Bushfires are an integral part of the Australian environment, and consequently Australian fire fighters are regularly confronted with the challenge of bushfire fighting activities. Bushfires can be extensive and long-lasting, and as a result fire fighters can be exposed to bushfire smoke for long periods without respite. Anecdotal evidence suggests that bushfire smoke exposure can lead to respiratory symptoms such as coughing, wheezing, and shortness of breath. In an optimal environment, fire fighters are equipped with respirators and protective filters to prevent the inhalation of the air toxics in bushfire smoke. Yet, reports from the fire ground indicate that the protective filters are not effective in preventing the inhalation of bushfire smoke. As a result, fire fighters have increasingly expressed concern about the ineffective equipment and the resultant respiratory symptoms during and after bushfire fighting. This research aims to establish a scientific data base to support the anecdotal evidence. The objectives of the research were: (1) to identify and quantify the air toxics in Western Australian bushfire smoke; (2) to profile the acute respiratory health effects associated with bushfire smoke exposure; (3) to assess the effectiveness of three different types of filters under controlled conditions in a smoke chamber, and in the field during fuel reduction burn-off; (4) to formulate recommendations for reducing fire fighters' exposure to bushfire smoke; and (5) to inform policy decision makers about the most effective form of respiratory protective equipment for bushfire fighting. Exposure trials were conducted in an experimental setting utilising bushfire smoke conditions in a smoke chamber and during prescribed burn-offs. Repeated measurements of respiratory symptoms, pulmonary function and oximetry were undertaken before and after bushfire smoke exposure. In addition, personal air sampling inside the respirators was undertaken to quantify and compare the levels of filtered air toxics. The analysis of the collected data demonstrated that, of those compared, the particulate/organic vapour formaldehyde filter was most effective in protecting fire fighters' respiratory health during the smoke exposure period of maximally 120 minutes. Further research would be useful to determine the v effectiveness of the filters under more realistic conditions during bushfire fighting activities. The findings of this research have resulted in a policy review in Western Australia. In 2006, the Fire and Emergency Services Authority of Western Australia (FESA) reviewed its Bush Fire Smoke Exposure Standard Operational Procedures 51, and now issues the recommended particulate/organic vapour/formaldehyde filters to the 1,000 FESA career fire fighters. The use of protective equipment for bushfire fighters is inadequately regulated worldwide and the recommendation implemented by FESA can be seen as proactive and in advance of national and international best practice. In conclusion, this project was instrumental in the translation of public health research into best practice that protects occupational health, without the need for the lengthy process of legislative reform. Fire fighter organisations in other countries with high frequencies of bushfires could learn from this example, and move to review their policies and introduce adequate personal protection for fire fighters.

Phthalate esters (PEs) belong to a class of organic compounds used as plasticisers in plastic materials such as polyvinyl chloride (PVC), polypropylene (PP), polyethylene terephthalate (PET) and so on, including those used in the food packaging industry. Phthalate plasticisers are not chemically bound to plastic materials and hence, migrate into items such as foodstuffs they house. The study aimed at investigating the prevalence of selected phthalate esters from plastic wrappers into food as well as the presence of food and/or pathogenic microorganisms. Plastic-wrapped cheese, vienna sausages and polony samples purchased from commercial stores in the four regions of Pretoria (Tswane), South Africa, were analysed for the presence of plasticisers; di-2-ethylhexyl adipate (DEHA), di-n-butyl phthalate (DnBP), benzyl-butyl phthalate (BBP), di-butyl phthalate (DBP) and dimethyl phthalate (DMP). Soxhlet extraction using hexane with florisil column cleanup was carried out. Analysis of PEs was by Gas Chromatography-Flame Ionization Detection (GC-FID). Microbiological investigations were performed using standard methods. The concentrations of PEs detected in food samples ranged from below detection limit (bdl) to 4.7003 μg/kg. However, DBP, DMP and BBP were predominantly present with more PEs detected in cheese compared to polony and vienna. In polony samples, DBP levels ranged from 0.0412 to 0.611μg/kg, in cheese, ranged from 0.049 to 0.256 μg/kg and in vienna DBP ranged from 0.074 to 0.209 μg/kg. The phthalate DMP ranged from 0.072 to 4.700 μg/kg in cheese, 0.056 to 0.241 μg/kg in polony and 0.092 to 0.816 μg/kg in vienna. The DEHA detected in cheese and polony was 0.120 μg/kg and 0.075 μg/kg respectively and no DEHA was detected in vienna sausages. For microbiological analysis, the total microbial activity (TMA) ranged from 6.8 x 104 to 1.03 x 108 cfu/g; coliforms ranged from no growth to 2.62 x 106 cfu/g; yeast ranged from no growth to 1.49 x 107 cfu/g; and mould ranged from no growth to 9.2 x 104 cfu/g. The results revealed that microbial activity was high in each sample type but revealed the absence of pathogens. Results revealed incidences of PEs in foods wrapped or packaged in plastics, which gave cause for concern and showed the need for proper monitoring and inspection of the levels of organo-microbial entities in the South African food wrapped in plastic wrappers. / Environmental Sciences / M.Sc. (Environmental Science)

