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Public Health

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    Retrospective Risk Assessment of Forestry Workers in the United States: Injuries, Fatalities, and Hazards Impacting Occupational Health
    (East Carolina University, 2022-12-02) Knecht, Heidi
    Forestry (including logging) is one of the most hazardous occupations due to environmental, ergonomic, chemical, mechanical, mental, and physical components of the job. In the United States (US), workplace injuries account for one-third of all injuries and one-sixth of all fatal injuries among people ages 20-64 years of age. The fatal accident rate of forestry workers in the US is 19-times higher than other physically demanding industries such as construction and manufacturing. Forestry workers must deal with multiple workplace factors that range from moving heavy machinery and other job tasks while adapting to changes in terrain and weather. Forestry workers also may encounter wild animals, arachnids, insects, and snakes. Arboviruses (transmitted primarily by mosquitoes) and bacterial pathogens (transmitted primarily by ticks) are potential health threats to foresters. There are a limited number of studies that have retrospectively assessed work-related injuries/fatalities in forestry/logging industries and current literature is deficient on the additional health hazards associated with foresters. Consequently, the purpose of this study is to compile what is known about potential health and safety risks in foresters from the standpoint of biological (e.g., insects/arachnids, plants); chemical (e.g., pesticides); ergonomic (e.g., awkward postures, forceful motions); physical (extreme temperature, noise, vibrations, and radiation); psychosocial (e.g., workplace factors that cause stress, strain, or interpersonal problems for the worker); and safety (e.g., beetles and trucking) hazards that impact the overall health and injury status of workers. The aims of this study on forestry workers are to: 1) Analyze causes of injuries/fatalities to inform future intervention studies focused on risk mitigation, 2) Build the foundation for using multiple databases to analyze trends in injuries/fatalities, 3) Determine whether there are any trends/associations between work-related risk factors and workplace injuries/fatalities among foresters/loggers over a 16-year period (2003-2019), 4) Evaluate trends in injuries/fatalities to determine where intervention efforts are most needed, 5) Systematically review current knowledge on health hazards in the forestry industry, and 6) Identify knowledge gaps related to forestry and logging injuries, and fatalities for future studies to address. Our findings determined that, for the period of study (2003-2018 for fatalities; 2005-2019 for injuries), "contact with objects and equipment" was the primary cause of injuries and fatalities. "Transportation"-related incidents ranked second for the cause of fatalities, while "falls, slips, & trips" was the second leading cause of injuries. Our systematic review of recent literature showed that while many studies have focused on machinery related injuries and deaths, some areas of occupational health in the forestry industry have been understudied with in the US in the last ten years. Areas identified as needing additional study include chemical exposures from pesticides and diesel exhaust, cold and heat related illnesses, and exposure to ticks and mosquitoes. Our findings identified major gaps in knowledge for health and safety of US forestry/ logging workers and occupational health outcomes. Future research should focus on these areas with an emphasis on intervention strategies that eliminate or mitigate the deleterious health effects of occupational exposures. By identifying specific needs of the forestry industry, more appropriate interventions and aids can be designed and implemented to benefit worker health and safety. Here, we have identified several areas of research that need to be addressed in the future. The areas identified here should be addressed in a collaborative effort between researchers and the forestry industry to promote worker health and safety.
