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Complaints associated with animal feeding facilities as reported to Ohio local health departments, 2006-2008.


Agriculture is an important industry in Ohio, contributing more than $73 billion and comprising 13% of the state's economy. Although the amount of land devoted to agriculture has decreased 3.7% in just five years (U.S. Department of Agriculture-National Agriculture Statistics Survey [USDA-NASS], 2009), the number of animals on Ohio farms has increased by 948,820 animals, nearly a 2% increase (USDA-NASS, 2009). Two types of animal feeding facilities (AFFs) are required to be permitted in Ohio: concentrated animal feeding facilities (CAFFs) and concentrated animal feeding operations (CAFOs).

CAFFs are regulated by the Ohio Department of Agriculture (ODA) due to the confinement of animals for 45 or more consecutive days and are defined by the number, i.e., mega, large, medium, and small, and type of animals housed. All mega and large facilities must obtain permits to install as well as permits to operate. Medium and small facilities could also require a permit if they have been found to discharge pollutants directly into U.S. waters (Ohio Department of Agriculture [ODA], 2007). CAFFs are inspected no less than twice each year by ODA.

CAFOs are regulated by the Ohio Environmental Protection Agency (OEPA). They are similar to CAFFs in that they confine animals for 45 or more days. They are also classified by size and species categories (U.S. Environmental Protection Agency [U.S. EPA], 2011). CAFOs, however, are considered significant contributors of pollutants and are required to obtain a National Pollutant Discharge Elimination Permit (Ohio Department of Natural Resources, ODA, OEPA, Ohio State University Extension, & Ohio Livestock Coalition, 2003). These facilities are inspected by OEPA no less than once every five years.

An AFF can be determined to be a CAFF and thus subject to ODA rules and regulations; a CAFO, which is subject to OEPA rules and regulation; or both a CAFF and a CAFO, which must abide by both ODA and OEPAs rules and regulations. At the time of our study in 2009, Ohio contained 176 ODA-permitted CAFFs, of which seven were also considered a CAFO. Eight additional AFFs were CAFOs only. According to estimates from the Livestock Environmental Permitting Program at ODA, permitted livestock facilities house about 90% of Ohio's layers (i.e., egg-producing poultry) (ODA, 2007). No more than 30% of dairy animals and less than 10% of all other poultry and livestock are housed in permitted facilities.

AFFs of any size can greatly benefit the surrounding community by adding revenue to the local economy and jobs. According to a 2002 survey, in two Ohio counties, Paulding and Van Wert, seven large dairies contributed 83 jobs and $23 million to the local economy, purchased the majority of their corn and all of their silage from local farming operations, and signed tax increments to contribute to the local economy (Roe et al., 2004).

Although livestock production is important to the Ohio economy, AFFs are a controversial topic. Many nearby residents fear the health and nuisance implications of these facilities. One concern pertains to the increased potential for zoonotic disease (Cole, Todd, & Wing, 2000; Iowa State University, 2002; Saenz, Hethcote, & Grey, 2002). Another concern is water contamination. It has been shown that overflow from manure lagoons and manure runoff from fields can result in fish kills (Ohio History Central, 2005; U.S. EPA, 2009). Air contamination and odor are also potential issues. Residents who live near an AFF can be at increased risk for headaches, wheezing, coughing, and other respiratory issues (Cole et al., 2000; Donham et al., 2007; Sigurdarson & Kline, 2006; Villeneuve, Ali, Challacombe, & Hebert, 2009; Wing & Wolf, 2000). These symptoms were reported as being much more severe than those who did not live near an AFF (Wing & Wolf, 2000). Noise is also a common concern (Smith, 2004).

To determine if any factual basis exists for these concerns in the state, the Ohio Department of Health's Zoonotic Disease Program conducted a survey to identify the most common nuisance and health complaints reported to local health departments. Special attention was given to the characteristics of the complaints by size and type of operation, source of the complaint, and if the issue was resolved. In particular, we wanted to determine if any adverse health events were associated with a resident living near an AFF. To provide a broader perspective, information was collected not just about permitted and nonpermitted livestock feeding facilities, but about nonlivestock AFF complaints as well.

