientific achievements. Full article
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Open AccessArticle
Mercury Exposure in Healthy Korean Weaning-Age Infants: Association with Growth, Feeding and Fish Intake
Int. J. Environ. Res. Public Health 2015, 12(11), 14669-14689; https://doi.org/10.3390/ijerph121114669 - 17 Nov 2015
Cited by 11 | Viewed by 2210
Abstract
Low-level mercury (Hg) exposure in infancy might be harmful to the physical growth as well as neurodevelopment of children. The aim of this study was to investigate postnatal Hg exposure and its relationship with anthropometry and dietary factors in late infancy. We recruited [...] Read more.
Low-level mercury (Hg) exposure in infancy might be harmful to the physical growth as well as neurodevelopment of children. The aim of this study was to investigate postnatal Hg exposure and its relationship with anthropometry and dietary factors in late infancy. We recruited 252 healthy Korean infants between six and 24 months of age from an outpatient clinic during the 2009/2010 and 2013/2014 seasons. We measured the weight and height of the infants and collected dietary information using questionnaires. The Hg content of the hair and blood was assessed using inductively coupled plasma mass spectroscopy. The geometric mean Hg concentration in the hair and blood was 0.22 (95% confidence interval: 0.20–0.24) µg/g and 0.94 (n = 109, 95% confidence interval: 0.89–0.99) µg/L, respectively. The hair Hg concentration showed a good correlation with the blood Hg concentration (median hair-to-blood Hg ratio: 202.7, r = 0.462, p < 0.001) and was >1 µg/g in five infants. The hair Hg concentration showed significant correlations with weight gain after birth (Z-score of the weight for age—Z-score of the birthweight; r = −0.156, p = 0.015), the duration (months) of breastfeeding as the dominant method of feeding (r = 0.274, p < 0.001), and the duration of fish intake more than once per week (r = 0.138, p = 0.033). In an ordinal logistic regression analysis with categorical hair Hg content (quartiles), dietary factors, including breastfeeding as the dominant method of feeding in late infancy (cumulative odds ratio: 6.235, 95% confidence interval: 3.086–12.597, p < 0.001) and the monthly duration of fish intake more than once per week (cumulative odds ratio: 1.203, 95% confidence interval: 1.034–1.401; p = 0.017), were significantly associated with higher hair Hg content. Weight gain after birth was not, however, significantly associated with hair Hg content after adjustment for the duration of breastfeeding as the dominant method of feeding. Low-level Hg exposure through breastfeeding and fish intake as a complementary food did not directly affect anthropometry in this population. If prolonged breastfeeding is expected, however, the Hg exposure through fish intake may need to be monitored for both mothers and infants. Full article
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Open AccessArticle
The Effects of Weight Perception on Adolescents’ Weight-Loss Intentions and Behaviors: Evidence from the Youth Risk Behavior Surveillance Survey
Int. J. Environ. Res. Public Health 2015, 12(11), 14640-14668; https://doi.org/10.3390/ijerph121114640 - 17 Nov 2015
Cited by 28 | Viewed by 2397
Abstract
The objective of this study was to examine the correlation between self-perception of being overweight and weight loss intentions, eating and exercise behaviors, as well as extreme weight-loss strategies for U.S. adolescents. This study uses 50,241 observations from the Youth Risk Behavior Surveillance [...] Read more.
