Participatory research in Northwest Atlanta's Proctor Creek Watershed: Using photovoice to explore environmental health risks at the water's edge

In this study we used a participatory research method, photovoice, to explore community perceptions about environmental health risks, community assets, and strengths in and around an urban, degraded watershed in Northwest Atlanta, Georgia. This watershed, formed by Proctor Creek, is a focal point for redevelopment and infrastructure investments for years to come. Using a community-based participatory research approach, 10 Proctor Creek residents (watershed researchers), and a university partner, engaged in data collection; participatory data analysis; internal discussions; translation of research findings into watershed restoration, community revitalization, remedial action, and policy solutions; and dissemination of results to fellow watershed residents, stakeholders, and decision makers. We present a conceptual model linking the watershed researchers' understanding of urban policies and practice in the Proctor Creek Watershed to environmental, neighborhood and housing conditions and their influence on health outcomes and quality of life. Engaging community members in defining their own community environmental health challenges and assets yielded the following primary themes: 1) threats to the natural environment, 2) built environment stressors that influence health, 3) blight and divestment of public resources, and 4) hope for the future. Residents’ vision for the future of the watershed - a restored creek, revitalized neighborhoods, and restored people - is fueled by a strong connection to history, memory, and sense of place. We demonstrate the value of local knowledge in identifying previously unaddressed environmental health risks in the Proctor Creek Watershed as well as solutions to reduce or eliminate them.     

Using critical ethnography to explore issues in health promotion

In this article, the author outlines the need for a critical research method in the field of health promotion to explore the determinants of health. These determinants, including healthy child development, employment and working conditions, and education, for example, underlie many of the health issues that individuals experience. They are, in turn, influenced by nebulous factors such as patterns of inequality, and cultural norms, which are difficult to research using conventional methodologies. The author provides an overview of critical ethnography as a method for health promotion research. She describes specific data collection and analysis techniques, with the addition of critical discourse analysis to add scope to ethnographic findings. She concludes with an overview of the congruence between critical ethnography and health promotion research, including a discussion of the differences between critical ethnography and participatory action research.     

Using matched areas to explore international differences in population health

In this paper, we develop and test a method for examining the influence of national level contextual influences on population health. Acknowledging calls for the use of experimental study designs to explore contextual influences on health, we develop a study design in which sets of local areas from Britain and Belgium became akin to two 'treatment' groups; one exposed to British society and culture and the other exposed to Belgian society and culture. The areas are matched on the basis of showing very strong similarities in economic, demographic and historical characteristics. Data describing these characteristics are obtained from national census data. A principal component analysis of these variables permits areas in Britain and Belgium with similar scores on the resulting components to be matched into pairs. A sequence of logistic regression models identifies between-country difference in the risk of reporting poor health. Our final model compares the risk of reporting poor health among Belgians and people from Britain living in similar local contexts, adjusting for any residual differences in individual level characteristics. We compare results from this new method with those from more conventional approaches. All approaches show that residence in Britain is associated with a substantial and significantly higher risk of reporting poor health for both men and women, after adjustment for both individual and local contextual influences. We then critically reflect on our method and on the context-composition framework for research into area variation in health. We conclude that whilst our approach succeeded in applying the idea of comparable groups with different exposures to an observational, international comparison, it also brought associated questions about external validity and the extent to which a sample of matched areas captures a 'national' context.     

Applying health behavior theory to multiple behavior change: considerations and approaches

BACKGROUND: There has been a dearth of theorizing in the area of multiple behavior change. The purpose of the current article was to examine how health behavior theory might be applied to the growing research terrain of multiple behavior change. METHODS: Three approaches to applying health behavior theory to multiple behavior change are advanced, including searching the literature for potential examples of such applications. RESULTS: These three approaches to multiple behavior change include (1) a behavior change principles approach; (2) a global health / behavioral category approach, and (3) a multiple behavioral approach. Each approach is discussed and explicated and examples from this emerging literature are provided. CONCLUSIONS: Further study in this area has the potential to broaden our understanding of multiple behaviors and multiple behavior change. Implications for additional theory-testing and application of theory to interventions are discussed.     

Using mixed methods research to explore the effect of an adaptation exercise on general population valuations of health states

Purpose  

To understand the effect of an adaptation exercise (AE) on general population values for rheumatoid arthritis (RA) states.     