Materials and Methods

Survey Development

A questionnaire was developed to quantify and qualify the complaints regarding AFFs for the years 2006-2008. The survey instrument was developed with the assistance of the Ohio Department of Health, ODA, OEPA, and The Ohio State University's Veterinary Public Health Program. The 52-item questionnaire queried the local health departments about complaints for the aforementioned years and collected more specific details associated with complaints that occurred during 2008 only. Definitions specific to this survey were also developed for various types of AFFs and types of complaints. The definitions can be found in Table 1.

Survey Dissemination

The questions were entered into the online survey Web site Survey Monkey. An e-mail explaining the objectives and purpose of our study was sent to the health commissioner of all 130 local health departments in Ohio as of April 20, 2009. Attached to the e-mail were the survey definitions and instructions, a link to the survey, and a printable copy of the questionnaire. The health commissioner was asked to either complete the questionnaire or forward it to the appropriate person within their department. Data collection took place between April 20, 2009, and June 15, 2009.

Data Collection and Analysis

All data were imported into a Microsoft Excel spreadsheet. Information was organized based on item, response, and local health department to allow comparisons between counties. Information from other sources, such as county and farm demographics, were also entered into the spreadsheet. Four local health departments were contacted to obtain further information about health complaints they received to ascertain if they appeared to be valid or were medically confirmed.

A formal statistical analysis was not conducted because the data were primarily descriptive and a statistical model such as ANOVA would not be particularly informative. In addition, accurate denominators for the number of nonpermitted AFFs in Ohio were not available.


General Information From 2006 to 2008

A response rate of 96.9% was achieved. Among the local health departments who did not respond, all were city health departments and none had CAFFs or CAFOs in their jurisdiction.

The local health departments were asked if they had received any nuisance or health complaints for 2006-2008. Most local health departments (67% [84/125]) reported that they received no complaints about AFFs during 2006-2008. Many of these local health departments were those located in cities or urban areas. No further information was obtained from these 84 local health departments.

Almost 30% (37/125) of local health departments reported having received at least one nuisance or health complaint and 3.2% (4/125) reported having received both a nuisance and health complaint. Local health departments were also asked to report whether or not the health complaints they had received could be validated. The definition of "valid" was left to the discretion of the local health department. The majority of local health departments, 81% (33/41), reported that they had not received valid health complaints for the years 2006-2008. Two local health departments (4.9%, 2/41) reported having received at least one valid health complaint during 2006-2008 and the remaining six local health departments (15%, 6/41) indicated that they were not aware if their local health department received any valid health complaints.

To determine which complaints were most common, local health departments that received complaints were asked to estimate the average number of complaints received each year for the period 2006-2008 (Table 2). Thirty-eight local health departments responded to this section of the questionnaire. The most common complaints reported were odors, with 79% (30/38) of local health departments having received between one and nine odor complaints and 7.9% (3/38) of local health departments having 10 or more odor complaints each year. Complaints relating to manure storage and field application were also common, with 76% (29/38) of local health departments reporting having received between one and nine complaints. Eight percent (3/38) received 10 or more complaints per year.

According to almost half of the local health departments (47%, 18/38), dead animal complaints were the easiest to resolve, with only 5.3% (2/38) of local health departments reporting that these complaints were difficult to resolve. Odor complaints were the most difficult complaints to resolve with 53% (20/38) of local health departments choosing this option.

The local health departments who reported a complaint were asked if the complaints were from residents who recently moved near an existing AFF Thirty-six percent (15/41) reported that the complaints were from residents who had lived near a facility for at least two years while 20% (8/41) reported that most complaints were from residents who lived near an existing facility for less than two years.

Detailed Complaints for 2008

Local health departments were asked to report detailed information about each complaint that was received by their office for 2008 only. They were asked to report the month of the complaint, the complaint source, the production type and facility type of the AFF involved, the cause or nature of the complaint, the issue or impact of the complaint, and the outcome of the complaint. In total, 70 complaints were received by 18 local health departments in 2008.

The most common month for receipt of a complaint was April, accounting for 21% (15/70) of the complaints, followed by August, with 11% (8/70) of the complaints. Residents living adjacent to an AFF accounted for over half (53% [37/70]) of the complaints, followed by other community members who reported 19% (13/70) of the complaints.

