BCIT Environmental Public Health Journal
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Evaluation of the daycare mangers’ knowledge, attitude, and practice on lead in drinking water at daycares licensed by the Fraser Health Authority
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Background: Daycares in BC fall under the Community Care and Assisted Living Act which require all daycare facilities to provide a safe environment, including drinking water. Young children who have been exposed to lead in drinking water at schools and daycares can incur serious health effects, including damage to cognitive development. Previous research has demonstrated that even low levels of blood lead concentration are associated with intellectual disability, slowed growth and development, lowered ability to concentrate, decreased academic achievement and behavioural problems. Individuals’ knowledge, attitude and practice (KAP) on drinking water can influence on how the children consume drinking water and potentially cause adverse health effects. This study evaluated daycare managers’ knowledge, attitude, and practice (KAP) on lead in drinking water related to this issue. Method: This study was conducted by collecting 106 responses from a KAP survey to evaluate the knowledge, attitude, and practices regarding drinking water contaminants. The survey was distributed to daycare managers in Fraser Health region. The responses were analyzed with regression and correlation, one-way ANOVA, and chi-square tests. Results: There was a statistically significant correlation between the age of daycare manger and their knowledge (t-test = 0.0309). All other tests showed no statistical correlation, difference, and/or association (p-value greater than significance level of 0.05 on all parameters) between managerial experiences, age of managers, types of daycares in their knowledge, attitude, and practice regarding lead in drinking water in daycare facilities. The data of KAP questionnaires indicated that most daycare mangers do not fully understand and not are sufficiently educated regarding lead toxicity in drinking water. Conclusions: The results of KAP surveys showed that an educational intervention by the government or local health authorities is highly recommended and needed to improve the daycare managers’ knowledge, attitude, and practice regarding lead in drinking water. Additional research is required to confirm this.
 
Potential risks and user preferences of helmet-sharing program provided by Vancouver’s Mobi bike-share program
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Background: Mobi is a bike-sharing program in Vancouver, BC that provides helmets for use with each bike. There is little research documenting risks associated with helmet-sharing, but an evidence review has shown that there is the potential for transmission of diseases that are known or presumed to be transmitted via fomites. This study attempted to ascertain public opinion of helmet-sharing and whether concern over the cleanliness of shared helmets affected likelihood of wearing them. Method: A survey was conducted to determine if there is a relationship between concern with helmet cleanliness and likelihood of wearing shared helmets. The researcher conducted surveys in-person at randomly chosen Mobi docking stations. An online (SurveyMonkey) survey was also distributed using Facebook, Twitter, Reddit and email. Results: Chi-square tests performed using NCSS determined that there was a statistically significant association between helmet use on personal bikes and use of Mobi helmet when riding Mobi bikes (p=0.00029). There was also an association between whether users found cleanliness the most important factor in their decision to wear the Mobi helmet (of cleanliness, aesthetics, legal requirement, safety and comfort/fit) and likelihood of wearing the Mobi helmet (p=0.02038). There was no association found between level of concern for cleanliness of the helmet and likelihood of wearing it (p=0.54995). Conclusions: Based on the results, there is an association between concern with the cleanliness of shared helmets are and how likely users are to wear them. Users that were most concerned about safety were more likely to use the Mobi helmet during every ride. Those that were most concerned about cleanliness were least likely to wear the Mobi helmet. However, this study also concluded that some users chose not to wear the provided helmets for reasons other than concern for cleanliness. Further research is required to determine how this will affect the health and safety of Mobi Bike users.
 
