NEHA January/February 2024 Journal of Environmental Health

The January/February 2024 issue of the Journal of Environmental Health (Volume 86, Number 6), published by the National Environmental Health Association.

JOURNAL OF Environmental Health Dedicated to the advancement of the environmental health professional Volume 86, No. 6 January/February 2024

www. neha.org

Published by the National Environmental Health Association

On Farm Food Processing Distribution and Retail Food Equipment Dietary Supplements Organic Foods

Life Cycle Analysis Green Building Products Environmental Declarations WaterSense ® Energy Star

Performance and Safety Energy Efficiency Filtration and Recirculation Components

Individual Onsite Wastewater Treatment Systems Advanced Treatment Systems Water Reuse

HACCP Allergens Plan Review SQF, BRC, IFS Food Equipment Traceability and Recall Supply Chain Food Safety

Residential Point-of-Entry/ Point-of-Use Treatment Units Municipal Treatment Chemicals Distribution System Components Plumbing and Devices

Standards • Audits • Testing • Certification Code Compliance • Webinars • Regulatory Support

Visit www.nsf.org/regulatory to submit inquiries, request copies of NSF standards or join the regulatory mailing list.

NSF International • 1-800-NSF-MARK • www.nsf.org/regulatory

JOURNAL OF Environmental Health Dedicated to the advancement of the environmental health professional Volume 86, No. 6 January/February 2024

ADVANCEMENT OF THE SCIENCE

ABOUT THE COVER

Rebuilding Caribbean Environmental Health Post-Crisis Programs: A Preliminary Study for Virtual Mentorship...............................................................................8 Workplace Hazards Impacting the Environmental Health Workforce: A Study Among Practitioners in the United States.................................................................................14

After the hurricanes in 2017 in the U.S. Caribbean, it was essential to rebuild, strengthen, and sustain essential environmental health services and systems. This month’s cover

ADVANCEMENT OF THE PRACTICE

article, “Rebuilding Caribbean Environmental Health Post-Crisis Programs: A Preliminary Study for Virtual Mentorship,” highlights the online mentorship program for newly hired and existing environmental health sta and leadership in Caribbean health departments that was developed by the National Environ- mental Health Association in partnership with the Centers for Disease Control and Preven- tion. The mentorship program provides a na- tional mentoring framework that can enhance the existing workforce and establish a pipeline for a strong future workforce. See page 8. Cover images © iStockphoto: VictoriaBar, bubaone, Pavel Maliasov, Ratsanai

Special Report: Growing Seeds and Students: Therapeutic Horticulture Programs and the Involvement of University Students .................................................................. 24 Direct From CDC/Environmental Health Services: Identify Contributing Factors and Root Causes to Help Stop and Prevent Foodborne Outbreaks ................................................ 28

The Practitioner’s Tool Kit: Using Water Activity to Control Foodborne Illness ........................... 32

Editorial: Decoding Training Needs: Developing a Needs Assessment Tool to Inform Workforce Capacity Building in Retail Food Safety ...................................................... 34

ADVANCEMENT OF THE PRACTITIONER

Environmental Health Calendar ...............................................................................................40

Resource Corner........................................................................................................................41

ADVERTISERS INDEX

JEH Quiz #4...............................................................................................................................42

AAS Davis Calvin Wagner Award.........................33 AEHAP Student Research Competition................43 CDP, Inc..................................................................7 Environmental Health and Land Reuse Certificate Program..............................................53 HS GovTech..........................................................56 JEH Advertising .................................................... 31 NEHA Awards..................................................5, 39 NEHA CP-FS Credential......................................30 NEHA Credentials................................................40 NEHA Endowment Foundation...........................49 NEHA Membership..........................................4, 31 NEHA REHS/RS Credential..................................52 NEHA REHS/RS Study Guide...............................53 NEHA/AAS Scholarship.................................38, 43 NSF......................................................................... 2

YOUR ASSOCIATION

President’s Message: A New Year Brings New Opportunities (and Challenges) ....................................... 6

Special Listing...........................................................................................................................44

A Tribute to Our 2023 Peer Reviewers......................................................................................46

In Memoriam: Ida Marshall.......................................................................................................48

NEHA News..............................................................................................................................50

NEHA 2024 AEC.......................................................................................................................54

January/February 2024 • Journal of Environmental Health

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An open access journal published monthly (except bimonthly in January/February and July/August) by the National Environmental Health Association, 720 S. Colorado Blvd., Suite 105A, Denver, CO 80246-1910. Phone: (303) 802-2200; Fax: (303) 691-9490; Internet: www.neha.org. E-mail: kruby@neha.org. Volume 86, Number 6. Yearly print subscription rates: $160 (U.S.) and $200 (international). Single print copies: $15, if available. Claims must be filed within 30 days domestic, 90 days foreign, © Copyright 2024, National Environmental Health Association (no refunds). Opinions and conclusions expressed in articles, columns, and other contributions are those of the authors only and do not reflect the policies or views of NEHA. NEHA and the Journal of Environmental Health are not liable or responsible for the accuracy of, or actions taken on the basis of, any information stated herein. NEHA and the Journal of Environmental Health reserve the right to reject any advertising copy. Advertisers and their agencies will assume liability for the content of all advertisements printed and also assume responsibility for any claims arising therefrom against the publisher. Advertising rates available at www.neha.org/jeh. The Journal of Environmental Health is indexed by Clarivate, EBSCO (Applied Science & Technology Index), Elsevier (Current Awareness in Biological Sciences), Gale Cengage, and ProQuest. The Journal of Environmental Health is archived by JSTOR (www.jstor.org/journal/ jenviheal). Full electronic issues from present to 2015 available at www.neha.org/jeh. All technical manuscripts submitted for publication are subject to peer review. Contact the managing editor for Instructions for Authors, or visit www.neha.org/jeh. To submit a manuscript, visit http://jeh.msubmit.net. Direct all questions to jeh@neha.org. Periodicals postage paid at Denver, Colorado, and additional mailing offices. POSTMASTER: Send address changes to Journal of Environmental Health , 720 S. Colorado Blvd., Suite 105A, Denver, CO 80246-1910.