The facility type that garnered the most complaints were other animal feeding facilities (OAFFs), with 34% (24/70) of the total. This was followed by nonpermitted CAFFs (13%, 9/70), permitted CAFFs (8.6%, 6/70), and pastured, nonconfined animals (4.3%, 3/70). CAFOs were not the target of any complaints reported to local health departments. The facility type was unknown in 40% (28/70) of the complaints. Of the six complaints about permitted CAFFs in 2008, 33% (2/6) were found not to be a nuisance or health risk. Similarly, 33% (2/6) were corrected after local health department intervention. One out of six (1.7%) of the complaints were corrected when referred to another agency and another 1.7% (1/6) resolved complaints on their own without any local health department intervention.

The production types that received the most complaints were swine facilities with 14% (10/70) of complaints and commercial dog kennels with 8.6% (6/70) of complaints. These were followed by bovine-dairy and poultry-layer (7.1% each, 5/70), poultry-broiler (5.7%, 4/70), bovine-beef and sheep and goats (2.9% each, 2/70), and zoo animals (1.4%, 1/70). Unknown production types accounted for 10% (7/70) of complaints. In 40% (28/70) of the complaints, the production type was not assessed or provided by the local health department.

When evaluating the most common cause of a complaint, live animals and solid manure were cited most often with each receiving 14% (10/70) of complaints. These were followed by complaints about liquid manure and dead animals with 12% (8/70) of complaints each, flies (7.1%, 5/70), unknown causes (4.3%, 3/70), other causes not listed (2.9%, 2/70), and barns and buildings (1.4%, 1/70). Pastured animals, processing and rendering, other vectors, rodents, and vehicles were not reported by any local health departments.

The most common reason for a complaint was air quality or odor outside the home, accounting for 57% (40/70) of complaints. Surface water contamination was the second most common issue, generating 11% (8/70) of the complaints, followed by nonspecific pollution (7.1%, 5/70), air quality and odor inside the home, unknown reasons (4.3% each, 3/70), and quality of life and other reasons not listed (2.9% each, 2/70). Human illness, animal illness, animal neglect, noise, property value, soil contamination, and groundwater contamination were each mentioned once (1.4%). Community illness, property damage, and wildlife issues were not deemed by any local health departments as a reason for a complaint.

Because odor was the most common complaint, this was examined in more detail. Forty-three local health departments reported that odor complaints occurred during 2008. Of these, swine facilities were most often identified as the source (14%, 6/43), followed by commercial dog kennels (9.3%, 4/43). "Other" production types not listed were the subject of 42% (18/43) of the complaints.

Regarding facility types, OAFFs received the most odor complaints with 28% (12/43) of the complaints, followed by nonpermitted facilities with 16% (7/43) of the complaints. Permitted CAFFs and pastured animals accounted for 4.7% (2/43) of the complaints each. The most common month for odor complaints was August with 19% (8/43) of the complaints, followed by April (16% [7/43]).

Four of the complaints were about an adverse health event. On further investigation of the health complaint, two local health departments reported that the health complaints were not valid and one local health department reported that the complaints were against a proposed but not an existing facility. The fourth local health department reported in error as on review no health complaints associated with an AFF were logged for 2008. Therefore no complaints about adverse health events were associated with an AFF validated by local health departments in 2008 as reported in our study.

The most common outcome was that the targeted facility corrected the reason for the complaint following local health department investigation. This occurred for 41% (29/70) of the complaints. The second most common outcome was that the situation was determined to not be a nuisance or health complaint and therefore required no local health department intervention (29%, 20/70). Seven complaints (10%, 7/70) were referred to another agency such as the Soil and Water Conservation District, the local extension office, or other applicable agencies and were then resolved. In five instances each (7.1%) the situation resolved without local health department intervention or the outcome was unknown. The situation continued to be an ongoing issue in four instances (5.7%).


A multitude of studies have been conducted about environmental and health issues associated with AFFs (Cole et al., 2000; Donham et al., 2007; Sigurdarson & Kline, 2006; Villeneuve et al., 2009). Public concerns about adverse health and environmental hazards have heightened as farms have become larger and animals more concentrated. Our survey was the first in Ohio to identify and quantify nuisance and health complaints associated with AFFs. All sizes and species of animal facilities were included so a comparison could be made to determine if larger livestock confinement operations generate more health and nuisance complaints than other facilities. Local health departments were chosen because their jurisdictions cover the entire state and they are mandated to address all types of nuisance complaints. Local health departments are frequently contacted by residents with environmental or health complaints. They also have trained and registered sanitarians who have the expertise to investigate and validate health and environmental impacts. Ohio is an ideal state to perform such a survey since it is diverse, containing both highly urban and agricultural areas with many areas of overlap.

