| Environmental public health indicators (EPHIs) are summary measures that describe baseline environmental health information by characterizing spatial and temporal trends of environmental hazards, exposures and health effects over person, place, and time. Both internationally and within the United States, environmental health practitioners have recognized the importance of developing EPHIs as a first step to understanding the environmental etiology of disease, identifying key risk factors and drivers, and developing effective prevention strategies. Previous indicator initiatives have explored the theoretical foundations for indicator development, however, few studies have applied these concepts to develop and evaluate EPHIs in the United States. This study explores methods and tools for the development and evaluation of environmental public health indicators (EPHIs) related to children's health and water in the state of Maryland.; A multistep approach to studying methods and tools for EPHI development was employed. A case-synthesis review of previous indicator models from environmental and public health practice was used to construct a framework to guide the subsequent phases of selection, development, and evaluation of EPHIs. The framework is organized around three assessment phases: scientific basis and relevance, analytic soundness and feasibility, and interpretation and utility. Within each phase, key elements to evaluate in the selection and development of EPHIs include: environmental health importance, public health importance, public concern, technical capacity and feasibility, analytic soundness, potential for intervention and prevention, and utility for policymakers. Within each element a series of 51 criteria were identified.; In the next step, four case studies derived from existing environmental regulatory and public health surveillance data were examined: (1) The first case study EPHI described total trihalomethanes (TTHMs) in public water supplies throughout Maryland. Results indicate that current TTHM levels pose a potential threat, particularly for children born to women who may be drinking public water with elevated levels during critical windows of fetal growth. (2) The second case study EPHI described the risk of PCBs and mercury in fish tissue. A hazard index analysis was used to estimate potential population exposure and risk. (3) The third case study EPHI examined the prevalence of low birth weight (% LBW). Interpretation of spatial and temporal trends is limited by the fact that % LBW is a multifactorial health outcome with unknown environmental etiology. (4) A fourth case study EPHI examined the development of biomarkers of exposure that characterize current levels of PCBs and organochlorine pesticides in maternal serum. (Abstract shortened by UMI.)... |