Submitted in fulfilment of the requirements for the Degree of Masters in Technology: Environmental Health, Durban University of Technology, 2017. / Shift work is a necessity for many organizations. Reasons for shift work are mainly to ensure continuous and optimized operations. Many studies on shift workers have concluded that it can lead to adverse physiological, social and psychological health effects. This study examines challenges associated with working shifts at a biscuits manufacturing factory. Results should be able to assist the employer in implementing effective interventions directed at limiting the negative effects of shift work on employees. This is a convergent parallel design multi method stud among 152 shift workers in a biscuits manufacturer located in Durban, KwaZulu Natal. An abbreviated and modified form of the validated SSI questionnaire was used (Barton et al. 1995). The questionnaire contained a battery of items designed to examine the relationship of health and personal adjustment to shift work. Owing to the exploratory nature of the study, a focus group methodology was also used and this allowed for in-depth qualitative research which catered for a more comprehensive understanding of the current shift work issues. A retrospective review of injury records of employees who sustained occupational injuries between 2012 and 2013 was also conducted. The sample comprised of 85 (56%) males and 63 (42%) females. Logistic regression was used to estimate the association between shift work and the likelihood of sleep disturbance, poor health outcomes and limited time for social and domestic activities, adjusting for age, sex, partner working, years working night shift, marital status, job class and years employed. Odds ratio (OR) for reported sleep disturbance was slightly higher among women (OR=1.65; 95% CI = 0.25; 10.84; p < 0.05) compared to males, but this was not statistically significant. Longer shift work experience (i.e.11-20 years) was significantly associated with better health status (OR=0.18; 95%CI = 0.06; 0.46; p < 0.05). Shift work experience (11 to 20 years) was also found to be significantly associated with limited time for both social (OR = 0.10; 95%CI = 0.03; 0.30) and domestic activities (OR= 0.25; 95% CI = 0.11; 0.57; p < 0.05) (Table 4). Age had no effect on social and domestic activities, but those 40 years and above were more likely to have limited time for social and domestic activities (OR = 3.06; 95%CI =0.60; 15.60 and OR= 2.5; 95%CI=0.47; 13.06). Those with more shift work experience seemed to have more time for social and domestic activities compared to those with less than 10 years experience. Findings from the FGD’s revealed that most participants (91%) did not get sufficient sleep time after night shift; this was mainly because of the chores they had to do after getting home form night shift and disturbances from the household and neighbours. The average time spent sleeping by majority of participants after night shift was 5 hours. Swollen feet, gastric, sleep disorders, indigestion and headaches were some common complaints experienced by shift workers in this study. About 27% of participants reported to have been injured at work before. These incidents were reported to be related to drowsiness and fatigue. The company’s incident records showed a total of 160 injuires between 2012 and 2013, of which 38 occurred during night shift. In 2012, the company recorded 65 injuries which included 51 first aid (FA) injuries, 6 minor injuries (MI) and 8 lost time (LT) injuries, as categorized by the company. 2013 had the highest number of incidents, with 95 total injuries, averaging to 7.9 injuries annually. There were 84 first aid incidents recorded for year 2013, 9 minor injuries and only 2 lost time injuries. Twenty three percent (15, n=65) incidents occurred during night shift in year 2012, of which 11% (7, n=65) were females. The number of night shift incidents slightly increased to 24% (23, n=95) in 2013 and females accounted for 9.40%. The records showed that majority of injuries happened between 17h00 and 21h00 at night. Results of this study provides evidence that shift work impacts negatively on the lives of the employees and can lead to adverse health outcomes such as poor dietary intake, headaches and swollen feet to mention but a few. / M