Journal of Environmental Health (ISSN 0022-0892)

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Kristen Ruby-Cisneros, Managing Editor Ellen Kuwana, MS, Copy Editor Hughes design|communications, Design/Production Cognition Studio, Cover Artwork Soni Fink, Advertising For advertising call (303) 802-2139 Technical Editors William A. Adler, MPH, RS Retired (Minnesota Department of Health), Rochester, MN Gary Erbeck, MPH

 Exploring Perception on Climate Change Through the American Climate Metrics Survey

 Measuring the Effectiveness of Environmental Health Practice

 Parental Knowledge, Attitudes, Efcacy, and Protective Behaviors About Thirdhand Smoke and Children Ages 0–17

Retired (County of San Diego Department of Environmental Health), San Diego, CA Thomas H. Hatfield, DrPH, REHS, DAAS California State University, Northridge, CA Dhitinut Ratnapradipa, PhD, MCHES Creighton University, Omaha, NE

Printed on recycled paper.

Volume 86 • Number 6

Walter S. Mangold Award

extraordinary adjective ex·traor·di·nary | ikˈstrôrd(ə)nˌerē 1. Going beyond what is usual, regular, or customary 2. Exceptional to a marked extent

Walter S. Mangold dedicated his life to the practice of environmental health in an extraordinary and exemplary way. In doing so, he became a beacon of excellence and inspiration for all environmental health pro- fessionals who followed after him. Do you have a colleague who fits the defini - tion of doing extraordinary environmental health work? Consider taking the time to nominate them for the Walter S. Mangold Award, our most prestigious award. Nomination Deadline: February 15, 2024 neha.org/mangold-award

Honoring a history of advancing environmental health. Walter F. Snyder was a pioneer in our field and was the cofounder and first executive director of NSF. He embodied outstanding accomplishments, notable contributions, demonstrated capacity, and leadership within environmental health. Do you know someone like that? Nominate them for the Walter F. Snyder Award for outstanding contributions to the advancement of environmental health. This award is cosponsored by NSF and NEHA. Nomination Deadline: May 1, 2024 neha.org/awards nsf.org/about-nsf/annual-awards Walter F. Snyder Award

January/February 2024 • Journal of Environmental Health

YOUR ASSOCIATION

Open Access

 PRESIDENT’S MESSAGE

A New Year Brings New Opportunities (and Challenges)

Tom Butts, MSc, REHS

A s you read this column, we are start- ing a new calendar year and per- haps a new budget or fiscal year as well. The optimist in me hopes that you and your agencies were successful in navigating budget preparation and approval processes. Hopefully, the financial support for your environmental public health programs and activities reflects the importance of those activities to the health of your community. The important services and programs that are part of our scope of work must have strong financial support (e.g., fees for ser- vice, general funds, grants) as well as sys- tems and software to support operations and allow for evaluation. I hope the vision statement of the National Environmental Health Association (NEHA)—healthy environments, protected communities, empowered professionals—is aligned with the vision of your agency. I also hope that the NEHA mission to build, sus- tain, and empower an e ective environmen- tal health workforce translates to resources, opportunities, and perhaps even funding for your organizations. Having the techni- cal skills to do our important work, as well as the communication skills to continually make the case for that work, is important. I hope you can draw on a strong peer network from your community and state, or even via national organizations such as NEHA, to support your work. During 2023 I have connected with many environmental public health practitioners at a liate conferences and the NEHA Annual Educational Conference & Exhibition. I am

ing at our work from that perspective. There are numerous quips, such as work smarter not harder, that could have been embraced in service to that directive. In action, what these guidelines meant was that as the regulatory systems we worked in came up for review or reauthorization, there was a focus on working with industry to identify where changes could be made to reduce unnecessary or ine ective elements. This focus was not about deregulation but about regulating in equally or more e ective ways that were better aligned with reaching regulatory goals in more a straightforward manner. Can regulation be elegant? Perhaps sometimes, but it can certainly be done more e ciently. We now have more tools and opportuni- ties than ever to bring together information and characteristics about our communities, businesses, and industries as we work to improve health outcomes and environmen- tal conditions. Collecting and using data e ectively are crucial for both public health and environ- mental health initiatives. Here are some thoughts about some of the ways to improve data collection and use in local communities. These ideas can be scalable based on your program needs. • Sensor Networks: Deploy sensor networks to monitor air quality, water quality, noise levels, and other environmental parameters. These sensors can provide real-time data and trigger alerts when thresholds are crossed. • GIS: Integrate environmental data into GIS platforms to visualize spatial relationships

We now have more tools and opportunities than ever to bring together information and characteristics to improve health outcomes and environmental conditions.

encouraged to see innovation in how duties are approached and openness to the use of new—but not unproven or unreliable—tech- nology to help respond to community con- ditions and site-specific concerns. I am also disappointed at times that the system that supports our work does not always do so in e ective, e cient, or elegant ways. Many years ago, former Colorado Gov- ernor John Hickenlooper gave three guide- lines to the various agencies and regulatory bodies in the state as they reexamined the existing rules: Be e cient, be e ective, and be elegant (3Es). As a local environmental health leader who was not directly required to abide by this call, I saw the value of look-

Volume 86 • Number 6

• Community Conversations: Tap into local community interest groups to provide ground-level insights not otherwise iden- tifiable. Small group conversations have proven particularly fruitful for me. There are many strategies and important considerations when working to improve e ciency or eectiveness to meet commu- nity needs. • Data Sharing and Integration: Facilitate data sharing among dierent agencies, organizations, and sectors. Integrated data from various sources can provide a more comprehensive picture. • Data Visualization and Communication: Translate complex data into understand- able visuals for both professionals and the public. Eective communication can drive awareness and action. • Capacity Building: Provide or access training for sta, other local health depart- ments, and environmental agencies to enhance their data collection, manage- ment, and analysis capabilities.