The objective of this study was to examine the correlation between self-perception of being overweight and weight loss intentions, eating and exercise behaviors, as well as extreme weight-loss strategies for U.S. adolescents. This study uses 50,241 observations from the Youth Risk Behavior Surveillance Survey (YRBSS) 2001–2009, which were nationally representative sample of 9th- through 12th-grade students in both public and private schools in the US. This study finds that, irrespective of the weight status base on self-reported weight and height, adolescents who perceive themselves as overweight have a stronger intention to lose weight, but do not develop better eating and exercise habits, compared with their counterparts of same gender and reported weight status. Normal-weight adolescents, if they perceive themselves as overweight, are more likely to engage in health-compromising weight-loss methods. This study shows that it is critical to transform weight-loss intentions into actual behaviors among overweight/obese adolescents and improve the efficacy of behavioral interventions against childhood obesity. It also highlights the need of establishing a correct perception of body weight among normal weight adolescents to curb extreme weight-loss methods. Full article
(This article belongs to the Special Issue Children, Adolescents and Nutrition)
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Open AccessArticle
Characterization of La/Fe/TiO2 and Its Photocatalytic Performance in Ammonia Nitrogen Wastewater
Int. J. Environ. Res. Public Health 2015, 12(11), 14626-14639; https://doi.org/10.3390/ijerph121114626 - 17 Nov 2015
Cited by 12 | Viewed by 2198
Abstract
La/Fe/TiO2 composite photocatalysts were synthesized by Sol-Gel method and well characterized by powder X-ray diffraction (XRD), scanning electron microscopy (SEM), nitrogen-physical adsorption, and UV-Vis diffuse reflectance spectra (UV-Vis DRS). It is interesting that the doped catalysts were in anatase phase while the [...] Read more.
La/Fe/TiO2 composite photocatalysts were synthesized by Sol-Gel method and well characterized by powder X-ray diffraction (XRD), scanning electron microscopy (SEM), nitrogen-physical adsorption, and UV-Vis diffuse reflectance spectra (UV-Vis DRS). It is interesting that the doped catalysts were in anatase phase while the pure TiO2 was in rutile phase. In addition, the composites possessed better physical chemical properties in photocatalytic activity than pure TiO2: stronger visible-light-response ability, larger specific surface area, and more regular shape in morphology. The photodegradation results of ammonia nitrogen indicate that: the La/Fe/TiO2 had higher catalytic activity to ammonia nitrogen waste water compared pure TiO2 and the other single metal-doped TiO2. pH 10 and 2 mmol/L H2O2 were all beneficial to the removal of ammonia nitrogen by La/Fe/TiO2. However, the common inorganic ions of Cl, NO3, SO42−, HCO3/CO32, Na+, K+, Ca2+ and Mg2+ in water all inhibited the degradation of ammonia nitrogen. By balance calculation, at least 20% of ammonia nitrogen was converted to N2 during the 64.6% removal efficiency of ammonia nitrogen. Full article
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Open AccessArticle
Induction of the Estrogenic Marker Calbindn-D9k by Octamethylcyclotetrasiloxane
Int. J. Environ. Res. Public Health 2015, 12(11), 14610-14625; https://doi.org/10.3390/ijerph121114610 - 17 Nov 2015
Cited by 5 | Viewed by 2067
Abstract
Interrupting the hormonal balance of an organism by interfering with hormones and their target receptors gives rise to various problems such as developmental disorders. Collectively, these reagents are known as endocrine disruptors (EDs). Cyclic volatile methyl siloxanes (cVMSs) are a group of silicone [...] Read more.
Interrupting the hormonal balance of an organism by interfering with hormones and their target receptors gives rise to various problems such as developmental disorders. Collectively, these reagents are known as endocrine disruptors (EDs). Cyclic volatile methyl siloxanes (cVMSs) are a group of silicone polymers that including octamethylcyclotetrasiloxane (D4). In the present study, we examined the estrogenicity of D4 through in vitro and in vivo assays that employed calcium-binding protein 9K (calbindin-D9k; CaBP-9K) as a biomarker. For in vitro investigation, GH3 rat pituitary cells were exposed to vehicle, 17β-estradiol (E2), or D4 with/without ICI 182 780 (ICI). CaBP-9K and progesterone receptor (PR) both were up-regulated by E2 and D4 which were completely blocked by ICI. Transcription of estrogen receptor α (ER α) was decreased by E2 and D4 but increased by ICI. D4 was also administered to immature female rats for an uterotrophic (UT) assay and detection of CaBP-9K. Ethinyl estradiol (EE) or D4 was administered subcutaneously with or without ICI. Although uterine weight was not significant altered by D4, an effect thought to be due to cytochrome P450 (CYP), it induced CaBP-9K and PR gene expression. Based on these results we reveal that D4 has estrogenic potential proven under in vitro and in vivo experimental conditions. Full article
(This article belongs to the Special Issue Endocrine Disruptors and Public Health)
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Open AccessArticle
Method for Assessing the Integrated Risk of Soil Pollution in Industrial and Mining Gathering Areas
Int. J. Environ. Res. Public Health 2015, 12(11), 14589-14609; https://doi.org/10.3390/ijerph121114589 - 13 Nov 2015
Cited by 5 | Viewed by 2107
Abstract
Industrial and mining activities are recognized as major sources of soil pollution. This study proposes an index system for evaluating the inherent risk level of polluting factories and introduces an integrated risk assessment method based on human health risk. As a case study, [...] Read more.
