Results from "Live Well", a randomized controlled community-based participatory intervention to prevent obesity in new immigrant mother-child dyads

BACKGROUND

Upon arrival, the prevalence of overweight and obesity is lower in new immigrants than their native counterparts in the U.S. With longer residency in the U.S., these differences converge over time, followed by higher prevalence among immigrants than native U.S. residents. Results from the Live Well project in the Greater Boston area demonstrate the viability of utilizing a culturally adapted, community-based participatory research (CBPR) approach to reduce weight gain among newly immigrated mother-child dyads.

METHODS

Haitian, Latina, and Brazilian mother-child dyads (n = 390), new to the U.S. (fewer than 10 years) were enrolled in a one- to two-year long CBPR lifestyle intervention that targeted dietary and physical activity behaviors. Attendance was recorded to establish dose. Demographics, anthropometrics, and relevant covariates were collected from participants at baseline, 6, 12, 18, and 24 months. Body Mass Index (BMI) was calculated using objectively measured height and weight. Linear mixed regression models were used to assess change in BMI and BMI z-score of mothers and children respectively.

RESULTS

At baseline, nearly 75% of mothers and 50% of children were either overweight or obese (BMI ≥ 25.0 and BMI z-score ≥ 85th percentile, respectively). Only 20% of mothers attended all 12 intervention sessions in year 1. Using intent-to-treat analyses, no significant time, intervention, or time × intervention effects were observed for weight change of mothers or children at follow-up. Mothers in the highest quantile (those who attended all 12 intervention sessions) had significant reductions in BMI at 18 months (1.76 units lower, 95%CI: -3.14, -0.37) and 24 months (2.61 units, 95%CI -3.92, -1.29) compared to mothers in the lower quantiles, including those with no exposure. Such dose effects on BMI z-scores were not noted for children.

CONCLUSIONS

Findings from Live Well demonstrate the viability of utilizing a CBPR approach to address overweight and obesity among immigrant mothers. Given the higher-than-expected prevalence of overweight and obesity among mother-child dyads by ~ 6 years of U.S. residency, and lower maternal participation rates in the intervention, additional research is necessary to identify the optimal intervention length, retention strategies, and approach to jointly support healthy maternal and child weight.

Long-term measurement study of urban environmental low frequency noise

BACKGROUND

Environmental low frequency noise (LFN < 125 Hz), ubiquitous in urban areas, is an understudied area of exposure science and an overlooked threat to population health. Environmental noise has historically been measured and regulated by A-weighted decibel (dBA) metrics, which more heavily weight frequencies between 2000 and 5000 Hz. Limited research has been conducted to measure and characterize the LFN components of urban environmental noise.

OBJECTIVES

We characterized LFN noise at two urban sites in Greater Boston, Massachusetts (USA) using dBA and full spectrum noise measurements with aims to (1.) analyze spatio-temporal differences in the two datasets; (2.) compare and contrast LFN metrics with dBA noise metrics in the two sites; and (3.) assess meteorological covariate contributions to LFN in the dataset.

METHODS

We measured A- and C-weighted, and flat, unweighted noise levels and 1/3-octave band continuously for 5 months using sound level meters sampling at f = 1 Hz and we recorded sound samples at 44.1 kHz. Our measurement sites were located in two urban, densely populated communities, burdened by close proximity to bus, rail, and aircraft routes.

RESULTS

We found that (1.) LFN does not follow the same seasonal trends as A-weighted dBA loudness; there are spatial differences in LFN and its very low frequency noise components (VLFN) between two urban sites; (2.) VLFN and LFN are statistically significant drivers of LCeq (nearly independent of frequency) minus LAeq, (LCeq-LAeq) >10 dB, an accepted LFN metric; and (3.) LFN was minimally affected by high wind speeds at either Site.

IMPACT STATEMENT

Environmental low-frequency noise (LFN < 125 Hz), ubiquitous in urban areas, is an understudied area of exposure science and an overlooked risk to population health. We measured environmental noise across the full spectrum of frequencies continuously for five months at two urban sites located in Environmental Justice communities. We found that LFN did not follow the same seasonal trends as A-weighted (dBA) loudness, and we observed spatial differences in LFN and very low frequency noise (VLFN < 20 Hz) at the two sites. Not characterizing LFN and basing noise regulations only on A-weightings, a poor predictor of LFN, may expose populations to LFN levels of concern.

Disinfection of Phi6, MS2, and Escherichia coli by Natural Sunlight on Healthcare Critical Surfaces

Ultraviolet (UV) radiation systems, commonly used to disinfect surfaces, drinking water, and air, stem from historical practice to use sunlight to disinfect household items after contagious illness. Currently, it is still recommended in viral outbreak contexts such as COVID-19, Ebola, and Marburg to expose soft surfaces to sunlight after washing with detergent or disinfecting with chlorine. However, sunlight that reaches the Earth's surface is in the UVA/UVB wavelengths, whereas UV disinfection systems typically rely on biocidal UVC. Our goal was to fill the evidence gap on the efficacy of sunlight disinfection on surface materials common in low-resource healthcare settings by seeding four surfaces (stainless steel, nitrile, tarp, cloth) with three microorganisms (viral surrogate bacteriophages Phi6 and MS2 and Escherichia coli bacteria), with and without soil load, and exposing to three sunlight conditions (full sun, partial sun, cloudy). We conducted 144 tests in triplicate and found: solar radiation averaged 737 W/m2 (SD = 333), 519 W/m2 (SD = 65), and 149 W/m2 (SD = 24) for full sun, partial sun, and cloudy conditions; significantly more surfaces averaged ≥ 4 log10 reduction value (LRV) for Phi6 than MS2 and E. coli (P < 0.001) after full sun exposure, and no samples achieved ≥ 4 LRV for partial sun or cloudy conditions. On the basis of our results, we recommend no change to current protocols of disinfecting materials first with a 0.5% chlorine solution then moving to sunlight to dry. Additional field-based research is recommended to understand sunlight disinfection efficacy against pathogenic organisms on healthcare relevant surfaces during actual outbreak contexts.