An important finding from the survey was that during 2006 to 2008 local health departments reported few valid adverse human health events associated with any AFF Environmental nuisance events, though, were reported. Complaints about odors, manure storage and application, and dead animals were most frequently reported to local health departments. This was followed by surface water pollution and increased fly and insect populations. All such events do have the potential to result in an adverse human health event. To prevent a nuisance from becoming an adverse health event or environmental hazard, a mechanism for investigation and abatement actions, when necessary, will continue to be warranted.

The survey also showed that permitted facilities (either CAFFs or CAFOs) in Ohio were not the major contributors of health or nuisance complaints received by local health departments. More complaints were associated with nonpermitted or nonlivestock AFFs. By contrast, only 184 permitted CAFFs and CAFOs are present in Ohio and they house only a fraction of Ohio's total livestock population other than poultry layers. Therefore, it is difficult to compare the relative proportion of complaints between permitted and nonpermitted AFFs without having denominators for the number of facilities and animals in nonpermitted facilities. Also, absolute numbers do not take into account the impact of an event. CAFOs and CAFFs by virtue of size may have a greater potential to negatively impact the health and quality of life of residents living around them. This is well recognized by the agriculture industry. Permitted facilities are required to have plans to minimize environmental nuisance issues and they are inspected regularly to ensure that plans are being followed. Voluntary standards, recommendations, and planning tools to address manure, vectors, and air quality have been suggested for nonpermitted production facilities (Iowa State University, 2007) as well.

Our survey also challenged a commonly held belief that the people who were most likely to complain were people who recently moved into agricultural areas. The findings of our survey suggest that this was not the case as residents who lived near a facility more than two years registered twice as many complaints as those who lived there less than two years. The more detailed survey of complaints in 2008 found that residents living adjacent or within one-half mile of the facility were more likely to register a complaint than any outside entity.

Although the ranking of complaint by issue was slightly different in the 2008 survey than the three-year survey, air quality and odor, water contamination, and manure continued to be primary concerns. Swine operations generated the most complaints, followed closely by commercial dog kennels, and less frequently, by dairy and poultry-layer operations. That the number of complaints from commercial dog kennels was second only to swine operations was a novel observation. It suggests that focusing only on complaints associated with livestock feeding facilities may lack perspective as OAFFs may also be responsible for causing nuisance and health complaints in Ohio. A seasonal peak of complaints occurred in April followed by August, which were likely associated with key months for land application of livestock manure and other agricultural activities.

Our study had several limitations. This was a retrospective survey and many local health departments did not keep information on all aspects of nuisance complaints and their information was not organized for easy retrieval. As a result, many "unknown" and "other" responses were encountered. In particular, in the 2008 survey, 40% of the nuisances were listed as "other" under species-based production types. A more exhaustive listing is needed to identify what production facilities were missed. In particular, equine facilities should have been an option. Also, a prospective study would have yielded much better information because local health departments would have known what data to collect.

Although the local health department response rate was high, it was found that other agencies, such as the Soil and Water Conservation District, the local extension office, or Department of Agriculture also receive and respond to complaints about AFFs. It was noted in the analysis that many local health departments automatically refer agricultural complaints to another agency (or other applicable agencies) and thus did not include the complaint in their nuisance logs. Therefore, the number of actual complaints received throughout Ohio is probably much higher than reported here. A more comprehensive picture of the quantification of nuisance and health complaints would require merging local health department complaints with reports from other agencies. To improve response, identify trends, and avoid duplication of efforts, Ohio could create and maintain a centralized database reporting system. Although such a database would be valuable for all involved parties, the costs of the program may be prohibitive.


Overall, the results of this survey show that local health departments do receive health and nuisance complaints regarding AFFs. Our study showed that larger permitted facilities, often referred to as "mega farms," are not responsible for the majority of these complaints. Local health departments could not confirm adverse human health events associated with living near an AFF in 2008. Most nuisance complaints are resolved with local health department or some other agency intervention. A future prospective survey of local health departments, with modifications of the survey tool, could better compare health and nuisance complaints between permitted and nonpermitted livestock facilities and compare complaints between livestock and nonlivestock facilities.

