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Job satisfaction and issues related to the retention of environmental health professionals in North Carolina.



Job satisfaction of environmental health professionals is a scarcely studied construct but is becoming more critical as baby boomer retirements loom and professionals change jobs to more lucrative private practice (Piroanac, 1991). In the local health departments of North Carolina, an environmental health specialist (EHS) (also known as a registered sanitarian) is required to have a bachelor's degree from a university or college with 30 credit hours of science. After being hired at a local health department, the EHS "intern" must complete a five-week hands-on course, Centralized Intern Training, followed by a period of supervised orientation in the local health department. He or she must pass a three-part exam (NEHA, oral, and written) administered by the North Carolina Board of Sanitarians to become a registered sanitarian and practice independently.

In North Carolina and other states across the country, recruitment and retention of environmental health professionals are critical issues. In order to address these issues, we investigated factors such as salary, job satisfaction, and intention to stay in current position.

Job satisfaction can be defined as "the favorableness or unfavorableness with which employees view their work (Castle, 2006)." Lambeth (1987) was first to report on the job satisfaction of public health sanitarians (also known as environmental health specialists or registered sanitarians). Lambeth studied sanitarians in six southern states, both in 1980 and 1985, using the Job Descriptive Index developed by Smith, Kendall, and Hulin (1969). In both of Lambeth's survey administrations, respondents' average job satisfaction level was approximately 70%, on a scale of 0%-100%. When satisfaction was evaluated by individual elements, 71% of respondents indicated they received low pay, 57% received inadequate pay, 73% saw limited opportunity for advancement, and 83% thought their opportunities were limited.

Lambeth (1987) also indicated job satisfaction increased as sanitarians aged; however, no statistical test was identified to substantiate this. Job satisfaction has generally been found to correlate with age (Blegen 8r Mueller, 1987; Oleckno & Blacconiere, 1993; Peterson ACT Wilson, 1996; Price, 2002) although some studies have not demonstrated this relationship (Adams & Bond, 2000; Mclaney & Hurrell, 1988; Oleckno & Blacconiere, 1987). Older workers may find more satisfaction in their jobs than younger workers as they have more experience and know better the type of work that is suitable for them. The changing nature of work may contribute to inconsistent study findings, as well as a lack of unified instruments or constructs to understand job satisfaction within the discipline.

In a 1986 mail survey of county environmental health practitioners in Illinois, 64% indicated they were somewhat to very dissatisfied (Oleckno & Blacconiere, 1987). The Occupational Needs Questionnaire (ON-Q) was used to determine level of dissatisfaction (Berger, 1983). Dissatisfaction with the opportunities for advancement and ability to earn a comfortable living were cited when subscale means were calculated. Respondents who were members of multiple professional associations outside of work were more satisfied than those who were not (eta = 0.025, p < .05). In addition, those with supervisory roles were more satisfied (eta = 0.23, p < .05). Although statistical significance was not demonstrated, Oleckno and Blacconiere (1987) indicated gender disparity in salary. No females earned an annual salary of greater than $26,000, while 29% of male respondents did. Further, 82.9% of females earned less than $18,000, while only 23.1% of men did. Job satisfaction was not found to increase with salary or age in this study.

Oleckno and Blacconiere (1993) completed a similar study using the ON-Q with a different study population: a large, diversified county health department in the southwestern U.S. Thirty-five percent of respondents indicated they had mild to moderate job dissatisfaction. In this health department, the most dissatisfying aspects of the job were the inability to earn a comfortable living and a sense of organizational inefficiency. Job satisfaction was not correlated with salary or age in this study; however, a significant correlation was found for professionals with more years on the job being less satisfied (eta = 0.210, p = .04). Further, backward multiple regression analysis indicated that area of job responsibility, level of educational attainment, and age were predictors of job satisfaction. Similar to previous studies (Lambeth, 1987; Oleckno & Blacconiere, 1987), financial compensation was an area of dissatisfaction.

