Public Health Commons^™

Diet Quality As Assessed By The Healthy Eating Index-2020 Among Individuals Diagnosed With And Without Type 2 Diabetes, Minghao Zhou, Hairui Yu, Renee Underwood, Hongning Cai, Tung Sung Tseng, Susu Luo

School of Public Health Faculty Publications

Background: Dietary management is key to preventing and controlling type 2 diabetes mellitus (T2DM). However, few studies have examined differences in Healthy Eating Index (HEI-2020) scores and components among individuals with and without diagnosed T2DM. This study aimed to assess gender differences in HEI-2020 scores and its 13 components by T2DM status. Methods: Using National Health and Nutrition Examination Survey (NHANES) data from 2011 to 2018, this cross-sectional study analyzed 19,464 adults. Diagnosed T2DM was identified via self-report or diabetes medication use. Diet quality was assessed using the HEI-2020, scored from 0 to 100, with a higher HEI score indicates …

Impact Of School Nurse Education On Factors Influencing Hpv Vaccine Communication With Parents, Jihye Choi, Efrat K Gabay, Jeanette Deason, Elizabeth Baumler, Diane Santa Maria, Daisy Mullassery, Lara S Savas, Erika Thompson, Sanghamitra M Misra, Paula M Cuccaro

Faculty, Staff and Student Publications

Human papillomavirus (HPV) can cause six cancer types but can be prevented with timely vaccination in early adolescence. However, despite the wide availability of the HPV vaccine, uptake remains suboptimal among US adolescents. School nurses are invaluable resources to students and their families regarding adolescent immunization needs. As part of the All for Them vaccination program, we assessed the impact of the continued nurse education (CNE) intervention on school nurses’ HPV vaccine communication with parents. Seventy-two school nurses and nurse administrators in Texas participated in the study. Using a single-arm study design, we measured participants’ potential barriers to and self-efficacy …

Perspective: Improving Social Connection And Inclusion Through Equitable Digital Health Solutions, Dominika Kwasnicka, Jaimon Kelly, Eleanor Quested, Loretta Baldassar, Suzanne Robinson, Richard Sinnott, Paul O’Halloran, Anne Tiedemann, Paul Flatau, Rajna Ogrin, Jane Farmer, Abby C. King

Research outputs 2022 to 2026

In this Perspective, we address the critical intersection of digital health, social connection, and health equity. Taking an interdisciplinary and complex adaptive systems perspective, we highlight evidence-based digital solutions to improve social connection and inclusion and, consequently, health outcomes. We describe actionable strategies for ensuring that digital health innovations benefit all, highlighting how user-centered design can address diverse needs, particularly for structurally disadvantaged populations.

Progression Of Non-Radiographic To Radiographic Axial Spondyloarthritis: A Risk Model Based On A Chinese Cohort Study, Rui Ying Deng, Xiaojia Xu, Jian Hua Peng, Feng Cai Shen, Yao Gong, Dan Min Wang, Hong Jin Liang, Shu Xin Huang, Zhao Peng Chen, Wen Long Wu, Ze Xin Zheng, Ling Lin, Zhi Duo Hou

Research outputs 2022 to 2026

Objectives: To evaluate the progression from non-radiographic axial spondyloarthritis (nr-axSpA) to radiographic axial spondyloarthritis (r-axSpA) in a Chinese cohort, identify associated risk factors in both clinical and imaging arms, and enable risk stratification based on these factors. Methods: Overall, 572 patients with nr-axSpA were enrolled with a median follow-up of 5 years. Cox proportional hazard regression analyses were conducted to identify potential risk factors associated with the progression from nr-axSpA to r-axSpA in both clinical and imaging arms. A risk-scoring system was then developed by assigning each independent predictor a weight based on its regression coefficient. Patients were subsequently categorized …

Slushies Before School: Exploring How Nearby Food Outlets Impact The Eating Behaviours Of Secondary Students In Perth, Western Australia, Sharonna Mossenson, Klug, Joelie Mandzufas, Jacinta Francis, Siobhan Hickling, Lukar Thornton, Gina Trapp

