Determinants of the Public Environmental Issues and Concerns: A Case Study in Rafsanjan, Iran

1 Department of Environmental Health Engineering, School of Health, Rafsanjan University of Medical Sciences, Rafsanjan, Iran. 2 Department of Health in Disasters and Emergencies, School of Health, Rafsanjan University of Medical Sciences, Rafsanjan, Iran. 3 Student Research Committee, Department of Environmental Health Engineering, School of Health, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.


Introduction
Nowadays, increased population, urbanization, as well as industrialization have accelerated the technology advancement as well as environmental degradation. As a result, the Earth is facing more environmental problems 1,2 . Consequently, environmental issues and problems have become increasingly important in recent decades 3, 4 . The most important environmental issues include air and water pollution, municipal and industrial wastewater, wastes' production, climate change, and global warming 4,5 . Environmental degradation along with lack of paying enough attention to these issues can cause many health problems for humans and other organisms 6, 7 .
Environmental pollutants have many effects, including development of various cancers and chronic diseases, such as congenital malformations, respiratory problems, and cardiovascular diseases, increase of the mortality risk in communities, and reduction of the labor and agricultural productivity 8, 9 . Environmental concern (EC) actually includes the extent to which people are aware of the environmental issues as well as their support and behaviors to address these problems 10 . Studies around the world reported that the public's concerns have increased in poor and wealthy communities regarding environmental issues 11 . Despite the rising concerns, the public's appropriate support and behavior are very poor 10,12 . The public and their concern about environmental degradation and pollution play an important role in improving the environmental issues and problems 13 . Studies indicated that increasing the public's environmental concerns can play an important role in promoting the environmentally friendly behaviors 14 . In fact, reducing environmental problems and issues as well as achieving sustainable development goals require behavior changes in all individuals of the society. Moreover, policies of various governments around the world seek to increase the level of awareness, general behavior, and culture in order to improve the quality of environmental issues 15,16 .
Many studies were carried out on the importance of public environmental concern in the developed and industrialized countries 14,17 . In a study by Liu et al., public environmental concern determinants were investigated and results showed that people with higher ecological paradigm values were more concerned about the environmental issues 14 . Liu and Mu studied the public environmental concern in china and found that the environmental concern was not the top issue in the china. Moreover, the environmental concern was related to the sociodemographic variables 17 .
However, in the developing and less developed countries, such as Iran, limited studies were conducted in this area 18 . Since further studies are required to address all aspects of these concerns, this study was carried out to determine the most important environmental issues, concerns of the public, their awareness, quality of these issues, and factors affecting them in Rafsanjan City, Iran.

Materials and Methods
In this descriptive-analytical study, the public's view point was investigated in terms of the most important environmental issues, people's knowledge about these issues, as well as the quality level of environmental issues in Rafsanjan City in 2019. In this study, the sampling size was calculated by Eq. 1 considering an error level of 5% (d = 0.05), confidence interval of 95% (Z = 1.96), and expected prevalence of 50% (P = 0.5).
n= (1) According to Eq. 1, 384 people were selected from different regions of Rafsanjan City using simple random sampling. Among these individuals, 312 people responded to the questionnaires completely.
Data collection was carried out by a researcher-made questionnaire that was administered among people referring to Rafsanjan City health centers. The questionnaire consisted of the participants' demographic characteristics (such as gender, age, education level) and questions about the most important environmental challenges, the knowledge level, and the environmental quality level of issues, including water, air, wastes, sewage, green space and parks, industry and industrialization of cities, household energy and fuel consumption, industry growth and associated pollution, as well as city cleanliness 4, 19, 20, 21 . The validity and reliability of this questionnaire were confirmed by 5 experts in the field of environmental health and health education using Cronbach's alpha coefficient of 0.82. In this questionnaire, the most important environmental issues in Rafsanjan were prioritized from 1 to 12 based on the importance of each issue. Later, these issues were ranked according to their importance percentage. Knowledge questions (9 questions with score range of 0-9) were scored from zero (unknowledgeable) to one (knowledgeable) and the environmental quality questions (13 questions with score range of 13-65) were also ranked as excellent (score of 5), good (score of 4), average (score of 3), inappropriate (score of 2), and very bad (score of 1). After data collection, descriptive statistical indices (mean and standard deviation) as well as Mann-Whitney and Kruskal-Wallis tests were used by SPSS-18 software in order to analyze the data.

Ethical Issues
This study is the result of a research project (research project No: 97220) approved by Rafsanjan University of Medical Sciences with Ethics Code of IR.RUMS.REC.1397.132.

