One Hour Pilot Training to Prevent Workers from Taking Home Workplace Contaminants

Abstract

Workers can accidentally transport chemical hazards from the workplace to the home, known as “take-home exposures”. Recent take-home lead-poisoning cases highlight the need for effective prevention training. A one-hour take-home prevention training was developed in partnership with a non-profit. The training was administered and evaluated during two training sessions with twenty-one trainees. The training was composed of a lecture and interactive activities. An illustrated poster was used with different prevention actions within a story line to reduce take-home exposures under three categories: facilities with formal health and safety programs, small businesses, and outdoor work. The effectiveness and acceptability of the training was measured by a survey and pre- and post-training exams. The second training exam responses showed a 14% (84% to 98%) increase in take-home prevention knowledge. Community-based prevention training could reduce the burden of chemical exposures on vulnerable workers and their families.

Introduction

The dangers of lead poisoning in children are well known, including developmental, behavioral, and neurocognitive impairment.¹ Lead can bioaccumulate in young children with multiple concurrent or repeated exposures. ² Many poisonings stem from a member of the household unknowingly bringing lead dust home from work.^3-5 Such take-home exposures can happen with a variety of chemicals including pesticides, polychlorinated biphenyls, asbestos, mercury, and others.^6-14 If a family is vulnerable to take-home, they may also experience other hazards with barriers to care, possibly contributing to health disparities.¹⁵

Workplaces that assess and monitor lead exposures according to the Occupational Safety and Health Administration’s (OSHA) lead protection standard¹⁶ are not required to evaluate take-home issues. Industries often do not train employees on this topic. However, studies document that key prevention behaviors include simple actions such as separate laundering of worker and family clothes, leaving work items at work, and showering at work.⁶ There is evidence that workers in high-exposure jobs can contaminate their cars and homes when they lack training or preventative controls even when OSHA programs are in place.^17,18 Cases of childhood lead poisoning continue to emerge,^4,5 including children of workers in industries that employ temporary or informal workers such as electronics recycling. This suggests the urgent need for prevention training tailored to workers and delivered either at work or in community settings.

Research has shown that trainings for low literacy workers are most effective when they include illustrations and interactive sessions.^19-21 While some health and safety training curricula regarding take-home exposures have illustrations and activities, some have been designed for health practitioners,²² and some were long or with technical jargon²³ (Table 1). Further, existing materials are often designed for a specific industry (e.g., agriculture) or contaminant (e.g., lead) and would be difficult to standardize across workplaces (Table 1). The highly specific trainings would be especially challenging in community settings for workers that may hold more than one job, or that go from job to job depending on employment opportunities, as is typical for temporary or informal workers.

Table 1.

Review of some educational materials related to prevention of take-home exposures

Educational Material	Advantages	Disadvantages
More than a paycheck (Poem) Barnwell (1981)43	Motivates employees Emotional lyrics Easy to understand	Tool that could be used as an activity in a training but is not self-contained Doesn't translate well in other languages
Protect your Family: Reduce Contamination at Home NIOSH (1997)6	Nice graphics emphasizing contamination Multiple plain languages (English and Spanish) Clear simple actions described for prevention Extensive list of take-home contaminants	Limited material for training sessions
Lead Safety for Workers Lead Safety for Workers, Lead Curriculum for LA Project. Cal DPH (2002)23	Very informative covering take-home lead key concepts Provides training activities and case studies Excellent prevention information Multiple languages (English and Spanish)	Requires high technical knowledge with regards to lead Content is long to cover in a short training session Specific to lead
Lead in the Workplace California Occupational Lead Poisoning Prevention Program (2005)44	Concise information covering take-home lead key concepts Prevention information for employees and employers Programs information for employers and employees	Does not present many graphics Limited material for training sessions Specific to lead
If You Work Around Lead, Don’t Take It Home! OSHA (2014)45	Concise information Provided separate prevention strategies for employers and employees Easy to read	Does not provide many graphics Limited material for training session Specific to lead
Protect Family and Friends: Stop Take-Home Lead Contamination Washington State Department of Labor and Industries (LNI), SHARP Program (2014)22	Very informative covering take-home lead key concepts Easy to read Lists of jobs and workplaces associated with take-home lead	Does not provide graphics Reading material is long, designed for health practitioners Limited material for training session Specific to lead
Don’t take lead home from your job! Cal DPH (2019)46	Easy to read Great graphics Concise information covering take-home lead key concepts Help information for employees Great explanation for take-home prevention strategies	Limited material on prevention techniques Limited material for training sessions Specific to lead
They Don’t Tell You Anything! (Play) Becker M (2019)47	Hands on and very interactive play dialogue Reenactment help reinforce materials Emphasizes teamwork	Needs long preparation time Not feasible for an hour-long training session Difficult if a worker is shy
Take-Home Lead Minnesota Department of Health (2019)48	Easy to read and different documents Good list of jobs and hobbies associated with take-home lead Concise information about take-home lead specific about health effects Great explanation for take-home prevention strategies	Does not present graphics Reading material is long Limited material for training session Specific to lead
LEAF. Limit Exposure Around Family Environmental Protection Agency (EPA) (2019)49	Makes use of variety of materials such as (Flyer, Poster, Magnet) Good use of visual aid Informative as well as interactive Multiple plain languages (English and Spanish)	Magnet is busy, hard to comprehend Specific to pesticides and farm workers