Research outputs 2022 to 2026

The external school food environment, comprising food outlets and marketing near schools, shapes what young people eat. Yet little is known about how Australian adolescents perceive and navigate these environments. Focus groups were conducted with 31 school students (Years 7–12) from Perth, Western Australia, to explore their experiences of the external school food environment and its influence on their food-related behaviours. Transcripts were thematically analysed and six themes were identified. Accessibility emphasised proximity, transport links, opening hours and speed of service, with older students using outlets as social spaces. Availability of slushies, energy drinks, snacks and fast-food meal deals influenced …

Temptation At The School Fence: A Qualitative Exploration Of The Impact Of External Food Outlets On The School Community, Sharonna Mossenson, Klug, Jacinta Francis, Siobhan Hickling, Lukar Thornton, Gina Trapp

Research outputs 2022 to 2026

Retail food outlets are commonly located in close proximity to schools, providing students with opportunities to purchase and consume food enroute to or from school. These outlets are typically unhealthy and disproportionately clustered near schools, and this trend has been increasing over time. While quantitative studies have established associations between school food environments and adolescent dietary behaviours, little is known about how school personnel perceive and experience their impacts. This qualitative study explored perspectives of school personnel (n = 9) from a secondary school in Perth, Western Australia, located 150 m from two retail food precincts (areas with a high …

The Effect Of School-Based Educational Session On Knowledge, Attitudes, And Beliefs Of Cervical Cancer Among Adolescents In Mixed Day High Schools In Embu County: A Quasi-Experimental Study, Lucy W. Kivuti-Bitok, Mugo, Dorothy Mituki, Christine Marete, Irene Ngune, Jessica Wells

Research outputs 2022 to 2026

Background: School-based interventions have proven effective in enhancing knowledge and altering attitudes toward cervical cancer among adolescents. This study aimed to evaluate the effect of a school-based educational intervention on the attitudes, beliefs, and knowledge of cervical cancer among adolescents in mixed-day high schools in Embu County. Methods: This study used a single-group, repeated cross-sectional design to assess the effect of a structured health education session on cervical cancer among adolescent boys and girls in mixed-gender secondary schools. A self-administered anonymous questionnaire was administered before and immediately after the post-intervention. The education session lasted 30–45 min, and the study population …

Implementation And Effectiveness Of A Food Education Intervention To Promote Plant-Based Foods: A Partially Cluster-Randomized Controlled Trial, Henna Vepsäläinen, Satu Kinnunen, Sari Niinistö, Leena Forma, Suvi T. Itkonen, Tuuli E. Korhonen, Liisa Korkalo, Heli Kuusipalo, Jelena Meinilä, Kaija Nissinen, Susanna Raulio, Ros Sambell, Mari Åkerlund, Suvi M. Virtanen, Maijaliisa Erkkola

Research outputs 2022 to 2026

Background: Legumes can substitute for meat and are thus a particularly important food group for environmental sustainability. As the use of legumes among Finnish children is marginal, there is potential for a substantial increase in their consumption. However, food education delivered through early childhood education and care (ECEC) settings has rarely focused specifically on environmentally sustainable foods, such as legumes. This study describes the implementation and effectiveness of an ECEC-delivered food education intervention within the FoodStep study. Methods: The partially cluster-randomized FoodStep intervention aimed to increase the supply of vegetables, legumes, fruits, berries, and sustainable fish while reducing the provision …

Local Government Policies Restricting Unhealthy Outdoor Food Advertising In Australia: Stakeholder Perspectives Identify Political Willingness Is Key To Overcoming Barriers, Alexia Bivoltsis, Frith Klug, Jacinta Francis, Clare Whitton, Gina S.A. Trapp, Claire E. Pulker

Research outputs 2022 to 2026

Background: Unhealthy outdoor food advertising is strongly linked to poor diet, highlighting the need for policies. Western Australian (WA) local governments (LGs) can restrict advertising on their owned infrastructure through their Public Health Plans, but limited policy action has occurred. This study aimed to explore the perspectives of WA LGs and public health organizations (PHOs) on current and potential policies restricting unhealthy outdoor food advertising on LG owned infrastructure to (1) identify barriers and enablers to the policy making process, (2) assess the current level of political willingness (i.e. political want, political can and political must) and (3) inform development …

Living Next Door To Mcdonald’S: A Qualitative Study Of Community Submissions And Resident Realities Pre- And Post Development, Roslyn Giglia, Jacinta Francis, Jana Buckle, Clare Whitton, Ros Sambell, Frith Klug, Lukar Thornton, Siobhan Hickling, Katherine Kent, Gina Trapp

