Environmental Health Risks
for Disease and Injury
in Mahoning County Homes
1996

Matthew A. Stefanak
Mahoning County Health Commissioner
Jane Warga, M.Ed.
Tracy Benzies-Styka, M.S.
Lori Nestor
Health Education and Assessment Unit


Mahoning County General Health District
Board of Health
2801 Market Street
Youngstown, Ohio 44507

Acknowledgements

Financial support for this study was provided by the Mahoning County Board of Health, the Ohio Board of Regents' Urban University Program, and Youngstown State University. Survey data were collected and compiled under the supervision of Carol Trube, RN, MBA, Data Manager, Center for Urban Studies, Gil Peterson, Ph.D., Director.


Introduction

What makes a community healthy? A national survey funded by the Kellogg Foundation in 1994 posed this question to a representative sample of 1,000 Americans. The interviewers discovered to their surprise that only three of the top 12 determinants of a healthy community cited by survey respondents were matters considered to be within the domain of public health or medicine. The most frequently cited "health" determinant, in fact, was environmental quality.

Health planners have tended to overlook environmental quality in their assessments of community health. Considering that most of the increase in the average American's life span in the last century has been due, not to better medical care for the sick, but rather to improvements in waste water disposal, a safer food supply, better housing, and provision of potable drinking water supplies, the scant attention paid the role of the environment in healthy communities is surprising. Fortunately, health planners' focus is beginning to extend beyond traditional measures of personal health to include environmental health and safety. Healthy People 2000, the U.S. Public Health Service plan to improve the health of Americans, first published in 1988, contains a number of objectives for improvement and protection of environmental health and safety in our communities.

The Mahoning County Board of Health offers this assessment of environmental health and safety risks in Mahoning County homes and progress toward Healthy People 2000 objectives as part of an ongoing effort to support the community health assessment and planning efforts of the Healthy Valley 2000 Commission for Community Health and others.


Methods

In June, 1996, the Mahoning County Board of Health commissioned the Center for Urban Studies at Youngstown State University to conduct an environmental health risk factor survey of Mahoning County households. A total of 456 adults were surveyed at a 95% confidence level with a ±2% margin of error.

Limitations

Although the telephone survey was stratified to obtain a representative number of responses from each of Mahoning County's townships, villages, and cities, survey data have not been weighted by age, race, gender, income or education to correct any imbalances in survey response rates for any of these characteristics. All of these demographic characteristics are known to influence many health risk factors. Therefore, prevalence estimates for such personal behavioral risk factors as cigarette smoking may not be representative of the Mahoning County adult population.

In addition, the information gathered in this survey was self-reported. The accuracy of this information depends on the truthfulness of respondents. Certain less socially acceptable behaviors such as smoking or seat belt non-use may be purposely under-reported, whereas more acceptable behaviors such as pet vaccination or recycling may be over-reported by respondents.


Results
Survey results along with related Healthy People 2000 objectives and comparative national, state and local data from other sources, when available, appear below. Demographic information about the survey respondents may be found in the Appendix.



Environmental Tobacco Smoke

Environmental tobacco smoke, or second-hand smoke, causes lung cancer and other respiratory diseases in healthy nonsmokers, and is especially harmful to children. The children of parents who smoke are more likely to develop respiratory and ear infections than children of parents who do not smoke. Increasing rates in hospitalization of children with asthma in recent years also may be be linked to environmental tobacco smoke exposure.

Although involuntary second-hand smoke exposure occurs in many public places, the major source of smoke exposure for young children is in their homes.


Healthy People 2000 Objectives:

3.4	Reduce cigarette smoking to a prevalence of no more than 15 percent among people aged 18 and older.
3.8	Reduce to no more than 20 percent the proportion of children aged 6 and younger who are regularly exposed to tobacco smoke at home.

Related Healthy People 2000 Objectives:

3.2 (16.2)

Slow the rise in lung cancer deaths to achieve a rate of no more than 42 per 100,000 people.

Lung Cancer Death Rates (per 100,000) in Mahoning County
	Group All persons Females Black males	1990-92 55.7 31.6 133.0	2000 Target 42 25.6 86.1

11.1	Reduce asthma morbidity, as measured by a reduction in asthma hospitalizations to no more than 160 per 100,000 people.

