Reducing Environmental Risk to Rural Low Income Families

减少农村低收入家庭的环境风险

• 批准号: 7125069
• 负责人: Patricia G Butterfield
• 金额: $ 54.98万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-09-21 至 2007-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7125069
• 关键词: carbon monoxide; children; clinical research; clinical trials; data collection methodology /evaluation; disease /disorder proneness /risk; environmental contamination; environmental exposure; environmental health; hazardous substances; health care service utilization; health education; health surveys; household; human subject; lead poisoning; longitudinal human study; low socioeconomic status; nursing intervention; occupational hazard; public health; questionnaires; residential mobility; rural area; water quality

DESCRIPTION (provided by applicant): More than 17 million children participate in public health programs funded by Title. V of the Social Security Act. Providing household environmental risk information to these families is a common sense way of integrating risk reduction into existing programs. However, the success of such efforts will be predicated on testing interventions that can be delivered in home and clinic settings. The proposed study will address 2 gaps in nursing science by yielding evidence addressing: 1) measures of rural children's environmental health (EH) risks, and 2) the effectiveness of a tailored environmental risk reduction (ERR) intervention delivered by public health nurses. Subjects include rural low-income children and adults; there is compelling evidence that exposures to children in the rural West differ from those in other parts of the country. Research aims include: 1) describe EH risks and perceptions of risk that impact the health of rural low-income children, 2) test the effectiveness of an ERR intervention on: a) ERR knowledge, b) ERR self-efficacy, c) stage of action, and d) biomarker (i.e., cotinine, lead) and household contaminant levels (i.e., radon, carbon monoxide, water contaminants), 3) test whether the effect of the ERR intervention persists over time, and 4) explore associations among key measures of risk, risk perception, family characteristics, and ERR. The proposed research uses a 2-arm parallel group RCT design. Subjects will receive an ERR intervention containing 10 standard and 5 tailored educational modules delivered during 4 home visits. Tailored educational materials will be derived from household test results. Consistency in the tailoring process will be assured by the use of decision-making software. Controls will receive usual and customary care; health service utilization metrics in both groups will be collected so that variability in usual care can be analyzed. Families will be recruited from 2 county health departments. A training and sustainability plan is in place to ensure that the intervention is provided in a uniform manner across subjects, site, and over time. Environmental health scientists have predominately adopted an agent versus a family perspective in applied research. An understanding of agents is necessary, but not sufficient in developing interventions aimed at empowering low-income families to make sound ERR decisions. The proposed research takes a nursing perspective by incorporating a broad view of contextual variables that influence children's environmental health. Such a view is consistent with national recommendations that translational EH research be framed and delivered in a manner that is meaningful to families, marginalized populations, and high-risk subgroups.

描述(由申请者提供)：超过1700万儿童参加由职称资助的公共卫生项目。《社会保障法》第五章。向这些家庭提供家庭环境风险信息是将减少风险纳入现有计划的常识性方法。然而，这种努力的成功将取决于能否在家庭和诊所环境中提供干预措施。这项拟议的研究将通过提供证据解决护理科学中的两个空白：1)衡量农村儿童的环境健康(EH)风险，以及2)由公共卫生护士提供的量身定制的环境风险降低(ERR)干预的有效性。研究对象包括农村低收入儿童和成人；有令人信服的证据表明，西部农村儿童与该国其他地区的儿童不同。研究目标包括：1)描述影响农村低收入儿童健康的高血压风险和对风险的认知；2)测试错误干预的有效性：a)错误知识，b)错误自我效能，c)行动阶段，d)生物标记物(即可替宁、铅)和家庭污染物水平(如氡、一氧化碳、水污染物)，3)测试错误干预的效果是否随时间持续，以及4)探索风险关键测量、风险认知、家庭特征和错误之间的关系。本研究采用双臂平行组随机对照试验设计。受试者将接受错误干预，包括在4次家访期间提供的10个标准和5个量身定制的教育模块。量身定做的教材将从家庭测试结果中提取。通过使用决策软件，将确保裁剪过程的一致性。控制组将接受常规护理和常规护理；将收集两组中的卫生服务利用指标，以便分析常规护理的可变性。家庭将从两个县卫生部门招募。制定了培训和可持续发展计划，以确保在不同对象、地点和时间范围内以统一的方式提供干预。环境健康科学家在应用研究中主要采用代理人而不是家庭的观点。在制定旨在增强低收入家庭作出正确错误决定的能力的干预措施时，对各种因素的了解是必要的，但还不够。这项拟议的研究通过结合影响儿童环境健康的背景变量的广泛视角，采取了护理的观点。这样的观点与国家的建议是一致的，即翻译的EH研究应以对家庭、边缘化人口和高危亚群有意义的方式制定和提供。