An additional follow-up study was completed using the ON-Q of environmental health professionals from a southern California health department and nine county health departments in northern Illinois (Oleckno, 1995). Thirty-five percent of the southern California cohort and 33.3% of the Illinois cohort indicated mild to moderate job dissatisfaction. For both cohorts, the inability to earn a comfortable living was cited as a reason for dissatisfaction. For the Illinois cohort, having more years on the job was negatively correlated with satisfaction (eta = 0.04, p > .05). This was not a statistically significant correlation for the California cohort.

In order to document support for increased salaries of environmental health professionals, Lawson and Ferng (1997) conducted a study in an Indiana county to determine taxpayer support. Approximately 72% of the respondents supported salary levels above the current pay range, and females and those with higher educational levels were more likely to support a pay increase for EHS.

In summary, salary and limited opportunities for career advancement were identified as areas of dissatisfaction for environmental health professionals (Lambeth, 1986; Oleckno & Blacconiere, 1987; Oleckno & Blacconiere, 1993).


Several instruments are available that attempt to measure job satisfaction. Among them are the Job Description Index, the revised Index of Work Satisfaction, ON-Q, and the Measure of Job Satisfaction (Castle, 2006). Questions from these instruments along with review by professionals in the field and expertise of the authors led to the final survey instrument for the study described here. Questions on the instrument included demographics, education, centralized intern training, salary, intentions to leave the job, and importance and satisfaction measures.

In order to assure anonymity in aggregate data, 10 North Carolina regional groupings were used rather than county level data (Table 1). The study population included all environmental health supervisors and specialists currently employed in a county health department in North Carolina. The survey instrument was emailed to environmental health supervisors in all counties in the state; the supervisors then distributed the survey to specialists. The survey was administered using Ultimate Survey, an online survey tool. Paper copies of the survey were also given to those who preferred a hard copy. Statistical analysis was completed using SPSS Version 13 for Windows and included frequencies and descriptive statistics, correlation, and analysis of variance.


The results of survey administration are compiled in this section according to demographics, salary, retention, and satisfaction.


At the time of the survey, local North Carolina health departments employed 887 registered sanitarians (RS) and RS interns (RSI). The survey was made available in April and May 2007. The overall response rate was 49% (N = 433) with regional response rates varying from 23% (Region 2) to almost 78% (Region 10). Of the respondents, 79% hold the registered sanitarian certification and 21% are registered sanitarian interns. Table 2 describes the number and gender of respondents by region.

As described in Table 3, over half of the respondents have worked 10 years or less, with the greatest percentage having 5 years or less experience in the field.

In order to become a registered sanitarian in North Carolina, a bachelor's degree with at least 30 credit hours of physical or biological science is required. The majority of respondents (33%) reported an undergraduate degree in biology; only 21% had an undergraduate degree specifically in environmental health, with the rest of the respondents reporting degrees in physical and earth sciences and other majors. The majority of respondents (73%) did not have a graduate degree, although 16% had some work towards a master's degree and some respondents either had a master's in science (6.4%), a master's in a nonscience field (3.7%), or a doctorate (0.5%).

Onsite wastewater protection (38.2%), food and lodging inspections (33.4%), and environmental health supervisor (17.1%) were the most frequently cited primary job duties.


The salary of environmental health specialists is grouped by years of practice in Table 4. The median aggregate salary for environmental health supervisors was $52,500-$54,999 with a range from less than $25,000 to $87,500-$87,999; further breakdown of this cohort is not possible while maintaining anonymity.

Respondents were also asked what they would consider an adequate salary for an environmental health specialist with five years of experience. Table 5 describes the perceived adequate salary and actual salaries for environmental health specialists with 0-5 and 6-10 years of experience.

In an analysis of salary by gender, two significant differences were identified. When restricted to 11-15 years of practice, there was a significant difference in salary by gender (t = 2.201, p = .049); the mean salary range for males was $47,500-$49,999 and the mean salary range for females was $40,000-$42,499. When restricted to 1620 years of practice, there was a significant difference in salary by gender (t = 2.207, p = .05); the mean salary range for males was $50,000-$52,499 and the mean salary range females was $45,000-$47,499. Differences in salary by gender and specific regions were not calculated due to small sample size.


Retention was first addressed by asking respondents their reasons for working at their current job; respondents checked all reasons from a predetermined list. The top five reasons for both supervisors and specialists are seen in Table 6.