• Interdisciplinary Collaboration: Encour- age collaboration among public health professionals, environmental scientists, nontraditional partners, policymakers, and technology experts to ensure a holistic approach to data utilization. • Real-Time Reporting: Establish mecha- nisms for real-time reporting of data to enable rapid responses to emerging public health and environmental issues. • Data Privacy and Security: Consider this issue carefully. Implement strong data privacy measures to protect individual privacy while still allowing for meaning- ful data analysis. There are many opportunities and chal- lenges we face from local to national levels. Bringing data, community insight, and part- ners to the table will hopefully ensure that environmental health programs are active, visible, and recognized in your agency and in your community.

between environmental factors and public health outcomes. Images often improve the impact of your messaging. • Crowdsourced Data: Encourage people in your jurisdictions to contribute data through apps and websites. These contri- butions can include reporting environmen- tal hazards, pollution levels, or unusual health symptoms. • Collaboration With Researchers: Col- laborate with research institutions to con- duct comprehensive studies on the aect of specific pollutants or environmental factors on health. This work can take many forms from project-specific col- laboration to the creation of an academic– health department partnership, such as a public health foundation. • Policy Impact Assessment: Use data to assess the impact of environmental poli- cies on public health outcomes. These assessments can be short and focused or broad in scope and more detailed, and they can inform health-based policy deci- sions and adjustments.

tbutts@neha.org

www.cdpehs.com (800) 888-6035

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January/February 2024 • Journal of Environmental Health

ADVANCEMENT OF THE SCIENCE

Open Access

Rebuilding Caribbean Environmental Health Post-Crisis Programs: A Preliminary Study for Virtual Mentorship

Roseann DeVito, MPH, PMP Elizabeth Landeen David Dyjack, DrPH, CIH Rebecca Labbo, MA Gagandeep Gill, DrPH National Environmental Health Association CAPT Justin Gerding, DHA Martin A. Kalis, MA LCDR Scott Daly, MPH, REHS Raymond Lopez Centers for Disease Control and Prevention Chintan Somaiya, MBA, MS, APM Sukhdeep Chera National Environmental Health Association Christine Vanover, MPH, REHS Centers for Disease Control and Prevention Lindsay Fahnestock, DrPH Manjit Randhawa, MPH, MD National Environmental Health Association

Abstract After the hurricanes in 2017 in the U.S. Caribbean, it was essential to rebuild, strengthen, and sustain essential environmental health (EH) services and systems. The National Environmental Health Asso- ciation, in partnership with the Centers for Disease Control and Prevention, developed an online mentorship program for newly hired and existing EH staff and health department leadership in Caribbean health departments. Participants were provided with both practical and didactic learning and were allowed to evaluate the program. Both mentors and mentees were high- ly satisfied with the knowledge and skills acquired, and mentees expressed it was relevant to their daily work. Based on the findings, we recommend both an online and a hybrid mentorship program for leadership- and inspec- tor-level workforces in EH and potentially in other fields. Keywords: environmental health, mentorship program, Caribbean, emer- gency preparedness, emergency response and recovery

258 U.S. weather disasters since 1980, hurri- canes have caused the most damage: $945.9 billion total, with an average cost of almost $21.5 billion per event. They are also respon- sible for the largest number of deaths: 6,593 between 1980 and 2020.” Climate change has a demonstrated impact on the frequency and intensity of hazardous events for coastal and island communities. Since 1979, the frequency of Category 3, 4, and 5 tropical cyclones has increased by 5% per decade (Kossin et al., 2020). With hurricanes pro- jected to increase in severity and frequency, a trained and prepared workforce will be essential for hurricane recovery efforts and to ensure preparedness for response to future emergencies (Ross, 2023). Puerto Rico and the USVI faced chal- lenges before the 2017 hurricanes, a reality that underscores the need for EH prepared- ness and recovery plans. These challenges included environmental hazards such as water and air quality, wastewater manage- ment, structural risks, vectorborne diseases, chronic illness, and healthcare access. EH plays a crucial role in safeguarding the health and safety of affected communities. Further- more, EH professionals are vital in aiding in the recovery from public health threats to

Introduction In 2017, two Category 5 hurricanes struck the U.S. Virgin Islands (USVI) and Puerto Rico. Hurricanes Irma and Maria devastated these U.S. territories, leaving many island residents without power, running water, or access to necessary resources. These hur- ricanes also devastated the governmental environmental health (EH) infrastructure. Vital EH services (e.g., retail food inspec- tions) were halted due to a lack of capacity within the health departments as priorities shifted to response and recovery. Many peo- ple migrated from the islands to seek safety or employment. This migration resulted in the USVI Department of Health and the Puerto