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    Accuracy of Wet Bulb Globe Temperature (WBGT) Obtained from Regional Weather Station Data for Agricultural Settings in Eastern North Carolina as Proxy for WBGT Obtained from Local Heat Stress Monitors
    (East Carolina University, 2022-12-01) Dillane, Danielle
    Introduction: Agricultural workers are at high risk of suffering from heat stress and subsequently developing heat-related illnesses (HRIs) due to the outdoor nature of their work. This risk can be exacerbated in hot, humid temperatures such as those that define the climate found in Eastern North Carolina (ENC). It is critical for employers to monitor worker safety and assess occupational heat exposure on a daily basis so that preventative measures can be taken as needed to reduce the risk of HRIs. The Wet Bulb Globe Temperature (WBGT) Index is considered the ‘gold standard’ for assessing occupational heat stress among outdoor workers. However, traditional WBGT instrumentation may not always be readily available. Alternatively, WBGT can be calculated through models utilizing weather station data that is routinely collected and therefore readily available. Previous models have estimated WBGT based solely on standard meteorological data using heat stress data obtained from military settings. The main purpose of this study was to assess the accuracy of calculating WBGT indices from weather station data compared to instrumentation-based data obtained from locally stationed heat stress monitors in an agricultural setting. The specific aims of this study are to: 1) assess the accuracy of utilizing WBGT indices obtained from weather station data as a proxy for those obtained from instrumentation (primary aim), and 2) determine how farmers across ENC evaluate daily heat stress risk and handle/report HRI symptoms and cases among their farmworkers (secondary aim). Methods: QUESTemp°34 heat stress monitors were set up daily, weather permitting, from 8AM to 5 PM at two agricultural sites in Bertie County during the period of April-July 2021. Weather station data were collected from Weather Underground (Weather Underground, 2020) using the zip code for both study sites. The OSHA Outdoor WBGT Calculator was utilized to calculate the outdoor WBGT index for each site using the collected daily weather station data. Solar irradiance was estimated using two methods: 1) estimated solar irradiance calculated by OSHA Outdoor WBGT Calculator [weather data-based method 1/WeatherCalc1] and 2) Estimated Irradiance Based on Cloud Cover table from the heat stress chapter (Chapter 4) of OSHA’s Technical Manual (Table 1) (OSHA, 2017) [weather data-based method 2/WeatherCalc2]. The hourly average of the measured (instrumentation-obtained) WBGT index was determined and compared to the hourly calculated WBGT index using weather station data. Additionally, a survey was developed and distributed via Qualtrics to farmers across 27 counties in ENC to assess how HRI symptoms are addressed through training and how HRIs are handled and reported once they arise. The survey contained original questions developed to address the research questions of this study. At least one cooperative extension agent from each of the 41 counties in ENC were asked to provide farmer contact information as a method of recruiting participants for the survey. The study was approved by East Carolina University’s (ECU) University and Medical Center Institutional Review Board (UMC-IRB#21-000428). Line graphs and scatter plots were created to visualize the data. Bland-Altman plots were also created to assess whether the approximation behaved the same at high versus low temperatures throughout the study period. Pearson correlations were calculated to assess the strength of association between the weather station data-based and instrumentation-based WBGT indices. Statistical analysis software R (R Core Team, 2021) was used to create Bland-Altman plots and correlations. Results: Line graphs and scatter plots showed the weather data-based WBGT indices (WeatherCalc1 and WeatherCalc2) tended to be higher than instrumentation-based WBGT indices (MonitorSite1 and MonitorSite2), and that the method for calculating solar irradiance impacted WBGT indices as WeatherCalc2 WBGT indices tended to be higher than WeatherCalc1 WBGT indices. All correlations were greater than 0.91. Despite a strong correlation, Bland-Altman plots suggest that utilizing zip code level weather data to calculate WBGT cannot be done accurately within ±1°C at least 90% of the time as a large portion of the data points fall outside of the limits of agreement set at ±1°C across all temperature ranges. This criterion was developed from the primary research article used for this study (Liljegren et al, 2008) which concluded accurate findings of WBGT predictions within ±1°C of the measured value 91-100% of the time, depending on location and functionality of instrumentation utilized. An overall response rate of 8.2% (147/1,788) was recorded for the survey. Survey results indicated that more widespread heat stress training is needed among agricultural workers, rest breaks with provided water need to be mandatory, a system needs to be in place for reporting and handling HRIs on individual farms, and more farmers need to assess risk of HRIs daily by checking either the heat index or WBGT index. Conclusion: Overall, utilizing zip code level weather data to accurately calculate WBGT indices that are within ±1°C of local instrument-measured WBGT indices cannot be accomplished at least 90% of the time, for either method used to calculate solar irradiance, using the model developed by Liljegren et al. (2008), thus answering the first primary research question for this study. For monitoring site 1, methods 1 and 2 of calculating weather data-based WBGT indices were accurate within ±1°C of instrumentation-based WBGT indices 45.0% and 30.5% of the time (respectively) for the entire study period. For monitoring site 2, methods 1 and 2 of calculating weather data-based WBGT indices were accurate within ±1°C of instrumentation-based WBGT indices 33.7% and 23.6% of the time (respectively) for the entire study period. This combined information answers the second primary research question for this study. However, the weather data-based WBGT indices were higher than instrumentation-based WBGT indices, indicating that their use may result in an overestimation of the risk of heat stress to workers. From a public health standpoint, the conservative and protective nature of overestimating WBGT indices utilizing weather data could be lifesaving. It is strongly recommended that all farmers across ENC provide annual heat stress training to their employees, implement a system for reporting and handling HRIs on their farm, provide water and mandatory rest breaks to employees, and check the heat index or WBGT index daily to assess heat exposure risks. These changes will directly provide a safer work environment for outdoor agricultural workers and could ultimately impact public health by lowering incidences of HRIs across ENC.
