Introduction to Environmental Health Final

Private Wells

10% of US population • Not regulated by EPA- Owners must periodically test to ensure safe to drink

0. On your first day of an internship at a Chicago Public Health Office, you are asked to find background information on air quality trends in the community. Chicago is in Cook County, Illinois- on the southwest corner of Lake Michigan. Since 2009, what year had the greatest number of days that would be considered "unhealthy" for people in Chicago with asthma or other lung disease? [0.25 points] a. 2010 b. 2012 c. 2014 d. 2016

2012

surface water

>50% of pollution is diffuse "runoff" from cities, farms Harder to control than point sources.

An example of primary prevention

A city adopts 100% green energy (wind power,solar power)

An example of tertiary prevention is:

A doctor prescribes antibiotics to a patient with tubercolis

What choice contains the correct definitions of both HAZARD and RISK? A. A hazard is something that causes injury and a risk is something that causes illness. B. A hazard has the possibility of causing harm. Risk is the probability of harm occurring. C. A hazard is something that causes illness and a risk is something that causes injury. D. A risk has the possibility of causing harm. Hazard is the probability of harm occurring.

A hazard has the possibility of causing harm. Risk is the probability of harm occurring.

Clean Water Act

A legally enforceable primary drinking water standard for contaminants in public water system

Secondary standard for drinking water

A non-enforceable standard that deals with cosmetic or aesthetic effects of drinking water

An example of secondary prevention

A pediatrician testa a healthy 1 year old child for their blood level. All hospital staff must receive a PPD test.

The graph below shows urine mercury (Hg) levels measured in children in small-scale goldmining regions in Africa. The "Alert" and "Action" levels are where people may suffer from adverse health effects, based on other studies. 9. Based on the graph here, which one of the follow statements is most likely true? a. Children working with mercury-gold amalgam are on average no more likely to have Hgrelated health problems than similar children living in the same area b. Children living outside the gold-mining areas are likely to have the same rate of Hg related health problems as children living in the Hg-exposed mining areas c. No significant differences would be seen in health problems between the three groups d. Although the children working with mercury-gold amalgam did not have medical exams, we would expect to see more neurological problems in that group than in the other two.

Although the children working with mercury-gold amalgam did not have medical exams, we would expect to see more neurological problems in that group than in the other two.

exposure

Any condition which provides an opportunity for an external environmental agents to enter the body

heat wave

At least three consecutive days with high temperatures of at least 90°F

The elderly are vulnerable to the effects of heat waves. Air conditioning systems are important adaptation measures to reduce the risk of heat-related illness as climate change increases the intensity of heat waves. The NYC Department of Health Environment and Health Portal provides access to data on a variety of topics that show how the environment affects health (e.g., air pollution, built environment, climate change). Using the Portal, determine which NYC borough has the lowest percentage of adults age >65 who report having air conditioning in the home? Link to the Portal

Bronx

Researchers would be able to use baby teeth to estimate exposures for all of the following studies EXCEPT: A. Case control study to examine metal dysregulation during the 2nd and 3rd trimesters (starting around 14 weeks gestational age) of pregnancy and autism diagnosis in childhood B. Case control study to examine breastfeeding duration in school-aged children with and without food allergies C. Case control study to examine metal exposure in the 1st trimester of pregnancy (0-13 weeks gestational age) and schizophrenia in adolescents D. Case control study to examine metal exposure in early life (from birth to age 3 years) and amyotrophic lateral sclerosis (ALS) diagnosis in adulthood

Case control study to examine metal exposure in the 1st trimester of pregnancy (0-13 weeks gestational age) and schizophrenia in adolescents

The NYC Department of Health Environment and Health Portal also provides a "Heat Vulnerability Index" (HVI) for each neighborhood. According to the DOH, the HVI is "a measure of how at risk a neighborhood is during extreme heat, compared to other neighborhoods. In NYC, the risk of illness or death related to heat waves is higher in communities with higher surface temperatures and less green space, and poor communities of color that have experienced historical racism and segregation. Each neighborhood receives a score from 1 (lowest risk) to 5 (highest risk) based on results from a statistical model that uses social and environmental factors to estimate risk of heat-related death across NYC neighborhoods." Using the Portal, determine which Manhattan neighborhood has the highest HVI? Link to the Portal A. Washington Heights/Inwood B. East Harlem C. Upper East Side D. CentralHarlem