Respondents were also asked the length of time they intended to stay in environmental health as a career, in their current program area, and in their current geographic location; results are shown in Table 7.

After each intention question from Table 7, respondents were asked to identify reasons for leaving. The responses for each were similar and are grouped in Table 8.


In order to determine factors that were fundamental to environmental health professionals, 49 items addressed importance and 46 parallel items addressed the satisfaction of environmental health professionals. For both the importance and satisfaction, items were grouped into one of the following categories: salary/benefits, supervisor, policy/procedure, working with public, geographic location, work environment and training/education. Reliability of the category scales was determined acceptable if Cronbach's alpha was greater than 0.7 (McMillan, 2004); all scales except satisfaction: salary benefits (a = 0.670) and policy procedures (a 0.647) met this criterion, as seen in Table 9. Table 10 provides the mean and standard deviation of the grouped categories, by supervisor and specialist. The respondents answered using a Likert scale such that 1 = strongly disagree, 2 = disagree, 3 = neutral, 4 = agree, and 5 = strongly agree.

An independent t-test was administered to determine if supervisors found different factors important or satisfying than specialists. Two comparisons were significant: satisfaction of training/education (t = 2.291, p = .025) and satisfaction of work environment (t = 2.329, p = .021). In both cases, supervisors were more satisfied than specialists.

An analysis of variance was completed to determine if aggregate specialist satisfaction data was different by region (Table 11); no results were statistically significant. When analyzing individual satisfaction questions, the following demonstrated significant differences between regions: I believe my salary is appropriate for my workload and job responsibilities (F = 2.403, p = .012) and I am satisfied with my opportunities for promotion (F = 2.083, p = .030). Region 3 had the highest salary satisfaction (3 = neutral on the Likert Scale), and Region 7 had the lowest (2.22--disagree). Region 8 had the highest promotion satisfaction (3.58--neutral) and Region 5 had the lowest (2.69--neutral).

When overall satisfaction was correlated with salary, a positive significant association was found (Pearson correlation coefficient = 0.095, p = .049); those with higher salaries were more satisfied with their job overall. Overall satisfaction was not significantly correlated with age, gender, or years of practice.



In terms of the male to female ratio, North Carolina (65/35) is similar to national data (66/33) provided by NEHA (2002) in their 2002 Nationwide Salary & Benefits Survey of Local/County Environmental Health Professionals. Greater discrepancy was seen in the number of years working in the discipline nationally (23%) and in North Carolina (33%) for those with less than five years' experience. Further, nationally, 24% have worked in the discipline for greater than 20 years (NEHA, 2002), while in North Carolina, this number is 20%. Only 21% of respondents have a degree from an environmental health program, indicating a need for recruiting at the high school and college level. Further, approximately 10% have a graduate degree; the lack of advanced degree attainment may hamper promotion and career development. In North Carolina, limited options are available for graduate study in environmental or public health and even fewer options are available in distance learning to allow professionals an opportunity to pursue a graduate degree while working full time.


The analyses of salary revealed two interesting findings: adequate pay and gender differences. Respondents were asked to indicate an adequate salary for someone with five years of experience; only four of ten regions (4, 5, 7, and 8) actually paid this amount for those with 6-10 years of experience. In general, these four regions represent the middle of the state (which is more populous). This is similar to national statistics; NEHA (2002) reported that environmental health professionals working in areas with greater than one million people earn 29%-50% more than those environmental health professionals working in areas with less than 50,000 residents. It is difficult for smaller health departments to recruit and retain employees with an inherently lower pay scale with few other incentives available for employees.

Female environmental health professionals with 11-20 years of experience earned significantly less than men. Olencko and Blacconiere (1987) also found women earned less than men and attributed it to the fact that women were new to the field. It seems women in this cohort have not attained equitable compensation yet, although those newer to the field are paid more equitably.