Industrial and mining activities are recognized as major sources of soil pollution. This study proposes an index system for evaluating the inherent risk level of polluting factories and introduces an integrated risk assessment method based on human health risk. As a case study, the health risk, polluting factories and integrated risks were analyzed in a typical industrial and mining gathering area in China, namely, Binhai New Area. The spatial distribution of the risk level was determined using a Geographic Information System. The results confirmed the following: (1) Human health risk in the study area is moderate to extreme, with heavy metals posing the greatest threat; (2) Polluting factories pose a moderate to extreme inherent risk in the study area. Such factories are concentrated in industrial and urban areas, but are irregularly distributed and also occupy agricultural land, showing a lack of proper planning and management; (3) The integrated risks of soil are moderate to high in the study area. Full article
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Open AccessArticle
Vulnerabilities to Temperature Effects on Acute Myocardial Infarction Hospital Admissions in South Korea
Int. J. Environ. Res. Public Health 2015, 12(11), 14571-14588; https://doi.org/10.3390/ijerph121114571 - 13 Nov 2015
Cited by 11 | Viewed by 2229
Abstract
Most previous studies have focused on the association between acute myocardial function (AMI) and temperature by gender and age. Recently, however, concern has also arisen about those most susceptible to the effects of temperature according to socioeconomic status (SES). The objective of this [...] Read more.
Most previous studies have focused on the association between acute myocardial function (AMI) and temperature by gender and age. Recently, however, concern has also arisen about those most susceptible to the effects of temperature according to socioeconomic status (SES). The objective of this study was to determine the effect of heat and cold on hospital admissions for AMI by subpopulations (gender, age, living area, and individual SES) in South Korea. The Korea National Health Insurance (KNHI) database was used to examine the effect of heat and cold on hospital admissions for AMI during 2004–2012. We analyzed the increase in AMI hospital admissions both above and below a threshold temperature using Poisson generalized additive models (GAMs) for hot, cold, and warm weather. The Medicaid group, the lowest SES group, had a significantly higher RR of 1.37 (95% CI: 1.07–1.76) for heat and 1.11 (95% CI: 1.04–1.20) for cold among subgroups, while also showing distinctly higher risk curves than NHI for both hot and cold weather. In additions, females, older age group, and those living in urban areas had higher risks from hot and cold temperatures than males, younger age group, and those living in rural areas. Full article
(This article belongs to the Special Issue Climate Change and Human Health)
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Open AccessArticle
Family Smoking, Exposure to Secondhand Smoke at Home and Family Unhappiness in Children
Int. J. Environ. Res. Public Health 2015, 12(11), 14557-14570; https://doi.org/10.3390/ijerph121114557 - 13 Nov 2015
Cited by 9 | Viewed by 2293
Abstract
Tobacco use adversely affects many aspects of well-being and is disliked by non-smokers. However, its association with family happiness is unknown. We investigated the associations of family unhappiness with smoking in family members and secondhand smoke (SHS) exposure at home in Hong Kong [...] Read more.