Alcohol consumption: protection against coronary heart disease and risks to health

In a prospective cardiovascular study of 1341 Trinidadian men aged 35-69 years undertaken between 1977 and 1986, the baseline prevalence rates of cardiac and arterial disease and diabetes mellitus were increased in the 118 (8.8%) who had been but were no longer regular drinkers. This finding suggested that awareness of these disorders was a discouragement to drinking alcohol. When this group and all with coronary heart disease (CHD) or diabetes at entry were excluded, a significant inverse trend was found between alcohol consumption in the week before recruitment and risk of CHD across the subsequent average follow-up of 7.5 years. Men who had taken 5-14 drinks had about half the CHD risk of those who had had no alcohol, even after allowance for age, ethnicity, smoking, blood pressure and serum cholesterol concentration. The overall morbidity and mortality experience in this community indicated a protective effect of alcohol against CHD, but adverse health consequences from multiple causes in drinkers who were alcohol dependent.     

Biomagnification of Trace Elements in the Aquatic Food Web in the Mekong Delta,South Vietnam Using Stable Carbon and Nitrogen Isotope Analysis

In the present study, we report the concentrations of 21 trace elements (V, Cr, Mn, Co, Cu, Zn, As, Se, Rb, Sr, Mo, Ag, Cd, Sn, Sb, Cs, Ba, Hg, Tl, Pb, and Bi), as well as the results of the analysis of stable carbon and nitrogen isotopes, of the various biota that make up the food web in the main stream of the Mekong Delta near Can Tho, South Vietnam. A significant trophic level-dependent increase was found in concentrations of Se, Rb, and Hg with increasing δ¹⁵N, indicating that an overall biomagnification of these elements occurred. However, the increase of Hg concentration per trophic level was lower than in previous studies. In contrast, the concentration of Mn showed an opposite trend in the food web of the Mekong Delta. In addition to these overall trends, the present study revealed that the biomagnification profiles of trace metals differ between crustaceans and fishes; concentrations of Mn, Cu, Zn, As, Sr, Mo, Ag, Cd, Sb, Cs, Ba, Tl, and Pb were significantly higher in crustaceans, whereas fishes showed higher concentrations of Cr, Rb, and Hg (trophic level determined by δ¹⁵N). The differences in the biomagnification profile between the major taxa might be attributed to differences in metal accumulation and in detoxification abilities such as possessing a metal-binding protein, e.g., metallothionein (MT).     

Pesticides and immunosuppression: the risks to public health

There is substantial experimental, epidemiological and other evidence that many pesticides in widespread use around the world are immunosuppressive. This poses a potentially serious health risk in populations highly exposed to infectious and parasitic diseases, subject to malnutrition, and inadequately served by curative health programmes. An expanded programme of research is needed to investigate this potential risk and to design precautionary measures.      

Dreaming of toilets: Using photovoice to explore knowledge,attitudes and practices around water–health linkages in rural Kenya

As part of a knowledge, attitudes, practices and empowerment (KAPE) project implemented by the United Nations University Institute for Water, Environment and Health (UNU-INWEH) in the Lake Victoria Basin, this paper reports findings from a photovoice study with women in Usoma, a lakeshore community in Western Kenya. Drawing on ecosocial and political ecology theory, findings reveal that access to water, perceptions and practices were shaped by ecological and broader structural factors. Further, collective actions to improve access were constrained by institutional and economic structures, thus (re)enforcing inequalities.     

Mosquitoes and their potential predators in rice agroecosystems of the Mekong Delta, southern Vietnam

Culex tritaeniorhynchus, Cx. gelidus, and Cx. quinquefasciatus, known vectors of Japanese encephalitis (JE), are distributed in rice agroecosystems in Asian countries. Very few integrated studies on the breeding habitats of rice-field mosquitoes, including JE vectors, have been conducted in Vietnam. We investigated the mosquito fauna and potential predators in 8 rice growing areas in the Mekong Delta region of southern Vietnam, during the wet and dry seasons of 2009. Mosquitoes and their predators were collected from a variety of aquatic habitats (rice fields, ponds, wetlands, shrimp ponds, ditches, canals, and rivers). We collected 936 Culex spp. (354 Cx. tritaeniorhynchus, 240 Cx. vishnui s.l., 189 Cx. fuscocephala, and 42 Cx. gelidus), 33 Uranotaenia, 25 Anopheles, and 9 Mimomyia (4 Mi. chamberlaini) in the dry season. During the rainy season, we collected 1,232 Culex spp. (132 Cx. vishnui s.l., 66 Cx. tritaeniorhynchus, 9 Cx. gelidus, 4 Cx. fuscocephala, and 2 Cx. bitaeniorhynchus), 236 Anopheles spp. (40 An. vagus and 1 An. sinensis), and 7 Uranotaenia (3 Ur. lateralis). Heteroptera such as Micronecta, Veliidae, and Pleidae were abundant and widely distributed in both seasons. Based on a stepwise generalized linear model, the abundance of mosquitoes and their predators in rice fields was high when the rice plant length was short and water depth was shallow. Therefore, the use of insecticides during the earlier stages of rice growth should be avoided in order to preserve the predator populations.     