Chlorine efficacy against bacteriophage Phi6, a surrogate for enveloped human viruses, on porous and non-porous surfaces at varying temperatures and humidity

While efficacy of chlorine against Phi6, a widely-used surrogate for pathogenic enveloped viruses, is well-documented, surfaces common to low-resource contexts are under-researched. We evaluated seven surfaces (stainless steel, plastic, nitrile, tarp, cloth, concrete, wood) and three environmental conditions-temperature (4, 25, 40 °C), relative humidity (RH) (23, 85%), and soiling-to determine Phi6 recoverability and the efficacy of disinfection with 0.5% NaOCl. Overall, Phi6 recovery was >4 log₁₀ PFU/mL on most surfaces after drying 1 hour at all temperature/humidity conditions. After disinfection, all non-porous test conditions (48/48) achieved ≥4 LRV at 1 and 5 minutes of exposure; significantly more non-porous surfaces met ≥4 LRV than porous (p < 0.001). Comparing porous surfaces, significantly fewer wood samples met ≥4 LRV than cloth (p < 0.001); no differences were observed between concrete and either wood (p = 0.083) or cloth (p = 0.087). Lastly, no differences were observed between soil and no-soil conditions for all surfaces (p = 0.712). This study highlights infectious Phi6 is recoverable across a range of surfaces and environmental conditions, and confirms the efficacy of chlorine disinfection. We recommend treating all surfaces with suspect contamination as potentially infectious, and disinfecting with 0.5% NaOCl for the minimum contact time required for the target enveloped virus (e.g. Ebola, SARS-CoV-2).

Selection of a SARS-CoV-2 Surrogate for Use in Surface Disinfection Efficacy Studies with Chlorine and Antimicrobial Surfaces

Initial recommendations for surface disinfection to prevent SARS-CoV-2 transmission were developed using previous evidence from potential surrogates. To the best of our knowledge, no appropriate surrogate for SARS-CoV-2 has been identified or confirmed for chlorine and antimicrobial surface disinfection. We completed a study to evaluate the efficacy of two hypothesized antimicrobial surfaces, and four chlorine solutions on nonporous and porous surfaces, against SARS-CoV-2 and three potential SARS-CoV-2 surrogates [coronavirus mouse hepatitis virus (MHV) and bacteriophages Phi6 and MS2], to identify a BSL-1 or BSL-2 virus to use in future studies. We found SARS-CoV-2 can be reduced >4 log10 on porous and nonporous surfaces within 30 s upon exposure to 0.5% NaOCl. The results indicate coronavirus MHV-GFP is inactivated faster than SARS-CoV-2 (MHV-GFP ≥ 6.08 log10; SARS-CoV-2 = 0.66 log10 at 30 s with 0.05% NaOCl on steel) and MS2 is inactivated more slowly. Phi6 is inactivated like SARS-CoV-2, and we propose Phi6 as a slightly conservative surrogate for SARS-CoV-2 chlorine disinfection. Additionally, disinfection of bacteriophages on wood was challenging, and exposure to antimicrobial surfaces had no disinfection efficacy as tested. We recommend using 0.5% chlorine on surfaces for a minimum of 30 s of contact to disinfect SARS-CoV-2 and recommend additional research on Phi6 disinfection with varied surfaces and conditions.

A field study to estimate inhalation rates for use in a particle inhalation rate exposure metric

Particle inhalation rate (PIR) is an air pollution exposure metric that relies on age-, sex-, and physical activity-specific estimates of minute respiratory volume (MRV; L/min-kg) to account for personal inhalation patterns. United States Environmental Protection Agency (USEPA)-generated MRV estimates derive primarily from relatively homogenous populations without substantial cardiorespiratory challenges. To determine if these MRV estimates are relevant to populations in generally poor cardiorespiratory health (e.g., the Boston Puerto Rican Health Study (BPRHS) population) or whether population-specific estimates are needed, we 1) estimated population-specific MRVs and compared them to USEPA MRV estimates, and 2) compared exposure distributions and health effect estimates using PIR with population-specific MRVs, PIR with USEPA MRVs, and ambient particle number concentration (PNC). We recruited 40 adults (80% Puerto Rican, mean age = 60.2 years) in Boston with health characteristics similar to the BPRHS population. We measured pulse, oxygen saturation, respiration rate, and inspiratory volume while participants walked, stood, sat, and lay down. Pulse, respiration rate, inspiratory volume, and MRV were greater when participants were walking/standing compared to sitting or lying down. We then calculated MRVs adjusted for age, sex, measured body weight, and physical activity using data from 19 Puerto Rican participants who wore a nose clip or held their nostrils closed. We applied the population-specific and USEPA MRVs to estimate ultrafine particle exposure for participants in the BPRHS (n = 781). We compared exposure distributions and health effect estimates using the PIR with population-specific MRV estimates, PIR with USEPA MRV estimates, and ambient concentrations. We found that while population-specific MRVs differed from USEPA MRVs, particularly for unhealthy participants, PIR exposure distributions and health effect estimates were similar using each exposure metric. Confidence intervals were narrower using the PIR metrics than ambient PNC, suggesting increased statistical efficiency. Even in our understudied population, using USEPA MRVs did not meaningfully change PIR estimates.

Water Source Preferences and Water Quality Perceptions among Women in the Eastern Region, Ghana: A Grounded Theory Study

Residents in the Eastern Region, Ghana with access to improved water sources (e.g., boreholes and covered wells) often choose to collect water from unimproved sources (e.g., rivers and uncovered wells). To assess why, we conducted two field studies to coincide with Ghana’s rainy and dry seasons. During the rainy season, we conducted semi-structured in-depth interviews among a convenience sample of 26 women in four rural communities (including one woman in the dry season). We asked each participant about their attitudes and perceptions of water sources. During the dry season, we observed four women for ≤4 days each to provide context for water collection and water source choice. We used a grounded theory approach considering the multiple household water sources and uses approach to identify three themes informing water source choice: collection of and access to water, water quality perception, and the dynamic interaction of these. Women selected water sources based on multiple factors, including season, accessibility, religious/spiritual messaging, community messaging (e.g., health risks), and ease-of-use (e.g., physical burden). Gender and power dynamics created structural barriers that affected the use of unimproved water sources. A larger role for women in water management and supply decision-making could advance population health goals.