Understanding this, a training was developed and evaluated through a partnership between researchers and the Massachusetts Coalition for Occupational Safety and Health (MassCOSH). MassCOSH serves many workers who are either currently employed, have been employed, or live with family members who are employed in industries that have a high potential for take-home exposures. Many workers assisted by MassCOSH are Hispanic and/or temporary workers who move through many roles in different industries. Hispanic workers in these settings often hold dangerous jobs^24-26 and have some of the highest rates of occupational injuries and illnesses^25,27,28 and occupational fatalities.²⁹ Being an immigrant, having low English proficiency, and having lower levels of educational attainment have been associated with higher rates of injuries among Hispanic workers.^24,27,30

In this manuscript we document: 1) the development of a one-hour take-home prevention training that was focused on behaviors of workers as they leave the workplace in a variety of jobs and 2) conducting a pilot test of this training to assess its acceptability and effectiveness at increasing prevention knowledge. This training was intended to educate trainees in case they ever encountered conditions at their work that could put them at risk of bringing contaminants home. Further, this training also intended to raise awareness of dangerous working conditions and health and safety actions that could be taken by family members of trainees and the community at large. This training is not intended to replace health and safety training at the workplace, but to provide a different perspective to workers and their families about take-home exposures. Prevention tips were offered to help these families prevent take-home exposures, regardless of their employer.

Methods

Development of the Training

Researchers approached MassCOSH, a workers’ health and safety non-profit with expertise in community-based training, and discussed the need for the training and how to adapt to low-literacy trainees. A training curriculum was jointly developed with the goal of educating workers on the risks and prevention of take-home exposures (see training details in Supplemental Information S1). Several in-person meetings were held among researchers and MassCOSH trainers to help develop training materials, outline the training curriculum, and create story-like recommendations with illustrations. The curriculum that was developed included techniques used by MassCOSH to deliver health and safety content to immigrant workers. Content in the training was adapted from the California Department of Public Health (Cal DPH) training modules for prevention of lead take-home exposure.²³ In order to reach a broader audience, content was not contaminant or industry specific. The curriculum was first developed in English and then translated into Spanish. Spanish translation was verified by several native Spanish speakers in the team for clarity and cultural appropriateness before it was finalized. Prior to the training, researchers held a “train-the-trainer” session with MassCOSH. The training had the overall objective of familiarizing workers on the concepts of preventing take-home exposures. It was especially geared to teach prevention tips that can be performed after leaving work and before going home or when a worker gets home.

Training plan

In brief, the training delivered by Spanish-English bilingual instructors followed this outline.

• Introduction (10 min): An ice breaker introduced trainers and trainees, followed by a real take-home case study of childhood lead poisoning.³¹

• Lecture (20 min): A short lecture described how contaminants can be transported home from work, type of workplaces more prone to this problem, and what to do if workers think they have a problem. The lecture was assisted by the use of a white board and an illustrated poster. The poster depicted steps to follow in a sequential order from when the worker leaves the workplace until the time spent with family at home. Story-like recommendations were specific to different work arrangements and are listed below (close-up shown in Figure 2).

