Topics A to Z

As part of NEHA's continuos effort to provide convenient access to information and resources, we have gathered together for you the links in this section. Our mission is "to advance the environmental health and protection professional for the purpose of providing a healthful environment for all,” as well as to educate and inform those outside the profession.


The Food and Drug Administration recommended restaurant inspection scores change to a format that incorporated three new categories of violations: priority, priority foundation, and core. It was uncertain whether interested consumers would value the more in-depth information or become more confused. The purpose of this study was to assess consumer perception of the recommended inspection system. Data were collected from an online survey. Results showed that consumers want convenient access to the information either online or on the wall of restaurants, and some consumers do want to read inspection reports and use them in making dining decisions. Choice of restaurant inspection format did appear to change consumer understanding and perceptions about some of the violations. Results also demonstrated the importance of the words used to categorize violations.

June 2017
June 2017
79.10 | 20-25
Jooho Kim, PhD, Jing Ma, PhD, Barbara Almanza, PhD, RD


The purpose of this study was to measure particulate matter (PM2.5) in pubs and bars prior to the adoption of a comprehensive, citywide smoke-free ordinance, as well as at multiple time points after adoption. Ten venues in a Southern U.S. city were measured at 1-month preordinance and at 1-, 3-, and 6-month postordinance. Air quality risk was determined by the U.S. Environmental Protection Agency’s Air Quality Index. Data revealed a statistically significant difference (p < .001; Eta2 = .889) in PM2.5 levels for the four time points. Air quality measurements showed that PM2.5 was 202.17 ± 97.89 (mean ± SD) at 1-month preordinance, 25.53 ± 14.18 at 1-month postordinance, 18.00 ± 8.43 at 3-month postordinance, and 10.77 ± 2.45 at 6-month postordinance. At the preordinance measurement, no venue was found to be in the “good” (minimal risk) range of the Air Quality Index; however, 100% of venues presented minimal air quality risk by the 3-month postordinance measurement. This study shows that adoption of smoke-free ordinances yields immediate reductions in health risks with continued air quality improvements up to 6-month postordinance (the last time point measured).


July 2018
July/August 2018
81.1 | 8-15
Ronald D. Williams, Jr., PhD, CHES, Department of Health and Human Performance, Texas State University, Jeff M. Housman, PhD, MCHES, Department of Health and Human Performance, Texas State University, Jennifer L. Evans, MEd, CHES, Department of Health Science, University of Alabama


Cooling towers have been linked to outbreak-related and nonoutbreak-related legionellosis. Proper cooling tower maintenance and disinfection are imperative for legionellosis prevention but not monitored in Allegheny County, Pennsylvania, which is a high incidence area. To investigate cooling tower maintenance and Legionella positivity, the Allegheny County Health Department (ACHD) performed a survey regarding the presence and maintenance of cooling towers and tested cooling towers for Legionella pneumophila (Lp). ACHD surveyed healthcare facilities, senior apartment buildings, and county-owned buildings.

Associations between maintenance practices and Lp were assessed using Wilcoxon rank-sum tests and multivariable linear regression. Of 408 building managers contacted, 377 (92%) completed the survey and 56 (15%) reported managing a building with a cooling tower. Among 42 cooling towers sampled, 20 (48%) tested positive for Lp. Factors associated with positivity included larger tower capacity, year-round usage, hospital status, and older tower age. Only cooling tower age was associated with Lp after stepwise regression.

Despite maintenance practices, many cooling towers were Lp positive. ACHD recommends that facilities develop a water management plan that is compliant with standards of the American Society of Heating, Refrigerating, and Air-Conditioning Engineers and also conduct annual basin water emptying, quarterly cleaning, and diligent inspection of older towers.


December 2018
December 2018
81.5 | 16-24
Lauren T. Orkis, MPH, CIC, Allegheny County Health Department, University of Pittsburgh, Kristen J. Mertz, MPH, MD and LuAnn L. Brink, MPH, PhD, Allegheny County Health Department, Maria M. Brooks, PhD, University of Pittsburgh, Robert M. Wadowsky, ScD, D(ABMM) and Stacy Gatto, Allegheny County Health Department
Additional Topics A to Z: Pathogens and Outbreaks
Jan|Feb 2014
76.6 | 48-54
Mubashir Ahmed, MBBS, MSc, Zafar Fatmi, MBBS, FCPS, Claudio J. Struchiner, Eduardo Massad, MD
Additional Topics A to Z: Hazardous Materials


We investigated a gastrointestinal illness cluster among persons who attended a baseball tournament (>200 teams) during July 2015. We interviewed representatives of 19 teams; illness was reported among only the 9 (47%) teams that stayed at Hotel A (p < .01). We identified 55 primary cases. A case-control study demonstrated that pool exposure at Hotel A was significantly associated with illness (odds ratio: 7.3; 95% confidence interval: 3.6, 15.2). Eight out of nine (89%) stool specimens tested were positive for Cryptosporidium, with C. hominis IfA12G1 subtype identified in two specimens. The environmental health assessment detected a low free available chlorine level, and pool water tested positive for E. coli and total coliforms. A possible diarrheal contamination event, substantial hotel pool use, and use of cyanuric acid might have contributed to this outbreak and magnitude. Aquatic facilities practicing proper operation and maintenance (e.g., following the Centers for Disease Control and Prevention’s Model Aquatic Health Code) can protect the public’s health.

May 2017
May 2017
79.9 | 16-22
Mary-Margaret A. Fill, MD, Centers for Disease Control and Prevention, Tennessee Department of Health, Jennifer Lloyd, MSPH, Shelby County Health Department, Tamal Chakraverty, MPH, MD, CPH, Shelby County Health Department, David Sweat, MPH, Shelby County Health Department
Additional Topics A to Z: Pathogens and Outbreaks

Chuck Lichon, R.S., M.P.H., Deputy Health Officer at District Health Department #2 in Michigan, developed a Children’s Environmental Health Power Point Program with the financial assistance of the Dow Chemical Company, Midland, MI.  The Power Points are approximately 25-35 minutes in length, allowing for a presentation to be made during one classroom setting, or to be used for a community presentation, allowing time for Q & A.  Some of the topics include: Sunwise, Body Art, Household Hazardous Waste, Meth, Recreational Water, and more.  They are free to download and use for presentations in your school, health department community presentations, or for media use.  Changes in the presentations should not be made without consent from the author, and/or the NEHA Board of Directors.  

The Crystal Meth PowerPoint is available via the link listed below:   

Chuck Lichon, R.S., M.P.H.
Additional Topics A to Z: Children's Environmental Health

Every day, thousands of shipments of toxic and radiological chemicals, traverse our highways and railways, as potential “agents of opportunity” for terrorists' use.  This informational session will describe:


  1. the public health threats due to Radiological and Chemical "Agents of Opportunity"
  2. the deficiencies in education and training of public health responders to these types of events, and
  3. the development and  relevance of a preparedness course called, "Radiological and Chemical Agents of Opportunity for Terrorism: The Emergency Medicine Response to Toxic Industrial Chemicals and Materials (TICs/TIMs) and Toxic Radiological Materials (TRMs)."
July 2015
Richard Collins, MS, REHS/RS, DAAS
Additional Topics A to Z: Hazards