The use of remotely sensed environmental parameters for spatial and temporal schistosomiasis prediction across climate zones in Ghana

Schistosomiasis control in sub-Saharan Africa is enacted primarily through preventive chemotherapy. Predictive models can play an important role in filling knowledge gaps in the distribution of the disease and help guide the allocation of limited resources. Previous modeling approaches have used localized cross-sectional survey data and environmental data typically collected at a discrete point in time. In this analysis, 8 years (2008-2015) of monthly schistosomiasis cases reported into Ghana's national surveillance system were used to assess temporal and spatial relationships between disease rates and three remotely sensed environmental variables: land surface temperature (LST), normalized difference vegetation index (NDVI), and accumulated precipitation (AP). Furthermore, the analysis was stratified by three major and nine minor climate zones, defined using a new climate classification method. Results showed a downward trend in reported disease rates (~ 1% per month) for all climate zones. Seasonality was present in the north with two peaks (March and September), and in the middle of the country with a single peak (July). Lowest disease rates were observed in December/January across climate zones. Seasonal patterns in the environmental variables and their associations with reported schistosomiasis infection rates varied across climate zones. Precipitation consistently demonstrated a positive association with disease outcome, with a 1-cm increase in rainfall contributing a 0.3-1.6% increase in monthly reported schistosomiasis infection rates. Generally, surveillance of neglected tropical diseases (NTDs) in low-income countries continues to suffer from data quality issues. However, with systematic improvements, our approach demonstrates a way for health departments to use routine surveillance data in combination with publicly available remote sensing data to analyze disease patterns with wide geographic coverage and varying levels of spatial and temporal aggregation.

"Back to the Future": Time for a Renaissance of Public Health Engineering

Public health has always been, and remains, an interdisciplinary field, and engineering was closely aligned with public health for many years. Indeed, the branch of engineering that has been known at various times as sanitary engineering, public health engineering, or environmental engineering was integral to the emergence of public health as a distinct discipline. However, in the United States (U.S.) during the 20th century, the academic preparation and practice of this branch of engineering became largely separated from public health. Various factors contributed to this separation, including an evolution in leadership roles within public health; increasing specialization within public health; and the emerging environmental movement, which led to the creation of the U.S. Environmental Protection Agency (EPA), with its emphasis on the natural environment. In this paper, we consider these factors in turn. We also present a case study example of public health engineering in current practice in the U.S. that has had large-scale positive health impacts through improving water and sanitation services in Native American and Alaska Native communities. We also consider briefly how to educate engineers to work in public health in the modern world, and the benefits and challenges associated with that process. We close by discussing the global implications of public health engineering and the need to re-integrate engineering into public health practice and strengthen the connection between the two fields.

Longitudinal associations of long-term exposure to ultrafine particles with blood pressure and systemic inflammation in Puerto Rican adults

BACKGROUND

Few longitudinal studies have examined the association between ultrafine particulate matter (UFP, particles < 0.1 μm aerodynamic diameter) exposure and cardiovascular disease (CVD) risk factors. We used data from 791 adults participating in the longitudinal Boston Puerto Rican Health Study (Massachusetts, USA) between 2004 and 2015 to assess whether UFP exposure was associated with blood pressure and high sensitivity C-reactive protein (hsCRP, a biomarker of systemic inflammation).

METHODS

Residential annual average UFP exposure (measured as particle number concentration, PNC) was assigned using a model accounting for spatial and temporal trends. We also adjusted PNC values for participants' inhalation rate to obtain the particle inhalation rate (PIR) as a secondary exposure measure. Multilevel linear models with a random intercept for each participant were used to examine the association of UFP with blood pressure and hsCRP.

RESULTS

Overall, in adjusted models, an inter-quartile range increase in PNC was associated with increased hsCRP (β = 6.8; 95% CI = - 0.3, 14.0%) but not with increased systolic blood pressure (β = 0.96; 95% CI = - 0.33, 2.25 mmHg), pulse pressure (β = 0.70; 95% CI = - 0.27, 1.67 mmHg), or diastolic blood pressure (β = 0.55; 95% CI = - 0.20, 1.30 mmHg). There were generally stronger positive associations among women and never smokers. Among men, there were inverse associations of PNC with systolic blood pressure and pulse pressure. In contrast to the primary findings, an inter-quartile range increase in the PIR was positively associated with systolic blood pressure (β = 1.03; 95% CI = 0.00, 2.06 mmHg) and diastolic blood pressure (β = 1.01; 95% CI = 0.36, 1.66 mmHg), but not with pulse pressure or hsCRP.

CONCLUSIONS

We observed that exposure to PNC was associated with increases in measures of CVD risk markers, especially among certain sub-populations. The exploratory PIR exposure metric should be further developed.

Indicators of improved water access in the context of schistosomiasis transmission in rural Eastern Region, Ghana

Populations with poor access to water, sanitation and hygiene (WASH) infrastructure are disproportionately affected by the neglected tropical diseases (NTDs). As a result, WASH has gained increasing prominence in integrated control and elimination of NTDs, including schistosomiasis. In order to identify underserved populations, relevant measures of access to WASH infrastructure at sub-national or local levels are needed. We conducted a field survey of all public water sources in 74 rural communities in the Eastern Region of Ghana and computed indicators of water access using two methods: one based on the design capacity and another on the spatial distribution of water sources. The spatial method was applied to improved and surface water sources. According to the spatial method, improved water sources in the study area were well-distributed within communities with 95% (CI_95%: 91, 98) of the population having access within 500m when all, and 87% (CI_95%: 81, 93) when only functional water sources were considered. According to the design capacity-based method, indicator values were lower: 63% (CI_95%: 57, 69) for all and 49% (CI_95%: 43, 55) for only functional sources. Surface water access was substantial with 62% (CI_95%: 54, 71) of the population located within 500m of a perennial surface water source. A negative relationship was observed between functional improved water access and surface water access within 300m. In this context, perceived water quality of the improved sources was also important, with a 17% increase in surface water access in towns with one reported water quality problem as compared to towns with no problems. Our study offers a potential methodology to use water point mapping data to identify communities in need of improved water access to achieve schistosomiasis risk reduction.

Critical discourse, applied inquiry and public health action with urban middle school students: Lessons learned engaging youth in critical service-learning

The Nuestro Futuro Saludable partnership designed a critical service-learning intervention focused on health equity and action. The ten-week afterschool intervention was implemented in a Boston middle school. Youths who took part in the intervention were knowledgeable about the social determinants of health in their communities, as well as to the barriers to health. Our findings indicate that engaging young people in a meaningful way will be critical if health improvement efforts are to be realized. We found that a critical service-learning framework that incorporates elements of applied inquiry and critical pedagogy was effective as a health intervention and provided opportunities for action.

