ADVANCEMENT OF THE PRACTICE
Stress Within the Profession Stress levels are of concern: we found that 84% of EH professionals reported feeling moderately or severely stressed. This find- ing is consistent, with a significantly higher proportion ( p -value < .05), compared with prior findings in the NEHA (2020b) needs assessment that found 74% of respondents were emotionally exhausted and 54% felt symptoms of burnout. Global stress levels were elevated due to the pandemic. Gamonal- Limcaoco et al. (2022) evaluated 1,091 adults in 41 countries using the Perceived Stress Scale (PSS-10) and found that 76% of those surveyed experienced increased worry due to the pandemic. Stress levels were reported at 19.1 on the scale of 0–40, which indicates moderate stress due to perceived susceptibil- ity to COVID-19. Women had higher levels of stress compared with men: 18.3 and 15.6, respectively. The highest stress levels of 20.4 and 20.7 were among younger age groups of people <30 years and students, respectively. Prasad et al. (2021) conducted a cross- sectional study of healthcare workers in the U.S. and found that 60% were afraid of expo- sure to COVID-19, 38% reported anxiety and depression, 43% experienced work overload, and 49% reported feeling symptoms of burn- out. Approximately 30% of these healthcare workers reported high stress due to at least one factor related to COVID-19 using a stress scale of 4–16. The average overall stress score was 9.52, with the highest score of 10.51 among nursing assistants. Social workers and medical assistants were next highest at 10.04 and 10.11, respectively. While no additional studies evaluating stress levels were identi- fied, it is clear that the COVID-19 pandemic adversely aected professionals working in the health and allied health fields. Educational Background and Needs We found that 46% of EH professionals in Montana have a bachelor’s degree, 27% have a master’s degree, and 8% have a doc- toral degree. In contrast, Gerding et al. (2019) reported that 72% of EH profession- als nationally have a bachelor’s degree, 31% have a master’s degree, and only 2% have a doctoral degree. In a national needs assess- ment of public health professionals, Sellers et al. (2015) found that 75% have a bachelor’s degree, 38% have a master’s degree, and 9% have a doctoral degree. In Montana, the dif-
ferences in proportions of EH professionals who have a bachelor’s degree were signifi- cantly lower ( p -value < .05) compared with the other two studies. The lower percentages of EH professionals in Montana who have bachelor’s and master’s degrees might be directly related to the short- age of qualified personnel. Furthermore, Gerding et al. (2019) reported that 22% of EH professionals with a bachelor’s degree in EH had graduated from EHAC-accredited programs. Our study found a significantly lower proportion ( p -value < .05) in Montana, with only 8% of respondents having matricu- lated from an EHAC-accredited program. Moreover, Gerding et al. (2019) found that only 17% of respondents who held a bach- elor’s degree studied EH; an equal amount had studied environmental science. By com- parison, our study found that 31% of EH professionals in Montana had studied envi- ronmental health, environmental science, community health, or health promotion. We found that slightly less than one half (43%) of EH professionals reported feeling that their education prepared or mostly pre- pared them for their jobs, with 83% report- ing that they continued to learn on the job. A prior survey of 51 EH professionals nation- ally indicated that respondents felt an esti- mated 10% of new hire candidates were not qualified for the job (Environmental Health & Equity Collaborative [EHEC], 2021). Fur- thermore, 80% also felt there was a low-level supply of qualified EH candidates. Specifically, 50% of those surveyed reported that new hires were somewhat competent in emergency preparedness, disease preven- tion, and indoor air quality. Their results also reported, however, that new hires were not prepared to manage onsite sewage systems, public swimming pools, lead prevention, day care and early child development facilities, body art, campgrounds, recreational vehicles, soils, public drinking water systems, recre- ational waters, and healthy homes. Addition- ally, 40% reported that many new hires were not proficient in assessment and analysis, community engagement, conflict resolution, cross-sector resolution, ArcGIS, organiza- tional behavior, risk communication, systems thinking, and toxicology. The study by EHEC (2021) also found that EH professionals need to be competent in climate change, customer service, data man-
agement, epidemiology, statistics, health risk assessment, hotel and tourist establishment inspections, outbreak investigations, public accommodations, septic tank pumping con- tractors, jails and prisons, cosmetics manu- facturing, and migrant labor camp inspec- tions. Our sample reported 12 primary areas of practice that included food safety, drinking water quality, wastewater, solid and hazard- ous waste, pools/spas/recreational waters, body art/tattoo/body piercing, public lodging, trailer courts and campgrounds, land use/ subdivisions, infectious disease, emergency response, and public nuisance complaint response. We also identified emerging areas that included database management, big data, data apps, ArcGIS, racial equity and cultural competence, social justice, emotional intel- ligence, remote sensing, and wearable tech- nology. Thus, the evolution of EH practice requires an ever-expanding skill set (Gerding et al., 2020). Demographics of the Profession Our survey results indicate that salaries ranged from $25,000–$100,000, with 45% earning between $45,000 and $65,000 and only 7% earning >$80,000. In comparison, Gerding et al. (2019) found the salary range for EH pro- fessionals to be from <$25,000 to >$145,000. Nonsupervisory personnel salaries ranged between $35,000 and $54,999. Our findings show that EH professionals in Montana earn less for the same services provided compared with EH professionals nationally. Self-identified gender is more balanced in Montana, with 58% self-identifying as female. This finding is significantly lower ( p -value > .05) than the 72% reported by Gerding et al. (2019). The racial makeup of EH profession- als in Montana appears to be significantly more homogeneous ( p -value < .05), though, with 94% self-identifying as White. Nation- ally, Gerding et al. (2019) reported that 86% of EH professional self-identified as White. Similarly, Sellers et al. (2015) found that 70% of their study sample self-identified as White. Further, a study of rural locations in Alabama found that 45% of EH professional self-identify as White (Wu et al., 2017). This comparison is a rural setting that is similar to Montana; however, the U.S. Census Bureau (2022) reports that the population of Ala- bama is 69% White, and the population of Montana is 89% White.
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Volume 86 • Number 2
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