Asthma Hospitalizations (per 100,000) in Mahoning County
	Group All Persons Children (age 14 and younger)	1994 191 356	2000 Target 160 225

Firearms Safety
 

The impulsive nature of many homicides and suicides suggests that a substantial portion of those events might be prevented if immediate access to lethal weapons was reduced, in particular through safe storage of guns and ammunition. The U.S. Public Health Service notes that more than half of the 20,000 homicide victims in the United States each year are killed by persons they know. In many instances, these homicides are committed impulsively and the perpetrators are immediately remorseful. Similarly, a substantial proportion of the Nation's 30,000 suicides each year are committed impulsively.

The controversy over gun control has obscured the fact that a range of environmental and behavioral strategies may be effective in reducing the immediate access of susceptible persons to loaded firearms. These strategies need not impinge on Second Amendment protections. For example, immediate access to loaded firearms would be reduced if weapons and ammunition were stored in separate locations, or if parents locked up their weapons and ammunition so that their children could not use them unsupervised.

Healthy People 2000 Objective:

7.11	Reduce by 20 percent the proportion of people who possess weapons that are inappropriately stored and therefore dangerously available.

Related Healthy People 2000 Objectives:

7.3	Reduce firearm-related deaths to no more than 11.6 per 100,000 people from major causes.

Firearm-Related Death Rates (per 100,000)
Group All Persons Blacks	1990 (U.S.) 14.6 33.4	1994 (Mahoning Co.) 27.6 120.9	2000 Target 11.6 30.0

7.19	Enact in 50 States and the District of Columbia laws requiring that firearms be properly stored to minimize access and the likelihood of discharge by minors.
9.15	Enact in 50 States laws requiring that new handguns be designed to minimize the likelihood of discharge by children.

Poisoning Prevention and Control

While poisoning deaths have continued their decline, the number of poisonings, especially among young children and older adults, remains high. Over 107,000 children under age five were treated in U.S. hospital emergency rooms for poisoning in 1987. Approximately 700,000 poison exposures involving children were reported to poison control centers that same year.

Poisoning risk and the severity of poison injury at home can be reduced by having immediate access to the poison control telephone number (1-800-872-5111) and syrup of ipecac to induce vomiting of swallowed poisons. Proper storage of household cleaners and medicines in homes with children is an important poison prevention measure.

Healthy People 2000 Objective:

9.8	Reduce nonfatal poisoning to no more than 88 emergency department treatments per 100,000 people.

Related Healthy People 2000 Objectives:

9.1	Reduce deaths caused by unintentional injuries to no more than 29.3 per 100,000 people.

Unintentional Injury Death Rates (per 100,000)
1994 Mahoning Co. 25.7	1987 U.S. 34.7	2000 Objective 29.3

9.2	Reduce nonfatal unintentional injuries so that hospitalizations for this condition are no more than 754 per 100,000 people.

Motor Vehicle and Bicycle Safety

Motor vehicle injuries, after firearms injuries, are the leading cause of injury death in Mahoning County. Motor vehicles were the injury mechanism for 36 deaths in Mahoning County in 1994. Seat belt and child safety seat use significantly reduce the risk of injury and death for motor vehicle occupants.

Head injury is the leading cause of death in motorcycle and bicycle crashes. Unhelmeted motorcycle riders are two times more likely to suffer a fatal head injury that helmeted riders. The risk of head injury for unhelmeted bicycle riders is more than 6 1/2 times greater than for helmeted bicyclists. Ohio has no bicycle helmet law, nor is helmet use for adult motorcycle riders required.

Healthy People 2000 Objectives:

9.12	Increase use of safety belts and child safety seats to at least 85 percent of motor vehicle occupants.
9.13	Increase use of helmets to at least 80 percent of motorcyclists and at least 50 percent of bicyclists.