Central harlem

Primary prevention clinical model

Childhood vaccines

Select the scenario that represents both a current hazard AND a current risk: a. Intact asbestos insulation behind a child's bedroom wall b. Intact lead-based paint on a wall (without chipping, peeling) c. Chipping lead-based paint on a radiator in a child's bedroom d. Bleach locked in a cabinet that is not accessible by a child

Chipping lead-based paint on a radiator in a child's bedroom

Your best next step in ascertaining the source of the illness would be to: e. Find samples of leftover food and culture them for bacteria f. Compile a list of everyone who attended the barbecue g. Culture samples of the same foods from the markets that supplied the barbecue h. Call local doctors and inquire about recent patients with similar symptoms

Compile a list of everyone who attended the barbecue

Primary Prevention: "Environmental Stewardship"

Control what we do to environment which then blocks harm to us

Environmental Stewardship

Control what we do to the environment, which then blocks harm to us.

6. Chapter 7 of the report highlights the impact of climate change on food safety, nutrition, and distribution. Which one of the following is a potential impact on the nutritional value of crops attributable to the rising carbon dioxide (CO2) levels in the atmosphere?

Decrease in protein content of barley, wheat, rice, and potato crops

The Clean Air Act requires:

EPA to set National Ambient Air Quality Standards (NAAQS) for 6 "criteria" air pollutants at levels to protect public health with an adequate margin of safety.

The decline in tuberculosis (TB) mortality in the USA from 1860 to 1940 was likely a result of all EXCEPT which one of the following: m. TB sanitariums and patient isolation n. Building codes and improved ventilation o. Effective antibiotic and surgical treatment p. Early detection of cases using skin testing

Effective antibiotic and surgical treatment

Based on what you know about foodborne diseases and the information above, which aspect of the picnic do you expect to start investigating? a. Canned foods for botulism b. Food brought to the barbecue c. Drinks served at the barbecue d. Influenza cases in families and teachers who attended

Food brought to the barbecue

The 40-140 rule

Foods should be held: below 40 F and above 140 F

engineering control example

Fume hood used for chemicals

As the director of the Department of Health's "Healthy Neighborhoods" program, you are contacted by a pediatrician because one of her 6-year old male patients with autism was found to have an elevated blood lead level of 20 mcg/dL. You happen to know that chelation therapy is not needed for this blood lead level because of a lecture you once heard, and you know that the "treatment" is to remove the source of lead. You take a detailed environmental history about the child's living environment, his parents' occupation and daily practices. All of these are potential sources of lead EXCEPT:

Fumes from his parents' power tools since he enjoys watching his parents do their home maintenance projects.

Heat Advisory

Heat index is forecast to reach 95°F to 99°F for at least two consecutive days or 100°F to 104°F for any length of time

excessive heat watch

Heat index is forecast to reach or exceed 105°F for at least two consecutive hours in the next 24 to 48 hours

heat index

How the air feels when temperature and humidity are combined

A laboratory technician in a petrochemical company wore a personal air monitor to measure levels of benzene in the lab. (Benzene is a toxic solvent that can cause blood cancers like leukemia) It was found that her exposure levels were higher than the limits that the Occupational Safety and Health Administration (OSHA) allows for exposure to benzene. Rank the following interventions from MOST effective to LEAST effective in protecting this lab technician: I. Wearing chemical suits at all timesII. Requiring the lab technician to take 15-minute breaks outside of lab every 2 hours III. Using a less harmful chemical to accomplish the same task in this lab

III,II,I

Mental Noise Theory

Individuals experiencing high levels of concern, anxiety, or fear, whether caused by real or perceived threats, demonstrate diminished ability to process information

Primary Prevention: "Public Health" Model

Intervene on environment to prevent disease initiation (examples: food preparation: regulation and testing)

Secondary prevention public health model

Intervene on environment to prevent disease progression

primary prevention Public Health model

Intervenes on environment to prevent disease initiation

What months have the highest average number of days that would be considered "unhealthy" for people in Chicago with asthma or other lung disease? [0.25 points] a. May and June b. June and July c. August and September d. January and February

