Melissa Jordan

New Evidence: Data Documenting Parental Support for Earlier Sexuality Education

BACKGROUND Numerous studies document support for sexuality education to be taught in high school, and often, in middle school. However, little research has been conducted addressing support for sexuality education in elementary schools. METHODS As part of the state Behavioral Risk Factor Surveillance System (BRFSS) Survey administration, the Florida Department of Health conducted the Florida Child Health Survey (FCHS) by calling back parents who had children in their home and who agreed to participate (N = 1715). RESULTS Most parents supported the following sexuality education topics being taught specifically in elementary school: communication skills (89%), human anatomy/reproductive information (65%), abstinence (61%), human immunodeficiency virus (HIV)/sexually transmitted infections (STIs) (53%), and gender/sexual orientation issues (52%). Support was even greater in middle school (62-91%) and high school (72-91%) for these topics and for birth control and condom education. Most parents supported comprehensive sexuality education (40.4%), followed by abstinence-plus (36.4%) and abstinence-only (23.2%). Chi-square results showed significant differences in the type of sexuality education supported by almost all parent demographic variables analyzed including sex, race, marital status, and education. CONCLUSIONS Results add substantial support for age-appropriate school-based sexuality education starting at the elementary school level, the new National Sexuality Education Standards, and funding to support evidence-based abstinence-plus or comprehensive sexuality education.

Associations between exposure to ambient benzene and PM2.5 during pregnancy and the risk of selected birth defects in offspring

OBJECTIVE A growing number of studies have investigated the association between air pollution and the risk of birth defects, but results are inconsistent. The objective of this study was to examine whether maternal exposure to ambient PM2.5 or benzene increases the risk of selected birth defects in Florida. METHODS We conducted a retrospective cohort study of singleton infants born in Florida from 2000 to 2009. Isolated and non-isolated birth defect cases of critical congenital heart defects, orofacial clefts, and spina bifida were identified from the Florida Birth Defects Registry. Estimates of maternal exposures to PM2.5 and benzene for all case and non-case pregnancies were derived by aggregation of ambient measurement data, obtained from the US Environmental Protection Agency Air Quality System, during etiologically relevant time windows. Multivariable Poisson regression was used to estimate adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) for each quartile of air pollutant exposure. RESULTS Compared to the first quartile of PM2.5 exposure, higher levels of exposure were associated with an increased risk of non-isolated truncus arteriosus (aPR4th Quartile, 8.80; 95% CI, 1.11-69.50), total anomalous pulmonary venous return (aPR2nd Quartile, 5.00; 95% CI, 1.10-22.84), coarctation of the aorta (aPR4th Quartile, 1.72; 95% CI, 1.15-2.57; aPR3rd Quartile, 1.60; 95% CI, 1.07-2.41), interrupted aortic arch (aPR4th Quartile, 5.50; 95% CI, 1.22-24.82), and isolated and non-isolated any critical congenital heart defect (aPR3rd Quartile, 1.13; 95% CI, 1.02-1.25; aPR4th Quartile, 1.33; 95% CI, 1.07-1.65). Mothers with the highest level of exposure to benzene were more likely to deliver an infant with an isolated cleft palate (aPR4th Quartile, 1.52; 95% CI, 1.13-2.04) or any orofacial cleft (aPR4th Quartile, 1.29; 95% CI, 1.08-1.56). An inverse association was observed between exposure to benzene and non-isolated pulmonary atresia (aPR4th Quartile, 0.19; 95% CI, 0.04-0.84). CONCLUSION Our results suggest a few associations between exposure to ambient PM2.5 or benzene and specific birth defects in Florida. However, many related comparisons showed no association. Hence, it remains unclear whether associations are clinically significant or can be causally related to air pollution exposures.

Identifying Heat Waves in Florida: Considerations of Missing Weather Data.

