This cross-sectional descriptive study assessed general environmental health literacy among students focusing on their knowledge, skills, attitudes and behaviors regarding the environmental health, stewardship, and sustainability, using a questionnaire consisting of 35 core questions from the Centers for Diseases Control (CDCs). Students ( N = 185) from three high schools in the district were asked through their class teachers to voluntarily complete the questionnaire. Results indicated that about 41% ( n = 77) of the students lacked knowledge regarding potential sources of radiation exposure and 70% ( n = 133) lacked knowledge regarding radon gas being the number one risk factor for lung cancer among non-smokers. Additionally, the ANOVA test indicated significant knowledge differences among school location. Students in school #1, located in the most affluent area, had significantly higher knowledge scores ( M = 4.39) than school #2 located in a moderately affluent area ( M = 3.50). Furthermore, we found significant differences in ethnicity on the environmental health attitude of the high school students. Black students reported lower positive environmental health attitude ( M = 29.86) than White students ( M = 32.63), Hispanic students ( M = 32.33) and Asian students ( M = 33.84). These findings demonstrated knowledge deficiency in some key areas in environmental health particularly the environmental diseases and conditions caused by manmade hazards such as pesticides, chemicals, radiation, air, water, and soil pollution. Targeted educational interventions to increase awareness and understanding of health effects, exposure to environmental hazards and carcinogens as well as risks associated to direct exposure as in this study, radon and radiation, should be provided to high school students. Practical education through tours where students can observe directly and participating in laboratory experiments could empower the students to translate this knowledge into positive environmental health behaviors and practices now and in the future.
Environmental health education and sustainability practices in schools are an important educational component in the 21st century (Hausbeck, Milbrath, and Enright, 1992) [
With the current condition of the world today, environmental education is to a large extent essential due to declining resources and diminishing environmental quality (Green, 2015) [
In lieu of the United States Healthy People 2020 objectives that emphasize designing environmental educational program to develop environmental literacy among students, this study assessed general environmental health literacy among students focusing on their knowledge, attitudes and behaviors regarding the environmental health, stewardship, and sustainability [
On the global stage, there has been renewed interest and focus on environmental issues, mostly with young people who are more engaged and leading the call to save the environment. Gronhoj and Thogersen (2012) argued that even though young people hold favorable environmental attitudes, they are less committed to pro-environmental behaviors which are largely influenced by their family context [
Interventions in any shape or form, must recognize, current knowledge levels as well as the contextual factors influencing the beliefs that translate into attitudes, irrespective of the facts. This study therefore assesses the environmental knowledge, attitude and behavior of high school schools.
1) What are the levels of awareness, knowledge, attitude, and behavior of high school students in environmental health issues?
2) Are there demographic differences in the levels of knowledge, attitude and behavior in environmental health issues among high school student participants?
This quantitative cross-sectional descriptive study was conducted to assess high school students’ knowledge, attitude and behavior regarding environmental health after obtaining an approval from the University’s Institutional Review Board.
Participants in this study consisted of 185 high school students in a south-eastern Texas school district with a population of 5040 high school students. The sample size of 185 was determined appropriate to yield significant results with a 95% confidence level and a 7% margin of error. All high schools in the school district were included in the study. A convenience sampling strategy (Sedgwick, 2013) with a captive audience approach was utilized to draw participants into the study [
The instrument utilized to collect data for this study consisted of demographic questions and core question aspects from the United States Centers for Disease Control (CDC) and has been utilized in previous studies (Ratnapradipa, Rhodes, & Brown, 2011 and Ratnapradipa, Brown, Middleton, et al., 2011) [
After the approval from Institutional Review Board was obtained a student researcher was asked to contact various teachers of the high schools in the Southeastern Texas school district and seek approval to come and deliver questionnaires. These high schools are located in a city with an estimated population of 118,129 (United States Census Bureau, 2015) [
According to Kurland and Gorr (2009), GIS offers a digital management of data sources to characterize research participants and the environment in which they live [
The data was processed and analyzed using SPSS (version 22). The data was cleaned and screened for out of range values and outliers. Descriptive analysis was used to describe the sample. Univariate and bivariate analysis were also used to determine if there is any relationship between the demographic variables and the levels of awareness of environmental health knowledge, attitude and behavior among the high school students.
