A Community-Based Trial to Prevent Lead Poisoning and Injuries

描述（由申请人提供）：住宅危害对儿童健康的贡献定义不清，但很明显，如果消除这些危害，美国儿童中一些最常见的疾病和残疾-包括伤害和铅中毒-将会下降。住宅危险也造成儿童健康方面的社会差距。这项修订后的以社区为基础的参与性研究应用--辛辛那提儿童医院和国家健康住房组织的合作--将延长正在进行的402人出生队列（随机试验中n=358）的随访，该队列旨在测试干预措施控制儿童居住危险的有效性，从2岁到5岁。这一延伸对于充分评估减少铅和伤害危害对儿童智力、行为问题和幼儿期最脆弱时期伤害的有效性至关重要。本申请的中心假设是，住房干预措施将减少铅中毒和住宅伤害的流行率在一个种族多样的儿童样本。本申请的目的和假设是：1.0确定铅危害控制对儿童血铅水平及其学习和行为问题风险的有效性。1.1在36、48和60个月的家访中，铅治疗组的住房单元的灰尘、土壤和水中的铅水平将显著低于伤害控制组。1.2被分配到铅治疗组的儿童在5年时的终生血铅水平将比被分配到损伤治疗组的儿童低20%以上。1.3铅治疗组的儿童在5岁时的智商得分高于损伤治疗组的儿童。1.4铅治疗组的儿童在5岁时的行为问题，特别是与ADHD相关的措施，比损伤治疗组的儿童少。1.5怀孕期间和幼儿期使用母体血液，脐带血，胎粪和儿童血液中的铅含量与智商分数呈负相关，与出生后最高血铅水平< 5 μ g/dL的儿童5岁时的行为问题直接相关2.0确定综合住房改造对儿童受伤风险的有效性。2.1与铅治疗组的儿童相比，被分配到多因素住房干预以预防伤害的儿童因住房伤害而进行的计划外医疗访问减少了30%。这是第一个测试多因素干预对美国儿童中两种最常见的疾病和残疾原因-铅中毒和住宅伤害-的一级预防的有效性的试验。如果有效的话，可以制定政策来减少与这些危险有关的疾病和残疾。这也将有助于解决目前关于低水平铅毒性的不良后果的争议，在以前认为是安全的血铅水平。我们与国家健康住房中心的伙伴关系将提高我们将研究成果转化和传播给当地和全国受影响社区的能力。

DESCRIPTION (provided by applicant): The contribution of residential hazards to children's health is poorly defined, but it is clear that some of the most prevalent disease and disabilities among U.S. children - including injuries and lead poisoning - would decline if such hazards were eliminated. Residential hazards also contribute to social disparities in children's health. This revised community-based participatory research application - a partnership of the Cincinnati Children's Hospital and the National tenter for Healthy Housing - would extend the follow-up of an ongoing 402-person birth cohort (n=358 in the randomized trial) designed to test the efficacy of interventions to control residential hazards in children, from 2 years of age through 5 years. This extension is critical to fully evaluate the efficacy of reducing lead and injury hazards on children's intellectual abilities, behavioral problems and injuries during the peak vulnerability of early childhood. The central hypothesis of this application is that housing interventions will reduce the prevalence of lead toxicity and residential injuries in a racially diverse sample of children. The aims and hypotheses of this application are: 1.0 Determine the efficacy of lead hazard controls on children's blood lead levels and their risk for learning and behavioral problems. 1.1 Levels of lead in dust, soil and water will be significantly lower for housing units in the lead treatment arm compared with the injury control arm at 36, 48 and 60 month home visits. 1.2 Children who are assigned to the lead treatment arm will have lifetime blood lead levels that are >20% lower than children assigned to the injury treatment arm at 5 years. 1.3 Children in the lead treatment arm will have higher IQ scores at 5 years than children in the injury treatment arm. 1.4 Children in the lead treatment arm will have fewer behavioral problems at 5 years, especially measures related to ADHD, than children in the injury treatment arm. 1.5 Higher lead exposure, measured during pregnancy and early childhood using maternal blood, cord blood, meconium and children's blood, is inversely associated with IQ scores and directly associated with behavioral problems at 5 years in children with postnatal maximal blood lead levels < 5 /jg/dL 2.0 Determine the efficacy of comprehensive housing modifications on children's risk for injuries. 2.1 Children who are assigned to a multifactorial, housing intervention to prevent injuries will have 30% fewer unscheduled medical visits for housing injuries compared with children in the lead treatment arm. This is the first trial to test the efficacy of a multifactorial intervention for the primary prevention of two of the most prevalent causes of disease and disability in US children - lead toxicity and residential injuries. If efficacious, policy could be developed to reduce disease and disability linked with these hazards. It would also help resolve the ongoing controversy about the adverse consequences of low-level lead toxicity at blood lead levels previously thought to be safe. Our partnership with the National Center for Healthy Housing will enhance our ability to translate and disseminate the research results to affected communities locally and nationally.