In North Carolina health departments, 28% of supervisors and 38% of specialists do not intend to make environmental health their career. The most commonly cited reasons were lack of career advancement opportunities and poor or inadequate salary. These results were similar to those reported by Lambeth (1987) in his 1980 survey: the majority of respondents indicated they were inadequately paid (57%) and received low pay (71%), and were not being paid what they felt they deserved (60%). Further, Lambeth reported that 73% felt limited opportunities for advancement were available and 83% felt opportunities were limited. In 1980, the role of environmental health professionals was expanding (e.g., hazardous waste, air quality) and science degrees were becoming required. These factors are now common to environmental health professionals, yet their concerns with salary and career advancement are still unfulfilled. In North Carolina, few job titles (promotions) can be attained by an environmental health professional, and once the RS designation is attained, no further professional recognition occurs.


Further supporting the retention issue of salary, when evaluating factors related to satisfaction, salary was the lowest mean for both supervisors (3.17) and specialists (3.12) as seen in Table 10. Supervisors were more satisfied with their training/education and work environment than specialists, similar to Oleckno and Blacconiere (1987), who found supervisors were more satisfied overall. Supervisor satisfaction could result from increased control of job factors. Although adequate salary and ability of county to pay differed by region, overall satisfaction did not. The items that revealed significant differences among regions were salary and opportunities for promotion. This quantitative data supports the qualitative reasons cited by EHS for wanting the leave the career, program, and geographic area.

The issues of inadequate pay and promotion were analyzed according to region. No region received a mean score indicating agreement that they were satisfied with pay or promotion opportunities. Regional scores were significantly different, indicating different strategies may need to be employed in rural versus metropolitan areas.

It was also determined that those with higher salaries were more satisfied with their job overall. Although salary is a difficult issue in state- or county-funded health departments, it appears to be the most telling sign of job retention and satisfaction.

Acknowledgements: The authors wish to acknowledge the assistance of Melissa Harrison for her initial research and administration of the survey instrument. The Northwest Partnership for Public Health is a collaborative organization of public health agencies supported by the N.C. General Assembly and the following North Carolina counties: Alleghany, Ashe, Davidson, Davie, Forsyth, Stokes, Surry, Watauga, Wilkes, and Yadkin. The Northwest Partnership was responsible for making this project possible.


Adams, A., & Bond, S. (2000). Hospital nurses' job satisfaction, individual and organizational characteristics. Journal of Advanced Nursing, 32(3), 536-543.

Berger, P (1983). Occupational needs questionnaire: An instrument to measure job satisfaction. Unpublished doctoral dissertation, Northern Illinois University.

Blegen, M.A., & Mueller, C.W (1987). Nurses' job satisfaction: A longitudinal analysis. Research in Nursing & Health, 10(4), 227-237.

Castle, N.G. (2006). An instrument to measure job satisfaction of nursing home administrators. BMC Medical Research Methodology, 6, 47. Retrieved October 15, 2007, from

Lambeth, J.D. (1987). A study of the job satisfaction of public health sanitarians in six southern states. Journal of Environmental Health, 49(5), 270-273.

Lawson, J., & Ferng, S. (1997). Taxpayers' attitudes toward local environmental health specialists: Salary levels, education levels, and services needed. Journal of Environmental Health, 59(10), 13-17.

Mclaney, M.A., & Hurrell, J.J. (1988). Control, stress, and job satisfaction in Canadian nurses. Work & Stress, 2, 217-224.

McMillan, J.H. (2004). Educational research: Fundamentals for the consumer (4th ed.). Boston: Pearson/A & B.

National Environmental Health Association. (2002). 2002 nationwide salary & benefits survey of local/county environmental health professionals. Denver, CO: Author.

Oleckno, WA. (1995). Environmental health practitioners. Journal of Environmental Health 58(4), 18-22. Retrieved March 13, 2008, from Academic Search Premier database.

Oleckno, WA., & Blacconiere, M.J. (1987). A study of county environmental health practitioners in Illinois. Journal of Environmental Health 50(2), 66-72.

Oleckno, WA., & Blacconiere, MJ. (1993). Job satisfaction among environmental health professionals: An examination of descriptors, correlates and predictors. Journal of Environmental Health 55(4), 10-15.

Peterson, M., & Wilson, J. (1996). Job satisfaction and perceptions of health. Journal of Occupational and Environmental Medicine, 38(9), 891-898.

Piroanac, D. (1991). How does your salary compare? Pollution Engineering 22, 12-15.