Acknowledgements: We would like to thank the following staff from the ODA: Mr. Kevin Elder, director of ODA's Livestock Environmental Permitting Program for his assistance in understanding the farm permitting process; and both Beverly Byrum, DVM, PhD, director of the Animal Disease and Diagnostic Laboratory, and Tony Forshey, DVM, state veterinarian, Animal Industry, for their input into developing the survey tool.

Corresponding Author: Kathleen Smith, State Public Health Veterinarian, 8995 E. Main St., Building 22, Reynoldsburg, OH 43068. E-mail:


Cole, D., Todd, L., & Wing, S. (2000). Concentrated swine feeding operations and public health: A review of occupational and community health effects. Environmental Health Perspectives, 108(8), 685-699.

Donham, K., Wing, S., Osterberg, D., Flora, J.L., Hodne, C., & Thu, K.M. (2007). Community health and socioeconomic issues surrounding concentrated animal feeding operations. Environmental Health Perspectives, 115(2), 317-320.

Iowa State University. (2007). Air management practices assessment tool. Retrieved from practices/homepage.html

Ohio Department of Agriculture. (2005). Fact sheet: Concentrated animal feeding facility size changed from animal unit definition to small, medium, large, and major. Reynoldsburg, Ohio: Author.

Ohio Department of Agriculture. (2007). Fact sheet: Livestock environmental permitting program. Reynoldsburg, Ohio: Author.

Ohio Department of Natural Resources, Ohio Department of Agriculture, Ohio Environmental Protection Agency, Ohio State University Extension, & Ohio Livestock Coalition (Eds.). (2003). Guidelines for livestock operations. Reynoldsburg, Ohio: Ohio Department of Agriculture.

Ohio History Central, Ohio Historical Society. (2005). Buckeye egg farm. Retrieved from php?rec=1672

Roe, B.E., Bowen, N., Kleinschmidt, A., Heffelfinger, K., Davis, G.A., Fleming, R.D., Langham, T., Lopshire, J.N., & Stockman, M. (2004). Economic and fiscal impacts: A case study of seven recently constructed dairies in Van Wert County and Paulding County, Ohio, 2004. Retrieved from

Saenz, R.A., Hethcote, H.W., & Grey, G.C. (2006). Confined animal feeding operations as amplifiers of influenza. Vector Borne Zoonotic Diseases, 6(4), 338-346.

Sigurdarson, S.T., & Kline, J.N. (2006). School proximity to concentrated animal feeding operations and prevalence of asthma in students. Chest--Official Publication of the American College of Chest Physicians, 129(6), 1486-1491.

Smith, D. (2004). Hearing loss protection for agricultural workers. AgriLife Extension, Texas A&M System. Retrieved from http:// HEARING-LOSS-PROTECTION3.pdf

U.S. Department of Agriculture-National Agriculture Statistics Survey. (2009). 2007 census of agriculture (Vol. 1). Retrieved from

U.S. Environmental Protection Agency. (2009). Potential environmental impacts of animal feeding operations. Retrieved from http://

U.S. Environmental Protection Agency. (2011). Regulatory definitions of large CAFOs, medium CAFOs, and small CAFOs. Retrieved from

Villeneuve, P., Ali, A., Challacombe, L., & Hebert, S. (2009). Intensive hog farming operations and self-reported health among nearby rural residents in Ottawa, Canada. BMC Public Health, 9, 330.

Wing, S., & Wolf, S. (2000). Intensive livestock operations, health, and quality of life among eastern North Carolina residents. Environmental Health Perspectives, 108(3), 233-238.