The public health impact of infection control, sterilization and regulation in tattooing
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Background: The purpose of this study was to look at infection control and sterilization procedures in relation to invasive services performed at Personal Service Establishments (PSEs) in British Columbia. The objective was to collect data on the opinions of regulation and infection control practices of persons currently working in the industries of: tattooing, micro-blading and permanent make-up. Method: Data was collected from a survey that was created and distributed online through Survey Monkey. A list of 261 personal service establishments throughout Vancouver Costal Health and Fraser Health were called and/or e-mailed and asked to participate in the online survey. Results and Analyses: Among the 261 PSEs contacted, 30 agreed to participate. They were asked about the regulation of their profession and their standard practices for infection control and sterilization. 3% of the respondent’s primary service was permanent make-up, 7% micro-blading, 7% piercing and 80% was tattooing. The majority of opinions on regulation were divided where 50% felt the industry was under regulated and 40% felt it was adequately regulated. 90% of the respondents agreed that formal training should be required before being allowed to tattoo and 43% of the respondents also agreed that the use of an autoclave should require certification. For infection control/sterilization procedures 100% of shops use one-time use (disposable) needles and ink caps, 80% use disposable tubes, 93% use cord and machine covers and 90% use disposable razors. 63% of the respondents do not use autoclaves because they use disposable items and therefore do not need to clean and sterilize re-usable equipment. The data compared in chi-squared analysis, age and formal training had a p-value of 0.01460 which indicates that there is an association between age and the belief that formal training should be required for those who practice tattooing. Those under 40 were more likely to indicate that formal training should be required. Conclusion: With a low response rate for micro-blading and permanent make-up it is not feasible to compare or contrast opinions and/or practices between the three services. The tattooing industry had the highest response rate and can be looked at in more detail. The information collected on tattooing could be used to develop a course to improve the safety of PSE’s. EHO knowledge in inspecting food service establishments is very high as a system has been put into place that ensures effective inspections. As well, the FOODSAFE program teaches safe practices to those who work in the kitchen. The growing popularity of PSEs now gives EHOs the opportunity to focus on creating safe work environments through the implementation of a training course and possibly altering the way inspections of each different PSE are conducted. Results of this study, along with other Canadian published data, should be considered when developing standardized training and education in the industry where invasive procedures are used.
 
Electronic cigarettes: what motivates people to use them?
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Background: Electronic cigarettes are a widely-used, yet still emerging technology. As such, there is relatively little data regarding the reasons why people take up their use. Many claim to use them as a smoking-cessation method. Concern exists that experimentation in non-smokers may lead to nicotine addiction and subsequent smoking. The purpose of this study was to determine the primary reasons for the commencement of electronic cigarette use, and to suggest way in which these findings could affect current policies and regulations pertaining to electronic cigarettes. Methods: A survey examining electronic cigarette use was prepared. The survey contained questions respecting primary motivation for use, frequency of use, present and former smoking status as well as agreement with common perception about electronic cigarettes. Basic demographic information was also collected. The survey was posted to “www.reddit.com” and was accessible to users who used electronic cigarettes themselves via the “/r/electronic_cigarettes” sub-Reddit for a period of five days. Once responses were collected, Chi-square tests of independence were run to determine if any associations existed. Responses were also compared to previous studies of a similar nature to see if any similarities existed. Results: In total, 155 responses were received. The majority of the respondents were males (89.7%) between the ages of 19 and 28 (47.7%). 30.32% listed their occupation as “student”, and almost three-quarters of the respondents had some post-secondary experience. 78.1% of respondents were former smokers, and 61.3% identified their primary reason for electronic cigarette use as “to quit smoking.” Chi-squared tests for association between responses yielded statistically-significant associations between being a previous smoker and believing that electronic-cigarettes are healthier than conventional cigarettes, and between gender (specifically being male) and reasons for electronic cigarette use (specifically “to quit smoking”). However, the latter result was possibly skewed by a higher response rate from males as opposed to females. Conclusion: The high proportion of previous smokers among electronic cigarette users suggested that quitting smoking was the most common reason individuals take up electronic cigarette usage. It is therefore suggested that studies be done to determine if their use is less harmful than that of conventional cigarettes, and that existing legislation regarding their use in public be modified in light of this evidence. It is also suggested that they be given consideration as a legitimate means of smoking cessation.
 