Research outputs 2022 to 2026

Background: The proliferation of fast-food outlets (FFOs) in residential areas has raised growing concerns about their impact on community health, safety, and wellbeing. This qualitative study examined both pre-development community consultation submissions and post-development resident experiences surrounding the development of a McDonald’s outlet in a newly established suburb on the urban fringe of Perth, Western Australia (WA). Methods: Using a qualitative descriptive design, the study analyzed 183 community submissions lodged with the local council prior to development and conducted semi-structured interviews with 11 residents living within 300 m of the outlet after construction. Results: Content analysis revealed strong opposition, with …

Improving Assessment And Documentation Adherence In An Age-Friendly Health System With A Focus On "What Matters", Thelma I. Arzu

Doctor of Nursing Practice Final Project Abstract

Purpose

To improve adherence in assessing and documenting “What Matters” (WM) using a standardized assessment and documentation process.

Background

The project was implemented within a large Age-Friendly Health System (AFHS) in Houston, Texas, comprised of a geriatric outpatient clinic and a House Call program. Although the 4Ms of AFHS were regularly documented in the outpatient setting, there was limited documentation in the House Call Program.

Methodology

A standardized process was established with clinician stakeholders to assess and document WM using simplified assessment criteria, the electronic medical record (EMR) 4Ms documentation phrase, and a designated location for the 4Ms phrase in …

Recommendations From Health Research For Children And Adolescents Living In The Kimberley Region Of Western Australia: A Scoping Review, Lisa Cannon, Elizabeth J. Elliott, Andrew Dossetor, Tracey W. Tsang, Md Irteja Islam, Alexandra L. Martiniuk, Habiba Naanai, Tuguy Esgin, Emily Carter, Lauren J. Rice

Research outputs 2022 to 2026

Background: Aboriginal leaders in Western Australia’s Kimberley region have voiced concern that research conducted on their lands is not being adequately used to inform meaningful change. Objective: This scoping review, grounded in an Aboriginal-academic partnership, identifies the child and adolescent health-related research conducted in the region and summarises the authors’ recommendations for knowledge translation. Methods: Drawing on PRISMA-ScR guidelines, we conducted a comprehensive search of multiple databases for publications between January 1967 and June 2025, focusing on children aged ≤ 18 years. Data extraction was conducted using Covidence, and publications were categorised based on the International Classification of Diseases (11th …

Barriers And Facilitators To Health Literacy Among Black Americans With Overweight And Obesity In South Carolina: A Mini-Ethnographic Study, Shelly Campbell-Timmons

Doctoral Dissertations and Projects

The purpose of this qualitative mini ethnography adapted from traditional ethnography with limited time and scope, was to explore and understand perceptions of barriers and facilitators to health literacy among Black Americans with overweight and obesity in three South Carolina counties. Population data showed that approximately 40.3% of U.S. adults are obese. Moreover, Non-Hispanic Black communities are disproportionately affected by overweight and obesity despite efforts to combat the weight-related health risk. Still, limited health literacy should be the focus of public health strategies like teach-back and plain language communication, to address overweight and obesity prevalence and disparities. The study was …

Harmonies Of Healing: A Secondary Data Analysis On Music Engagement And Quality Of Life In Older Adults, Theophilus Eben Nartey

Doctoral Dissertations and Projects

The purpose of this quantitative, cross-sectional secondary data analysis was to examine the relationship between music engagement and self-reported quality of life among adults aged 60 years and older, using data from the Health and Retirement Study (HRS). Guided by the Biopsychosocial-Spiritual (BPSS) framework, the study explored whether music engagement significantly predicted perceived well-being in later adulthood while accounting for chronic health conditions. Secondary data from the HRS public-use dataset were analyzed using IBM SPSS Statistics Version 29. The final analytical sample consisted of 1,582 adults aged 60 years or older with complete data on all variables included in the …

Progress, Poetry, And Peace: Romantic Ideals And The Present Day, Kristen Dawn Morgan Hess

Masters Theses

In the busy, technologized, and mechanized life that most people live today, it can be difficult to find true rest, comfort, and peace because the very technology and machinery that is marketed as providing these 21st-century amenities often fall short in their delivery. Taking a look backward at the Romantic era ideals presented in the poetry of William Wordsworth can offer people today the chance to gradually improve their mental, physical, and emotional health by slowing down, minimalizing, and moderating their lifestyles. This thesis talks about the historical background of three of Wordsworth’s poems— “Lines Written in Early Spring,” “The …