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    Evaluation of the use of Wastewater Based Epidemiology as a Surveillance Tool and the Potential effects of Vaccines and Students Beliefs and Practices in Mitigating the Spread of COVID-19 Among Students at East Carolina University
    (East Carolina University, 2022-12-01) White, Avian
    Worldwide, newly emerging and re-emerging infectious diseases and pathogens have led to increases in the number and frequency of disease outbreaks. Although these disease outbreaks are not new, increases in outbreaks have led to the need for public health agencies to effectively monitor disease spread. It has been estimated that 25% of 60 million deaths occurring yearly are the result of infectious diseases (Fauci et al., 2005; Nii-Trebi, 2017). Thus, disease monitoring tools are of utmost importance. The outbreak and spread of a severe acute respiratory illness in China alerted the world to a potentially new or re-emerging pathogen. As the virus rapidly spread, it was named "Severe Acute Respiratory Syndrome 2" (SARS-CoV-2) by the World Health Organization (WHO). The SARS-CoV-2 virus was deemed a public health emergency and later declared a pandemic as people across the world contracted COVID-19. The rapid spread of the COVID-19 pandemic underscored the need for disease monitoring and surveillance to mitigate spread. SARS-CoV-2 causes fever, dry cough, shortness of breath and in some instances loss of taste and smell. However, some persons, particularly those with pre-existing conditions, may experience severe symptoms of high fever, severe cough pneumonia, and even death (WHO, 2020). In the United States alone, an estimated 88,044,073 cases have occurred since the start of the epidemic (Worldometer, 2022). Early strategies to handle the epidemic included temporary sheltering in-place orders, and many institutions including schools and universities shifted to online strategies to ensure continuity in learning. As these entities later sought to fully re-open and regain a sense of normalcy, many were tasked with establishing monitoring systems to help detect potential outbreaks. The use of wastewater-based surveillance was evaluated as a tool in helping to identify when and where student polymerase chain reaction (PCR) testing should be conducted. Here, we utilized wastewater-based epidemiology by sampling dormitory wastewater thrice weekly during Spring and Fall 2021. Data obtained from this sampling was used to help identify potential cases of COVID-19 in dormitories. Additionally, as vaccines were developed and distributed, the relationship between vaccination rates and COVID-19 cases on campus was investigated. Lastly, students' attitudes and behaviors toward the virus were also evaluated by administering an online survey tool designed through REDCAP systems. This survey utilized a Likert scale where possible to aid in analysis and comparison of student responses between Spring 2021 and Fall 2021 semesters. Results from this study found significantly higher concentrations of SARS-CoV-2 in wastewater were observed during the Spring relative to the Fall semester. Dorms with higher numbers of COVID-19 cases also had higher concentrations of SARS-CoV-2 in their wastewater. A significant inverse relationship was observed between vaccine rates and student COVID-19 cases. As vaccinations rates increased within the dormitories, the number of student cases decreased. Students became more receptive to the vaccine in the Fall semester in comparison to the Spring. This change in attitudes may have helped the University's vaccination rates in the Fall semester thus affecting student COVID-19 rates. Here, we saw students a significant difference in virus perception between Spring 2021 and Fall 2021 semesters. Specifically, a lower number of students having a negative perception of the virus. Additionally, students reported having less restrictive behavior (e.g., visitors, mask wearing) in Fall 2021 compared to Spring 2021. Overall, this study showed that universities may successfully use surveillance techniques such as wastewater-based epidemiology to help determine when swarm testing of students should be initiated. It also provided evidence that vaccination campaigns may have helped to reduce the incidence rate of COVID-19 on campus. Gaining an understanding of how students feel and behave regarding the threat of disease outbreaks, the implementation of various preventative measures, and the effects that changes in educational delivery platforms may have on learning and social interactions are also important for developing successful programs to mitigate the spread of diseases.