Rico Department of Health having depleted resources and fewer trained staff members to conduct EH inspections. Ironically, the 2017 hurricanes created conditions where a sufficiently resourced and skilled EH workforce would have greatly benefited the health, safety, and economic security of the affected commu- nities. Therefore, if health department EH programs had been maintained, then a suf- ficient and skilled workforce of EH profes- sionals would have been available in the most affected areas. According to the Office for Coastal Man- agement within the National Oceanic and Atmospheric Administration (2023), “Of the

Volume 86 • Number 6

People-Centered Approach to Mentorship

TABLE 1

A structured approach was implemented and comprised two main components: didactic group training and practical mentorship. The 12-week program used expert instructional designers in the EH training field. Before the mentorship program launch, NEHA con- ducted several in-person trainings on EH and provided inspection kits to the jurisdic- tions. These activities were foundational to the capacity-building eorts of the USVI and Puerto Rico. The didactic group training included six EH webinars and two quality improvement check-ins. The webinars were either 1- or 2-hr long and provided information and data on the chosen webinar topics (Table 1). This component provided a foundation of knowl- edge for mentees to then be able to conduct EH work. The practical component included the use of the NEHA LMS platform based on the needs of each program. The LMS housed all webinars, recordings, assignments, group message boards, private message boards, resources, and materials. Participants could communicate with their mentors and with other mentees, read and comment on materi- als and assignments, and rewatch webinars. The practical component of this mentorship program was intended to apply knowledge learned in the training webinars to enhance practical skills in place of a hands-on shad- owing experience. NEHA leveraged its vast network of sub- ject matter experts to aid in the design of the program and to serve as mentors. Pro- gram sta secured four mentors with a wide range of expertise in all areas of EH. Two levels of mentors were secured: 1) retired EH leaders and 2) EH specialists who rou- tinely conduct inspections. Retired leaders mentored the leadership-level cohort and current EH specialists mentored the inspec- tor-level cohort. Mentors provided one-on-one mentoring to mentees through assignments, resources, and check-ins twice a month. Mentors also supported cohort engagement within the LMS, each conducting at least one training webinar for the entire cohort. Of the 21 mentees, four groups were formed, each assigned to one mentor. All groups included a mix of both USVI and

Webinar Topics

Webinar Title

Description

Length of Time (hr)

Outbreak Investigation

Approach and steps for outbreak investigation (including in a COVID-19 environment) and using social media as a tool in outbreak investigations Handling, preparing, and storing food in a way that best reduces the risk of individuals becoming sick from foodborne illnesses Types of permits and licenses available and the process to apply, review, and grant permits and licenses Methods to limit or eradicate mammals, birds, insects, or other arthropods that transmit disease pathogens

Food Safety

Permitting and Licensing Processes

Vector/Pest Control

Interpersonal Skills, Professional Behavior, and Human Relations

Verbal and nonverbal communications

Professional Written Communication

Professional reports, conference presentations, and formal communications

address drinking water quality, wastewater management, healthy homes, food safety, and vectors—all of which are impacted by hurricanes. Maintaining a skilled workforce through extensive training is crucial in these areas of expertise (Brooks et al., 2019; Chan- dra et al., 2021). After the hurricanes, the National Envi- ronmental Health Association (NEHA) received funding through a Centers for Dis- ease Control and Prevention (CDC) coop- erative agreement to support USVI and Puerto Rico in rebuilding and strengthening their EH program capacity. The goal was to rebuild and strengthen EH services and sys- tems after the hurricanes. The project aimed to train and provide hands-on experience to EH sta through mentorship, which builds a foundation of knowledge, skills, and field experience for these professionals to conduct inspections, assess hazards, and enhance their skills. The mentorship program sup- ported existing and newly hired EH sta in gaining or expanding technical and manage- ment skills. Mentorship Program Description The mentorship program incorporated training and hands-on experience for inspectors and leadership in the EH work- force in the USVI and Puerto Rico. Mentees

gained knowledge and skills in EH topics, while the leadership cohort focused on programmatic skills. Initially in person, the program pivoted to virtual due to travel restrictions in 2020 during the COVID-19 pandemic. The virtual format was essential for these isolated communities, and NEHA collaborated with CDC, the USVI Division of Environmental Health, and the Puerto Rico Department of Health to ensure rel- evant content. The program used a learning management system (LMS) and launched in March 2021.

Methods

Participant Characteristics A total of 21 mentees participated in the virtual program: 9 from USVI and 12 from Puerto Rico. Among the USVI participants, 6 were at the inspector level and 3 were at the leadership level. Among the Puerto Rico participants, 6 were at the inspector level and 6 were at the leadership level. Of the participating mentees, 33% held a degree in EH, while 11% had a certificate in EH. Some mentioned on-the-job experience and tak- ing Food and Drug Administration and Food Code courses. The majority (61%) had ≥10 years of experience in EH, while 33% had ≤3 years of experience.

January/February 2024 • Journal of Environmental Health

ADVANCEMENT OF THE SCIENCE

FIGURE 1

Mentor Agreement With Virtual Mentorship Responsibilities and Goals ( N = 4)

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

The LMS system/platform was easy to navigate.

100

I was able to identify and accommodate different communication styles.

My mentees met their individual goals.

I was able to employ strategies to enhance my mentees’ knowledge and abilities.

I was able to acquire resources for my mentees.

I worked with my mentees to set career goals.

My mentees were able to network effectively.

I worked effectively with mentees whose personal backgrounds are different.

100

% of Mentors

Note. LMS = learning management system.

