An overview of the Be Well Home Health Navigator Program to reduce contaminants in well water: Design and methods

BACKGROUND

The Be Well Home Health Navigator Program is a prospective, randomized controlled trial (RCT) implemented to compare a community health navigator program to usual care program to reduce contaminants in drinking water.

DESIGN AND SETTING

This 4-year two-armed RCT will involve well owners in Oregon that have private drinking water wells that contain arsenic, nitrate, or lead above maximum contaminant levels.

INTERVENTION

The intervention leverages the trusted relationship between Cooperative Extension Service (CES) Community Educators and rural well owners to educate, assist and motivate to make decisions and set actionable steps to mitigate water contamination. In this study, CES will serve as home health navigators to deliver: 1) individualized feedback, 2) positive reinforcement, 3) teach-back moments, 4) decision-making skills, 5) navigation to resources, 6) self-management, and 7) repeated contact for shaping and maintenance of behaviors. Usual care includes information only with no access to individual meetings with CES.

MEASURABLE OUTCOMES

Pre-specified primary outcomes include 1) adoption of treatment to reduce exposure to arsenic, nitrate, or lead in water which may include switching to bottled water and 2) engagement with well stewardship behaviors assessed at baseline, and post-6 and 12 months follow-up. Water quality will be measured at baseline and 12-month through household water tests. Secondary outcomes include increased health literacy scores and risk perception assessed at baseline and 6-month surveys.

IMPLICATIONS

The results will demonstrate the efficacy of a domestic well water safety program to disseminate to other CES organizations.

TRIAL REGISTRATION NUMBER

NCT05395663.

Assessing disabling and non-disabling injuries and illnesses using accepted workers compensation claims data to prioritize industries of high risk for Oregon young workers

INTRODUCTION

Young workers are especially vulnerable to occupational injuries and illnesses. There is a continued need to investigate injury burden among young workers across demographics and industry to inform targeted interventions. Workers compensation (WC) claims are important for quantifying work-related injuries and illnesses, however published studies have focused on disabling claims. This study extended previous research on Oregon young workers by including the most recent WC claims data to identify patterns of injury and high risk industries.

METHODS

We obtained all accepted disabling claims (N = 13,360) and a significant portion of non-disabling claims (N = 24,660) on workers aged 24 years and under from 2013 to 2018. Claim count, rate and cost were calculated by year, age, gender, industry, and injury type. A prevention index (PI) method was used to rank industries in order to inform prevention efforts.

RESULTS

Average annual disabling and non-disabling claim rates were 111.6 and 401.3 per 10,000 young workers. Workers aged 19-21 (disabling: 119.0 per 10,000 and non-disabling: 429.3) and 22-24 years (115.7 and 396.4) and male workers (145.3 and 509.0) had higher claim rates than workers aged 14-18 (80.6 and 297.0) and female workers (79.8 and 282.9). The most frequent injury types were "struck by/against" (35.6%) and "work-related musculoskeletal disorders (WMSDs)" (19.5%). High risk industries included agriculture, construction, and manufacturing for both genders combined. For female young workers, the highest risk industry was healthcare.

CONCLUSIONS

This study demonstrated the added value of non-disabling WC claims data. Using both disabling and non-disabling data and PI method, agriculture, construction, manufacturing and healthcare industries were identified as priority workplaces to prevent common and costly injuries among Oregon young workers. Practical Applications: While the industries identified are considered hazardous for all workers, findings in this study can guide targeted research and prevention efforts specific to young workers.

Evaluating Oregon's occupational public health surveillance system based on the CDC updated guidelines

Background

The Oregon Occupational Public Health Program (OOPHP) monitors occupational health indicators (OHIs) to inform occupational safety and health (OSH) surveillance. In 2018, OOPHP evaluated the performance of the OSH surveillance system and identified areas for future improvement.

Methods

Following the Centers for Disease Control and Prevention (CDC) updated guidelines for evaluating public health surveillance systems, the OOPHP evaluation team engaged internal and external stakeholders using a mixed‐methods approach. Operational measures for ten surveillance attributes were developed. Multiple data collection methods resulted in credible evidence for evaluation conclusions. Analyses included summary statistics and qualitative analysis of interviews, a focus group, and online surveys.