Piped water consumption in Ghana: A case study of temporal and spatial patterns of clean water demand relative to alternative water sources in rural small towns

Continuous access to adequate quantities of safe water is essential for human health and socioeconomic development. Piped water systems (PWSs) are an increasingly common type of water supply in rural African small towns. We assessed temporal and spatial patterns in water consumption from public standpipes of four PWSs in Ghana in order to assess clean water demand relative to other available water sources. Low water consumption was evident in all study towns, which manifested temporally and spatially. Temporal variability in water consumption that is negatively correlated with rainfall is an indicator of rainwater preference when it is available. Furthermore, our findings show that standpipes in close proximity to alternative water sources such as streams and hand-dug wells suffer further reductions in water consumption. Qualitative data suggest that consumer demand in the study towns appears to be driven more by water quantity, accessibility, and perceived aesthetic water quality, as compared to microbiological water quality or price. In settings with chronic under-utilization of improved water sources, increasing water demand through household connections, improving water quality with respect to taste and appropriateness for laundry, and educating residents about health benefits of using piped water should be prioritized. Continued consumer demand and sufficient revenue generation are important attributes of a water service that ensure its function over time. Our findings suggest that analyzing water consumption of existing metered PWSs in combination with qualitative approaches may enable more efficient planning of community-based water supplies and support sustainable development.

"They See Us As Machines:" The Experience of Recent Immigrant Women in the Low Wage Informal Labor Sector

This study explores the organization of work and occupational health risk as elicited from recently immigrated women (n = 8) who have been in the US for less than three years and employed in informal work sectors such as cleaning and factory work in the greater Boston area in Massachusetts. Additional interviews (n = 8) with Community Key Informants with knowledge of this sector and representatives of temporary employment agencies in the area provides further context to the interviews conducted with recent immigrant women. These results were also compared with our immigrant occupational health survey, a large project that spawned this study. Responses from the study participants suggest health outcomes consistent with being a day-laborer scholarship, new immigrant women are especially at higher risk within these low wage informal work sectors. A difference in health experiences based on ethnicity and occupation was also observed. Low skilled temporary jobs are fashioned around meeting the job performance expectations of the employer; the worker's needs are hardly addressed, resulting in low work standards, little worker protection and poor health outcomes. The rising prevalence of non-standard employment or informal labor sector requires that policies or labor market legislation be revised to meet the needs presented by these marginalized workers.

Low demanding parental feeding style is associated with low consumption of whole grains among children of recent immigrants

We explored the influence of immigrant mothers feeding style on their children's fruit, vegetable and whole grain intake and how this relationship differed by mother's time in the U.S. Baseline data were collected on mother-child (3-12 yrs) dyads enrolled in Live Well (n = 313), a community-based, participatory, randomized controlled lifestyle intervention (2008-2013). Socio-demographics, years of residence in the U.S., behavioral data, and responses to the Caregiver's Feeding Styles Questionnaire (CFSQ) were obtained from the mother. Measured heights and weights were obtained for both mother and child. Child dietary intake was assessed using the Block Food Screener. Separate multiple linear regression models were run, adjusting for child and mother covariates. Interactions between feeding styles and years in the U.S. (<5 and ≥ 5 years), ethnicity, and child age were tested. Sixty-nine percent of mothers were overweight or obese, 46% of the children were overweight or obese. For mothers in the U.S. for<5 years, having a low demanding/high responsive style was associated with lower child intake of whole grains in adjusted models vs. a high demanding/high responsive style (p < 0.05). This was not seen for mothers in the U.S. for≥5 years. Thus, the influence of feeding style on dietary intake may change with length of time in the U.S. These hypotheses-generating findings call for future research to understand how broader socio-cultural factors influence the feeding dynamic among immigrants.

Occupational health outcomes among self-identified immigrant workers living and working in Somerville, Massachusetts 2006-2009

This study examines the burden of occupational health risks among a convenience sample of three immigrant worker populations (Brazilian, Haitian, and El Salvadoran) in Somerville, Massachusetts. In this community based research initiative (n = 346), logistic regression is used to analyze immigrant occupational health survey data collected from 2006 to 2009. In this study, injuries at work were significantly associated with lower English proficiency (OR = 1.8, 95 % CI 1.1-3.0), workers between the ages of 46 and 65 (OR = 2.7, 95 % CI 1.0-7.0), service workers (OR = 13.8, 95 % CI 1.8-105.2), production workers (OR = 10.8, 95 % CI 1.3-90.1), construction workers (OR: 21.7, 95 % CI 2.8-170.9) and immigrants with no health insurance (OR = 1.8, 95 % CI 1.0-3.1). Injuries were negatively associated with years in the US with more established immigrants in the US >15 years reporting more injuries at work. Older immigrants who have been in the US longer but are less proficient in English, and are still employed in low-wage occupations with no health insurance suffered more injuries than recent immigrants. Further validation of this result is required.

Characterizing the low wage immigrant workforce: a comparative analysis of the health disparities among selected occupations in Somerville, Massachusetts

BACKGROUND

This study estimates job-related risks among common low wage occupations (cleaning, construction, food service, cashier/baggers, and factory workers) held by predominantly Haitian, El Salvadorian, and Brazilian immigrants living or working in Somerville, Massachusetts.

METHODS

A community-based cross-sectional survey on immigrant occupational health was conducted between 2006 and 2009 and logistic regression was used to assess the job-related risks among the most common low wage occupations.

RESULTS

Construction workers reported significantly higher health risks, and lower access to occupational health services than the other occupations. Compared to cashier/baggers, the reference population in this study, cleaners reported significantly lower access to health and safety and work training and no knowledge of workers' compensation. Factory workers reported significantly lower work training compared to cashier/baggers. Food service workers reported the least access to doctors compared to the other occupations.

CONCLUSION

We found significant variability in risks among different low wage immigrant occupations. The type of occupation independently contributed to varying levels of risks among these jobs. We believe our findings to be conservative and recommend additional inquiry aimed at assuring the representativeness of our findings.

Immigrating to the US: what Brazilian, Latin American and Haitian women have to say about changes to their lifestyle that may be associated with obesity

Our goal was to explore the perceived determinants of obesity in Brazilian, Latin American and Haitian women. This is part of an ongoing community-based participatory intervention. Focus groups by immigrant group were conducted and themes extracted. Women expressed differences in beliefs, attitudes, and barriers regarding diet and physical activity in the US versus their home country. Participants thought food in the US is "less natural," there is less time for preparation, and there is more variety. The weather is a barrier to physical activity in the US and work is more physically demanding. Job-related efforts were not considered physical activity. They reported higher levels of stress, less control of their time and less social support in the US. Providing immigrants with appropriate support and education early in the acculturation process has the potential to help prevent obesity.