Follow-up study of private well users affected by groundwater arsenic in the Surrey-Langley area
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Background: Arsenic is a potent toxicant and Group 1 human carcinogen which occurs naturally in certain sediments and can contaminate groundwater. In the Surrey-Langley area of British Columbia, a 2007 study of private wells found that 43% of wells tested contained arsenic concentrations above the maximum acceptable concentration (MAC) prescribed in Health Canada’s Guidelines for Canadian Drinking Water Quality. The well owners who participated in the 2007 study were informed of the results and of effective treatment methods that would remove the arsenic contamination. This is a follow-up study that surveyed affected well users approximately 10 years later in order to identify whether the well users had subsequently made any water treatment or behavioral changes to improve the quality of their drinking water, and also to determine whether knowledge translation of the arsenic risk had been effective. Methodology: This study contacted and enrolled private well users who were living at properties which had previously been included in the 2007 study and, in 2007, were found to have arsenic levels above the MAC in the groundwater. Respondents who agreed to participate completed a questionnaire designed to identify what treatment methods or behavioral methods they use to mitigate the risk posed by arsenic contamination. Pre-treatment and post-treatment samples of their drinking water were collected and the arsenic concentrations were analyzed. The effectiveness of treatment devices for arsenic removal was evaluated. The groundwater arsenic concentrations from approximately 10 years apart were compared to identify if arsenic levels had changed. Results: Of the 42 properties that participated in the 2007 study and had groundwater arsenic levels above the MAC, 17 participated in this follow-up study. 14 of the participants also took part in the 2007 study 10 years ago. 79% of participants had not known prior to taking part in the 2007 study that their drinking water contained arsenic levels above the MAC. All 79% then either installed reverse osmosis treatment devices to remove arsenic from their drinking water, or switched to using bottled water for drinking. This indicates that knowledge translation of the health risk was effective. Of the 8 properties using treatment devices rather than bottled water, to mitigate the arsenic risk, 2/8 (25%) were ineffective at reducing arsenic. In addition, arsenic groundwater concentrations were not found to have changed significantly in 10 years (p = 0.11). Conclusion: Participation in the 2007 study was viewed as useful and informative by participants. Knowledge translation of the health risk and the need for risk mitigation was effective, but 25% of treatment devices were found to be ineffective at removing arsenic from drinking water. These results suggests that further knowledge translation of the need for routine testing for arsenic in post-treated drinking water may be beneficial to affected private well users.
 
The practicality of using a smartphone as a sound level meter
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Background & Purpose: Sound is of vital importance for human life, it is one of the main forms of communication between people. However, sound that is a nuisance to others is considered noise. Too much noise can be disruptive and affects one’s enjoyment of life and can lead to ill health effects. In some municipalities, bylaw officers or Environmental Health Officers (EHOs) are tasked with enforcing the local noise bylaw. “Sound Level Meters” (SLM) are certified instruments enforcement officers use to accurately measure sound. However, accurate SLMs can be bulky and expensive. In this technological society, almost everyone has some type of smart phone capable of installing applications (apps) that mimic SLMs. The purpose of this project was to determine the accuracy of phone SLM apps compared to real SLMs. Method: Three Android & three iOS SLM apps were downloaded from the internet and installed on two Android and one iOS smartphone. The sound source was computer generated white noise. A type 1 SLM was used to set the white noise to three different sound levels, 80db, 65 dB, & 50 dB. Each Android and iOS smartphone measured the white noise at each sound level utilizing the three different SLM apps. Results were analyzed between the different apps and smartphones. The MANOVA and ANOVA statistical tests were used to analyze the data. Results: All MANOVA and ANOVA tests showed statistically differences between the apps and the SLM (p=0.00000). The power for all MANOVA tests was 100%, therefore there is confidence that the findings reflect the truth and there really is a difference between the different applications, smartphones, and interaction of applications and smartphones. Therefore, the smartphone/app combination tested were not able to replicate the noise level as measured by the SLM. Conclusion: It can be concluded that any individual Android SLM application can have significantly different mean decibels values across different Android smartphones. Different Android smartphones can also have significantly different means decibels across different Android applications. Results for iOS smartphones can only indicate significant mean decibels across the different SLM applications. Therefore, it is not recommended that smartphones with sound level measuring apps be used in place of SLMs.
 
