Reducing pesticide exposures to preschool-age children in California child care centers

长期、低水平的室内农药暴露与儿童的不良健康结果有关， 包括癌症和认知、神经和呼吸问题。最近的研究表明， 在儿童保育设施中以喷雾剂形式使用，使幼儿和工作人员接触有害化学品。 美国有1300万6岁以下儿童，加州有100万6岁以下儿童参加 儿童保育项目。与成年人相比，年幼的儿童更容易受到杀虫剂的影响，因为他们 发育中的器官和身体系统可能在发育的关键时期受到损害。干预措施 为了减少儿童保育中心的杀虫剂暴露， 该方案还包括虫害综合防治（IPM）以及提供实际技术援助和后续咨询。IPM是一种 管理害虫的方法，重点是防止虫害，监测害虫，并限制使用 有害的杀虫剂。农药是作为最后手段使用的，主要是作为自给式诱饵， 污染室内环境。由经过儿童保健培训的护士领导的IPM干预计划 顾问在工作人员的知识、政策和实践方面显示出积极的变化;然而，这些研究 没有包括对照组，也没有评估干预措施是否减少了儿童对农药的接触。 这项研究的目的是减少儿童接触农药的儿童保育中心，以改善他们的长期- 长期健康。在北方加州的四个县进行的一项随机对照试验将比较杀虫剂的变化， 分配到IPM干预与注意力控制干预的儿童保育中心之间的暴露， 体力活动。100个儿童保育中心，为社会经济和种族多样化的学龄前儿童提供服务， 年龄的孩子将被录取。这项研究将仿照一个成功的护士领导的儿童保健 咨询干预包括教育研讨会，材料和工具，以及中心特定的 七个多月的咨询。此外，该研究还将包括测量农药的新方法。 儿童保育中心（灰尘）和儿童保育环境（硅树脂）中个别儿童的浓度 腕带）。该研究的目的是确定护士领导的IPM干预（1）是否增加了儿童保育中心 员工的IPM知识，（2）改进中心的IPM政策和实践，（3）减少害虫问题（即，害虫 目前，害虫残留），（4）增加主任的自我效能，（5）减少农药暴露在儿童保育 中心环境，以及（6）减少干预儿童保育中心的儿童水平农药暴露 与控制中心相比。这项研究有助于实现《健康人2020》设定的公共卫生目标， 通过教育和以社区为基础方案改善环境健康， 促进儿童保育环境卫生政策变化的国家方案。改善儿童的体能 环境和减少有害的农药接触将支持幼儿的成长， 发展，使他们在进入幼儿园时健康并准备好学习。

Chronic, low level indoor pesticide exposures are associated with adverse health outcomes in children, including cancer and cognitive, neurological, and respiratory problems. Recent studies show that pesticides applied as sprays are used in child care facilities exposing young children and staff to harmful chemicals. Thirteen million children in the United States and one million children in California under six years of age attend child care programs. Compared with adults, young children are more vulnerable to pesticides since their developing organs and bodily systems can be damaged during critical windows of development. Interventions to reduce pesticide exposure in child care centers have focused on teaching child care staff about integrated pest management (IPM) and providing hands-on technical assistance and follow-up consultation. IPM is an approach to managing pests that focuses on preventing infestations, monitoring for pests, and limiting the use of harmful pesticides. Pesticides are used as a last resort and primarily as self-contained baits, which do not contaminate indoor environments. IPM intervention programs led by nurses trained as child care health consultants have shown positive changes in staff knowledge, policies, and practices; however, these studies did not include control groups or assess whether the intervention reduced pesticide exposures to the children. The goal of this study is to reduce children’s exposure to pesticides in child care centers to improve their long- term health. A randomized-control trial in four northern California counties will compare changes in pesticide exposure among child care centers assigned to an IPM intervention versus an attention control intervention on physical activity. One hundred child care centers serving socio-economically and ethnically diverse preschool- age children will be enrolled. This study will be modeled on a successful nurse-led child care health consultation intervention comprised of an educational workshop, materials and tools, and center-specific consultation over seven months. In addition, the study will include novel methods of measuring pesticide concentrations in child care centers (dust) and to individual children in the child care settings (silicone wristbands). The study aims are to determine if a nurse-led IPM intervention (1) increases child care center staff’s IPM knowledge, (2) improves center’s IPM policies and practices, (3) reduces pest problems (i.e., pests present, pest residue), (4) increases director’s self-efficacy, (5) reduces pesticide exposures in child care center environments, and (6) reduces child-level pesticide exposures in the intervention child care centers compared to the control centers. This study contributes to public health goals set by Healthy People 2020 to improve environmental health through educational and community-based programs and will inform state and national programs promoting environmental health policy changes in child care. Improving children’s physical environment and reducing harmful exposures to pesticides will support young children’s growth and development so they are healthy and ready to learn as they enter kindergarten.