Crossing the chasm of mistrust: collaborating with immigrant populations through community organizations and academic partners

As a community partner and an academic researcher, we experienced the direct and extended benefits of a relatively small-scale, community-engaged informed consent process that developed in an immigrant occupational health study, Assessing and Controlling Occupational Health Risks for Immigrant Populations in Somerville, Massachusetts. The practice of human participants research played a positive role in the community, and both community partners and researchers, as well as the larger academic community, reaped unexpected benefits during the five-year project (2005-2010), which continue into the present. Lessons learned from our experience may be helpful for wider application.

Population vulnerability to biannual cholera outbreaks and associated macro-scale drivers in the Bengal Delta

The highly populated floodplains of the Bengal Delta have a long history of endemic and epidemic cholera outbreaks, both coastal and inland. Previous studies have not addressed the spatio-temporal dynamics of population vulnerability related to the influence of underlying large-scale processes. We analyzed spatial and temporal variability of cholera incidence across six surveillance sites in the Bengal Delta and their association with regional hydroclimatic and environmental drivers. More specifically, we use salinity and flood inundation modeling across the vulnerable districts of Bangladesh to test earlier proposed hypotheses on the role of these environmental variables. Our results show strong influence of seasonal and interannual variability in estuarine salinity on spring outbreaks and inland flooding on fall outbreaks. A large segment of the population in the Bengal Delta floodplains remain vulnerable to these biannual cholera transmission mechanisms that provide ecologic and environmental conditions for outbreaks over large geographic regions.

Research as curriculum: engaging undergraduates and community residents in immigrant health research partnerships

BACKGROUND

Engaging undergraduate students in applied community research partnerships can promote greater health equity by providing students with the skills and capacity to work collaboratively with diverse populations.

OBJECTIVES

The aim of this project was to develop a sustainable model to engage community members and students in public health research.

METHODS

Using an integrated research-as-curriculum model, students, community members, and faculty collaborated on the study design and implementation.

CONCLUSIONS

Community residents in the classroom provided insights that strengthened the research process and helped to develop our understanding of contextual factors that influence health and well-being. This model provides a mechanism by which to fully incorporate undergraduate students in interdisciplinary partnership research for health.

Occupational health and safety experiences among self-identified immigrant workers living or working in Somerville, MA by ethnicity, years in the US, and English proficiency

In this community based research initiative, we employed a survey instrument predominately developed and administered by Teen Educators to assess occupational health risks for Haitian, Salvadoran, and Brazilian immigrants (n = 405) in Somerville, MA, USA. We demonstrate that a combined analysis of ethnicity, years in the US, and English proficiency better characterized the occupational experience of immigrant workers than considering these variables individually. While years in the US (negatively) and English proficiency (positively) explained the occurrence of health risks, the country of origin identified the most vulnerable populations in the community. Brazilians, Salvadorans, and other Hispanic, all of whom who have been in the US varying length of time, with varying proficiency in English language had twice the odds of reporting injuries due to work compared to other immigrants. Although this observation was not significant it indicates that years in the US and English proficiency alone do not predict health risks among this population. We recommend the initiation of larger studies employing c community based participatory research methods to confirm these differences and to further explore work and health issues of immigrant populations. This study is one of the small number of research efforts to utilize a contemporaneous assessment of occupational health problems in three distinct immigrant populations at the community level within a specific Environmental Justice context and social milieu.

Development of the live well curriculum for recent immigrants: a community-based participatory approach

BACKGROUND

There are few weight gain prevention interventions aimed at new immigrants. Live Well, a community-based participatory research (CBPR) study, was designed to address this gap.

OBJECTIVE

The goal of this paper is to describe the development of the Live Well nutrition and physical activity curriculum.

METHODS

The curriculum draws on behavioral theory and popular education and was co-created, implemented, and will be evaluated by community partners and academic researchers.

RESULTS

The time it took to develop the curriculum exceeded initial estimates. However, the extra time taken was spent engaging in needed dialogue to create a better product, fully co-created by academic and community partners. Additionally, working with an outside expert created the opportunity for all partners to train together, build capacity, and increase cohesion. Our approach developed relationships and trust, and resulted in a unique curriculum.

CONCLUSIONS

The commitment to partnership resulted in a curriculum to empower immigrant women to improve health decisions and behaviors. This will inform future research and programming targeting other at-risk and new immigrant communities.

Effective control of Schistosoma haematobium infection in a Ghanaian community following installation of a water recreation area

BACKGROUND

Urogenital schistosomiasis caused by Schistosoma haematobium was endemic in Adasawase, Ghana in 2007. Transmission was reported to be primarily through recreational water contact.

METHODS

We designed a water recreation area (WRA) to prevent transmission to school-aged children. The WRA features a concrete pool supplied by a borehole well and a gravity-driven rainwater collection system; it is 30 m(2) and is split into shallow and deep sections to accommodate a variety of age groups. The WRA opened in 2009 and children were encouraged to use it for recreation as opposed to the local river. We screened children annually for S. haematobium eggs in their urine in 2008, 2009, and 2010 and established differences in infection rates before (2008-09) and after (2009-10) installation of the WRA. After each annual screening, children were treated with praziquantel and rescreened to confirm parasite clearance.

PRINCIPAL FINDINGS

Initial baseline testing in 2008 established that 105 of 247 (42.5%) children were egg-positive. In 2009, with drug treatment alone, the pre-WRA annual cumulative incidence of infection was 29 of 216 (13.4%). In 2010, this incidence rate fell significantly (p<0.001, chi-squared) to 9 of 245 (3.7%) children after installation of the WRA. Logistic regression analysis was used to determine correlates of infection among the variables age, sex, distance between home and river, minutes observed at the river, low height-for-age, low weight-for-age, low Body Mass Index (BMI)-for-age, and previous infection status.

CONCLUSION/SIGNIFICANCE

The installation and use of a WRA is a feasible and highly effective means to reduce the incidence of schistosomiasis in school-aged children in a rural Ghanaian community. In conjunction with drug treatment and education, such an intervention can represent a significant step towards the control of schistosomiasis. The WRA should be tested in other water-rich endemic areas to determine whether infection prevalence can be substantially reduced.

Traffic exposure in a population with high prevalence type 2 diabetes--do medications influence concentrations of C-reactive protein?