Data For Advocacy Intention Using Pmt, Alice Ann Crandall

ScholarsArchive Data

This includes the deidentified data and code for the article Advocacy Intention Across Politically Sensitive Health Issues: A Cross-Sectional Study Using Protection Motivation Theory

Discovering Repurposable Drugs For Alzheimer's Disease And Related Dementias: Target Trial Emulation Using Decentralised Real-World Data, Qiong Wu, Lu Li, Yuqing Lei, Ting Zhou, Huilin Tang, Bingyu Zhang, Yiwen Lu, Maxwell Salvatore, Dazheng Zhang, Jiayi Tong, Tingyin Wang, Siqi Chen, Haoyang Li, Zhenxing Xu, Yu Huang, Yu Hu, Na Hong, Yujia Zhou, Fongci Lin, Kyra O'Brien, Yong Chen, Ruowang Li, Hua Xu, Fei Wang, Jiang Bian, David Wolk, Yong Chen

College of Population Health Faculty Papers

BACKGROUND: Alzheimer's disease and related dementias (ADRD) affect nearly 6.9 million Americans, with the number expected to triple by 2050, while disease-modifying therapies remain unavailable. Drug repurposing, which identifies new indications for already approved medications, offers a more efficient and cost-effective pathway to accelerate development of effective therapies for ADRD. The aim of this study is to identify potential drug repurposing signals by systematically screening routinely prescribed drugs for associations with progression from mild cognitive impairment (MCI) to ADRD.

METHODS: We conducted a multi-site target trial emulation using electronic health record (EHR) data from four decentralised databases: INSIGHT Clinical Research …

Lidocaine Combined With Low-Dose Esketamine For Movement-Evoked Pain After Hepatectomy: A Double-Blind Randomised Controlled Trial, Yan Xu, Li Zhou, Qianqian Tang, Feng Yu, Jingwen Wu, Siyu Yan, Min Cai, Jialu Wan, Yi Kang, Lajing Luowu, Mengmeng Zhou, Lulong Bo, Daniel I Sessler, Chunling Jiang

Faculty, Staff and Student Publications

Introduction: Pain following hepatectomy may delay recovery and increase opioid use. We tested the primary hypothesis that combining lidocaine and low-dose esketamine would reduce movement-evoked pain 24 h after hepatic resection. We also evaluated whether this approach reduced opioid consumption and improved quality of recovery.

Methods: Patients having elective hepatic resections were allocated randomly to receive lidocaine-esketamine or placebo from induction of anaesthesia until the end of surgery. After surgery, patients allocated to lidocaine-esketamine were given a continuous infusion of lidocaine with esketamine for 72 h. All patients received transversus abdominis plane blocks with ropivacaine 2 mg.kg-1 after induction of …

Hydroxyethyl Starch And Perioperative Complications: A Systematic Review And Meta-Analysis, Daniel I Sessler, Lorenzo Pradelli, Massimiliano Povero, Daniel Chappell, E Wang

Faculty, Staff and Student Publications

Background: Based on renal injury reported in critically ill and septic patients, the U.S. Food and Drug Administration issued a black box warning regarding hydroxyethyl starch (HES 130/0.4) use in 2013 and expanded the warning to surgical and trauma patients in 2021. Similarly, the European Medicines Agency initiated withdrawal of hydroxyethyl starch in 2022. This study was a new meta-analysis focused on renal injury designed to complement a 2021 meta-analysis of perioperative hydroxyethyl starch use, adding 45 trials and 6,895 patients. The focus was acute kidney injury and preoperative-to-postoperative change in creatinine concentration in surgical patients.