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    Commentary: Suicide risk is high, but often overlooked, in autistic spectrum disorder populations
    (2022-05-07) Curtis, Luke
    Self-Harm Significantly Higher in Populations with ADHD, Anxiety, ASD, Depression, and Eating Disorders. I appreciated your recent paper on the large and well-matched studies on nonfatal self-harm and suicide among adolescents in the UK Clinical Practice Research Datalink (Cybulski et al. 2021). This large study involved 56,008 self-harm cases and 1,399,356 controls aged 10–19 years and reported that many diagnoses were associated with significantly higher rates of self-harm. Compared to controls, the risk of self-harm was significantly higher in attention-deficit/hyperactivity disorder (ADHD) (OR 3.3, 95% CI 3.1–3.4), anxiety disorder (OR 3.8, 95% CI 3.7–3.9), autism spectrum disorder (ASD) (OR 2.4, 95% CI 2.3–2.6), depression (OR 7.9, 95% CI 7.8–8.2), and eating disorders (OR 3.1, 95% CI 3.0–3.2) (Cybulski et al. 2021).
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    Adaptation of a Modified Diet Quality Index to Quantify Healthfulness of Food-Related Toy Sets
    (2022) Jilcott Pitts, Stephanie; Lazorick, Suzanne; Stage, Virginia C.; Poston, Jacqueline R.; Watkins, Rachel E.
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    Laboratory Determination of Gravimetric Correction Factors for Real-Time Area Measurements of Electronic Cigarette Aerosols
    (2022) Sousan, Sinan; Pender, Jack; Streuber, Dillon; Hale, Meaghan; Shingleton, Will; Soule, Eric
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    Association of Patient Sex and Pregnancy Status With Naloxone Administration During Emergency Department Visits
    (2021) Forbes, Lauren A.; Canner, Joseph K.; Milio, Lorraine; Halscott, Torre; Vaught, Arthur Jason
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    Filtration Efficiency of Surgical Sterilization Fabric for Respiratory Protection During COVID-19 Pandemic
    (2021) Sousan, Sinan; Garcia, Nicole; White, Avian; Balanay, Jo Anne
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    Masculinity, Resources, and Retention in Care: South African Men’s Behaviors and Experiences While Engaged in TB Care and Treatment
    (2021-02) Kipp, Aaron; Daniels, Joseph; Medina-Marino, Andrew; Glockner, Katherine; Grew, Emily; Ngcelwane, Nondumiso
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    Perceptions of Nutrition Education Classes Offered in Conjunction with a Community-Supported Agriculture Intervention Among Low-Income Families
    (2021) Pitts, Stephanie B Jilcott; Lu, Isabel; Hanson, Karla L; Kolodinsky, Jane; Ammerman, Alice S.; Sitaker, Marilyn; Wang, Weiwei; Volpe, Leah C; Belarmino, Emily H.; Garner, Jennifer; Gonsalves, Liana; Seguin, Rebecca A
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    Snacking, Sugar-Sweetened Beverage Consumption and Child Obesity in Low-Income Households
    (2021) Pitts, Stephanie B. Jilcott; Walsh, Christine E.; Seguin-Fowler, Rebecca; Ammerman, Alice S.; Hanson, Karla; Kolodinsky, Jane; Sitaker, Marilyn; Ennett, Susan