A total of 185 students from three different high schools were involved in the study. Schools involved in the study were assigned numbers (i.e., school #1 up to #3).
Environmental knowledge was investigated with 7 questions on solid waste disposal, sewage treatment, green house, hand washing, asthma trigger, radiation exposure and risk factor for lung cancer (see
Schools | Gendera | Ethnicitya | Classificationa | Age (yrs)a | Work Statusa | |||||
---|---|---|---|---|---|---|---|---|---|---|
Total (%) | Total (%) | Total (%) | Total (%) | Total (%) | ||||||
School #1 | Male | 42 (43.8) | White | 39 (40.6) | Freshman | 0 (0.0) | 14 | 0 (0.0) | Not working | 55 (57.3) |
Female | 54 (56.3) | Black | 20 (20.8) | Sophomore | 1 (1.0) | 15 | 1 (1.0) | Part-time work | 40 (41.7) | |
Hispanic | 8 (8.3) | Junior | 82 (85.4) | 16 | 22 (22.9) | Full time work | 1 (1.0) | |||
Asian | 23 (24.0) | Senior | 13 (13.5) | 17 | 63 (65.6) | |||||
Others | 6 (6.3) | 18 | 10 (10.4) | |||||||
19 | 0 (0.0) | |||||||||
School #2 | Male | 28 (43.8) | White | 6 (9.4) | Freshman | 12 (19.0) | 14 | 3 (4.7) | Not working | 42 (65.6) |
Female | 36 (56.3) | Black | 30 (46.9) | Sophomore | 8 (12.7) | 15 | 9 (14.1) | Part-time work | 21 (32.8) | |
Hispanic | 26 (40.6) | Junior | 30 (47.6) | 16 | 13 (20.3) | Full time work | 1 (1.6) | |||
Asian | 1 (1.6) | Senior | 13 (20.6) | 17 | 27 (42.2) | |||||
Others | 1 (1.6) | 18 | 7 (10.9) | |||||||
19 | 1 (1.6) | |||||||||
School #3 | Male | 8 (32.0) | White | 6 (24.0) | Freshman | 13 (52.0) | 14 | 6 (24.0) | Not working | 20 (80.0) |
Female | 16 (64.0) | Black | 7 (28.0) | Sophomore | 5 (20.0) | 15 | 8 (32.0) | Part-time work | 3 (12.0) | |
Hispanic | 9 (36.0) | Junior | 1 (4.0) | 16 | 3 (12.0) | Full time work | 2 (8.0) | |||
Asian | 1 (4.0) | Senior | 6 (24.0) | 17 | 5 (20.0) | |||||
Others | 2 (8.0) | 18 | 1 (4.0) | |||||||
19 | 2 (8.0) | |||||||||
Total | Male | 78 (42.2) | White | 51 (27.6) | Freshman | 25 (13.5) | 14 | 9 (4.9) | Not working | 117 (63.2) |
Female | 106 (57.3) | Black | 57 (30.8) | Sophomore | 14 (7.6) | 15 | 18 (9.7) | Part-time work | 64 (34.6) | |
Hispanic | 43 (23.2) | Junior | 113 (61.1) | 16 | 36 (20.5) | Full time work | 4 (2.2) | |||
Asian | 25 (13.5) | Senior | 32 (17.3) | 17 | 95 (51.4) | |||||
Others | 9 (4.9) | 18 | 18 (9.7) | |||||||
19 | 3 (1.6) |
Note. aNot all participants provided demographic information.
Environmental Knowledge Items | Overall Correct Responses n (%) |
---|---|
The most frequent means of disposing solid waste is landfill | 97 (52.4) |
Improper sewage treatment can cause diseases outbreak | 147 (79.5) |
Car exhaust contribute to greenhouse gas effects | 117 (63.2) |
The easiest and most effective way to avoid becoming ill is frequent hand washing with soap and water | 142 (76.8) |
Trigger for asthma can be cockroach infestation, mold and second hand smoking | 127 (68.6) |
Potential source of radiation exposure include TV and computer, ultraviolet light, and smoke detectors | 77 (41.6) |
The number one risk factor for lung cancer among non-smokers is Radon | 33 (17.8) |
solid waste, about 52% (n = 97) of the high school students reported knowledge of the use of landfill for solid waste disposal compared to 36% (n = 67) of the students who do not know that. Secondly, majority (79%, n = 147) of the students know that improper sewage treatment can cause disease outbreak. In addition, the students know about hand washing (76%, n = 142) and trigger for asthma (68%, n = 127). However, about 41% (n = 77) of the high school students reported no knowledge of potential sources of radiation exposure and 16% (n = 30) of the students thought it is false that they could get radiation exposure from TV, computer, ultraviolent light and smoke detectors. In addition, out of 185 students, 133 (70%) of the students have no knowledge that the number one risk factor for lung cancer among non-smokers is Radon.