Are absorbent pads suitable alternatives for tattoo dressing?
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Background: Tattoo is a form of body modification that involves injecting ink underneath the epidermis using a needle. According to BC’s Guidelines for Personal Services Establishments this kind of invasive procedure will require wound dressing but the kind and sterility of the wound dressing has not been specified. During a tattoo convention an Environmental Health Officer (EHO) noticed that some tattoo artists were using absorbent pads for wound dressing. Absorbent pads are not sterile; therefore there is a concern of microbial infections at the tattoo wounds. This study examined the viability of using absorbent pads, which are non-sterile, as tattoo wound dressings. Method: 3M Quick Swabs were used to swab absorbent pads to collect the microorganisms present on the surface. 3M Petrifilm E. coli/Coliform Count Plates were used to culture E. coli and Coliform which could be present on the SanidermTM sterile tattoo dressing and absorbent pads. The presence of E. coli colonies on the petrifilm would show up as blue dots, while coliform colonies would be red dots. The total colony forming units (CFU), which include both E. coli and coliform colonies, were counted to assess the general sanitation conditions of both types of dressing. Results: Zero CFU were found from sampling the SanidermTM dressings and absorbent pads purchased from tattoo supply shops within Metro Vancouver. Conclusions: In the field of Environmental Health, coliform is often used as an indicator for the degree of sanitary quality; while E. coli is used as an indicator for fecal contamination. Therefore, the results of this study, indicated that the absorbent pads have high degree sanitation and are free from fecal contamination.
 
Evaluating two methods of testing residual sanitizer concentrations in food service establishments
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Objective: Utensils and tableware are food contact surfaces that have the potential to transmit disease-causing microorganisms if not washed, cleaned and sanitized correctly in a food service establishment. To prevent utensils and tableware from becoming vectors of disease, it is essential that operators and staff are able to adequately sanitize them and accurately test for it in a quick and convenient manner. It is also essential that Environmental Health officers are able to test whether adequate sanitization is occurring during their routine inspections. Currently there are no guidelines indicating the correct method of testing. Therefore, this study investigated two methods used to test residual sanitation concentration in a dishwasher. The purpose of this research was to determine if there is any difference in the two methods currently being used, and if so, which method is the more reliable one. Methods: LaMotte Chlorine Test Strips were used to detect the levels of chlorine in a commercial dishwasher. The chemically treated strips were dipped onto a freshly wet and washed utensil and directly in the rinse water of a dishwasher. Results: The difference in the mean of 60 samples from two independent groups was analyzed. Thirty samples were obtained from location one, the dishware l, and thirty samples were obtained from location two, the rinse water of the commercial dishwasher. The mean residual concentration was calculated and compared. The means demonstrated there is a significant difference (p = 0.035)between the two groups; the average residual concentration was lower for the dishware compared to the rinse water. Conclusion: Dishware is a vector capable of transmitting disease causing microorganisms if not sanitized adequately. Thus, it is important to ensure that dishes in a food service establishment have been thoroughly sanitized. The testing of that requires a consistent and reliable method. It is safe to assume that testing on the dishware is the best course of action to err on the side of caution.
 