Assessing the health benefits of advice services: using research evidence and logic model methods to explore complex pathways

Poverty is positively associated with poor health; thus, some healthcare commissioners in the UK have pioneered the introduction of advice services in health service locations. Previous systematic reviews have found little direct evidence for a causal relationship between the provision of advice and physical health and limited evidence for mental health improvement. This paper reports a study using a broader range of types of research evidence to construct a conceptual (logic) model of the wider evidence underpinning potential (rather than only proven) causal pathways between the provision of advice services and improvements in health. Data and discussion from 87 documents were used to construct a model describing interventions, primary outcomes, secondary and tertiary outcomes following advice interventions. The model portrays complex causal pathways between the intervention and various health outcomes; it also indicates the level of evidence for each pathway. It can be used to inform the development of research designed to evaluate the pathways between interventions and health outcomes, which will determine the impact on health outcomes and may explain inconsistencies in previous research findings. It may also be useful to commissioners and practitioners in making decisions regarding development and commissioning of advice services.     

The environment and its impact on health: old risks, new risks

The objective of this article is to investigate three representative elements of environmental health from a geographical perspective taking the Autonomous Community as the unit of analysis: legionnaire's disease, chemical safety and food safety. Legionnaire's disease is a pathology with a specific epidemiological profile; males, adults, and with previous chronic pathologies and habits. The official response, with regard to recent outbreaks and the increase in the incidence of legionnaire's disease, has differed between autonomous communities due to peculiarities and different organizational cultures. Both the sinking of the ship Prestige and the accident at the oil refinery at Puertollano (Ciudad Real) have increased concern in the population about chemical substances, so familiar in our environment. However it is not only the big accidents which are relevant: it is surprising to learn that most of the registered poisonings are due to domestic cleaning goods. The pending challenge from the Public Health point of view is to elaborate the Report on Human Exposure to Environmental Chemical Agents which, undoubtedly, will help to establish differences between type and class. Finally, the number of outbreaks of food poisoning continues to be of concern; this should lead us to think about the effectiveness of food safety programmes and to focus on the home, being place where most of the outbreaks occur. The General Sanitary Inspection of Food ought to be a good tool to help improve food safety.     

Race, heart disease worry and health protective behavior

This study links heart disease worry with self initiated changes in diet and exercise health protective behaviors (HPB), among blacks and whites. Utilizing the concept 'vulnerability', from the Health Belief Model, it is hypothesized that worry about heart disease will more readily translate into diet and exercise health behaviors for blacks than for whites. The data come from a national probability survey of families in the United States (N = 1167). The findings indicate substantial support for the hypothesis when both race and socioeconomic status (SES) are considered. Among whites, heart disease worry has no effect on health protective behavior. For blacks, worry about heart disease does have a pronounced effect on HPB, but only among lower SES blacks. A test for interaction indicates that the low SES black slope is significantly different than the slopes in the other race-SES categories. These findings contrast sharply with much of the traditional (system contact) prevention literature which depicts lower SES minority populations as less active in preventive behavior. A system barriers explanation is explored, which argues that lower SES minority persons turn to HPB as an alternative to impersonal public medicine. There was no support for this explanation; rather, lower SES blacks involved in health protective behavior express more confidence in the health care system.     

Using foresight methods to anticipate future threats: the case of disease management

We describe a unique foresight framework for health care managers to use in longer-term planning. This framework uses scenario-building to envision plausible alternate futures of the U.S. health care system and links those broad futures to business-model-specific "load-bearing" assumptions. Because the framework we describe simultaneously addresses very broad and very specific issues, it can be easily applied to a broad range of health care issues by using the broad framework and business-specific assumptions for the particular case at hand. We illustrate this method using the case of disease management, pointing out that although the industry continues to grow rapidly, its future also contains great uncertainties.