Type 2 Diabetes (T2D) and particulate air pollution are associated with inflammatory dysregulation. We assessed the modifying effects of diabetes medications on the association of C-reactive protein (CRP), a marker of inflammation, and traffic exposure in adults with T2D (n = 379). CRP concentrations were significantly positively associated with residence ≤100 m of a roadway, >100 m and ≤200 m of a roadway and increased traffic density for individuals using insulin. For individuals using oral hypoglycemic medications (OHAs), CRP was significantly negatively associated with residence >100 m - ≤200 m of a roadway and multiple roadway exposure in an interaction model. Among people with diabetes, individuals on insulin appear to be most vulnerable to the effects of traffic exposure. Disease severity among insulin users may promote the pro-inflammatory response to traffic exposure, though diabetes medications may also modify the response. Possible anti-inflammatory effects of OHAs with traffic exposure merit further evaluation.

Diagnostic accuracy of urine filtration and dipstick tests for Schistosoma haematobium infection in a lightly infected population of Ghanaian schoolchildren

Two screening methods, reagent dipsticks for hematuria and urine filtration for Schistosoma haematobium eggs, were evaluated for their sensitivity and specificity in diagnosing infection with S. haematobium in lightly infected Ghanaian children. Schoolchildren aged 8-18 years (n=255) provided urine samples on three occasions. Overall, 36.4% of girls and 50.7% of boys presented with eggs at least once; 3.3% of girls and 7.5% of boys presented with both eggs and hematuria three times. Many children presented with eggs but without hematuria, or with hematuria but without eggs. When each child was screened three times, the sensitivity of each test method improved by at least 22.9% as compared with single screening, but previously unidentified infections were detected at the third screening, indicating that even three screenings is insufficient. Nearly half of lightly infected children (<50 eggs/10 ml urine, by maximum egg count) were egg-positive during only one of three screenings. Thus, data presented here indicate that when individuals are screened repeatedly, infection status can be assessed more accurately, control programs can be properly evaluated, and population estimates of S. haematobium infection may be made with increased confidence, as compared with single screening.

Neurocysticercosis: risk and primary prevention strategies update

Neurocysticercosis results from the infestation of the central nervous system with invading tapeworm larvae. Though uncommon in the US prior to 1965, new cases are currently being diagnosed at an unprecedented rate. Drawing on environmental health, intervention and risk data retrieved from standard/alternative databases and in-country sources, we present an update and summary of modifiable risk factors and field-tested primary prevention measures. While points of intervention, subpopulations at risk and overall magnitude of the problem are addressed, particular attention is paid to defining risk reduction measures that can be adopted by individuals and high risk groups in the near-term to interrupt or eliminate pathways of exposure leading to disease transmission. Though global eradication is not attainable in the near future, effective preventative measures exist and should be taken now by international travellers and workers, US/foreign government agencies, and individuals living in endemic regions to reduce human suffering.

Residential traffic exposure, pulse pressure, and C-reactive protein: consistency and contrast among exposure characterization methods

BACKGROUND

Traffic exposure may increase cardiovascular disease (CVD) risk via systemic inflammation and elevated blood pressure, two important clinical markers for managing disease progression.

OBJECTIVES

We assessed degree and consistency of association between traffic exposure indicators as predictors of C-reactive protein (CRP) and pulse pressure (PP) in an adult U.S. Puerto Rican population (n = 1,017).

METHODS

Cross-sectional information on health and demographics and blood data was collected. Using multiple linear regression, we tested for associations between CRP, PP, and six traffic exposure indicators including residential proximity to roads with > 20,000 vehicles/day and traffic density [vehicle miles traveled per square mile (VMT/mi2)]. Diabetes and obesity [body mass index (BMI) >or= 30 kg/m2] were tested as effect modifiers.

RESULTS

CRP was positively associated with traffic density in the total population [36% CRP difference with 95% confidence interval (CI) 2.5-81%] for residence within the highest versus lowest VMT/mi2 level. With BMI >or= 30, CRP showed significant positive associations with five of six traffic indices including residence <or= 200 m versus > 200 m of a roadway [22.7% CRP difference (95% CI, 3.15-46.1)] and traffic density in the third highest versus lowest VMT/mi2 level [28.1% difference (95% CI, 1.0-62.6)]. PP was positively associated with residence within <or= 100 m of a roadway for the total population [2.2 mmHg (95% CI, 0.13-4.3 mmHg)] and persons with BMI >or= 30 [3.8 mmHg (95% CI, 0.88-6.8)]. Effect estimates approximately doubled for residence within <or= 200 m of two or more roadways, particularly in persons with diabetes [8.1 mmHg (95% CI, 2.2-14.1)].

CONCLUSIONS

Traffic exposure at roadway volumes as low as 20,000-40,000 vehicles/day may increase CVD risk through adverse effects on blood pressure and inflammation. Individuals with elevated inflammation profiles, that is, BMI >or= 30, may be more susceptible to the effects of traffic exposure.

Characterizing urban traffic exposures using transportation planning tools: an illustrated methodology for health researchers

Exposure to elevated levels of vehicular traffic has been associated with adverse cardiovascular and respiratory health effects in a range of populations, including children, the elderly, and individuals with pre-existing heart conditions, diabetes, obesity, and genetic susceptibilities. As these relationships become clearer, public health officials will need to have access to methods to identify areas of concern in terms of elevated traffic levels and susceptible populations. This paper briefly reviews current approaches for characterizing traffic exposure and then presents a detailed method that can be employed by public health officials and other researchers in performing screening assessments to define areas of potential concern within a particular locale and, with appropriate caveats, in epidemiologic studies examining traffic-related health impacts at the intra-urban scale. The method is based on two exposure parameters extensively used in numerous epidemiologic studies of traffic and health-proximity to high traffic roadways and overall traffic density. The method is demonstrated with publically available information on susceptible populations, traffic volumes, and Traffic Analysis Zones, a transportation planning tool long used by Metropolitan Planning Agencies and planners across the USA but presented here as a new application which can be used to spatially assess possible traffic-related impacts on susceptible populations. Recommendations are provided for the appropriate use of this methodology, along with its limitations.

Transferring knowledge about human subjects protections and the role of institutional review boards in a community-based participatory research project

Among the first tasks in a collaboration between Tufts University and community organizations in Somerville, MA, was designing an interview instrument to assess occupational health needs among immigrant workers. Human subjects protections was a critical issue, but community partners were not well informed about the need for such protections or the role of the institutional review board (IRB). During research meetings, members of the team from Tufts trained community collaborators to work with research participants and organized a presentation by a key university IRB administrator. We present findings from the process evaluation of this project and suggest ways to (1) assess community partners' understanding about working with research volunteers, (2) train collaborators, and (3) involve IRBs.