Results

Twenty stakeholders took part in this evaluation, with an average participation rate of 55%. Results showed the Oregon OSH surveillance system was simple, flexible, and highly accepted by its stakeholders. Funding security presents challenges for stability. A lack of timeliness of OHIs, low relevance of OHIs to local OSH issues, and the system's ineffectual data dissemination all limit the usefulness of the OSH surveillance system. A review of key data sources for the system showed good data quality and predictive value positive, but relatively poor sensitivity and representativeness.

Conclusions

The evaluation team successfully adapted attributes and examples in the CDC guidelines to this Oregon OSH surveillance evaluation. The evaluation findings have informed the development of recommendations for improvements to OOPHP's OSH surveillance. Future research is needed to develop guidance specific to OSH surveillance evaluation.

A Systematic Literature Review on Water Insecurity from an Oregon Public Health Perspective

This paper systematically reviews existing United States-based water insecurity literature with the goal of understanding the evidence base for developing public health water insecurity intervention strategies in Oregon. The authors conducted the systematic literature review using an adjusted PRISMA reporting checklist to document the review process. Results find 11 public health-related water insecurity interventions including surveillance practices and indicator and policy development. Research on water insecurity health impacts and solutions is still an emerging field. Nevertheless, state agencies perceive a risk to communities from inadequate safe water and are taking steps to assess and reduce these risks. From the review, strategies include improving water affordability, carrying out community education events, documenting drought risk and water loss, and tracking improvements in safe drinking water compliance. The review finds opportunities to take varied approaches that are community-specific, partnership-based and culturally relevant. Recommendations for Oregon include characterizing communities experiencing water insecurity, assessing community needs, tracking regional water scarcity and recognizing the human right to water in Oregon.

A Systematic Literature Review for Evidence of Aphanizomenon flos-aquae Toxigenicity in Recreational Waters and Toxicity of Dietary Supplements: 2000⁻2017

Previous studies of recreational waters and blue-green algae supplements (BGAS) demonstrated co-occurrence of Aphanizomenon flos-aquae (AFA) and cyanotoxins, presenting exposure risk. The authors conducted a systematic literature review using a GRADE PRISMA-p 27-item checklist to assess the evidence for toxigenicity of AFA in both fresh waters and BGAS. Studies have shown AFA can produce significant levels of cylindrospermopsin and saxitoxin in fresh waters. Toxicity studies evaluating AFA-based BGAS found some products carried the mcyE gene and tested positive for microcystins at levels ≤ 1 μg microcystin (MC)-LR equivalents/g dry weight. Further analysis discovered BGAS samples had cyanotoxins levels exceeding tolerable daily intake values. There is evidence that Aphanizomenon spp. are toxin producers and AFA has toxigenic genes such as mcyE that could lead to the production of MC under the right environmental conditions. Regardless of this ability, AFA commonly co-occur with known MC producers, which may contaminate BGAS. Toxin production by cyanobacteria is a health concern for both recreational water users and BGAS consumers. Recommendations include: limit harvesting of AFA to months when toxicity is lowest, include AFA in cell counts during visible blooms, and properly identify cyanobacteria species using 16S rRNA methods when toxicity levels are higher than advisory levels.

State-Issued Identification Cards Reveal Patterns in Adult Weight Status

BACKGROUND

State-issued identification cards are a promising data source for neighborhood-level obesity estimates.

METHODS

We used information from three million Oregon state-issued identification cards to compute age-adjusted estimates of average adult body mass index (BMI) for each census tract in the state. We used multivariate linear regression to identify associations between weight status and population characteristics, food access, commuting behavior, and geography.

RESULTS

Together, home values, education, race, ethnicity, car commuting, and rural-urban commuting area (RUCA) explained 86% of the variation in BMI among tracts. BMI was lower in areas with higher home values and greater educational attainment, and higher in areas with more workers commuting by car.

DISCUSSION

Our findings are consistent with other research on socioeconomic disparities in obesity. This demonstrates state-issued identification cards are a promising data source for BMI surveillance and may offer new insight into the association between weight status and economic and environmental factors. Public health agencies should explore options for developing their own obesity estimates from identification card data.