June and July

You work for a nonprofit organization whose mission is to support safety for vulnerable populations of workers and you are establishing a new partnership with domestic cleaners. All of these can be considered barriers to reducing risk of complications from respiratory illnesses in the domestic cleaner population EXCEPT:

Lack of protection under the EPA's Federal Insecticide, Fungicide and Rodenticide Act (FIFRA) when purchasing a pesticide spray from a supermarket to use on the cockroaches found in their home

PM exposure linked to:

Lung diseases, cardiovascular disease, premature births, premature mortality, cancer (diesel)

negative amplication

Messages with negative words receive closer attention, are remembered longer, and have a greater impact than messages with positive words

Which one of these is NOT a harmful health effect of inorganic arsenic exposure? a. Lung cancer b. Motor neuropathy (damage of motor nerves) causing "wrist drop" and "foot drop" c. Heavily pigmented (darkened) thickened skin on the palms and soles d. Skin cancer

Motor neuropathy (damage of motor nerves) causing "wrist drop" and "foot drop"

SDWA (Safe Drinking Water Act) can mean:

New contaminants can be added over time!

7. Chapter 7 of the report highlights the impact of climate change on food safety, nutrition, and distribution. Food safety can be impacted by changes in air and water temperatures, weather-related changes, and extreme events that can shift the seasonal and geographic occurrence of bacteria, viruses, pests, parasites, fungi, and other chemical contaminants. Currently, which one of the following infectious food contaminants would be LEAST expected to increase with warming air and water temperatures? a. Norovirus b. Salmonella c. Campylobacter d. E. Coli

Norovirus

biological oxygen demand

Nutrient overload -> Algae thrives. Microorganisms use up the dissolved oxygen as they eat the excessive organic matter. Increase in the: Biologic oxygen demand (BOD)

By 2030, New York City buildings will have completely transitioned to cleaner fuel for boilers and heating systems, replacing the heavy oils that are still used for heat. This transition will benefit New Yorkers because: a. It will eliminate carbon monoxide poisoning deaths across the city b. Benzene, a hazardous air pollutant will be reduced, which will put NYC in compliance with the National Ambient Air Quality Standards (NAAQS) c. Lead emissions will be reduced, which will reduce the average blood lead level of children who live in buildings with boilers d. Particulate matter emissions (especially PM2.5) will be reduced, which will reduce the number of pollution-related respiratory and cardiovascular diseases

Particulate matter emissions (especially PM2.5) will be reduced, which will reduce the number of pollution-related respiratory and cardiovascular diseases

Prevention of Foodborne Illnesses

Pasteurization, cooking, irradiation, paper storage temperature , hygiene

Risk Perception

People respond to risks as they perceive the risks to be

Overall population (adults and children) blood lead levels have declined by about 80% to 90% from the 1970s until today. This is one of the great success stories of modern US public health. Which of the following is the most likely cause of this drop? A. Banning of lead paint in homes B. Phasing out of lead additives in gasoline C. Enforcement of the OSHA lead standard D. Better calcium supplementation in the US diet

Phasing out of lead additives in gasoline

Safe Drinking Water Act (SDWA)

Regulate drinking water in public systems -MCLs -emerging contaminants of concern examined for possible future regulation (CC List) -well water NOT regulated!

Clean Air Act (CAA)

Regulate outdoor air pollutants -NAAQS (PM10, PM2.5, O3, CO, NO2, SO2, Lead) -HAPs

The safe drinking act regulates:

Regulates discharge of pollutants into surface water

Public health goal

Regulates drinking water contaminants in public water systems that may pose health risks by establishing primary and secondary standards

Clean Water Act (CWA)

Regulates point pollution sources into surface water and recreational water -Permits to discharge pollutants -States must regulate run-off (state implementation plans)

Hazard Elimination example

Replacing benzene with a nontoxic chemical

administrative control example

Rotating assembly line tasks

You determine, through your activities above, that the most likely source for the outbreak was the chicken that was roasted on the barbecue. Based on the food lecture and readings, which one of these foodborne pathogens was the most likely cause? i. Salmonella j. Staph aureus toxin k. Hepatitis A l. E. coli 0175

Salmonella

Secondary prevention clinical model:

Screening of asymptomatic individuals to catch a disease very early

Secondary Prevention: "Clinical" Model

Screening of asymptomatic individuals. Tuberculosis: - - - Identify cases Confine (hospitals, sanatorium) Treatment of latent tuberculosis (e.g after a + PPD)

The deepening political polarization of attitudes about climate change in the United States is a barrier for the implementation of climate-related policies. Which one of the following can be an effective strategy for communicating with stakeholder(s) that are resistant to acknowledging the existence and impact of climate change?