• Factories (usually, a medium-to-large enterprise, with a formal health and safety program): When leaving work worker must: leave work items, clothing and boots in the workplace locker; wash work clothes in the workplace; shower at work including hair, change into clean clothes from a clean locker; separate work underwear from personal items during transport to the home and when washing clothes at home; and clean home and car often with vacuum and wet methods.

• Small businesses or services: When leaving work worker must: leave work items, clothing and boots in the workplace locker if there is a locker; wash face, hands, and arms at the end of the shift on a work sink (if no shower is available); change into clean clothes; keep work clothing, boots, and items separate from personal items during transport to the home; shower first thing when getting home including washing your hair; store and wash work clothes separately from family’s; and clean home and car often with vacuum and wet methods.

• Outdoor work (usually, a small contractor with no formal health and safety program): When leaving work worker must: wear a protective outer layer of clothing (or coverall or uniform) if there is nowhere to change at the workplace; wash face, hands, and arms at the end of the shift using wet wipes if there is not a work sink or shower; remove outer layer of clothing, boots, and any tools or personal protective equipment and store them separately from personal items during transport to the home; shower first thing when getting home including washing your hair; store and wash work clothes separately from family’s; and clean home and car often with vacuum and wet methods.

• Interactive activities (20 min): Hands-on activities included: 1) a trivia game to reinforce key take-home concepts and prevention tips (Figure 1) and 2) a find “what went wrong” activity where participants practiced hazard identification on a drawing of a worker getting home from work. Trivia questions were intended to be easy to answer, because the main objective was to emphasize repetition of new concepts. Some trivia answers were also silly, but culturally appropriate, as to introduce humor and create a relaxed learning atmosphere.

• Wrap up (10 min): Content was summarized, and questions were answered.

Figure 2.

Illustrations used in a poster providing story-like take-home-prevention recommendations for different work arrangements (full version of the poster including these illustrations is in Supplemental Information Appendix S1.2)

Figure 1.

Photos depicting training aided by an illustrated poster and trivia activity.

Recruitment

MassCOSH recruited participants by inviting community members from their worker center activities to a health and safety training at a local Parish. Trainee attendance was limited to drop-ins typical of the MassCOSH worker center activities at the time of this training. Trainees were eligible if they were: 1) 18 years of age or older, 2) living in Greater Boston area, 3) and spoke English or Spanish. Recruitment was not limited to currently employed workers, as MassCOSH participants were likely to live with a high-risk worker at their homes, have held a relevant job in the past, or hold a relevant job in the future even if currently unemployed. Training was designed for a wide variety of jobs to accommodate the wide audience typical of MassCOSH worker centers.

Training Pilot Evaluation

The training was held in two sessions: November 29, 2017 and March 1, 2018. The first session pilot tested the content over two hours. Feedback obtained during the first session was used to make any necessary changes to improve materials and the overall session. During the first training session, we also tested different activities not included in the second training session (e.g., role-playing to learn how to separate work and personal items in a work locker) to choose activities that best engaged the audience. The second session, lasting one hour, generated a preliminary evaluation of the finalized materials.

At each session researchers administered consent, collected demographic information, and administered a pre training multiple choice ten-question assessment upon arrival. Questions were read aloud for those needing assistance. MassCOSH provided beverages and food during the training. At the end of each session, a post-training assessment (identical to pre training assessment) was administered and two to four participants were asked to provide specific feedback about the poster with an emphasis on clarity and cultural appropriateness of the language used. Results from the assessments were not shared with trainees. Trainers and trainees were asked to fill out an evaluation survey. Trainees received a certificate and a twenty dollar gift card to compensate for transportation costs.

Training acceptability was qualitatively assessed from survey responses on the overall training session quality (questions from excellent to poor), the materials presented, the group’s participation, and the instructors’ ability to answer questions. Effectiveness was measured by comparing assessment scores from before and after the training and participant and trainer surveys. Assessment questions asked if workers understood good behaviors known to prevent bringing contaminants home, such as: 1) not using work shoes in the home, 2) showering and cleaning up after work, 3) changing work clothes at home, 4) washing work clothes separately from family clothes, 5) separating work and personal items at work, 6) ideal cleaning methods are vacuuming and wet wiping. The surveys were intended to get feedback about whether or not this kind of training - the content and delivery format - would be helpful for workers in their communities. This information was used reflexively to refine tailoring of the training. Descriptive statistics were performed using SPSS Version 17.0.2; however further statistical analysis was not explored between pre-and-post assessments because of the small sample size.