Methods: This study searched …

Cardiovascular Disease Incidence And Cancer Risk In Two Large European Prospective Cohorts, Emma Fontvieille, Vivian Viallon, Laia Peruchet-Noray, Quan Gan, N. Charlotte Onland-Moret, Yvonne Koop, Anne Tjønneland, Nicola Bondonno, Verena Katzke, Rudolf Kaaks, Matthias B. Schulze, Catarina Schiborn, Calogero Saieva, Vittorio Simeon, Claudia Agnoli, Rosario Tumino, Fulvio Ricceri, Leila Luján-Barroso, Maria José Sánchez, Conchi Moreno-Iribas, Konstantinos K. Tsilidis, Marc J. Gunter, Adam Butterworth, Elio Riboli, Heinz Freisling, Pietro Ferrari

Research outputs 2022 to 2026

Our study investigated the association between incident cardiovascular disease (CVD) and subsequent cancer risk in two large European prospective cohorts. We included 568,926 adults from the European Prospective Investigation into Cancer and Nutrition and United Kingdom Biobank, all of whom were free of CVD, cancer and type 2 diabetes at baseline. Multivariable Cox proportional hazards regression models were used to estimate cancer hazard ratios (HRs) and 95% confidence intervals (CIs) in relation to incident CVD events. CVD was treated as a time-varying exposure, and models accounted for time since CVD diagnosis and other lifestyle factors. Study-specific estimates were pooled using …

Underfunded And Undervalued: Community-Based Health Promotion Practitioners’ Experiences Of Western Australia’S Prevention Sector, Ruth M. Wallace, Leesa N. Costello, Elizabeth J. Cook

Research outputs 2022 to 2026

Prevention is a central policy focus of contemporary health promotion, offering cost-effective strategies to reduce disease burden and improve population well-being. Despite this, Australia allocates a small proportion of its health budget to prevention, with funding models characterized by short-term cycles and competitive tendering. While the consequences for public health are well documented, the impact on the health promotion workforce remains underexplored. Workforce health and stability are critical for program delivery, ethical practice, continuity of relationships with communities, and the capacity to sustain long-term prevention efforts. This qualitative study examined the experience of 19 community-based health promotion practitioners in Western …

Early Immune Dysregulation In Mtb/Siv Co-Infection Resists Cart Treatment At The Single-Cell Level, Riti Sharan, Yi Zou, Zhao Lai, Korri Weldon, Todd Bradley, Xi Luo, Hulin Wu, Shabaana A Khader, Deepak Kaushal

Faculty, Staff and Student Publications

Using single-cell transcriptomics of bronchoalveolar lavage cells from Mtb/SIV co-infected rhesus macaques on cART, we reveal profound immune dysregulation during early SIV co-infection of latent tuberculosis. SIV induces a sharp decline in CD4+ T cells, NK, and NKT cells, with incomplete recovery of Mtb-specific TH1 effector responses despite viral suppression. Instead, a persistent TH17-skewed environment emerges, alongside sustained myeloid inflammation driven by Type I interferon signaling and pro-inflammatory regulators such as KLF6 and NFKB1. Ligand-receptor network analyses demonstrate expanded CD4+ T cell-macrophage crosstalk and loss of immune homeostasis that cART fails to fully restore. These findings expose …

Navigating The Maternal Health Crisis: Enhancing Maternal Health Outcomes In New Jersey, Nyrobi Barnes

Doctoral Dissertations and Projects

The purpose of the study was to better understand the implications of race and ethnicity on perinatal health experiences and maternal health outcomes in non-Hispanic Black women (nHBw) in New Jersey and mitigate the maternal health crisis. A secondary outcome was to propose an evidence-based initiative to elicit equitable care in New Jersey via grant-funded programs at the New Jersey Department of Health. Although New Jersey has made progress in improving maternal and infant health outcomes, racial disparities continue to persist. The research aims to further understand implications of race and ethnicity on adverse perinatal health experiences and maternal health …

Exploring The Impact Of Spiritual Fitness On Combat Veterans In Their Recovery From Ptsd, Chronic Pain, And Sleep-Related Impairments, Minnette Danielle Sandoval Cornish

Doctoral Dissertations and Projects

The purpose of this phenomenological study was to explore how combat veterans utilize and perceive spiritual practices in their recovery from PTSD chronic pain, and sleep-related impairments (SRIs). Guided by Self-Determination Theory (Deci & Ryan, 2017) the study sought to understand which spiritual practices combat veterans used, how they incorporated the practice into recovery, and how they perceived the impact of those practices in managing their symptoms. Participants included 13 combat veterans who self-identified as using spiritual practices in their recovery from PTSD, chronic pain, and SRIs. Data was collected through semi-structured interviews and a focus group. Interview and focus …

Predictors Of Academic Performance In First-Year Bsn Students: The Role Of Emotional Exhaustion, Alcohol Use, And Resilience, Jennifer Nerius