Sharing stories that engage an emotional response

You are working for the Delaware Department of Health in Sussex County, a rural area with many farms. You receive a call from a local resident who just moved into a 40-year old home that uses a private well for drinking water. She recently had the well water tested. She wants to get your opinion on whether the water is safe for her and her infant daughter to consume. The test results are posted below. The first step is to compare the results to the EPA's Primary and Secondary Drinking Water Standards to determine if any results exceed those Standards. Which of the following statements about her well water is accurate to relay to the concerned mother?

She should use an alternative water source to mix the baby's formula until the well water is treated to avoid blue baby syndrome (methemoglobinemia

A family of five went to a school sports banquet on a Thursday evening. After dinner they packed up some of the cheesecake dessert, brought it home and left it on the kitchen counter. They ate the cheesecake on Saturday evening. They reported it looked and tasted fine, and it didn't seem to have "gone off" or looked unusual despite being left on the counter. On Sunday morning, four of five members of the family awoke with nausea, cramps, and diarrhea. Three vomited several times. None had a fever. By Monday morning, all were tired but could eat and drink without nausea or other symptoms. Based on this information, which one of the following is the most likely causative agent? Is this illness most likely toxigenic or invasive?

Staph aureus, toxigenic

Toxigenic bacteria

Symptoms start after 30 minutes to 8 hours

Invasive bacteria

Symptoms start after 4 to 7 days

Imagine you are working for the Suffolk County (Long Island) Department of Health. You are asked to attend a community meeting a few days after the debris was found in the park in Brentwood, and to give a brief statement. Select the ONE best set of key messages to use in this situation, in our role as a representative of the health department: a. Toxic and deadly chemicals like DDT and asbestos were found in your park. These chemicals will give your children cancer. Get your children tested for chemicals in the emergency room right away! b. Debris was found in the park. This is not a big deal and will not poison you or your children. Calm down, people. The concentration of chemicals is not high enough to cause illnesses. If you're really concerned, just find somewhere else for your kids to play. c. The dumping of debris was wrong and should not have happened in your community. While we do not think this presents any immediate risk to families, the main concern is that we ultimately do not know what ongoing low level exposures may mean for the health of children who were frequently in the park. The most important steps for now are to reduce further exposures by avoiding the park and removing your shoes before entering home so you don't bring soil inside. d. Carcinogenic and neurotoxic compounds were detected by analytical testing of debris discovered at the park. Upon risk assessment, it was determined that the levels did not exceed established background levels in the locale. While biomonitoring is not recommended, concerned residents should contact their physician to discuss any concerns about subclinical or clinical effects.

The dumping of debris was wrong and should not have happened in your community. While we do not think this presents any immediate risk to families, the main concern is that we ultimately do not know what ongoing low level exposures may mean for the health of children who were frequently in the park. The most important steps for now are to reduce further exposures by avoiding the park and removing your shoes before entering home so you don't bring soil inside

The most likely source of contaminant of concern (the one exceeding MCL) questions #1 is: a. Corrosion of the water pipes b. Fertilizer run-off from nearby farmland c. Leakage from old underground fuel storage tanks d. Byproduct from the disinfection process for the well water

The fertilizer run off from near by farm

. Chapter 3 of the US "Climate and Health Assessment" report provides an overview of climate change and air quality effects. Some outdoor air pollutants that can be affected by climate change are from natural sources like pollen released by trees, grass, and weeds. Climate change may alter the production, allergenicity (how potent the allergen is), distribution, and timing of these airborne allergens (aeroallergens). According to the report, which one of the following statements is FALSE? a. The length of ragweed season has actually decreased for the southern part of the United States (including Texas) b. The length of ragweed season stayed the same for cooler areas (the upper midwestern part of the United States, including Illinois and Wisconsin, and parts of Canada) c. Heavy rainfall can change airborne allergen (aeroallergen) concentrations d. Carbon dioxide (CO2) in the atmosphere encourages the growth of plants that release pollens and other airborne allergens

The length of ragweed season stayed the same for cooler areas (the upper midwestern part of the United States, including Illinois and Wisconsin, and parts of Canada)

Maximum contaminant level (MCL)

The level below which no expected health risk for a person drinking 2 liters per day for a lifetime (not a legally enforceable standard- a goal level that does not consider technology or cost)

particulate matter

The smaller the particle, the more likely it can be inhaled deep into the lungs, where air exchange happens with the bloodstream.