Puerto Rico participants. Three groups included personnel at the inspector level, with one group for leadership-level men- tees. The leadership cohort was separate due to the varying level of mentorship needed and the discussion topics. In the practical component of the program, mentors in the leadership cohort focused more heavily on enhancing leadership skills. Group 1 (lead-

ership) had nine mentees, Group 2 (inspec- tors) had five mentees, Group 3 (inspectors) had three mentees, and Group 4 (inspec- tors) had four mentees. Inspectors had private web conferencing or phone meetings twice a month with their mentors, whereas leadership mentees met once per month. These meetings covered topics such as continuing training, address-

ing challenges, sharing successes, and dis- cussing needed resources. Mentees were encouraged to participate in all training components and a certificate of completion was awarded to all participants. Optional participation included webinars, quality improvement sessions, one-on-one mentor- ing, group mentoring, and cohort engage- ment via the LMS.

Volume 86 • Number 6

Data-Driven Program Assessment and Evaluation Participant data drove the mentorship pro- gram’s education component. A needs assess- ment was developed and disseminated to better understand mentee knowledge, con- fidence, skills, prior training, and interests related to the EH field. The resulting informa- tion enabled program sta to design the men- torship experience to meet mentee needs and interests. The needs assessment helped iden- tify training topics, preferred communication methods, learning styles, and informed the curriculum developed by NEHA. Mentors then created presentations and provided resources based on the curriculum. Evaluations were implemented during and after the mentorship program to ensure a high-quality experience. Two quality improve- ment check-ins provided real-time feedback. Mentees and mentors completed logs to track progress and challenges. Program adjustments were made based on collected information, including a Spanish language post-webinar discussion for mentees who spoke Spanish. Program improvements were implemented as needed. The goal was to ensure a high- quality mentorship experience. As such, evaluations were conducted during and after the program to monitor progress and inform adjustments. Weekly mentee logs were shared with mentors, and mentor logs were shared with program sta. Program changes were implemented based on collected data. Weekly logs and real-time feedback provided opportunities for improvement. Quality improvement check-ins allowed for real-time adjustments to enhance the program. Fur- ther, a post-program survey was administered to both mentees and mentors, and interviews with select mentees were conducted. Overall, data and feedback were used to optimize the mentorship experience for participants. Results Based on mentor logs submitted twice a month, mentors spent an average of 7 hr/week prepar- ing activities, assignments, and webinars for the program. Mentors spent approximately 4 hr/week communicating with their mentees via various channels. Most mentors did not meet with each mentee weekly but indicated that weekly time with mentees was ideal. A total of 13 mentees submitted at least one weekly log during the mentorship, with

5 mentees completing one log for each week. On average, mentees spent 3.5 hr/week on activities, webinars, and reading resources and reported spending slightly less than 1 hr/ week in communication with their mentor. Overall, mentors were satisfied with the program and rated their experience as a men- tor as very good (75%) or good (25%). Men- tors felt the program length was appropriate, although one mentor expressed that the pro- gram could have been longer to dive deeper into the topics and to create stronger relation- ships with mentees. Likewise, mentors perceived the program to have a good balance between instruction and one-on-one opportunities; one mentor expressed that there could have been more structured instruction. Figure 1 shows men- tor agreement with the various goals and components of the virtual mentorship. A total of 10 mentees completed the post- program survey. In all, 80% of respondents rated the mentorship program as excellent, and 20% rated it as very good. Of the men- tees, 90% found the mentorship program to be an extremely valuable experience. Overall, mentees were satisfied with their mentor and the learning opportunities oered in this program. They reported that they found their mentor knowledgeable and prepared, and the webinars increased their knowledge. Mentees felt supported in their learning and had opportunities to practice new skills. They also found the topics rele- vant and felt more prepared for their job. Most mentees (80%) felt that the time spent with their mentor was the appropriate amount of time and that the 12-week program was the right duration for a virtual mentorship; how- ever, 20% reported that they felt the program was not long enough. Furthermore, 90% of mentees felt the mentorship program bal- anced instruction and one-on-one opportu- nities well. Mentees highly rated webinar topics, one-on-one opportunities with their men- tor, and assigned activities. They were also satisfied with participation expectations but rated the message board and weekly activ- ity logs lower. To assess the knowledge and skills acquired from the mentorship pro- gram, mentees were asked to indicate their confidence in key EH areas before and after the program (Figure 2). Mentee confidence in key areas increased by an average of 40%

after the mentorship program. The most sig- nificant improvements were in interpersonal skills, professional written communication skills, and human relations. Discussion The successes of the mentorship program far outweigh the challenges. Similar themes were captured from the surveys and interviews from mentor and mentee perspectives. This program demonstrated that NEHA program sta could pivot from an in-person to a vir- tual experience and still provide a high-qual- ity, interactive, and personalized experience. The mentors and mentees were highly satis- fied with the knowledge and skills acquired, and mentees expressed that the program was relevant to their daily work. Language barriers, however, were a com- mon theme throughout the feedback process. We recommend and encourage the inclusion of multilingual program facilitators for vir- tual and in-person mentorship programs to address any language and trust barriers. It is important to emphasize that these programs are not successful without several supportive factors. Based on NEHA’s exten- sive experience implementing these types of programs, necessary factors include: • buy-in from interested parties such as part- ners, funders, and employers; •clear communication about the impor- tance of the program; • relevance of program materials; and •a trusting relationship among mentees, mentors, and program facilitators. Mentorship Program Strengths First, the relationship between mentors and mentees was the main success and is essential to establish. As one mentee stated, “You need to understand the person to make an impact. It is important to establish communication and respectful interactions.” Mentors were knowledgeable, listened, and provided expert guidance and exper- tise. One mentee explained that the best part of the program was “getting to meet the mentors and working one-on-one with my mentor. It was an eye-opening experience to see the scope of the EH field and learn from professionals with vast experience on the topics discussed.” Second, mentors and mentees noted that the EH topics and content areas covered were