Background Using current climate models, regional-scale changes for Florida over the next 100 years are predicted to include warming over terrestrial areas and very likely increases in the number of high temperature extremes. No uniform definition of a heat wave exists. Most past research on heat waves has focused on evaluating the aftermath of known heat waves, with minimal consideration of missing exposure information. Objectives To identify and discuss methods of handling and imputing missing weather data and how those methods can affect identified periods of extreme heat in Florida. Methods In addition to ignoring missing data, temporal, spatial, and spatio-temporal models are described and utilized to impute missing historical weather data from 1973 to 2012 from 43 Florida weather monitors. Calculated thresholds are used to define periods of extreme heat across Florida. Results Modeling of missing data and imputing missing values can affect the identified periods of extreme heat, through the missing data itself or through the computed thresholds. The differences observed are related to the amount of missingness during June, July, and August, the warmest months of the warm season (April through September). Conclusions Missing data considerations are important when defining periods of extreme heat. Spatio-temporal methods are recommended for data imputation. A heat wave definition that incorporates information from all monitors is advised.

Using an environmental public health tracking biomonitoring study to validate safe water restoration efforts in Florida.

CONTEXT Inorganic arsenic is a carcinogen when consumed over many years and is the type of arsenic that is associated with well water. Private wells in many central Florida counties have been found to contain levels of arsenic above 10 μg/L, which is the maximum contaminant level (MCL) established by the US Environmental Protection Agency. OBJECTIVE The purpose of this study was to test whether individuals living in homes with arsenic levels above the MCL who use bottled water or have a point of use (POU) filter on their main source of water in the house (eg, kitchen sink) are ingesting unsafe levels of arsenic through other unfiltered water sources in the home. DESIGN Case-control study of residents with private wells above (case) and below (control) the MCL for arsenic in drinking water (10 μg/L) conducted between April and July 2013. SETTING AND PARTICIPANTS Residents with private wells living in Hernando County, Florida, where nearly 400 unique wells of 1200 tested have been found to have elevated arsenic levels (targeted sampling). INTERVENTION Participants with elevated water arsenic levels were referred to the Florida Safe Water Restoration Program for assistance in obtaining bottled water vouchers and/or POU filters. MAIN OUTCOME MEASURES Creatinine-corrected total urinary arsenic levels and information on water use and consumption behaviors, dietary intake, and other possible exposure sources. RESULTS Total urinary arsenic levels were similar for cases using POU filters or bottled water when compared with controls (geometric means of 7.17 and 7.19 μg/L, respectively). CONCLUSIONS The current practice used by the Florida Safe Water Restoration Program of supplying POU filters or bottled water to households with arsenic levels in private wells between 10 and 50 μg/L appears to be sufficient to protect residents from arsenic exposure through tap water.

Developing a smartphone interface for the Florida Environmental Public Health Tracking Web portal.

As smartphone and tablet devices continue to proliferate, it is becoming increasingly important to tailor information delivery to the mobile device. The Florida Environmental Public Health Tracking Program recognized that the mobile device user needs Web content formatted to smaller screen sizes, simplified data displays, and reduced textual information. The Florida Environmental Public Health Tracking Program developed a smartphone-friendly version of the state Web portal for easier access by mobile device users. The resulting smartphone-friendly portal combines calculated data measures such as inpatient hospitalizations and emergency department visits and presents them grouped by county, along with temporal trend graphs. An abbreviated version of the public health messaging provided on the traditional Web portal is also provided, along with social media connections. As a result of these efforts, the percentage of Web site visitors using an iPhone tripled in just 1 year.

Uncertainty in maternal exposures to ambient PM2.5 and benzene during pregnancy: Sensitivity to exposure estimation decisions.

We investigate uncertainty in estimates of pregnant womens exposure to ambient PM2.5 and benzene derived from central-site monitoring data. Through a study of live births in Florida during 2000-2009, we discuss the selection of spatial and temporal scales of analysis, limiting distances, and aggregation method. We estimate exposure concentrations and classify exposure for a range of alternatives, and compare impacts. Estimated exposure concentrations were most sensitive to the temporal scale of analysis for PM2.5, with similar sensitivity to spatial scale for benzene. Using 1-12 versus 3-8 weeks of gestational age as the exposure window resulted in reclassification of exposure by at least one quartile for up to 37% of mothers for PM2.5 and 27% for benzene. The largest mean absolute differences in concentration resulting from any decision were 0.78 µg/m(3) and 0.44 ppbC, respectively. No bias toward systematically higher or lower estimates was found between choices for any decision.