Results
All of participants (n = 312), 62.5% were male, 71.4% were within the age range of 20 -40 years, and 55.9% had a bachelor's degree and higher. The majority of participants (42.7%) were self-employed, 67.4% were homeowners, and 64.4% lived in the city for more than 15 years. In terms of the participants' satisfaction level, 34.5% were dissatisfied with the environmental status of Rafsanjan City, 16.7% were satisfied, and 48.7% were at the moderate level of satisfaction. Moreover, the majority of participants (55%) reported that the environmental status of Rafsanjan City was similar to that of other cities in Iran and 29.1% considered it worse than other cities. Moreover, 61.7% of the participants stated that they did not use public transportation even once during the week. Table 1 represents the most important environmental issues of this city that needs to be addressed according to the participants. Based on the findings, the most important environmental concerns were related to water quantity and quality (58.6%), application of pesticides and toxins (38.3%), as well as air pollution (33%), respectively. The environmental quality of the city from the public's perspective is shown in Table 2. As it can be seen, the quality of access to green space and parks (55.2%) and safety of food, vegetables, and fruits (42.2%) were at appropriate levels. The quality of drinking water and water resources (55.1%) as well as access to cycling routes (72.3%) were not appropriate from the participants' view point.  Vol (5), Issue (4), December 2020, 1109-16 Jehsd.ssu.ac.ir 1112  Table 3 includes the most important measures to improve the environmental quality of Rafsanjan City from the public's view point. The required environmental measures needed for the citizens were improving the air quality as well as increasing the public's culture and knowledge regarding environmental issues. Moreover, 23% of the participants stated that they could pay more than the annual municipal tax to improve their city's environment. The level of public's knowledge and satisfaction with regard to environmental programs, plans, and services in Rafsanjan City is represented in Table  4. The highest level of the public's knowledge and satisfaction was attributed to programs, plans, and services for green space and tree planting (85.7% and 40%, respectively), as well as waste collection (77.4% and 36.6%, respectively). Furthermore, the lowest level of the public's knowledge and satisfaction was related to programs and plans for controlling traffic and air pollutants (41.7% and 18.7%, respectively).  Table 5 represents the relationship between the knowledge level and environmental issues quality from the participants' perspective in Rafsanjan City with regard to their demographic characteristics. The mean score of knowledge about environmental issues (score range of 0 to 9) was 5.91 ± 2.53 and the mean score of satisfaction from environmental quality (score range of 13 to 65) was 36.07 ± 7.21. The results indicated a significant relationship between education level, knowledge level, and environmental issues quality. Participants with higher education level had higher knowledge mean scores (P = 0.024), but the mean score of environmental quality of the city was higher from the viewpoint of the individuals with lower education level (P = 0.042). A significant relationship was also found between occupation and knowledge level. Moreover, knowledge level of the unemployed people was lower than other occupations (P = 0.008). The knowledge mean score of homeowners was higher than tenants and this relationship was statistically significant (P = 0.006). The knowledge mean5 score of those who do not use public transportation weekly was higher (P = 0.034) and the environmental quality level of the city was higher from their perspective and this relationship was statistically significant (P = 0.012).

Discussion
Public environmental issue is among the most important problems among the people around the world 22 . This study aimed to determine the most important public environmental issues and concerns in Rafsanjan City, Iran. According to the findings, the most public important environmental concerns were related to water quantity and quality, application of pesticides and toxins, as well as air pollution, respectively. Moreover, the quality of drinking water and water resources, access to cycling routes, urban planning, and air  Vol (5), Issue (4), December 2020, 1109-16 Jehsd.ssu.ac.ir 1114 quality were not at an appropriate level from the participants' view point, which require more attention from the authorities. The literature also showed that the issue of water quality and quantity is one of the most important environmental issues and concerns in Iran due to the excessive water consumption especially in agriculture and industry, recent droughts, as well as imbalanced and reduced precipitation in different parts of Iran 23,24 . Excessive use of pesticides and toxins in Rafsanjan City of Iran (more than 700 tons per year) to control pistachio (as one of the most important agricultural crops in the region) pests has raised the public's environmental concerns regarding this issue 25 . Furthermore, air pollution is one of the most important environmental issues worldwide, especially in Iran, which has become more widespread due to industrialization and application of fossil fuels and motor vehicles. It also causes side effects on the environment, human health, and other organisms 26,27 .Air pollution condition is critical in Rafsanjan City due to its proximity to industrial centers and increased use of motor vehicles 28 ; so, the public understands and is concerned about this environmental issue.
The results of this study showed that the environmental measures should be taken for the citizens to improve the air quality as well as to increase the public's culture and knowledge regarding environmental issues. Furthermore, the highest level of the public's knowledge and satisfaction was about the programs, plans, and services for green space and waste collection. However, the lowest level of the public's knowledge and satisfaction was attributed to air pollutants' control.
The knowledge mean scores were higher in people with higher levels of educational level and the mean scores of environmental quality of the city was higher from the viewpoint of participants with lower educational levels. In the study conducted by Liu and Mu over the public environmental concern in china, the findings showed that the environmental concern in people with higher income and education was higher than others 17 , which is consistent with our study. Other studies also indicated that despite the public's increasing environmental concerns, the pro-environmental behavior is inappropriate in many societies. Based on the literature, this environmental awareness has not become an attitude and behavior that require to review the method of environmental education 10 . In environmental psychology, several studies were conducted on the effective ways of changing environmental behavior and the factors affecting them. This suggests that using appropriate educational theories and models can be very effective, including NAM (norm activation model), VBN (value-belief-norm), and TPB (theory of planned behavior) 11,29 . Therefore, it is recommended to use these appropriate educational methods to improve the citizens' environmental behavior, especially in consuming water and pesticides in agriculture.

Conclusion
In this study, a researcher-made questionnaire was used to evaluate the most important public environmental issues and concerns in Rafsanjan, Iran. The most important environmental concerns and issues were related to water quantity and quality, application of pesticides in agriculture, and air pollution. Therefore, management of water resources, improvement of the drinking water quality, proper education to promote behavior about application of pesticides for farmers, air quality monitoring, and pollution control are among the essential environmental activities.

Study limitation
The main limitation in this research was low cooperation of people in completing the questionnaire.