January/February 2024 • Journal of Environmental Health

ADVANCEMENT OF THE SCIENCE

FIGURE 2

Pre- and Post-Mentorship Program Confidence of Mentees in Competency Skills ( N = 13)

100

Food Safety

Vector/Pest Control

Permitting and Licensing

Outbreak Investigations

Professional Behavior

Interpersonal Skills

Written Communication

Human Relations

Competency Skill

Pre-Mentorship Program

Post-Mentorship Program

relevant and of interest to the mentees. Over- all, feedback showed that mentees found the webinars informative, well-organized, and delivered smoothly. Lastly, many mentees mentioned that they found the peer-to-peer learning beneficial. They also stated that comprehending the pro- cedures and processes in dierent geographic areas and locales and meeting new EH col- leagues were all beneficial. The virtual aspect of the mentorship pro- gram was beneficial due to the ease and flex- ibility of participation from anywhere, the ability to connect with mentees from dier- ent locales, and the content being readily accessible at any time. Mentors and mentees emphasized the importance of their relation- ship as the main success factor in the pro- gram, with mentees valuing understanding, communication, and respectful interactions.

Mentors provided expert guidance and men- tees appreciated learning from experienced professionals in the field. Recommendations Most of the suggested program improve- ments are straightforward. To enhance the webinars, it would be beneficial to provide more in-depth and advanced coverage of topics and use real-world scenarios for bet- ter learning and practical application of skills to address field-related issues. While the mentees expressed satisfaction with the LMS, there were some recommendations to improve its functionality and ease of use and to provide additional training on its features. One challenge that was identified was the lack of engagement from some mentees, who felt that the experience would have been more enriching if everyone had been more

actively involved. Drawing from our expertise in developing and implementing mentorship and leadership programs, we recommend including more activities to stimulate con- versations, increase mentee comfort levels, and raise mentor awareness about how to be responsive to each individual as well as to group dynamics. Other recommendations included reducing the frequency of emails, creating a chat group for better communica- tion, incorporating more group activities, and addressing language barriers by providing more content in Spanish. Based on the findings and feedback received, we highly recommend considering an online mentorship program for leader- ship- and inspector-level workforces in EH and other fields, especially when faced with in-person challenges in the future. The ben- efits of a virtual program are even more evi-

Volume 86 • Number 6

Conclusion We acknowledge that there will be continu- ous challenges with leadership, training, and mentorship due to the changing needs of the work environment. The mentorship program case study from this program could serve as a model for other organizations and governmental departments, especially local and small governments. The program is low cost because it does not require travel, has a workflow that could easily be replicated, and can be integrated with other departments and organizations to increase cross-collaboration and interdisciplinary work. This virtual mentorship program model provides the opportunity to meet and work with individuals outside of participant work- places and fields of work. To understand the eectiveness of this program model, we recommend conducting a larger cohort with participants from multiple fields of work. In this way, information could be collected to determine how other governmental enti- ties, nonprofits, and the private sector could benefit from online and hybrid mentorship, training, and leadership programs. We also recommend including program sustainability and resource-sharing plans in developing a virtual or hybrid program, if applicable. The transfer of knowledge, skills, and abil- ities from one generation to the next through an organized mentorship program can accel- erate the performance of the new and emerg- ing leader workforce in EH. For an established organization, this virtual mentoring program requires a small amount of new investment

dent as our workforce becomes busier. Vir- tual options allow for increased scheduling flexibility and provide valuable professional development opportunities that might other- wise be unavailable. Additionally, we want to highlight the value of in-person interactions in hybrid training formats. For example, some men- tors and mentees in the virtual mentorship program had prior in-person training and meetings as part of another program, which we believe contributed to the success of this virtual program. We also recommend a hybrid approach combining in-person opportunities with virtual experiences. This approach would fulfill the expressed desire from mentees for more hands-on field experience. The NEHA Annual Educational Conference (AEC) & Exhibition would be an ideal venue for the in-person component of this hybrid approach, providing a nexus point for NEHA, CDC, mentors, and mentees to come together in a conducive learning envi- ronment that encourages networking, sup- port, and recognition. The AEC is a prime setting that reinforces collaboration and pre- pares participants for future successes, next steps, and opportunities. Other organiza- tions and health departments interested in a mentorship program could consider a simi- lar hybrid approach. We recommend imple- menting these improvements to enhance the mentorship program and create a more eective and engaging learning experience for all participants.

into online learning platforms (i.e., an LMS), subject matter experts, and sta. Our experience with this virtual mentoring program demonstrates that a modest invest- ment in such an eort is eective in workforce capacity building in complex, dynamic, post- hurricane recovery conditions in isolated island communities. Given the findings and success of this eort, we recommend that a national men- toring framework to support rural, frontier, and territorial governmental EH be established to leverage the intellectual capital of senior-level and recently retired individuals. The resulting mentoring program will enhance the skills of the new EH workforce. This strategy can serve as a model for establishing a future pipeline for a strong EH workforce. Acknowledgements: This article was made possible with support from CDC under Cooperative Agreement #NU1RO5000001. We thank participants from the USVI and Puerto Rico for their commitment and local knowledge. We also thank our technical advisors at the National Center for Environ- mental Health for their invaluable support throughout the project, as well as our trusted and committed mentors. This support greatly contributed to the successful implementation and evaluation of the project by NEHA. Corresponding Author: Lindsay Fahnestock, National Environmental Health Association, 720 South Colorado Boulevard, Suite 105A, Denver, CO 80246-1910. Email: lfahnestock@neha.org.

