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

1 摘要 2 大约 3,400 万美国人依靠私人水井提供饮用水。私人水井有 3 被排除在《安全饮用水法》之外。因此，使用私人水井的人们并没有受益 4 本法规定的污染防治活动。这是一个公共健康问题，因为有毒 私人水井提供的饮用水中经常检出砷、硝酸盐和铅等 5 种化学物质 6 浓度超过《安全饮用水法》规定的最大污染物水平。长期接触 饮用水中的 7 种有毒物质会增加多种慢性疾病的风险。美国多个州已 8 个国家已实施或正在提出立法政策，要求对私人水井进行检测和处理。作为 9 实施这些政策的州数量增加，公共卫生机构提供计划至关重要 10 帮助房主遵守这些新政策，特别是在了解水领域 11 测试结果并选择合适的修复方案。之前的计划增加了试井和 12项危害知识，但大多数私人井用户仍然没有测试井水或进行补救 发现13个危险。随后，需要确定个人层面的干预措施是否会更有效。 14 可有效促进减少、减轻或消除接触污染井的行为 15 水。非专业医护人员在临床环境中可以有效地改善结果和管理 16 种慢性病，并可能能够提供具有成本效益的咨询，以促进环境健康 17 受污染水井的房主的决策。因此，我们建议开展社区活动 18 项功效试验汇集了大学研究人员、州和地方机构以及推广机构 19 服务。我们共同提议由社区健康导航员通过 20 延伸服务。具体来说，我们将在俄勒冈州的一个农村县进行一项随机对照试验，以 21 测试 3 种不同干预措施的可接受性、保真度、可扩展性和功效，以减少有害影响 22 通过采用适当的井水处理而接触有毒物质。完成后，我们将 23 制定了一个私人油井安全干预计划，该计划已经过实证检验和修改 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 方法有更好的机会跨多个利益相关者（即扩展服务、 26 个州卫生机构）。这些信息有可能减少美国农村地区的健康差距 27 与家庭饮用水源有关。

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.