Protocols used by investigators were reviewed and approved by the Harvard T.H. Chan School of Public Health Institutional Review Board. All participants signed an informed consent form in their native language.

Results

Trainee population

The two sessions had eight and thirteen trainees, for a total of twenty-one trainees. Trainees were Hispanic, Spanish speakers (preferred language), with more women (n=fourteen) than men (n=seven), aged twenty-six to over fifty-six, and had a range of educational backgrounds (though most had no high school diploma). Trainees’ current or most recent occupations were mixed including jobs such as construction and janitorial services. Detailed information is in Table 2.

Table 2.

Demographics of the trainees that participated in the take-home prevention training

Characteristics	Training 1 (n = 8)	Training 2 (n = 13)
Gender
Female	5	9
Male	3	4
Participants’ age
26 to 40 years old	1	4
41 to 55 years old	2	4
56 years old or older	5	5
Ethnicity
Hispanic or Latino	8	13
Current or last occupation
Construction		1
Janitorial	1	5
Other	7*	7**
Education
Less than high school diploma GED	4	9
High school diploma or GED	1	2
Some college but no degree	3	1
Associate degree		1

^*Other jobs included salesmen, maintenance, baker, daycare assistant, food packing plant.

^**Other jobs included food company, nanny, and homecare

Qualitative assessment

Participants rated both training sessions from good to excellent and highlighted the topic’s importance and need for training. Trainings were well received, and activities were successful at engaging all participants. Trainees said that the story-like recommendations depicted by the poster illustrations were easier to understand than words alone. Further, trainees said that the illustrations provided a clear sense of what actions needed to be done first and how to proceed in an ideal order (i.e., showering and changing clothes before playing with their family). Trainers reported they were pleased with the level of participation and how questions were addressed, but suggested improvements for time management. All participants responded that they were confident about being able to use the knowledge learned from the training.

After the first training, training materials were revised to incorporate feedback, and primarily simplified for clarity and better time management. During the first training, participants had difficulty understanding assessment questions. As a result, trainers had to read and explain questions aloud, which may have artificially inflated pre training baseline scores. After simplifying the assessment, all participants during the second training were able to answer without explanations – even though literacy levels in the second group were lower overall. Trainees were more receptive to the poster during the second training session, appreciating captions that were added underneath illustrations. Trainees were also more receptive to a poster that included three broad work arrangement categories in its recommendations instead of four (i.e., during the first training small businesses and services were displayed as different work arrangements). Further, trainees were much more enthusiastic and engaged during the trivia in the second training partly because it was made simpler, funnier, and easier to answer so it did not go overtime.

Quantitative assessment

Knowledge of take-home prevention behaviors improved six percent after the first training, with an increase in assessment score average from eighty-seven percent to ninety-three percent. In the second training there was a fourteen percent improvement on the assessment, from eighty-four percent to ninety-eight percent (details in Table 3).

Table 3.

Quantitative assessment results from the two take-home prevention trainings

	Pre assessment	Post assessment
Training 1	87 (60-100)% n = 7	93(80-100)% n = 8
Training 2	84(50-100)% n = 13	98(80-100)% n = 12

Discussion

The take-home exposure prevention training focused on take-home prevention behaviors for different work arrangements without being contaminant specific. When we assessed effectiveness of the refined training (during the second training session), there was a fourteen percent (average baseline of eighty-four percent) increase in knowledge between pre- and post-training assessments. These results suggest a knowledge gain similar to that described in other literature in which pre- and post-training assessments were used to evaluate public health educational interventions for low-income adults or workers. In one pilot related to oral health literacy, there was an average gain of 13-33 percent and baseline of 64-75 percent depending on the audience tested.³² One evaluation of an occupational health and safety training for salon workers demonstrated a knowledge gain similar to our study, with an average gain of eighteen percent (average baseline of seventy-eight percent).³³ On another study, the development of health and safety training materials for workers in beryllium-using industries demonstrated an average knowledge gain of fourteen percent (average baseline of eighty-two percent).³⁴ Although sample size in our trainings was small compared to some of the tested trainings in the literature, we set our intentions in line with other community-based health trainings in public health, which often consider developing an early pilot of training materials with small groups. This allows for an emergent training to be shaped by community input prior to rigorous testing, while still assessing for acceptability and basic knowledge changes in participants. One example is the development and evaluation of a sexual abuse prevention program for adults with mental retardation that only used six subjects trained in pairs for a total of three training sessions.³⁵ Lumley et al.,³⁵ found an average knowledge gain of seventeen percent (based on a pre-assessment score of sixty-seven percent). This pilot suggested that results, even from that small sample size, could be a good start for developing much-needed education programs on the topic.

