Scale validation and prediction of environmental health literacy in Brazil.

Environmental Health Literacy (EHL) focuses on significant impact of environmental factors on human health and emphasizes the importance of public awareness and engagement in identifying and mitigating environmental health risks. This paper presents a study in the Distrito Federal, Brazil, aimed at evaluating EHL and identify the main socioeconomic characteristics capable of predicting EHL levels. Using the EHL Scale, which assesses knowledge, attitudes, and behaviors toward environmental health, this research applies a questionnaire to 397 respondents. Through descriptive statistics and confirmatory and exploratory factor analyses, the study validates the scale for the Brazilian context and offers structural adjustments for the air scale. Using the socioeconomic data we implemented a predictive Random Forest algorithm to forecast EHL levels on each of the scales. By extracting the Shapley values from the model, we established the most relevant variables to predict EHL, offering valuable insights for policymakers, health and environmental professionals to enhance public engagement with environmental health issues. The results indicate that social vulnerability features are predictive of EHL, including education, income, age, ethnicity, presence of disability and use of continuous medication. This study identifies factors that bolster policy strategies to communicate environmental health risks and promote behavior change regarding the environment and self-care.