Tobacco use adversely affects many aspects of well-being and is disliked by non-smokers. However, its association with family happiness is unknown. We investigated the associations of family unhappiness with smoking in family members and secondhand smoke (SHS) exposure at home in Hong Kong children. In a school-based survey in 2012–2013, 1238 primary school students (mean age 8.5 years, standard deviation 0.9; 42.6% boys) reported family smoking, SHS exposure at home and whether their families had any unpleasant experience caused by smoking or SHS in the past 30 days (tobacco-related unpleasant experience), and rated the overall level of happiness in their families (family unhappiness). Multivariable logistic regression was used to study the associations of tobacco-related unpleasant experience and family unhappiness with family smoking and SHS exposure at home. Tobacco-related unpleasant experience and family unhappiness were reported by 27.5% and 16.5% of students. Unpleasant experience was more strongly associated with family smoking than SHS exposure at home. Family unhappiness was associated with both family smoking (odds ratio 2.37; 95% confidence interval 1.51–3.71) and SHS exposure at home (1.82; 1.39–2.40). These results suggest a previously neglected possible impact of tobacco use on family happiness. Full article
Open AccessArticle
Particulate Matter Exposure in a Police Station Located near a Highway
Int. J. Environ. Res. Public Health 2015, 12(11), 14541-14556; https://doi.org/10.3390/ijerph121114541 - 13 Nov 2015
Cited by 2 | Viewed by 2646
Abstract
People living or working near roadways have experienced an increase in cardiovascular or respiratory diseases due to vehicle emissions. Very few studies have focused on the PM exposure of highway police officers, particularly for the number concentration and size distribution of ultrafine particles [...] Read more.
People living or working near roadways have experienced an increase in cardiovascular or respiratory diseases due to vehicle emissions. Very few studies have focused on the PM exposure of highway police officers, particularly for the number concentration and size distribution of ultrafine particles (UFP). This study evaluated exposure concentrations of particulate matter (PM) in the Sinying police station near a highway located in Tainan, Taiwan, under different traffic volumes, traffic types, and shift times. We focused on periods when the wind blew from the highway toward the police station and when the wind speed was greater than or equal to 0.5 m/s. PM2.5, UFP, and PM-PAHs concentrations in the police station and an upwind reference station were measured. Results indicate that PM2.5, UFP, and PM-PAHs concentrations in the police station can be on average 1.13, 2.17, and 5.81 times more than the upwind reference station concentrations, respectively. The highest exposure level for PM2.5 and UFP was observed during the 12:00 PM–4:00 PM shift while the highest PAHs concentration was found in the 4:00 AM–8:00 AM shift. Thus, special attention needs to be given to protect police officers from exposure to high PM concentration. Full article
(This article belongs to the Special Issue Occupational Safety and Related Impacts on Health and the Environment)
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Open AccessArticle
Greywater Disposal Practices in Northern Botswana—The Silent Spring?
Int. J. Environ. Res. Public Health 2015, 12(11), 14529-14540; https://doi.org/10.3390/ijerph121114529 - 13 Nov 2015
Cited by 4 | Viewed by 2309
Abstract
Disposal of greywater is a neglected challenge facing rapidly growing human populations. Here, we define greywater as wastewater that originates from household activities (e.g., washing dishes, bathing, and laundry) but excludes inputs from the toilet. Pollutants in greywater can include both chemical and [...] Read more.