Findings from the first training session, with only a six percent increase from pre to post assessment, suggested that there was a high literacy problem with the assessment itself, which may have resulted in giving away answers unintentionally when explaining the questions in person. Regardless, modifying the assessment to simpler questions for the second training session made time management more effective, and the assessment required less assistance beyond reading it aloud. Although during the second training the baseline was lower than that of the first training (average of eighty-four percent rather than eighty-seven percent), some participants still obtained a hundred percent score in the pre assessments. During both sessions, some trainees were familiar with concepts related to the prevention of take-home even before the training.

Although our training evaluation was limited, it followed standard evaluation metrics of trainings in occupational safety and health.²¹ The National Institute for Occupational Safety and Health (NIOSH) review of trainings in occupational safety and health suggests that the use of pre- and post-assessments is effective at assessing the knowledge and skills gained during a training, and that a survey helps understand the reaction of the trainees with the training.²¹ Future steps, following the standard evaluation metrics by NIOSH, would include collecting a larger data set of pre- and post-assessments to validate the effectiveness of the training, as well as measurements of behavior change after the training or measurable changes in take-home exposures in a home or car specific to the training.

During both sessions, trainers discussed different types of workplaces or sources of contaminants with the trainees. Participants also discussed, with reference to the poster, that the different approaches for prevention depend on the different workplace hazards and controls that each person encounters in each type of workplace. In this training, key recommendations were divided into three major categories – mainly depending on the different controls provided in the workplace. Even if not ideal, it is very possible that some factories with a lead program in place may not have showers or lockers for their workers, therefore trainees employed at factories still benefit from learning about recommendations from the small businesses section. Although the training materials were designed with what is known about protecting workers from take-home lead and pesticides – the two take-home contaminants with the greatest number of educational materials (Table 1) – it is likely that these behavioral precautions may also protect workers from other take-home contaminants.

The take-home exposure prevention training we developed was intentionally tailored towards delivery to workers directly within a community setting. This community implementation method was prioritized over a more controlled evaluation in a workplace setting. Training community members has the advantage that knowledge would spread through a tight-knit community where there’s a high prevalence of effected workers – this is called diffusion innovation theory in social sciences.^36-40 Either the worker was likely to work in a high exposure job in the past, present, or future, or they are likely to know someone who does. Therefore, the education and knowledge may be generally useful to the community even if it’s not immediately relevant to the trainee. On the other hand, we also acknowledge that trainings in community settings must still address barriers that already exist for training workers in complex health and safety concepts. Specifically, for immigrant workers, cultural awareness of the trainer is crucial as well as the ability to integrate cultural knowledge, beliefs, values, and traditions into management and work practices in health and safety.⁴¹ Many of these workers may even be employed in workplaces that may not take responsibility for health and safety. Further, other potential barriers that need to be addressed may include language, experience, literacy, financial limitations, work beliefs, and health beliefs.⁴² Within our training, we focused on addressing barriers of cultural awareness and language primarily, due to the nature of our partnership with MassCOSH. It was more challenging to address other barriers beforehand in the preparation of the training given the variability of the drop-in audience that attended these pilot trainings. However, MassCOSH trainers were equipped and trained to deal with many of these barriers during the training as needed.

The strengths of this training, derived from trainees’ and trainers’ feedback, were the use of story-like recommendations that were reinforced with interactive activities, and its delivery by a non-profit with experience in community-based worker training with low-literacy bilingual immigrants. Another advantage of this training compared to other existent trainings is that it was short, worker-centered, easy to comprehend, and applicable to a variety of different jobs and contaminants. NIOSH found that short training sessions are better at preparing workers for recognizing hazardous exposure situations and adopting safer work practices.²¹