Price, M. (2002). Job satisfaction of registered nurses working in an acute hospital. British journal of Nursing, 11(4), 275-280.

Smith, PC., Kendall, L.M., & Huhn, C.L. (1969). The measurement of satisfaction in work and retirement. Chicago: Rand McNally.

Tracy L Zontek, PhD, CIH, CSP

Candice Cline DuVernois, MPH

Burton R Ogle, PhD, CIH, CSP

Corresponding Author: Tracy L. Zontek, Assistant Professor, Western Carolina University, Environmental Health Program, 106A Moore Hall, Cullowhee, NC 28723. E-mail:
County Assignments to Region

Region   North Carolina Counties

1        Cherokee, Clay, Graham, Haywood, Jackson, Macon, Swain,
2        Buncombe, Burke, Caldwell, Cleveland, Henderson, Madison,
           Rutherford-Polk-McDowell, Yancey-Mitchell-Avery
3        Davidson, Davie, Forsyth, Stokes, Surry, Watauga-Ashe-
           Alleghany, Wilkes, Yadkin
4        Alexander, Cabarrus, Catawba, Gaston, Iredell, Lincoln,
           Mecklenburg, Rowan, Stanly, Union
5        Alamance, Caswell, Chatham, Durham, Guilford, Orange,
           Person, Randolph, Rockingham
6        Anson, Cumberland, Harnett, Hoke, Lee, Montgomery, Moore,
           Richmond, Scotland
7        Edgecombe, Franklin, Granville-Vance, Halifax, Johnston,
           Nash, Wake, Warren, Wilson
8        Bladen, Brunswick, Columbus, Duplin, New Hanover, Onslow,
           Pender, Robeson, Sampson
9        Bertie, Currituck, Dare, Hertford-Gates, Hyde, Martin-
           Tyrell-Washington, Northampton, Pasquo-tank-Perquimans-
10       Beaufort, Carteret, Craven, Greene, Jones, Lenoir, Pamlico,
           Pitt, Wayne

Respondent Number and Gender by Region

Region     No. of      % of Total    Gender No.    Gender
         Respondents   Respondents      M/F          M/F

1             16            3.7         12/4        75/25
2             19            4.4         16/3      84.2/15.8
3             56           12.9        41/15      73.2/26.8
4             83           19.1        49/34        59/41
5             77           17.7        50/27      64.9/35.1
6             27            6.2        17/10        63/37
7             54           12.4        34/20        63/37
8             28            6.5        18/10      64.3/35.7
9             17            3.9         13/4      76.5/23.5
10            56           12.9        33/23      58.9/41.1
ALL          434          100.0       283/150     65.2/34.6

Number of Years Practicing
as an Environmental Health

No. of Years   No.    %

0-5            147   33.9
6-10            94   21.7
11-15           52   12.0
16-20           54   12.4
>20             86   19.8
Total          433    100

Salary by Years of Practice for

Years of   Total Median Salary

0-5           35,000-37,499
6-10          40,000-42,499
11-15         45,000-47,499
16-20         47,500-49,999
>20           50,000-52,499
Total            N = 359

Perceived and Actual Salaries of Specialists
with Five Years' Experience

Region      Perceived      Actual Salary       Actual Salary
         Adequate Salary     0-5 Years     6-10 Years Experience
          Median Range      Experience         Median Range
                           Median Range

1            42,500        32,500-34,999          37,500
2         45,000-47,499       32,500           42,500-44,999
3         42,500-44,999    35,000-37,499       40,000-42,499
4         40,000-42,499    37,500-39,999       42,500-44,999
5            44,000        35,000-37,499          45,000
6         47,500-49,999    37,500-39,999          42,500
7         40,000-42,499    35,000-37,499       40,000-42,499
8         40,000-42,499    30,000-32,499       42,500-44,999
9         40,000-42,499    30,000-32,499       35,000-37,499
10        40,000-42,499    35,000-37,499       37,500-39,999

Top Five Reasons for Working at Current Job

Reason                            % of Specialists   % of Supervisors

Believe in protecting the
  environment                           67.7               77.0
Enjoy working outdoors                  63.8               66.2
Enjoy working with the public           51.0               60.8
Can work independently                   73                60.8
Wanted to use my college degree         58.5               58.1