The Vida Verde Women's Co-Op: Brazilian immigrants organizing to promote environmental and social justice

We reviewed the key steps in the launch of the Vida Verde Women's Co-Op among Brazilian immigrant housecleaners in Somerville, MA. The co-op provides green housecleaning products, encourages healthy work practices, and promotes a sense of community among its members. We conducted in-depth interviews with 8 of the first co-op members, who reported a reduction in symptoms associated with the use of traditional cleaning agents and a new sense of mutual support. Critical to the co-op's success have been the supportive roles of its academic partners (Tufts University and the University of Massachusetts, Lowell), effective media outreach, and a focus on advancing social justice. Next steps include implementing a formal business plan and assessing the appropriateness of cooperatives in other industries.

Environmental health practice: statistically based performance measurement

OBJECTIVES

State environmental and health protection agencies have traditionally relied on a facility-by-facility inspection-enforcement paradigm to achieve compliance with government regulations. We evaluated the effectiveness of a new approach that uses a self-certification random sampling design.

METHODS

Comprehensive environmental and occupational health data from a 3-year statewide industry self-certification initiative were collected from representative automotive refinishing facilities located in Rhode Island. Statistical comparisons between baseline and postintervention data facilitated a quantitative evaluation of statewide performance.

RESULTS

The analysis of field data collected from 82 randomly selected automotive refinishing facilities showed statistically significant improvements (P<.05, Fisher exact test) in 4 major performance categories: occupational health and safety, air pollution control, hazardous waste management, and wastewater discharge. Statistical significance was also shown when a modified Bonferroni adjustment for multiple comparisons was performed.

CONCLUSIONS

Our findings suggest that the new self-certification approach to environmental and worker protection is effective and can be used as an adjunct to further enhance state and federal enforcement programs.

Lead and methylene chloride exposures among automotive repair technicians

Potential exposures among repair technicians engaged in vehicle resurfacing operations prior to spray painting have not been thoroughly characterized. Environmental and personal air monitoring conducted in the State of Rhode Island have shown that automotive repair technicians may be exposed to metal particulates in sanding dust and methylene chloride vapors during vehicle paint removal operations. Hand wipe samples demonstrated that metals in sanding dust adhered to the hands of workers throughout the duration of the work day and were available for incidental ingestion from the handling of food/nonfood items and hand-to-mouth contact. A blood lead (PbB) screening effort among 21 workers at 2 facilities showed that 4 non-/less-exposed workers had mean PbB levels at the U.S. geometric mean of 2.8 microg/dL, while 2 out of 9 (22%) dedicated vehicle repair technicians had PbB levels at or above 30 microg Pb/dL whole blood--the level for potential adverse reproductive effects. Methylene chloride exposures were also found to exceed the Occupational Safety and Health Administrations (OSHA) 8-hr time-weighted average (TWA) action level and permissible exposure limit (PEL) in a limited number of samples (120 and 26 ppm, integrated work shift samples). Our findings suggest that thousands of professional technicians and vocational high school students may be at increased risk of adverse reproductive and/or other systemic effects.

The concordance of pollution prevention and occupational health and safety: a perspective on U.S. policy

BACKGROUND

Occupational health and pollution prevention, although conceptually linked by the common goals of preventing exposure to toxic materials and lowering risk functions, have been largely confined to separate patterns of practice and professional development. Some analysts see this as a missed opportunity for synergy and raising the level of protection afforded to both the worker and the ambient environment. By using current specific examples we show how strategies that integrate pollution prevention and occupational health practices can be effective at reducing chemical exposures and environmental releases beyond the levels normally achieved using traditional methods alone.

METHODS

Similarities in approaches to addressing chemical hazards at the source, are analyzed in the context of U.S. policy and recent state and federal initiatives. Results obtained from the analysis of multi-pathway risks found within the automotive refinishing sector serve as examples of how best to select engineering and control strategies.

RESULTS

Industry survey, metal speciation, and methylene chloride usage data from studies conducted in Rhode Island, coupled with case reports from other settings, demonstrate that opportunities exist to concurrently mitigate multiple environmental and occupational health hazards.

CONCLUSIONS

The collaborative initiatives undertaken in the automotive refinishing industry sector demonstrate that an integrated environmental and occupational health approach can more effectively address multiple chemical releases and workplace exposures. Such synergy should be advanced in the future by similar integrative and collaborative strategies.

Chemical characterization of sanding dust and methylene chloride usage in automotive refinishing: implications for occupational and environmental health

Surface preparation activities conducted during automotive refinishing present several potential human health and environmental risks. This study examines the chemical composition of vehicle sanding dust and the prevalence of methylene chloride use as a basis for evaluating potential chemical exposures in the work environment, fugitive environmental releases, and take-home toxics. This article reports on the findings of (1) a statewide technology and work practices survey of 353 licensed auto body shops and (2) laboratory analyses of sanding dust representing more than 200 vehicles, 10 commercial body filler compounds, and work shirts worn during vehicle sanding while using nonventilated equipment. Survey data revealed that the majority of shops (78%) do not use ventilated sanding equipment, that most workers (55%) take their work clothes and shoes home at the end of the workday, and that 17% of the respondents used a methylene chloride-based paint stripper as an adjunct to mechanical sanding. Laboratory results showed that Pb, As, Cr, Mn, and Ni were present in the sanding dust at every facility tested. Lead concentrations in sanding dust were found to be highest at facilities that performed complete vehicle refinishing (range 770 to 7300 ppm) and at a collision repair shop that used a high-lead content body filler compound (1800 ppm). Hexavalent chromium also was found in two vocational high school paint dust samples at concentrations of 54 and 710 ppm. When total lead and chromium concentrations reached 7300 and 2300 ppm, respectively, facility sanding dust samples failed the U.S. Environmental Protection Agency's Toxicity Characteristic Leaching Procedure for hazardous waste. Metals found in the sanding dust also were present on the work shirts of technicians-ranging from 0.06 (Cd) to 81 (Mg) microg/inch2 of cloth-who sanded on paint without ventilated equipment. Results suggest that sanding dust and methylene chloride paint strippers used in vehicle resurfacing operations pose a potential hazard to human health and the environment.