The main weaknesses of this pilot study to assess the trainings’ effectiveness were the small sample size and its lack of follow-up. Future work should include larger size of trainees and an assessment of behavior changes and take-home contamination. However, the small sample size of the trainings granted a very interactive intimate space, so in the future it may be desirable to increase the number of training sessions rather than the number of trainees per session to achieve a larger sample size. NIOSH review suggests that an ideal sample size per group of trainees is equal or less than twenty-five participants.²¹

Another weakness of this training is that it does not cover information related to sources, transport, and every typical control to mitigate exposures in the different workplaces that can result in take-home exposures. This was done intentionally as to reduce the length of the training and because we covered many different workplaces at the same time. It would have been unfeasible to go over every workplace scenario, particularly given the drop-in community-center format. If a specific workplace was looking for a training that covered both inside and outside of the workplace, the one-day training from Cal DPH may be more appropriate. A weakness of the training poster is that it does not distinguish between use of a personal car or public transportation; however, the same recommendation of separating work items from personal items would apply in either mode of transportation. The training does not acknowledge the high likelihood of workers using a laundromat; however, the same recommendation of washing work and family clothes separately would also apply. Although a disadvantage that the training did not include more details (i.e., different types of transportation or different places of doing laundry), having an interactive lecture during the small group class gave us an opportunity to answer any questions related to specific family situations.

Take-home exposures are one of the silent dangers that arise due to gaps in occupational health and safety. Regardless of the limitations of this pilot study, interacting with trainees provided confirmation that this training addresses an important and relevant topic for workers. We also confirmed that delivery would be feasible as an add-on module tacked on to other lead prevention or workplace safety training programs, or in a community non-profit setting. We aim to expand this training’s use with other stakeholders including other non-profits, labor organizations, community and faith groups, and students in public schools. A tailored version of this training could also be tested with different worker audiences within different industry sectors at high-risk for take-home exposures. Community-based take-home exposure prevention training could reduce the burden of chemical exposures on vulnerable workers and their families.

Biography

Diana Ceballos is an Assistant Professor in Environmental Health at Boston University with a Doctoral degree in Environmental and Occupational Hygiene and a Master of Science in Atmospheric Chemistry. Dr. Ceballos has fifteen years of experience in occupational health research in different industries. Dr. Ceballos was an industrial hygienist with the National Institute for Occupational Safety and Health, where she was involved in several cases of lead poisoning related to take-home exposure.

Mariana Guerrero is a Freelance Sustainability Business Consultant who advises small businesses on how to reduce their environmental footprint. Mariana graduated as a BA from Harvard University with a concentration on Environmental Studies. Before starting consulting, Mariana worked at the Harvard T.H. Chan School of Public Health as a Research and Educational Session Coordinator, and Teacher Assistant for Environmental Health. Mariana’s professional focus has been on leadership in environmental sustainability evaluation, implementation, and prevention.

Andrew Kalweit has experience conducting research at the intersection of the behavioral sciences and community health programming for marginalized youth and families. He currently works for the National Council of Urban Indian Health, performing an environmental health capacity assessment for urban health programs that serve Native Americans. Mr. Kalweit holds a Master of Public Health and Bachelor of Science degrees in Chemistry and Human Development.

Richard Rabin is an OSHA authorized trainer at MassCOSH, leading OSHA 10 and RRP trainings in both Spanish and English for workers in a range of industries. Mr. Rabin holds a Master of Science and a Master of Arts degrees. Mr. Rabin directed the Occupational Lead Poisoning Registry at the Massachusetts Department of Labor for over twenty years, and has published several articles on both child and adult lead poisoning.

John Spengler, Akira Yamaguchi Professor of Environmental Health and Human Habitation, and Director of the JPB Environmental Health Fellowship Program at the Harvard T.H. Chan School of Public Health, has conducted research on personal monitoring, air pollution health effects, indoor air pollution, and a variety of environmental sustainability issues. Several of his investigations have focused on housing design and its effects on ventilation rates, building materials’ selection, energy consumption, and total environmental quality in homes.

Robert F. Herrick is an Instructor at Harvard University’s T.H. Chan School of Public Health. From 1994 to 2018 he was Senior Lecturer (Environmental Health). Prior to that, he spent seventeen years with the National Institute for Occupational Safety and Health. He has a BA (Chemistry) from the College of Wooster, a Master’s (Environmental Health Science) from the University of Michigan and a Doctor of Science degree (Environmental Health) from Harvard School of Public Health.