The knowledge questions were recoded “correct” (1) and “Incorrect” (0) to get the total knowledge score which ranged from 0 to 7 (M = 4.0, SD = 1.51). No significant differences were found between Males and Females, Ethnicity, and whether or not the high school students were working or not. There was however a significant yet weak correlation between age of the high school students and their total knowledge score (r = 0.222, p = .002). In terms of Location of the high schools, there was a significant difference (F (2, 182) = 7.628, p = .001, η p 2 = 0.077. A post-hoc analysis using Tukey shows that high school students in School #1 (M = 4.39, SD = 1.25) had significantly higher total knowledge scores than School #2 (M = 3.50, SD = 1.76).
The environmental health attitude of the high students ranged from 14 to 41 with an average score of 31.90 (SD = 4.41). Secondly, environmental health behavior scores of the students ranged from 0 to 64 with an average score of 39.23 (SD = 6.67).
In terms of gender of the high school students, no significant differences were found between environmental health Attitudes of males (M = 31.39, SD = 4.4) and females (M = 32.34, SD = 4.2); t (182) = 1.45, p = 0.148. There was also no significant differences found between environmental health behavior of males (M = 38.59, SD = 6.3) and females (M = 39.74, SD = 6.9); t (182) = 1.167, p = 0.245.
Other demographic variables were also tested for differences. There were no significant differences found for Age, Classification, and Work status. Significant differences were however found for location of the high school and ethnicity on environmental health attitude but not environmental health behavior. A one-way Analysis of Variance (ANOVA) results showed an overall significant difference in location on environmental health attitudes of high school students (F (2, 182) = 4.97, p = .008, η p 2 = 0.052. Post hoc analysis using Tukey showed that students in school #1 (M = 32.61, SD = 3.25) had higher positive environmental health attitudes than students in school #2 (M = 30.52, SD = 5.37). No other comparisons were statistically significant.
In addition, ANOVA results also showed an overall significant differences in ethnicity on environmental health attitude of high school students (F (4, 180) = 5.33, p = 0.000, η p 2 = .106. Post hoc analysis using Tukey showed that Black students (M = 29.86, SD = 4.85) had significantly lower positive environmental health attitude than White students (M = 32.63, SD = 3.59, Hispanic students (M = 32.33, SD = 4.47), and Asian students (M = 33.84, SD = 3.14). No other comparisons were statistically significant. The preceding results above showed a trend by location and ethnicity of the high school students.