References

Brooks, B.W., Gerding, J.A., Landeen, E., Bradley, E., Callahan, T., Cushing, S., Hailu, F., Hall, N., Hatch, T., Jurries, S., Kalis, M.A., Kelly, K.R., Laco, J.P., Lemin, N., McInnes, C., Olsen, G., Strat- man, R., White, C., Wille, S., & Sarisky, J. (2019). Environmen- tal health practice challenges and research needs for U.S. health departments. Environmental Health Perspectives , 127 (12), Article 125001. https://doi.org/10.1289/EHP5161 Chandra, A., Marsh, T., Madrigano, J., Simmons, M.M., Abir, M., Chan, E.W., Ryan, J., Nanda, N., Ziegler, M.D., & Nelson, C. (2021). Health and social services in Puerto Rico before and after Hurricane Maria: Predisaster conditions, hurricane damage, and themes for recovery. Rand Health Quarterly , 9 (2), Article 10.

Kossin, J.P., Knapp, K.R., Olander, T.L., & Velden, C.S. (2020). Global increase in major tropical cyclone exceedance probability over the past four decades. Proceedings of the National Academy of Sciences of the United States of America , 117 (22), 11975–11980. https://doi.org/10.1073/pnas.1920849117 National Oceanic and Atmospheric Administration, O©ce for Coastal Management. (2023). Fast facts: Hurricane costs . https:// coast.noaa.gov/states/fast-facts/hurricane-costs.html Ross, L. (2023, September 6). How to prepare for increased hurricane intensity . National Environmental Education Foundation. https:// www.neefusa.org/story/climate-change/how-prepare-increased- hurricane-intensity

January/February 2024 • Journal of Environmental Health

ADVANCEMENT OF THE SCIENCE

Open Access

Workplace Hazards Impacting the Environmental Health Workforce: A Study Among Practitioners in the United States

Garry Dine, MPH, MOHS Edith Cowan University David T. Dyjack, DrPH, CIH National Environmental Health Association Sue Reed, MSc, MEngSc, PhD Edith Cowan University Jacques Oosthuizen, MMedSci, PhD Edith Cowan University conducted in October 2020 by the National Environmental Health Association (NEHA, 2020) reported health and safety concerns that included burnout; lack of personal pro- tective equipment (PPE); and a paucity of supplies, training, and guidance. In Australia and New Zealand, vehicle acci- dents; slips, trips, and falls; biological and chemical exposures; mental stress; and work- place violence have been found to be common workplace hazards among EHPs (Dine et al., 2021, 2022; Kuhn et al., 2021; Oosthuizen et al., 2022). In Western Australia, workplace burnout was also found to be a major hazard among EHPs due to work setting, poor stang ratios, lack of resources, and poor manage- ment support (Oosthuizen et al., 2022). The COVID-19 pandemic provided an unparalleled opportunity for EHPs to dem- onstrate their versatile knowledge and skills as frontline public health experts (Mahase, 2020; Oosthuizen et al., 2022; Rodrigues et al., 2021; Ryan et al., 2021). It was not fore- seen that providing EH services during an unprecedented pandemic, however, would create such high levels of hostility against health ocials and make their jobs danger- ous, especially at a time when public health was most vulnerable. In the U.S., there have been numerous reports of health ocers being physically attacked, receiving death threats, and being demeaned and demoral- ized in their e orts to contain the pandemic and protect the community against the virus (Barry-Jester, 2021; Mello et al., 2020; Said, 2020; Topazian et al., 2022). It has been suggested that, in some instances, local health ocers quit their jobs after receiving threats. A national survey of local health departments identified 222 posi- tion departures by public health ocials nationally (Ward et al., 2022). As such, our

Abstract Our study examined the occupational health and safety (OHS) issues that impact environmental public health workforces across various health departments in the U.S. The objective was to generate an OHS risk profile for the workforce to inform future preventative strategies. Data for our study were collected via a cross-sectional online survey ( N = 158) supplemented by a virtual focus group ( N = 7) discussion to confirm and explore some of the themes and data items that emerged from the survey. Descriptive statistics were used to provide information about the variables in the data sets and to identify relationships between them. Nonparametric tests were used to determine statistical significance between two or more variables that were not normally distributed. Focus group data were analyzed thematically. Our study indicates that the environmental health (EH) workforce in the U.S. is exposed to a range of significant workplace hazards. Some of the OHS concerns identified in our study are similar to those observed in Australia and New Zealand. Biological and chemical exposures appear to be important hazards; however, further study is required to determine the nature and mechanism of these hazards within the EH workforce. Furthermore, our study suggests that the COVID-19 pandemic had a significant impact on the health and safety of EH professionals. Keywords: environmental health practitioners, occupational health and safety, environmental health workforce

Introduction The functions of environmental health pro- fessionals (EHPs) have broadened exponen- tially over the years, with more responsibili- ties being added to their job description to such an extent that Greenberg (2020) com- pares an EHP to a “local community’s family doctor.” EHPs are no longer just compliance health inspectors and sanitarians, as other public health professionals and the broader community sometimes perceive. It is there- fore important to assess and understand the modern role of EHPs and the hazardous envi- ronments in which they operate. Our study

examined the occupational health and safety (OHS) issues that a ect EHP workforces across various health departments in the U.S. The objective was to generate an OHS risk profile for the workforce to inform future preventative strategies. While the environmental health (EH) workforce in the U.S. is a fundamental con- tributor of public health to state, tribal, local, and territorial agencies (Gerding et al., 2019), there is limited information on the di erent workplace exposures that impact EHPs. A survey of state, local, federal, tribal, and territorial EH professionals ( N = 767)