Motorcycle Helmet Use in Ohio*
1994 28%	1995 26%

* by persons involved in crashes Source: Ohio Department of Public Safety

Related Healthy People 2000 Objectives:

9.4	Reduce deaths from falls and fall-related injuries to no more than 2.3 per 100,000 people.

Fall-Related Injury Death Rates (per 100,000)
1994 Mahoning Co. 2.3	2000 Objective 2.3

9.9	Reduce nonfatal head injuries so that hospitalizations for this condition are no more than 106 per 100,000 people.
9.10	Extend to 50 States laws requiring safety belt and motorcycle helmet use for all ages.
9.21	Increase to at least 50 percent the proportion of primary care providers who routinely provide age-appropriate counseling on safety precautions to prevent unintentional injury.

Fire and Burn Injury Prevention

The risk of dying in homes without smoke detectors is about twice that of dying in homes with detectors. Most smoke detectors are powered by batteries that must be replaced periodically.

Scalding water injury risk, especially for children, can be reduced by setting hot water heaters at 120^o Fahrenheit or lower.

Healthy People 2000 Objective:

9.17	Increase the presence of functional smoke detectors to at least one on each habitable floor of all inhabited residential dwellings.

Related Healthy People 2000 Objectives:

9.6	Reduce residential fire deaths to no more than 1.2 per 100,000 people.

Residential Fire Death Rates (per 100,000)
1994 Mahoning Co. 0.75	2000 Objective 1.2

9.16	Extend to 2,000 local jurisdictions the number whose codes address the installation of fire suppression sprinkler systems in those residences at highest risk of fire.

Radon

The U.S. Environmental Protection Agency estimates that radon exposure causes about 20,000 cases of lung cancer each year in the United States. Although Mahoning County does not have the geological formations which give rise to high levels of radon production, radon levels in a particular home cannot be predicted with any accuracy from test results in a neighboring home. Consequently, all homes should be tested for radon.

Lung cancer risk of radon exposure is amplified in cigarette smokers. Children may also be at special risk: those with radon exposure before the age of 20 appear to have a greater risk of developing lung cancer than those exposed later in life.

Healthy People 2000 Objectives:

11.6	Increase to at least 40 percent the proportion of homes in which homeowners/occupants have tested for radon concentrations and that have either been found to pose minimal risk or have been modified to reduce risk to health.
11.6a	Increase to at least 50 percent the proportion of homes with smokers.
11.6b	former smokers or children in which homeowners/occupants have tested for radon concentrations and that have either been found to pose minimal risk or have been modified to reduce risk to health.

Related Healthy People 2000 Objectives:

11.12	Expand to at least 35 the number of States in which at least 75 percent of local jurisdictions have adopted construction standards and techniques that minimize elevated indoor radon levels in those building areas locally determined to have elevated radon levels.
11.13	Increase to at least 30 the number of States requiring that prospective buyers be informed of the presence of lead-based paint and radon concentrations in all buildings offered for sale.

Drinking Water and Sewage Disposal

Many families in Mahoning County rely on private wells for drinking water: 13,755 according to the 1990 census. Improper well construction and contamination from home sewage and surface water can render well water unsafe. The Mahoning County Board of Health recommends that homeowners test their well water at least once each year.

At least 14,362 Mahoning County homes utilize septic systems for waste water disposal. The Ohio Environmental Protection Agency and the Board of Health estimate that 27% of home septic systems are failing to adequately treat waste water. Up to 1.2 million gallons of untreated or undertreated sewage is discharged into yards, streams, road ditches, and ground water each day from home septic systems in Mahoning County. The Ohio State University Extension and the Board of Health recommend that septic system owners have their systems pumped and serviced regularly. Septic systems with aeration motors should be serviced semi-annually.

Related Healthy People 2000 Objectives:

11.3	Reduce outbreaks of waterborne disease from infectious agents and chemical poisoning to no more than 11 per year.
11.9	Increase to at least 85 percent the proportion of people who receive a supply of drinking water that meets the safe drinking water standards established by the Environmental Protection Agency.

Unsafe Private Drinking Water Wells Mahoning County, 1995*
All Wells	Wells Serving Homes with Malfunctioning Septic Systems
31%	39%

*tested for mortgage lenders

Lead Hazards

Lead poisoning is the most prevalent environmentally-related disease in children. The most common source of lead in children's environment is lead paint and dust in children's homes. Lead paint can be found in any home built before 1978, but those built before 1950 present the greatest risk of exposure for young children.