Since location and ethnicity of the high school students were the only significant results concerning their environmental health attitudes, the researchers explored these results further by looking at the association between these two variables in the population. A chi-square test of independence shows a significant relationship between location and ethnicity of the high school students, χ2 (8, N = 185) = 60.02, p < 0.001. Further analysis was thus performed to help us understand these relationships by focusing on the ethnicity within the location of the specific high schools of interest (School #1 and School #2). School #3 had too few respondents for any meaningful comparison. Within School #1, ANOVA results showed significant differences in ethnicity on the environmental health
Ethnicity | School Location | ||
---|---|---|---|
School #1 | School #2 | School #3 | |
White | 39 | 6 | 6 |
Black | 20 | 30 | 7 |
Hispanic | 8 | 26 | 9 |
Asian | 23 | 1 | 1 |
Other | 6 | 1 | 2 |
attitude of the high school students (F (4, 91) = 3.027, p = 0.022, η p 2 = 0.117. Post hoc analysis using Tukey showed that within school #1 location, Blacks (M = 30.90, SD = 3.02) had significantly lower positive environmental health attitude than Asian students (M = 34.17, SD = 3.35) and no other comparisons were statistically significant. However, within school #2 location, there were no overall significant differences in Ethnicity. This finding could be attributed to fewer ethnic groups represented in school #2’s location as can be seen in
GIS/GPS was applied to augment this study. GIS data points on the location of the High Schools were collected and post processed in order to spatially display school location and the related mean scores on environmental knowledge, attitude, and behavior (see
This study assessed high school students’ knowledge, attitude, and behavior regarding environmental health. A total of 185 high school students from three different high schools in a South Eastern Texas school district were as to voluntarily respond to a questionnaire that gauged the knowledge level, attitude and behaviors on environment health. The results of the environmental health knowledge assessment of the high school students showed that most of the high school students only have appreciable knowledge about environmental practices that are tangible and solid or liquid based. It is also likely that most of the students that correctly self-reported knowledge of these environmental practices have at one point interacted or experienced these practices for example hand washing, disease outbreak, and asthma. Environmental knowledge on intangible or invisible practices such as Radon gas release and radiation exposure received the lowest knowledge scores. It is also worth arguing that majority of the high school students have not seen where their solid wastes end up. With slightly above average scores in environmental health knowledge, it is fair to say that there is insufficient basic knowledge about environmental health among the high school students. Previous studies among college students (e.g., Ratnapradipa, Brown, Middleton & Wodika, 2011) also found similar results [
On the other hand, high school students scored well on some knowledge items such as environmental triggers for asthma (68.6%) and cause for diseases outbreak due to improper sewage treatment (79.5%). This may have resulted from common knowledge of topic and the actual occurrences of the health conditions caused by these factors. For example, seasonal allergies and pollution which frequently tend to trigger asthma symptoms to students with this condition. Common allergens include dust mites pollen, animal dander, molds, certain food such as peanuts, second hand smoke, cockroach droppings, chemical fumes, vehicle exhaust, and particulate matter from polluted air. Similarly, with regard to sewage treatment, higher percentage true scores could be due to familiarity of the topic by high school students. Majority of students would not hesitate to immediately correlate sewage with disease outbreak because the content is filthy and undesirable to be around it.
The application of GIS in this study provided the mean to enhance and improve this study by providing a unique way to visualize and geographically analyze and display data to show which school performed better than the other. With the ability to spatially visualize school location in relation to their average scores in environmental knowledge and behavior, GIS can set need to examine population level factors related to these findings in this study. For example the geographic and spatial distribution of population and school locations can be directly related to the social and economic status of these populations.
As with many environmental health studies, these responses were self-reports. Although anonymity of the students was used to encourage true responses, social desirability could not be eliminated and no additional information was used to verify the accuracy of these responses especially the behavioral responses. Students also self-selected to participate in this study, so the results may not necessarily reflect the opinions of those who did not participate. Although all the three high schools in this district participated in this study, some schools and sub groups willingly participated more than others as can be seen in the descriptive results. Therefore, these results may be limited in some comparisons. Future studies could focus on getting representative numbers for all the sub groups in the current population or compare these results with other school districts in the southeastern Texas region.
With the exception of ethnicity differences in knowledge scores, the overall trend in this study has revolved around Location of the high school students and Ethnicity when it comes to environmental health attitude and knowledge (not behavior). Specifically, Blacks tended to self-report lower positive environmental health attitudes than White students, Hispanics and Asian students. In addition, school #1 which is located in predominantly affluent neighborhood reported higher environmental knowledge and higher positive environmental health attitude than school #2 that is in predominantly Hispanic and Black neighborhood. While this does not attest to any causation insinuations, it is unbiased to assert that there is an environmental health knowledge gap and an environmental health attitude disparity that needs to be addressed through curriculum adjustments and addressing the source of the attitudes that are detrimental to the health of high school students. Targeted interventions such as risk awareness and direct exposure to key environmental issues (in this study, Radon exposure and radiation exposure) where students can observe directly could empower the students to translate this knowledge into positive environmental health behaviors now and in the future.
Msengi, I.G. and Doe, R. (2017) Assessment of Environmental Health Knowledge, Attitude and Behavior among High School Students in a USA Southeast Texas School District. Open Journal of Preventive Medicine, 7, 247-260. https://doi.org/10.4236/ojpm.2017.712020