Disposal of greywater is a neglected challenge facing rapidly growing human populations. Here, we define greywater as wastewater that originates from household activities (e.g., washing dishes, bathing, and laundry) but excludes inputs from the toilet. Pollutants in greywater can include both chemical and biological contaminates that can significantly impact human, animal, and environmental health under certain conditions. We evaluate greywater disposal practices in nonsewered, low-income residential areas in Kasane (264 dwellings/ha), Kazungula (100 du/ha), and Lesoma (99 du/ha) villages in Northern Botswana through household surveys (n = 30 per village). Traditional pit latrines were the dominant form of sanitation (69%, n = 90, 95% CI, 59%–79%) while 14% of households did not have access to onsite sanitation (95% CI 0%–22%). While greywater disposal practices varied across villages, respondents in all sites reported dumping greywater into the pit latrine. Frequency varied significantly across villages with the highest level reported in Kasane, where residential density was greatest (p < 0.014, χ2 = 9.13, 61% (n = 23, 95% CI 41%–81%), Kazungula 41% (n = 22, 95% CI 20%–62%), Lesoma 13% (95% CI 0%–29%). Disposal of greywater in this manner was reported to limit contamination of the household compound and reduce odors, as well as pit latrine fecal levels. Some respondents reported being directed by local health authorities to dispose of greywater in this manner. Environmentally hazardous chemicals were also dumped directly into the pit latrine to reduce odors. With high household to pit latrine ratios particularly in rental properties (4.2 households, SD = 3.32, range = 15 units, average household size 5.3, SD = 4.4), these greywater and pit latrine management approaches can significantly alter hydraulic loading and leaching of chemicals, microorganisms, and parasites. This can dramatically expand the environmental footprint of pit latrines and greywater, increasing pollution of soil, ground, and surface water resources. Challenges in greywater disposal and pit latrines must be addressed with urgency as health behaviors directed at minimizing negative aspects may amplify the environmental impacts of both greywater and pit latrine excreta. Full article
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Open AccessArticle
Association of Exposure to Radio-Frequency Electromagnetic Field Radiation (RF-EMFR) Generated by Mobile Phone Base Stations with Glycated Hemoglobin (HbA1c) and Risk of Type 2 Diabetes Mellitus
Int. J. Environ. Res. Public Health 2015, 12(11), 14519-14528; https://doi.org/10.3390/ijerph121114519 - 13 Nov 2015
Cited by 11 | Viewed by 12572
Abstract
Installation of mobile phone base stations in residential areas has initiated public debate about possible adverse effects on human health. This study aimed to determine the association of exposure to radio frequency electromagnetic field radiation (RF-EMFR) generated by mobile phone base stations with [...] Read more.
Installation of mobile phone base stations in residential areas has initiated public debate about possible adverse effects on human health. This study aimed to determine the association of exposure to radio frequency electromagnetic field radiation (RF-EMFR) generated by mobile phone base stations with glycated hemoglobin (HbA1c) and occurrence of type 2 diabetes mellitus. For this study, two different elementary schools (school-1 and school-2) were selected. We recruited 159 students in total; 96 male students from school-1, with age range 12–16 years, and 63 male students with age range 12–17 years from school-2. Mobile phone base stations with towers existed about 200 m away from the school buildings. RF-EMFR was measured inside both schools. In school-1, RF-EMFR was 9.601 nW/cm2 at frequency of 925 MHz, and students had been exposed to RF-EMFR for a duration of 6 h daily, five days in a week. In school-2, RF-EMFR was 1.909 nW/cm2 at frequency of 925 MHz and students had been exposed for 6 h daily, five days in a week. 5–6 mL blood was collected from all the students and HbA1c was measured by using a Dimension Xpand Plus Integrated Chemistry System, Siemens. The mean HbA1c for the students who were exposed to high RF-EMFR was significantly higher (5.44 ± 0.22) than the mean HbA1c for the students who were exposed to low RF-EMFR (5.32 ± 0.34) (p = 0.007). Moreover, students who were exposed to high RF-EMFR generated by MPBS had a significantly higher risk of type 2 diabetes mellitus (p = 0.016) relative to their counterparts who were exposed to low RF-EMFR. It is concluded that exposure to high RF-EMFR generated by MPBS is associated with elevated levels of HbA1c and risk of type 2 diabetes mellitus. Full article
(This article belongs to the collection Health Care and Diabetes)
Open AccessArticle
Overweight and Obesity and Associated Factors among School-Aged Adolescents in Six Pacific Island Countries in Oceania
Int. J. Environ. Res. Public Health 2015, 12(11), 14505-14518; https://doi.org/10.3390/ijerph121114505 - 13 Nov 2015
Cited by 9 | Viewed by 2288
Abstract
The aim of this study was to assess overweight and obesity and associated factors in school-going adolescents in six Pacific Island countries in Oceania. The sample included 10,424 school-going adolescents predominantly 13–16 years old from Fiji, Kiribati, Samoa, Solomon Islands, Tonga, and Vanuatu. [...] Read more.