Intention to Stay in Environmental Health,
in Program Area, and Geographic Area

Length of       Length of Stay in EH as Career
Time Worked
                Supervisor %   Specialist %

<1 year               2.7            0.6
1-5 years            18.9           14.8
6-10 years            6.8           22.8
Entire career        71.6           61.8

Length of        Stay in Same Program Area
Time Worked
                Supervisor %   Specialist %

<1 year               2.7            1.1
1-5 years            23             22.2
6-10 years            8.1           23.1
Entire career        66.2           53.3

Length of        Stay in Geographic Area
Time Worked
                Supervisor %    Specialist

<1 year               1.4            0.8
1-5 years            18.9           19.4
6-10 years            6.8           21.4
Entire career        73             58.2

Most Cited Reasons for Leaving

                             Stay in EH as Career

Reason                       Supervisor %   Specialist %

Lack of career advancement       20.3           30.9
Poor or inadequate salary        20.3           30.9
Job too stressful                <10            11.4

                             Stay in Same Program Area

Reason                       Supervisor %   Specialist %

Lack of career advancement      -10.0           25.1
Poor or inadequate salary        23.0           28.1
Job too stressful                14.9           12.3

                             Stay in Geographic Area

Reason                       Supervisor %   Specialist %

Lack of career advancement       10.8           24.2
Poor or inadequate salary        17.6           29.8
Job too stressful                12.2           <10

Reliability of Independent Predictor Variables

Independent Variable                Number of Items   Measured Alpha

Importance: Salary benefits                4              0.719
Importance: Policy procedures              4              0.750
Importance: Supervisor                     5              0.851
Importance: Working with public            4              0.825
Importance: Geographic location            3              0.760
Importance: Work environment              19              0.903
Importance: Training education             7              0.809
Satisfaction: Salary benefits              4              0.670
Satisfaction: Policy procedures            4              0.647
Satisfaction: Supervisor                   5              0.947
Satisfaction: Working with public          4              0.726
Satisfaction: Geographic location          4              0.864
Satisfaction: Work environment            19              0.883
Satisfaction: Training education           7              0.799

Importance and Satisfaction Mean Responses by Supervisor
and Specialist

Importance or         Factor         Nonsupervisors   Supervisors
Satisfaction         (Group)
                                     Mean   SD        Mean   SD

Importance      Salary/benefits      4.59   0.491     4.55   0.467
Importance      Supervisor           4.55   0.474     4.56   0.444
Importance      Policy               3.83   0.652     3.83   0.594
Importance      Public               4.38   0.551     4.43   0.479
Importance      Location             4.14   0.657     4.02   0.731
Importance      Environment          4.30   0.419     4.33   0.388
Importance      Training/education   4.29   0.496     4.27   0.455
Satisfaction    Salary/benefits      3.17   0.760     3.12   0.787
Satisfaction    Supervisor           3.82   0.890     3.93   1.058
Satisfaction    Policy               3.73   0.568     3.77   0.649
Satisfaction    Public               3.98   0.543     4.08   0.514
Satisfaction    Location             4.06   0.678     4.13   0.686
Satisfaction    Environment          3.66   0.550     3.79   0.413
Satisfaction    Training/education   3.75   0.596     3.90   0.490

Regional Satisfaction with Salary and Promotion

         Salary Satisfaction  Promotion Satisfaction

Region    Mean        SD       Mean        SD

1         2.60       0.986     3.20       0.862
2         2.61       1.145     3.11       1.132
3         3.07       1.007     3.09       1.024
4         2.81       1.214     2.89       1.217
5         2.71       1.171     2.69       1.091
6         2.48       0.975     2.74       0.944
7         2.22       1.192     2.79       1.133
8         2.96       1.126     3.58       0.945
9         2.94       1.237     2.81       1.223
10        2.80       0.970     2.96       1.170
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Author:Zontek, Tracy L.; DuVernois, Candice Cline; Ogle, Burton R.
Publication:Journal of Environmental Health
Article Type:Cover story
Geographic Code:1USA
Date:Oct 1, 2009
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