You are doing your Applied Practicum Experience (APE) at the Michigan Department of Health (DOH) and are assigned to the Environmental Health team. The team just completed an exposure assessment in a community who had a public (municipal) water system that was contaminated with PFOA (perfluorooctanoic acid). PFOA is one type of PFAS (perfluoroalkyl and polyfluoroalkyl substances) compound. As part of the exposure assessment, the DOH collected blood from a random sample of adults in the community, and also collected blood from a random sample of adults from a community in Michigan (with similar sociodemographics) that does not have a PFAS contaminated water supply. In preparation for your work with the Environmental Health team, you review information on PFAS compounds from the Agency for Toxic Substances and Disease Registry (ATSDR): https://www.atsdr.cdc.gov/pfas/ You also read the draft report from the exposure assessment. Table 1 from the report is posted below Which one of the following is the most likely explanation for the results in Table 1? [0.25 points] a. Community B has a coal-fired power plant b. The source water for Community B municipal water system is contaminated with waste from a factory that made "Teflon' products c. The source water for Community A municipal water system is contaminated from the use of aqueous firefighting foam at a local military base d. Community A has an aging water infrastructure, with most water service delivery pipes made of lead

The source water for Community A municipal water system is contaminated from the use of aqueous firefighting foam at a local military base

Which of the following statements is TRUE about the type of water pollution portrayed in the photograph above? a. This is a non-point source of pollution, which is a type of pollution that is more difficult to control because of its diffuse and variable sources that can run-off into source water b. This is a point source of pollution and is regulated by a "permit" system under the Clean Water Act c. This is a non-point source of pollution and is regulated by a "permit" system under the Safe Drinking Water Act d. This is a point source of pollution, and does not pose a risk to local source water

This is a non-point source of pollution, which is a type of pollution that is more difficult to control because of its diffuse and variable sources that can run-off into source water

Types of Foodborne Infectious Disease

Toxigenic bacteria and invasive bacteria and viruses

tertiary prevention clinical model:

Treat symptomatic disease to prevent complications (e.g., asthma inhaler for treatment during asthma attack)

Tertiary Prevention: "Clinical" Model

Treat symptomatic disease to prevent complications. (E.g.Tuberculosis: - Treatment of active disease with antibiotics)

Trust Determination Theory

Trust is the most important factor determining the perception of risk.

Potential sources of mercury toxicity in New York City include all but which of the following: A. Traditional religious ceremonies B. Recycling of compact fluorescent light bulbs C. High fish consumption in the diet D. Water wells drilled into aquifers in rock that contains high levels

Water wells drilled into aquifers in rock that contains high levels

Personal Protective Equipment (PPE) example

Wearing fall protection harness

Collary

When heating or cooling, bring foods through the 40-140 F region AS RAPIDLY AS POSSIBlE

The United States Global Change Research Program released a Climate and Health Assessment in 2016. The following 3 questions can be answered by reviewing sections of the report (Chapter 1: Climate Change and Human Health, and Chapter 7: Food Safety, Nutrition, and Distribution). 5. Chapter 1 of the report provides an overview of climate change and human health. Changes in precipitation and temperature can have direct and indirect impacts on public health. By mid-century (2050), all of the following are projected changes in precipitation and temperature across the United States EXCEPT: a. Heat waves will become more intense b. Frequency and intensity of extreme precipitation events will increase c. Longer-term droughts will intensify in large areas of the Southwest, the southern Great Plains, and the Southeast d.Winter and spring precipitation will increase uniformly over the United

Winter and spring precipitation will increase uniformly over the United States

As a State Department of Health employee in charge of the"ClimateMitigation and Adaptation" program, you are tasked with speaking to various stakeholders around the state to gain support for the program. Your first meeting is for residents of a rural conservative county that has been generally opposed to green/renewable energy. After meeting with local officials, you learn that many families in the area are hunters and fishers. Which of the following would be a successful communication strategy?