Having a chronic illness may feel alienating, yet examination of the literature shows limited research on social connectedness and health. In order to contribute to the understanding of this impact of illness, I examined perceived levels of social connectedness in persons with chronic diseases (CD), functional somatic syndromes (FSS) and medically unexplained symptoms (MUS). A major focus of this study was to investigate the association of social connectedness with depression, anxiety, and general health in patients with ongoing symptoms of illness. Data collection was obtained through the use of four online surveys collectively known as VOICE (Verification of Coping, Illness and Experience). For the purposes of this study, five measures were used: the Social Connectedness Scale, Short Form Health Survey (SF-36), Patient Health Questionnaire depression scale (PHQ-8), Hopkins Symptoms Checklist (HSCL) and the Social Impact Scale. Participants were recruited through announcements via online message boards and support groups, as well as through the distribution of brochures in local medical practices. A total of 148 participants (80% female) completed all four surveys. Results indicated that the chronic illness groups did not significantly differ in social connectedness, although there was some indication that the FSS group felt more social isolation. Regression analyses indicated that, while accounting for socio-cultural and health factors, social connectedness was the strongest predictor of depression (β = - .43, p < .001), anxiety (β = -.48, p < .001) and general health (β = .34, p < .001) in chronically ill persons. The independent and robust relationship of social connectedness with psychological and physical health in individuals with chronic illness suggests that this is an important factor deserving of future research with important clinical applications.

Moyamoya disease is a rare entity characterized by progressive narrowing of intracranial blood vessels. In most cases, Moyamoya does not respond well to medical therapy and often leads to surgical revascularization. The physiological benefits of the revascularization surgery for Moyamoya patients have been well documented, yet the effects of surgery on cognitive skills and abilities are far less studied. Participants in the current study were 33 patients, 24 to 85 years of age, who underwent revascularization surgery at the Mayo Clinic in Jacksonville, Florida. All patients underwent a physical and cognitive preoperative evaluation, where speech, memory, and intellectual processes were measured. After surgery, patients returned for three follow-up assessments over a period of six months. All patients experienced stabilization or improvement of physiological symptoms. Regarding cognitive functions, speech, memory, and intellectual processes improved significantly after surgery. Results showed not only a reduction of physiological symptoms, but also a significant cognitive improvement postsurgery. This study adds to the research of this disease and to the benefits of treatment. More research can only strengthen these findings and educate healthcare professionals; helping them reaffirm Moyamoya patients have a better quality of life, by reinforcing the benefits of revascularization surgery.

Childhood obesity is a major health problem facing children in the United States. How parents view their children's weight is an important consideration for health care professionals. The purpose of this study was to explore parental perceptions of their children's weight and health.

For many health conditions, African Americans bear a disproportionate burden of disease, injury, death, and disability compared to European Americans. African Americans also use health services less frequently than do European Americans and this underuse of services contributes to health disparities in the United States. Studies have shown that some disparities are present not as a result of poor access to care, but, to a certain extent, as a result of the experiences patients have at their doctors' offices. It is, therefore, essential to understand African American patients' perspectives and experiences with healthcare providers. Past studies have shown that four barriers affect the quality of patient-provider relationships for African Americans: perceived discrimination, medical mistrust, race discordance, and poor communication. The studies, however, have not looked at how these barriers manifest when African Americans speak about their perspectives and experiences with health care providers. This project was a secondary data analysis of qualitative data provided by adult African American community members from Portland, Oregon with diabetes or hypertension or both, each of whom participated in one of 10 focus groups. The focus groups were conducted as part of a study that applied community based participatory research (CBPR) principles to understand patients' experiences with their doctors. Using a deductive approach, this analysis enhanced the understanding of how the barriers play a role in patient-provider relationships. Further, the analysis showed how the barriers are interrelated. In learning African American patients' experiences and perspectives on these four key barriers, the investigator proposes recommendations for healthcare providers as to how they can best deliver quality care for African Americans.

Indiana University-Purdue University Indianapolis (IUPUI) / Smoke-free legislation in the United States has unintentionally resulted in a decline in alcohol consumption. However, more recently electronic-cigarettes (e-cigs), which are associated with alcohol use, are reportedly being used to circumvent smoking bans. The present study surveyed community dwelling individuals in the United States reporting e-cigs may be used where they drink (N=365, mean age=33.63, SD=9.91, 53.2% female, 78.9% Caucasian) to examine how e-cig use and alcohol consumption varies by the presence of smoking prohibition where one consumes alcohol. Results indicated that smoking prohibition was associated with a greater likelihood of being an ecig user than a cigarette user (OR=3.40, p<.001) and a higher likelihood of being an e-cig user than a dual user (OR=3.37, p<.001). Smoking prohibition was not associated with AUDIT scores (B=-0.06, p=.21), total drinks (B=-.07, p=.19), or average drinks (B=-0.02, p=.76). E-cig users reported significantly fewer average drinks when smoking is prohibited as compared to allowed, t(55)=3.26, p=.002. Overall, current results suggest smoking prohibition is associated with a greater likelihood of being an e-cig user; however, smoking prohibitions are not associated with alcohol consumption and related problems in the current participants, who all reported being able to use e-cigs where they consume alcohol. Future research should address potential conceptual, methodological, and sample limitations in order to better discern this relationship, as this line of research could have important implications for e-cig policy and alcohol use treatment

