What does the public know about environmental health? A qualitative approach to refining an environmental health awareness instrument

Despite an increased level of interest in environmental health concerns among the American public, awareness of the risks associated with environmental hazards is generally lacking. Assessing population awareness is typically performed through surveys, yet a comprehensive national environmental health questionnaire is currently unavailable. In 2009, a Delphi study using environmental health experts from federal, state, and local government and academia identified 11 core areas of environmental health (air, water, radiation, food safety, emergency preparedness, healthy housing, infectious disease and vector control, toxicology, injury prevention, waste and sanitation, and weather and climate change) and provided content validity for 443 questions covering 25 specific topics for possible inclusion on a national instrument. The authors' study described in this article used the qualitative approach of focus groups to refine the questions. Questions were divided into four sections and randomly assigned to a focus group location; 32 individuals participated. Results indicated that many perceptions are based on misinformation (or lack of information), which may lead to poor environmental health decision making.