Healthy People 2000 Objective:

11.11

Perform testing for lead-based paint in at least 50 percent of homes built before 1950.

Related Healthy People 2000 Objectives:

11.4	Reduce the prevalence of blood lead levels exceeding 15 ug/dL and 25 ug/dL among children aged 6 months - 5 years to no more than 300,000 and zero, respectively.

Children with Blood Lead Elevations in Mahoning County, 1995
Level	Number
> 15 ug/dL > 20 ug/dL	587 296

11.13

Increase to at least 30 the number of States requiring that prospective buyers be informed of the presence of lead-based paint and radon concentrations in all buildings offered for sale.

Household, Medical and Hazardous Waste Disposal

Although household hazardous waste accounts for less than 5 percent of the waste sent to landfills and incinerators in the United States, the hazardous chemicals present in small amounts in this waste can contribute to drinking water contamination, either by leaching out of landfills, or if incinerated, as toxic gas or ash.

Ongoing or annual recycling programs for motor oil, pesticides, and paint are available in Mahoning County to divert these household hazardous wastes from landfills. In addition, used needles, syringes, and other medical wastes produced at home may be diverted from landfills into drop-off programs at Board of Health clinics throughout Mahoning County. Home medical waste is generated in 11 percent of Mahoning County households according to 1996 survey results.

Related Healthy People 2000 Objective:

11.15

Establish curbside recycling programs that serve at least 50 percent of the U.S. population and continue to increase household hazardous waste collection programs.

Percentage of Population Served by Curbside Recycling Programs
1996 Mahoning Co.	2000 Target
75%	50%

Source: Mahoning County Solid Waste Management District

Food Safety

Although the majority of food-borne illness outbreaks reported to health departments are linked to commercial food service operations such as restaurants and institutional food preparers, consumers may reduce their risk of food-borne illness by using safe food-handling practices at home.

Healthy People 2000 Objectives:

12.1	Reduce infections caused by key food-borne pathogens to incidences of no more than:

Food-borne Diseases, 1995
	Disease Cases(per 100,000) Salmonella species Campylobacter jejune Escherichia coli 0157:H7 Listeria monocytogenesn	Mahoning Co. 5.7 9.4 0.4 n/a	Ohio 14.2 12.6 1.0 n/a	2000 Target 16 25 4 .05

12.3	Increase to at least 75 percent the proportion of households in which principal food preparers routinely refrain from leaving perishable food out of the refrigerator for over 2 hours and wash cutting boards and utensils with soap after contact with raw meat and poultry.

Rabies Prevention

The growing incidence of rabies in wildlife, particularly in raccoons, in the United States increases the potential for human exposure to rabid animals, through handling of either wildlife or domestic animals not protected through rabies vaccination.

Effective and inexpensive rabies vaccinations for pet dogs, cats, and ferrets are widely available at veterinary offices and pet vaccination clinics. Dog, cat, and ferret vaccination is mandatory in most Mahoning County communities.

Related Healthy People 2000 Objective:

20.12

Reduce post-exposure rabies treatments to no more than 9,000 per year.

Post-exposure Rabies Treatments in Mahoning County
1994	1995
7	5

Conclusion

This report documents some of our communities' successes in lowering environmental health risk factors, and disease, injury and death rates in Mahoning County. Several positive indicators stand out when compared to the U.S. and Ohio:

• fewer adults smoke in Mahoning County
• more adults refrain from smoking around children at home
• knowledge of poison control resources is higher in Mahoning County
• most homes in Mahoning County are equipped with smoke detectors
• more domestic animals in Mahoning County are vaccinated against rabies

Other environmental health and safety indicators are more of a cause for concern:

• maintenance of private drinking water and sewage disposal systems is inadequate
• child safety seat and bicycle helmet use rates are low
• most homes have not been tested for lead and radon hazards
• although more firearms are safely stored at home, firearm death rates are extraordinarily high

Is our community healthy? We hope that the information contained in this study helps those working to fashion a definition of health that includes environmental quality as an essential priority for a healthy community.


Appendix:

Demographic Information about Survey Respondents

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