Doctoral Dissertations and Projects

The first year of nursing school can be academically demanding and emotionally challenging as students adjust to rigorous coursework, clinical expectations, and professional responsibilities. Understanding factors that influence student well-being and academic success is important for supporting students during this transition. The purpose of this quantitative longitudinal correlational study was to examine the relationships among emotional exhaustion, alcohol use, resilience, and academic performance in first-year Bachelor of Science in Nursing (BSN) students. Guided by Resilience Theory, the study explored whether resilience was associated with emotional exhaustion and alcohol use and whether emotional exhaustion, resilience, and alcohol use predicted academic performance. …

Can The Safety Net Support Families Through Childbirth?, Hyojeong Kim, Colleen Heflin, Taryn Morrissey

Center for Policy Research

Childbirth is a life event that often disrupts maternal employment and household earnings just as family expenses increase. In the United States, families do not have access to a national paid parental leave program and must rely on a patchwork of safety net programs that were not designed specifically to support households during pregnancy and the immediate postpartum period. This brief uses linked administrative data from the Virginia Longitudinal Data System (2016–2021) to describe changes in household earnings and social welfare benefits before and after childbirth among low-income mothers receiving the Supplemental Nutrition Assistance Program (SNAP) or Temporary Assistance for …

Implementation Readiness For National Cancer Survivorship Care Standards, Christiane J. El Khoury, Meera Gupta, Maryem Shirzadi, Heidi Dowst, Martha Mims, Maysa Abu-Khalaf, Hoda Badr

Kimmel Cancer Center Faculty Papers

IMPORTANCE: Cancer survivorship care is a growing public health priority, yet delivery remains variable across health systems. The National Standards for Cancer Survivorship Care provide a framework for high-quality care, but little empirical evidence exists regarding health system readiness to implement these standards in routine practice.

OBJECTIVE: To assess implementation readiness for the National Standards for Cancer Survivorship Care and identify perceived barriers to implementation.

DESIGN, SETTING, AND PARTICIPANTS: This real-time Delphi survey study was conducted from January to March 2025 at a National Cancer Institute-designated comprehensive cancer center. Participants were multidisciplinary experts involved in cancer survivorship care delivery, care …

Software Tools And Simulation Exercises For Radiation Oncology Cyber-Attack Resiliency, Yevgeniy Vinogradskiy, James Lamb

Department of Radiation Oncology Faculty Papers

This review summarizes the rationale for radiation oncology cyberattack simulation exercises, recent results from multi-institutional resiliency drills, and the landscape of software tools developed to help clinics resume radiotherapy treatments rapidly and safely during a cyberattack or other major clinical software outage. Simulation exercises using record-and-verify (R&V) downtime and File Mode treatment delivery have identified failure modes not apparent in theoretical planning alone, including risks related to treatment documentation, repeated fractions, patient setup, and missed safety checks. Available software tools emphasize insulated backup of DICOM-format planning data and clinical notes, treatment-state dashboards, File Mode treatments, redundant R&V installations, and human-readable …

Understanding Factors Associated With 911 And 988 Use In Mental Health Crises Original Paper Open Access, Michiko Ueda, Colleen M. Heflin, Yanhong Liu, Qingyi Yu, Seethalakshmi Ramanathan

The Lender Center for Social Justice

The 988 Suicide and Crisis Lifeline was launched in July 2022 as an alternative to 911 for mental health crises. However, little is known about the factors influencing decisions to use 911 or 988 among individuals most likely to benefit from 988, including those with suicidal ideation. This study analyzes individual characteristics associated with the likelihood of calling 911 during a mental health crisis and examines awareness of, willingness to use, and concerns about 988. An anonymous online survey was conducted in early 2024 with 1,894 U.S. adults aged 18–50, oversampling racial minorities. Logistic regression models were estimated for four …

Staff Re-Entry Plan — Indian Trail, Flett, Woodridge, Travis Schulhauser

Spokane Wildfire Academic Consortium Repository

Following the downgrade of Level 3 Evacuation orders at Flett Middle School and Indian Trail and Woodridge elementary schools on Aug. 9, district staff worked with Fulcrum Environmental Consulting to conduct visual inspections and air-quality testing at these sites. More than 100 interior and exterior locations were tested, with indoor air quality within the Good-to-Moderate range under the EPA Air Quality Index. Inspectors also found no indication of unusual ash, soot or other settled particulates inside or outside the buildings.