Reducing Environmental Risk to Rural Low Income Families

描述（由申请人提供）：超过1700万儿童参加由标题资助的公共卫生计划。《社会保障法》第五条。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方案的一种常识性方式。然而，这些努力的成功将取决于可以在家庭和诊所环境中提供的测试干预措施。拟议的研究将通过提供证据解决护理科学中的2个差距：1）农村儿童环境健康（EH）风险的措施，以及2）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。受试者包括农村低收入儿童和成人;有令人信服的证据表明，西部农村儿童的暴露情况与该国其他地区不同。研究目标包括：1）描述影响农村低收入儿童健康的EH风险和风险感知，2）测试ERR干预的有效性：a）ERR知识，B）ERR自我效能，c）行动阶段，和d）生物标志物（即，可替宁、铅）和家庭污染物水平（即，氡、一氧化碳、水污染物），3）测试ERR干预的效果是否随时间持续，以及4）探索风险、风险感知、家庭特征和ERR的关键指标之间的关联。拟议的研究使用2臂平行组RCT设计。受试者将接受ERR干预，包括在4次家庭访视期间提供的10个标准和5个定制教育模块。将根据家庭测试结果编制有针对性的教育材料。将通过使用决策软件来确保裁剪过程的一致性。对照组将接受常规和常规护理;将收集两组的卫生服务利用指标，以便分析常规护理的变异性。将从2个县卫生部门招募家庭。制定了培训和可持续性计划，以确保在不同受试者、研究中心和不同时间以统一的方式提供干预。环境卫生科学家在应用研究中主要采用了代理人与家庭的观点。了解代理人是必要的，但不足以制定干预措施，旨在使低收入家庭作出合理的ERR决定。拟议中的研究需要一个护理的角度来看，纳入了广泛的背景变量，影响儿童的环境健康。这种观点与国家建议一致，即转化型EH研究应以对家庭、边缘化人群和高风险亚群有意义的方式进行框架和交付。

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.