Effectiveness and scalability of a home health navigator program to reduce environmental hazards

1篇摘要 2大约有3400万美国人依靠私人威尔斯井来供应饮用水。私人威尔斯井 3、不适用《饮用水安全法》。因此，使用私人威尔斯水井的人没有受益 四是本法规定的污染防治活动。这是一个公共卫生问题，因为有毒 私威尔斯提供的饮用水中经常检出砷、硝酸盐、铅等5种化学物质 6浓度超过安全饮用水法的最大污染物水平。长期暴露于 7饮用水中的有毒物质会增加患几种慢性疾病的风险。美国的几个州已经 8个国家已实施或正在提出立法政策，要求对私人威尔斯井进行测试和处理。为 9实施这些政策的州的数量增加，公共卫生机构提供一个计划至关重要。 10帮助房主遵守这些新政策，特别是在了解水的领域 11测试结果和选择适当的补救措施。以前的项目增加了油井测试， 12了解危害，但大多数私人水井用户仍然没有测试他们的井水或补救措施， 发现13种危害。因此，有必要确定个人一级的干预措施是否会更有效， 14有效促进减少、减轻或消除对污染井的暴露的行为 15水非专业卫生保健工作者在临床环境中有效地改善了结果和管理 16的慢性疾病，并可能能够提供具有成本效益的咨询，以促进环境健康 17决策之间的房主已污染威尔斯。因此，我们建议开展一个社区 18个功效试验，汇集了大学研究人员，州和地方机构，以及推广 19服务。总之，我们提出了一个社区疗效试验，由社区健康导航员通过 20推广服务具体来说，我们将在俄勒冈州的一个农村县进行随机对照试验， 21测试3种不同干预手段的可接受性、保真度、可扩展性和有效性，以减少有害 通过采用适当的井水处理，减少22种有毒物质的接触。完成后，我们将 23制定一个私人油井安全干预计划，该计划已通过经验测试和修改， 24研究通过捕获成本并保留最有效的干预成分，我们的合作社 25方法有更好的机会在多个利益相关者（即推广服务， 26个国家卫生机构）。这些信息有可能减少美国农村地区的健康差距， 27个与家庭的饮用水源有关。

1 Abstract 2 Approximately 34 million Americans rely on private wells to supply their drinking water. Private wells are 3 excluded from the Safe Drinking Water Act. Consequently, people who use private wells have not benefited 4 from pollution prevention activities mandated by this law. This is a public health concern because toxic 5 chemicals such as arsenic, nitrate, and lead are frequently detected in drinking water provided by private wells 6 at concentrations that exceed the Safe Drinking Water Act's maximum contaminant levels. Chronic exposure to 7 toxics in drinking water increase the risk of several chronic diseases. Several states in the U.S. have 8 implemented or are proposing legislative policies to require testing and treatment of private wells. As the 9 numbers of states implementing these policies increase, it is critical that public health agencies offer a program 10 to aid homeowners with adherence to these new policies, specifically in the domains of understanding water 11 test results and choosing appropriate remediation solutions. Previous programs increased well testing and 12 knowledge of hazards, yet the majority of private well users still did not test their well water or remediate 13 detected hazards. Subsequently, there is a need to determine if individual-level interventions would be more 14 effective for promoting behaviors that would reduce, mitigate, or eliminate exposure to contaminated well 15 water. Lay health care workers are effective in clinical settings with improving the outcomes and management 16 of chronic diseases, and may be able to provide cost-effective counseling to promote environmental health 17 decision making among homeowners that have contaminated wells. Thus, we propose to conduct a community 18 efficacy trial that brings together university-based researchers, State and Local agencies, and Extension 19 Services. Together, we propose a community efficacy trial implemented by community health navigators via the 20 Extension service. Specifically, we will conduct a randomized controlled trial in one rural county in Oregon to 21 test the acceptability, fidelity, scalability and efficacy of 3 different intervention arms to reduce harmful 22 toxicant exposures through the adoption of appropriate well water treatment. Upon completion, we will 23 produce a private well safety intervention program that has been tested and modified through empirical 24 research. By capturing the costs and retaining the most efficacious intervention components, our cooperative 25 approach has a better chance of scalability into practice across multiple stakeholders (i.e. Extension services, 26 state health agencies). This information has the potential to reduce health disparities in rural America that are 27 related to a household's source of drinking water.