Volume 86 • Number 6

an invitation letter with an embedded link to the survey via the email on file with NEHA. For the virtual focus group discussion, potential participants were invited via NEHA social media and e-news platform. The focus group discussion was conducted using Micro- soft Teams in June 2022. A total of seven EH professionals from dierent county health departments consented to participate in the focus group, which lasted 90 min. After, cap- tions (i.e., a transcript file) were downloaded and copied into Word for thematic analysis. The aim of the analysis was to develop a broad understanding of themes and how data from the focus group compared with data from our survey. We then used descriptive statistics to provide information about the variables in the data sets and identify the relationships between them. We used nonparametric tests (i.e., Kruskal–Wallis H test and Mann–Whit- ney U test) to determine statistical signifi- cance between two or more variables that were not normally distributed. Results A total of 158 participants completed the sur- vey. Of these participants, 48.7% self-identi- fied as male, 50.0% self-identified as female, and 1.3% preferred not to self-identify. The sample age distribution was 21.5% (25–34 years), 25.3% (35–44 years), 21.5% (45–54 years), 22.2% (55–64 years), and 9.5% (65–74 years). The average number of years worked as an EHP was 15.9 years. The greatest per- centage of the respondents (29.2%) worked at a regional local government, followed by 19.0% at a state department of health, 17.7% at a metropolitan local government, and 15.8% at other public health agencies. All respondents indicated that they received edu- cation at the college or university level. General Workplace Exposures Survey respondents were asked to report on specific workplace exposures (in hours) that they could recall in a typical week prior to completing the survey. The main workplace exposure reported by participants (3.1%) was the average hours of exposure to direct sunlight with or without appropriate sun protection. This exposure was followed by average hourly exposure to chemicals (2.1%), with disinfectants being the main reported chemical substance (15.2%). Hourly average exposure

to biological hazards was indicated by 2.1% of the respondents, with the main reported expo- sures being sewage (47.5%), mold and fungi (41.1%), and airborne pathogens (35.5%). Hourly average exposure to dust was indicated by 1.7% of the respondents, with the main dust exposures being organic or vegetable dust (14.6%) and biological aerosols (7%). There was no significant dierence between expo- sure hazards and demographic variables (e.g., gender, age group, employer description, job position, education level). General Organization Commitment to Occupational Health And Safety Table 1 presents participant responses to OHS statements related to the management com- mitment of their organization to OHS. In gen- eral, most participants expressed satisfaction with the OHS commitment of their employ- ers. There were concerns, however, with some high-risk tasks and risky situations. Psychosocial Demands of Work To assess work psychological demands, par- ticipants were asked questions related to time demand, cognitive demand, job satisfaction, and job control. In general, most respondents gave the impression of a positive psychosocial workplace environment at their respective organizations. A few areas of concern, how- ever, were observed. Most respondents indicated that they find their job moderately stressful (41.4%). Many reported that their job is mildly stressful (29.0%) or not stressful at all (2.1%). A con- cerning percentage of respondents, however, indicated that they find their job very stress- ful (20.0%) or extremely stressful (7.6%). There was no significant dierence between the level of job stress and demographic variables (e.g., gender, age group, employer description, job position, education level). More than 30% of participants indicated that they are sometimes or often pressured to work long hours. A Kruskal–Wallis test showed a significant dierence among the cat- egory age group: H (4) = 11.44, p =.022. Post hoc pairwise comparisons showed that the age group of 65–74 years was dierent compared with the age group of 35–44 years ( p =.030). Furthermore, there were dierences when the following age groups were compared: 65–74 years with 25–34 years ( p =.019); 55–64 years with 35–44 years ( p =.032); and 55–64 years

study also provided an opportunity to assess the occupational health impact of the pan- demic on the EHP workforce. Methods Data for our study were collected via a cross- sectional online survey supplemented by a virtual focus group discussion to confirm and explore some of the themes and data items that emerged from the survey. We chose these methods for data collection because the required data were not available in the scientific literature and not directly observ- able (Phillips, 2017). In addition, the survey method allowed for rapid deployment and return of surveys as well as maximum reach of the target population. The Australian National Hazard Exposure Worker Surveillance (NHEWS) survey was adapted for our study. This survey was devel- oped by the Australian Safety and Compensa- tion Council in 2008. Questions included in the NHEWS survey were selected from vari- ous other surveys, including the European Working Conditions Survey (Eurofound, 2015) and the Employee Core Module of the National Exposures at Work Survey (Boiano & Hull, 2010). We adapted the NHEWS survey for our research by deleting some questions related to tasks, behaviors, or other areas not relevant to EHPs. We added several questions to cover EHP issues not specifically addressed in the NHEWS instrument (e.g., asbestos exposure, COVID-19, workplace incidents). Our sur- vey comprised nominal, ordinal, Likert scale, and ratio scale questions. Overall, our survey contained 34 questions, some of which had multiple parts, and was structured around 10 key themes: demographics, working arrange- ments, physical hazards, chemical hazards, psychosocial hazards, work symptoms, work- place violence, workplace asbestos, COVID- 19, and workplace incident reporting. We used a purposive sampling approach for the cross-sectional survey, which allowed any potential respondent to self-select into the sample; thus, we avoided potential sample bias. This sample approach was considered appropriate because EH is a small workforce and the target population is well defined. We distributed the survey, administered via the Qualtrics online survey platform, through a collaboration with NEHA in September 2021. Potential survey respondents were sent

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