Parents make decisions on behalf of their children on a daily basis. Some parents in the United States face the unique decision of whether or not to allow football participation for their child at a very young age. Using sensemaking theory, I examined how parents assessed the risks involved in making the decision to allow their child to play tackle football. I interviewed 24 participants in the form of 12 parental couples who had children playing middle school football and coded their responses to identify themes and strategies for risk assessment. Themes that emerged were decision-agency (parent and child agency), risk assessment (downplaying risk, acknowledgement of risk with rationalizations, zero risk assessment), and decision-making concepts (cultural influence, familial identity, social influences, information sources). I expanded on the sensemaking supposition of individual identity by arguing that familial identity can also impact decision-making. A key finding to this study was the typology of parents that emerged including football families-parent agency, hesitant family- parent agency, and child focused family-child agency. The type of family reflected families' reception to community culture, impact of social influence, and openness to information sources. Family type also impacted the risk assessment process and belief of control over outcomes in football participation.

Traffic is a problem across the globe, reaching perniciously into cities and communities nearly everywhere. The United States (US) has its share of traffic problems; of the ten cities with the highest traffic delay times in 2022, four were in the US. While nearly everyone living in the US has likely experienced traffic congestion of some kind, some cities are notoriously worse than others. In New York City (NYC), traffic congestion has been a problem as far back as 1913, when Fifth Avenue was so traffic-clogged it could take 40 minutes to go 23 blocks. Today, of the 25 most congested traffic corridors in the US, three are in NYC. One of these runs through the South Bronx, an environmental justice neighborhood we highlight in this dissertation. Traffic congestion is a source of air pollution (traffic-related air pollution, or TRAP) and noise, and it can result in property damage, injuries, and fatalities from collisions with other vehicles, pedestrians, or those using other forms of transportation. Both traffic congestion and TRAP have been associated with numerous negative health outcomes. For example, TRAP is associated with respiratory, cardiovascular, neurological, and pregnancy outcomes, including asthma exacerbation, incident childhood and adult asthma, reduced lung function, atherosclerosis, hypertension, stroke, myocardial infarction, cardiovascular-related mortality, cognitive decline, neurodevelopmental outcomes, pregnancy loss, term low birth weight, and small for gestational age birth. In general across the US, communities of color and higher-poverty neighborhoods face greater exposure and health burden from traffic. Throughout this dissertation, we study traffic congestion and TRAP through two lenses: (1) environmental justice; and (2) policy. Additionally, we assess the cardiovascular health impacts of TRAP. In Chapter 1, we provide background on the problem of traffic, focusing on NYC and the South Bronx. In Chapter 2, we present a case study from the South Bronx, where a new trucking-intensive warehouse was opened in 2018. In this study, we quantified the increase in vehicles and trucks following the opening of the warehouse and estimated the resulting increases in black carbon (BC) and noise. We discuss the injustice in the methods used to assess the environmental impact of the warehouse, the warehouse’s siting in a predominantly Black and Lantinx community already overburdened with trucking-intensive industries, and the desire of the community to instead use the land for a community park. In Chapter 3, we present a study quantifying how traffic congestion in NYC changed during the COVID-19 pandemic. We assess how NY on Pause, the state’s stay-at-home order, impacted traffic congestion by comparing the magnitude of traffic decreases in environmentally burdened or systematically disadvantaged neighborhoods to the magnitude of decreases in less burdened and more advantaged neighborhoods. We discuss the implications of these results for upcoming traffic policies in NYC, such as congestion pricing. In Chapter 4, we present a study evaluating diurnal changes in TRAP in NYC during NY on Pause. We discuss the implications of these results for congestion pricing, including the potential timing of TRAP decreases. In Chapter 5, we present an epidemiologic study of TRAP and myocardial infarction (MI) in New York State, identifying hazard windows of exposure in a study period where the mean nitrogen dioxide (NO₂) concentration was substantially lower than the hourly national standard. We discuss implications for the NO₂ National Ambient Air Quality Standards (NAAQS) and suggest that the current standard may be insufficient to protect population cardiovascular health. Finally, in Chapter 6, we conclude with a discussion of recommended research directions and policy considerations.