Survey of risk reduction and pollution prevention practices in the Rhode Island automotive refinishing industry

In 1996 a survey of pollution prevention, environmental control, and occupational health and safety practices was conducted in the Rhode Island automotive refinishing industry sector. In conjunction with project partners, the Rhode Island Department of Environmental Management developed a multidimensional survey instrument to identify risk reduction opportunities. Investigators sought to characterize the range of environmental and industrial hygiene control employed by Rhode Island facilities for the purposes of focusing state technical and compliance assistance efforts. Data were collected on a diverse range of subject areas including work force demographics; source reduction; potential health hazards; worker protection and safety; solid and hazardous waste management; and air pollution control. Nearly one-half of the shops employ three or fewer people, and in many cases, spray painters double as body repair technicians thereby increasing their potential exposure to workplace contaminants. While nearly all of the shops reported that they use spray painting booths, only 38% own booths the more effective downdraft design. Based on the self-reported data, recently promulgated state air pollution control regulations (requiring the use of compliant coatings, enclosed or modified spray gun cleaners, and high-volume, low-pressure, spray guns) appear to be effective at motivating companies toward source reduction. A range of risk reduction opportunities were identified as input material changes, technology changes, and improved operating practices. Better methods of risk communication; a professional licensing requirement; and targeted training, compliance, and technical assistance would help to achieve greater levels of risk reduction in this mature, high-hazard industry.

Ischemic heart disease and acute myocardial infarction mortality among police officers

The relationship between the occupation of police officer and ischemic heart disease (IHD) mortality was examined through case-control studies using 1968/78 death certificate records from Rhode Island and Utah. IHD was divided into two subcategories--acute myocardial infarction (AMI) and other IHD. In both states, the odds ratio (OR) for AMI was significantly elevated (Rhode Island, OR = 1.3; Utah, OR = 1.8), and was higher than the OR for other IHD (Rhode Island, OR = 1.1; Utah, OR = 1.4). The odds ratio for AMI was higher in the less than 65 yr age group (Rhode Island, OR = 2.1; Utah, OR = 2.1) than in the greater than or equal to 65 yr age group (Rhode Island, OR = 0.9; Utah, OR = 1.6). These results suggest that the elevated risk for IHD among police officers observed in this and other studies is primarily due to an elevated risk for AMI. The pattern of diminishing risk with age suggests a risk factor, possibly stress, the effect of which diminishes when exposure ceases at retirement.

Cause-specific mortality among male textile workers in Rhode Island

Cause-specific mortality patterns among male textile workers in Rhode Island who died during the period 1968-1978 were examined using the proportionate mortality ratio (PMR) method. Textile worker decedents were identified by the usual occupation and industry statements on Rhode Island death certificates. A statistically significant PMR elevation was observed for nonmalignant respiratory disease (NMRD) among male textile workers (PMR = 110; Observed deaths [Obs] = 433; 95% confidence interval (CI) = 102-120). The PMRs for NMRD by specific textile occupation and by type of textile manufacturing generally exhibited the pattern expected for work-related mortality owing to textile dust exposure. High PMRs were observed among carding, lapping, and combing operatives, the decedents who probably had the highest dust exposure (PMR = 166; Obs = 24; CI = 114-243), and among operatives most likely to have worked in cotton manufacturing (PMR = 137; Obs = 47; CI = 104-179). This is the first report of excess mortality from NMRD among male textile workers in the United States. This finding is consistent with previous evidence that exposure to cotton dust can cause disabling chronic lung disease. Also noteworthy were statistically significant elevated PMRs for cancers of the rectum and esophagus among decedents who had been engaged in textile dyeing and finishing. Owing to the lack of direct information about occupational exposures and smoking habits of the decedents and uncertainties in classifying decedents by type of textile manufacturing, this investigation should be viewed as being exploratory in nature.

Cause-specific mortality among Rhode Island jewelry workers

Cause-specific mortality patterns among Rhode Island jewelry manufacturing workers, as identified on death certificates from 1968 to 1978, were examined using the proportionate mortality ratio (PMR) method. Among males, elevated PMRs were observed for nonmalignant kidney disease (PMR = 163; Observed deaths [Obs] = 19; p less than or equal to .05), liver cancer (PMR = 297; Obs = 6; p less than or equal to .05), drug dependence (PMR = 379; Obs = 5; p less than or equal to .05), and accidental poisonings (PMR = 274; Obs = 8; p less than or equal to .05). All but one of the deaths from accidental poisonings involved drugs or drugs and alcohol. Among females, elevated PMRs were observed for stomach cancer (PMR = 174; Obs = 20; p less than or equal to .01), peptic ulcer (PMR = 235; Obs = 8; p less than or equal to .05), diseases of the skin and subcutaneous tissue (PMR = 383; Obs = 5; p less than or equal to .05), and drug dependence (PMR = 674; Obs = 3; p less than or equal to .05). Exposure to known renal toxins (heavy metals and solvents) used in the jewelry industry may account for the excess deaths from kidney disease. The elevated PMR for liver cancer may be due to exposure to solvents (trichloroethylene, perchloroethylene, carbon tetrachloride) that cause liver cancer in animals. The elevated PMRs for drug dependence and accidental poisonings may be due to the socioeconomic status of jewelry workers, or to the interaction between solvents used in jewelry manufacturing and drugs, or drugs and alcohol. Because of the lack of information about the specific occupational exposures of the decedents, this should be viewed as an exploratory investigation requiring further follow-up.

Agreement of occupation and industry data on Rhode Island death certificates with two alternative sources of information

There is increasing interest in documenting the putative health effects of occupational hazards, prompting Federal and State efforts that rely primarily on occupational information obtained from the death certificate. Previous studies have assessed the agreement of occupational data on death certificates with actual lifetime employment by using current employment data from census records for comparisons. Such analyses have largely been confined to males. We compared lifetime occupational information obtained from a panel survey for both sexes with death certificate data for 446 deceased panel members. After adjusting for inadequate information, the occupation recorded on the death certificates of the men agreed with the occupation recorded in the survey 66 percent of the time. The comparable percentage for the industry where the deceased had been employed was 78 percent. Among the women's records, agreement on occupation was 65 percent, and on industry, 69 percent. Using another sample of death certificates, comparisons of the information for 322 decedents with city directory data produced similar results. The higher level of agreement for women was due in part to the large number who were reported as "housewives." In a separate analysis, the agreement rate for nonhousewives declined. Suggestions for improvements in the recording of occupational data and the constraints imposed by the use of death certificate data in occupational epidemiology are presented.