Blood concentrations of lead and mercury in British Columbians (2009-2010)
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Background and Purpose: Adverse effects of lead and mercury on human health due to environmental and occupational exposures require a public health attention. These metals can cause severe harm to vulnerable populations such as children and pregnant women. The probability of chronic and harmful exposure is higher in occupational settings. Monitoring the levels of these two metals in blood is an important tool to identify and quantify exposure to these metals in the environment. Monitoring data provides vital information required for management of health risk posed by these metals. The purpose of this study was to perform a comparative analysis of blood lead levels and blood mercury levels within the province of British Columbia on the health services data obtained from BC Centre of Disease Control. The primary objective was to compare the levels of lead and mercury in blood among different health authorities of British Columbia. The secondary objective was to compare the levels of lead and mercury among different age groups and gender. Methods: The blood lead and mercury concentrations used for the analysis were provided by Environmental Health Services at the British Columbia Centre for Disease Control (BCCDC). The data comprised of blood analyses that were ordered by physicians during the period of 2009-2010 for reasons not disclosed. Access to this data was provided by Dr. Reza Afshari with the permission of Dr. Tom Kosastsky for the completion of this project only. Statistical analysis of data was performed using Microsoft Excel 2013 and SAS University Edition Analytic Software. Various descriptive and inferential statistical tests were performed on the data to determine the differences of blood mercury and lead levels among different genders, Health Authorities and age groups. Results: The levels of blood mercury and lead concentrations were not significantly different in males and females in province (p-value 0.5543 for mercury; p-value 0.5336 lead). However, it was found that blood levels of lead were higher in Interior Health and “Unknown” category (p<0.02), while blood mercury levels were significantly higher in coastal health authorities (highest in Vancouver Coastal Health Authority, followed by Fraser Health Authority and Vancouver Island Health Authority) (p<0.001). For both toxic metals, levels were highest in age group of 50 and above. (p<0.0001 for mercury, p<0.02 for lead). Conclusion: The statistical analysis of lead and mercury data was useful in characterizing the exposure among Health Authorities, age and sex of the people tested in province of British Columbia. Analysis of mercury data has generated clear patterns inferring association between coastal Health Authorities and elevated mercury levels. Vancouver Coastal Health had highest median mercury levels 4.02 μg/L higher than other health authorities (p<0.0001). Analysis of lead data established a pattern among physicians suggesting that they are more likely to order a test if the patient is under 18 years of age. Median levels were found to be highest in Interior Health Authority and “Unknown”
 
An evaluation of British Columbia’s guideline for the sale of foods at temporary food markets in allowing the sale of potentially hazardous food
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Background and the purpose: British Columbia’s Guideline for the Sale of Foods at Temporary Food Markets is a document that Environmental Health Officers’ (EHOs) and farmers’ market managers will have to consult with when determining what food products are allowed to be sold in farmers’ markets. This guideline plays a vital role because it indirectly influences EHOs’ and farmers’ market managers’ judgments and the public’s risk exposure to potentially hazardous foods (PHFs) in farmers’ markets. It is necessary to evaluate and compare BC’s guideline with other provinces’ to see where it sits in the spectrum with respect to its permissibility in allowing the sale of PHFs in farmers’ markets, perhaps contributing to the further revision or development of the farmers’ markets guideline or policy. Methods: An online Google Docs survey consisting of 20 questions was created to ask farmers’ market managers from British Columbia and other provinces in Canada whether their farmers’ markets allow the sale of the five food types: poultry, shell egg, sauerkraut, unpasteurized juice/cider and cheese and how these foods are handled and stored. Results: There were 56 farmers’ market managers who participated in this survey (46% from BC and 54% from outside BC). Chi-square results had p-values greater than 0.05 for all the five surveyed categories. Two-tail t test results had p-values less than 0.05 in the raw poultry and sauerkraut categories. Discussion: Although no association between the location of farmers’ markets in Canada and the sale of the five surveyed food categories, BC farmers’ market managers disallowed the sale of raw poultry and unpasteurized juice more often than markets outside BC whereas fewer BC farmers’ market managers disallowed the sale of eggs and cheese when compared to markets outside BC. A significant difference in the handling and storage practices of raw poultry and sauerkraut was identified between farmers’ market managers in BC and outside BC. Also, BC’s managers were shown to have safer food handling practices to raw poultry, sauerkraut and unpasteurized juice than managers from outside BC. Conclusion: The types of foods sold in BC and outside BC appeared similar as this survey found no differences between the five surveyed PHF categories allowed for sale. However, handling practices of these foods did vary, and that might be associated with guidelines, or with farmers’ market manager knowledge. Of concern, BC farmers’ market indicated that eggs and juices were sourced and made on farms. These two categories required more attention and food safety awareness from both EHOs and farmers’ market managers. Overall, the survey responses reaffirmed that review and approval for the sale of potentially hazardous food from EHOs and scrutiny from farmers’ markets managers must be in place to ensure public’s safety as well as minimizing public’s risk exposure to improperly handled PHF sold in farmers’ markets.