A Community-Based Trial to Prevent Lead Poisoning and Injuries

描述（由申请人提供）：居住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，美国儿童中一些最普遍的疾病和残疾——包括伤害和铅中毒——将会下降。居住危险也造成儿童健康方面的社会差异。这项修订后的社区参与性研究申请——由辛辛那提儿童医院和国家健康住房中心合作——将延长对正在进行的402人出生队列（随机试验中n=358人）的随访，旨在测试干预措施对控制2岁至5岁儿童居住危害的有效性。这一扩展对于充分评估减少铅和伤害危险对儿童智力能力、行为问题和伤害的影响至关重要。本应用程序的中心假设是，住房干预将减少铅中毒和居住伤害的患病率在不同种族的儿童样本。本应用程序的目的和假设是：1.0确定铅危害控制对儿童血铅水平的影响及其对学习和行为问题的风险。1.1在36个月、48个月和60个月的家访中，与伤害控制组相比，铅治疗组的住房单元的灰尘、土壤和水中的铅水平将显著降低。1.2被分配到铅治疗组的儿童在5岁时的血铅水平将比被分配到损伤治疗组的儿童低100 - 20%。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与损伤治疗组相比，先导治疗组的儿童在5岁时出现的行为问题更少，尤其是与多动症相关的措施。1.5在妊娠期和幼儿期使用母亲血、脐带血、胎粪和儿童血测量较高的铅暴露与智商分数呈负相关，并与产后最大血铅水平< 5 /jg/dL的儿童5岁时的行为问题直接相关。2.1与主要治疗组的儿童相比，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将减少30%。这是首个测试多因素干预对美国儿童两种最常见的疾病和残疾原因（铅中毒和住宅伤害）一级预防效果的试验。如果有效，可以制定政策以减少与这些危害有关的疾病和残疾。这也将有助于解决目前关于低水平铅中毒的不良后果的争议，此前认为血铅水平是安全的。我们与国家健康住房中心的伙伴关系将增强我们将研究成果转化和传播给地方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.