Sara M. Morrow, MPH-VPH

College of Public Health

The Ohio State University

Jeanette O'Quin, MPH-VPH, DVM

College of Veterinary Medicine

The Ohio State University

Armando E. Hoet, DVM, PhD, DACVPM

College of Veterinary Medicine

College of Public Health

The Ohio State University

J. R. Wilkins III, DrPH

College of Public Health

The Ohio State University

Fred DeGraves, DVM, PhD

Ogden College of Science

and Engineering

Western Kentucky University

Kathleen A. Smith, MPH, DVM, RS

Zoonotic Disease Program

Ohio Department of Health
Table 1

Definitions Established for 2006-2008 Animal Feeding Facility Survey

Affirmation Definition

Animal feeding facility Any operation that raises animals,
 (AFF) regardless of size and means of
 confinement, for food or fiber
Concentrated animal AFF that is regulated by the Ohio
 feeding operation (CAFO) Environmental Protection Agency and is
 required to have a National Pollutant
 Discharge Elimination Permit due to the
 discharge of pollutants into U.S.
 waters and the confinement of animals
 (Ohio Department of Agriculture [ODA],
Concentrated animal AFF that is regulated by the Ohio
 feeding facility (CAFF) Department of Agriculture and is
 required to obtain a permit to install
 and operate due to the confinement of
 animals (ODA, 2005)
Nonpermitted concentrated AFF that confines 25 or more adult
 animal feeding facility animals but that does not require a
 permit to operate due to not meeting
 the requirements for a CAFO or CAFF
Other animal feeding AFF that houses fewer than 25 animals
 facility but that is not considered a
 recreational farming operation
Confined/confinement Housing animals for 45 days or more in
 a 12-month period; the ground the
 animals are housed on is not used to
 grow any type of vegetation during the
 normal growing season (ODA, 2005)
Nuisance complaint Any complaint against any AFF that does
 not immediately involve a threat to
 human health
Health complaint Any complaint against any AFF that does
 immediately involve a threat to human
Production type Bovine-beef, bovine-dairy,
 poultry-broilers, poultry-layers,
 poultry-turkeys, sheep/goats, swine,
 kennel (dog, commercial), deer
 (farmed), ducks/geese, exotic/zoo,
 wildlife, other animal facility not
 listed, unknown

Table 2

Number of Complaints Per Year and Ease of Resolution of Complaints
Regarding Any Animal Feeding Facility as reported by 38 Ohio Local
Health Departments for 2006-2008

Complaint Average Number of Complaints Per Year

 [greater than 1-9 None
 or equal to]10

Odors 7.9% (3) 78.9% (30) 13.2% (5)
Manure application/storage 7.9% (3) 76.3% (29) 15.8% (6)
Dead animals 0% (0) 76.3% (29) 23.7% (9)
Surface water pollution 0% (0) 71.1% (27) 28.9% (11)
Increase in fly and 2.6% (1) 65.8% (25) 31.6% (12)
 insect population
Air quality 0% (0) 52.6% (20) 47.4% (18)
Well water contamination 0% (0) 44.7% (17) 55.3% (21)
Respiratory illness in 0% (0) 15.8% (6) 84.2% (32)
Nonrespiratory illness 0% (0) 13.2% (5) 86.8% (33)
 in humans

Complaint Ease of Resolution

 Neutral Very Easy Easy

Odors 0% (0) 15.8% (6)
Manure application/storage 15.8% (6) 0% (0) 28.9% (11)
Dead animals 23.7% (9) 0% (0) 47.4% (18)
Surface water pollution 23.7% (9) 0% (0) 23.7% (9)
Increase in fly and 31.6% (12) 0% (0) 18.4% (7)
 insect population 23.7% (9)
Air quality 0% (0) 7.9% (3)
Well water contamination 18.4% (7) 0% (0) 18.4% (7)
Respiratory illness in 10.5% (4) 5.3% (2) 0% (0)
 humans 7.9% (3)
Nonrespiratory illness 5.3% (2) 0% (0)
 in humans 5.3% (2)

Complaint Ease of Resolution

 Difficult Very N/A

Odors 39.5% (15) 13.2% (5) 15.8% (6)
Manure application/storage 23.7% (9) 7.9% (3) 15.8% (6)
Dead animals 5.3% (2) 0% (0) 23.7% (9)
Surface water pollution 10.5% (4) 5.3% (2) 28.9% (11)
Increase in fly and 21.2% (8) 5.3% (2) 31.6% (12)
 insect population
Air quality 18.4% (7) 10.5% (4) 44.7% (17)
Well water contamination 10.5% (4) 2.6% (1) 57.9% (22)
Respiratory illness in 2.6% (1) 5.3% (2) 78.9% (30)
Nonrespiratory illness 5.3% (2) 5.3% (2) 78.9% (30)
 in humans
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Article Details
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Author:Morrow, Sara M.; O'Quin, Jeanette; Hoet, Armando E.; Wilkins, J.R., III; DeGraves, Fred; Smith, Kath
Publication:Journal of Environmental Health
Article Type:Report
Geographic Code:1U3OH
Date:May 1, 2013
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