The aim of this study was to assess overweight and obesity and associated factors in school-going adolescents in six Pacific Island countries in Oceania. The sample included 10,424 school-going adolescents predominantly 13–16 years old from Fiji, Kiribati, Samoa, Solomon Islands, Tonga, and Vanuatu. Bivariate and multivariable analyses were conducted to assess the relationship between dietary behaviour, substance use, physical activity, psychosocial factors, social-familial influences, and overweight or obesity. The prevalence of overweight and obesity was determined based on self-reported height and weight and the international child body mass index standards. Results indicate a prevalence of overweight or obesity of 24.3% and obesity of 6.1% in the six countries, ranging in terms of overweight or obesity and obesity from 12.0% and 0.4% in Vanuatu to 58.7% and 21.1% in Tonga, respectively. In multivariable regression analysis, being female was associated with overweight, carbonated soft drink use with obesity, sedentary behaviour with overweight or obesity, suicidal ideation with overweight, having close friends and peer support with overweight and obesity, parental or guardian supervision with overweight, and parental or guardian bonding was associated with overweight or obesity. High prevalence rates of overweight and obesity were found and several factors identified which can help guide interventions. Full article
Open AccessArticle
An Enhanced Variable Two-Step Floating Catchment Area Method for Measuring Spatial Accessibility to Residential Care Facilities in Nanjing
Int. J. Environ. Res. Public Health 2015, 12(11), 14490-14504; https://doi.org/10.3390/ijerph121114490 - 13 Nov 2015
Cited by 18 | Viewed by 2312
Abstract
Civil administration departments require reliable measures of accessibility so that residential care facility shortage areas can be accurately identified. Building on previous research, this paper proposes an enhanced variable two-step floating catchment area (EV2SFCA) method that determines facility catchment sizes by dynamically summing [...] Read more.
Civil administration departments require reliable measures of accessibility so that residential care facility shortage areas can be accurately identified. Building on previous research, this paper proposes an enhanced variable two-step floating catchment area (EV2SFCA) method that determines facility catchment sizes by dynamically summing the population around the facility until the facility-to-population ratio (FPR) is less than the FPR threshold (FPRT). To minimize the errors from the supply and demand catchments being mismatched, this paper proposes that the facility and population catchment areas must both contain the other location in calculating accessibility. A case study evaluating spatial accessibility to residential care facilities in Nanjing demonstrates that the proposed method is effective in accurately determining catchment sizes and identifying details in the variation of spatial accessibility. The proposed method can be easily applied to assess other public healthcare facilities, and can provide guidance to government departments on issues of spatial planning and identification of shortage and excess areas. Full article
(This article belongs to the Special Issue Methodological Innovations and Reflections-1)
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Open AccessArticle
Poly-Tobacco Use among High School Students
Int. J. Environ. Res. Public Health 2015, 12(11), 14477-14489; https://doi.org/10.3390/ijerph121114477 - 13 Nov 2015
Cited by 16 | Viewed by 2882
Abstract
Although cigarette use by adolescents is declining, emerging tobacco products are becoming increasingly popular and youth may use more than one type of tobacco product. The purposes of this study were: (1) to assess patterns of poly-tobacco use among a representative sample of [...] Read more.
Although cigarette use by adolescents is declining, emerging tobacco products are becoming increasingly popular and youth may use more than one type of tobacco product. The purposes of this study were: (1) to assess patterns of poly-tobacco use among a representative sample of high school students and (2) to determine how beliefs correlate with poly-tobacco use. Data came from the 2013 North Carolina Youth Tobacco Survey (n = 4092). SAS logistic regression survey procedures were used to account for the complex survey design and sampling weights. Among all high school students in NC in 2013, 29.7% reported current any tobacco use, with 19.1% reporting current poly-tobacco use, and 10.6% reporting current use of only one product. Among poly-tobacco users, 59.3% reported that one of the products they currently used was cigarettes. Positive tobacco product beliefs were found to be significantly associated with poly-tobacco use. Communication campaigns, policy efforts, and future research are needed for prevention, regulation, and control of poly-tobacco use among adolescents, which represents a significant public health problem. Full article
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