Lead Exposure and Developmental Disabilities in Preschool-aged Children

Context: Lead is a preventable environmental toxin that has been previously associated with deficits in cognition, academic performance, attention, and behavior in children. Very few studies, however, have examined the relationship between exposure to lead and documented developmental disabilities. Objective: This study examined the relative risk of lead exposure on developmental disabilities in preschool-aged children. Design: A statewide lead surveillance data set containing blood lead level (BLL) was integrated with another statewide data set containing developmental disability classifications for special education placement for preschool-aged children. Participants: The participants were the 85 178 children (average age 2.6 years) whose records in both data sets were able to be linked. Forty-six percent of the participants had an identified developmental disability. Main Outcome Measure: Developmental disability classification served as the main outcome measure. Results: A high BLL, defined as 5 &mgr;g/dL or more, was associated with significantly increased risk for developmental disabilities (risk ratio [RR] = 1.04; 95% CI = 1.01-1.08), particularly intellectual disability (RR = 1.58, 95% CI = 1.10-2.25) and developmental delay (DD; RR = 1.11, 95% CI = 1.06-1.17). Conclusions: The results of this study are consistent with previous research identifying an association between lead exposure and numerous intellectual and educational outcomes and demonstrate that high BLL is associated with meeting eligibility criteria for developmental disabilities in young children. Continued research, surveillance, and prevention efforts are needed to further reduce the negative impacts of lead on individuals and society. Reducing or eliminating lead exposure would improve outcomes for individual children (eg, better academic performance) and reduce the burden to society (eg, lower enrollments in special education systems).

Health Impact Assessments and Extreme Weather—Challenges for Environmental Health

Background: The Florida Department of Health, Environmental Public Health Tracking Program, in collaboration with the Escambia County Health Department and the University of West Florida, used the Health Impact Assessment Framework to examine adverse health outcomes that may be related to an extreme flood event in Pensacola, Florida (Escambia County) during April 29 to May 3, 2014. In this 2014 flood event, portions of Pensacola received more than 15.5 in of rain in a single day. Infrastructure impacts from this extreme event included destroyed bridges and roads and the failure of many sewage lift stations. Objective: To determine whether there were associated increases in injury, illness, and death, data on reportable diseases, hospitalizations, emergency department (ED) visits, and deaths that occurred during the impact period in 2014 were compared with a control period in 2008. Design: We used an ecological design to compare impact and control periods and examined the proportion of hospitalizations, ED visits, and deaths potentially attributable to the extreme flood event. Results: The results of this comparison were mixed, with some Escambia County zip codes showing increased hospitalizations and ED visits, and some zip codes showing a decrease. However, countywide, there were increases in the proportion of both injury- and respiratory-related hospitalizations and ED visits during the impact period. Conclusions: It is challenging to characterize human health impacts from natural disasters such as extreme floods. Still, it is believed that specific policy changes could result in fewer health impacts during future flood events. For example, this study recommended raising the electric panels on lift stations above the flood elevation to keep them operational during extreme rainfall events. For more maps and tables, consult the complete project report available online at http://www.floridatracking.com/HealthTrackFL/document/Escambia_HIA_Report.pdf.

Physical Exposures, Work Tasks, and OSHA-10 Training among Temporary and Payroll Construction Workers

Objective: We characterize and compare the self-reported physical exposures, work tasks, and OSHA-10 training in a non-probabilistic sample of temporary and payroll construction workers. Methods: In June 2016, a total of 250 payroll and temporary general laborers employed at Florida construction sites completed a survey at the job site as part of the falls reported among minority employees (FRAME) study. Results: Workers employed through temp agencies (57.1%) were significantly more likely to report moving or lifting materials more than 100 pounds than payroll workers (38.5%; P < 0.01). Temporary construction workers with 10-hour OSHA training (22.2%) spent significantly less time with intense hand use/awkward hand posture than temporary workers without 10-hour OSHA training (46.9%; P = 0.048). Conclusions: Temp construction workers with OSHA 10-hour training reported less hazardous physical postures than workers without the same training.