You partner with the local hunting club to have around table discussion featuring local resident's concerns stories about loss of hunting land and fish availability due to climate change

example of natural contaminants in bedrock:

arsenic and uranium

sources of contaminant in drinking water

discharge from pertroleum refineries; fire retardants; ceramics, electronic; solder

Ground Water Rule of 2006

established risk targeted approach to reduce facel contamination of public groundwater sources.

example of non point source

farmland creates run-off

Routes of Exposure for food

ingestion

Routes of Exposure for water

ingestion, skin absorption, inhalation

routes of exposure for soil/dust

ingestion, skin absorption, inhalation

Routes of Exposure for air

inhalation

Routes of exposure for consumer products

inhalation, skin absorption, ingestion

Based on what we know so far from epidemiologic studies, residents of Community A may be at higher risk for: a. Bone cancer b. More robust (improved) antibody response to vaccines c. Reduction in cholesterol levels d. Kidney cancer

kidney cancer

Local television news reported the discovery of construction waste that was illegally dumped in a public park in the Brentwood community in Long Island. The park is well used by families and children of all ages. It is not known how long the material was there before being discovered; but it is estimated to be at least 2 weeks. The park has been closed, the debris has been contained, and scheduled activities at the site have all been cancelled for the foreseeable future. Watch this clip: https://abc7ny.com/family/lead-ddt-found-in-long-island-park-/84298/ Upon review of the environmental testing data, the levels of the contaminants in the soil were consistent with "background levels" (typical levels found in NY soil due to widespread industrial and agricultural activities in the past / or current). Air testing detected no asbestos in the air (so unlikely a risk that people will breathe it in; it "stays" in the soil). 3. All of the following are factors that contributed to risk perception in this case EXCEPT for: a. Children affected b. Imposed nature of the hazard c. Natural origin of exposure d. Unfamiliar chemicals e. Lack of trust

natural origin of exposure

What outdoor air pollutant is the main contributor to the results found for Question #11? (e.g, what pollutant tends to be highest in those months) [0.5 points] a. PM10 b. Carbon Monoxide c. Oxides of sulfur d. Ozone

ozone

What is criteria for air pollutant regulated by the the clean air act:

ozone, lead, nitrogen dioxide, sulfate dioxide, particulate matter, carbon monoxide

Fit-testing of respirators is associated with which of the following controls?

personal protective equipment

Clean water regulates:

point source discharges into surface waters (permits)

clean water regulates and sets:

quality standards for surface water contaminants.

NYC has created a "Resilient Neighborhoods" program: a place-based planning initiative, led by the Department of City Planning (DCP) in collaboration with communities and other agencies, to identify neighborhood-specific strategies, including zoning and land use changes, to support the vitality and resiliency of communities in the floodplain and prepare them for future storms. Review the report for Rockaway Park and Rockaway Beach, Queens- this neighborhood was chosen as one of the ten Resilient Neighborhoods in the program because it was severely damaged by Hurricane Sandy flooding, and also because the expansion of the floodplain makes it vital for buildings in this area to be retrofitted or designed to withstand future flooding: All of the following are recommendations for the resiliency framework for Rockaway Park and Rockaway Beach EXCEPT:

reducing access to the waterfront

Clean Water does not:

regulate nonpoint sources- states must manage run-off

PM10 & PM2.5 is

regulated by the clean air act

Groundwater is not:

regulated by the clean water act

Mount Storm is the site of an environmental air quality monitoring site in West Virginia. Peak daily ozone levels are recorded there at about 12:00 midnight, particularly in the summer, which seems unusual, because it's in the middle of a forest, with very little human activity around. The most likely source for this ozone would be: a. Coal-fired steel plants in Pittsburgh PA b. Rush-hour automobile traffic in Washington DC c. Off-gassing of VOCs from Appalachian pine forests d. Greenhouse gas production

rush-hour automobile

Public Water System

• 90% of US population • More than 155,000 systems in US • Regulated by the EPA • ~50% source water is surface water ~50% is groundwater