A Community-Based Trial to Prevent Lead Poisoning and Injuries

预防铅中毒和伤害的社区试验

• 批准号: 7813987
• 负责人: BRUCE P LANPHEAR
• 金额: $ 58.5万
• 依托单位: CINCINNATI CHILDRENS HOSP MED CTR
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-07-13 至 2012-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7813987
• 关键词: 2 year old; 5 year old; Accounting; Adverse effects; Affect; African; African American; Age; Americas; Asthma; Attention; Attention deficit hyperactivity disorder; Birth; Blood; Cause of Death; Child; Child health care; Childhood; Childhood Injury; Clinic; Clinical Trials Design; Cognitive; Collaborations; Communities; Data; Death Rate; Disease; Dust; Enrollment; Failure; Family; Goals; Hazard Controls; Home environment; Home visitation; House Call; Housing; Impulsivity; Injury; Intervention; Language; Lead; Lead Poisoning; Learning; Life; Link; Measures; Meconium; Medical; Modification; Morbidity - disease rate; Outcome; Pediatric Hospitals; Persons; Policies; Pregnancy; Prevalence; Primary Prevention; Problem behavior; Public Health; Randomized; Readiness; Reading; Research; Research Personnel; Research Proposals; Risk; Safety; Sampling; Schools; Scientist; Secondary Prevention; Soil; Time; Translating; Treatment Efficacy; Umbilical Cord Blood; Visit; Water; adverse outcome; arm; base; blood Pb concentration; blood lead; cohort; community based participatory research; criminal behavior; disability; early childhood; efficacy testing; follow-up; hazard; high risk; improved; interest; lead exposure; mortality; motor vehicle injury; postnatal; prevent; programs; randomized trial; safety testing; skills; social disparities

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.

描述（由申请人提供）：居住危害对儿童健康的影响尚不明确，但很明显，如果消除此类危害，美国儿童中一些最常见的疾病和残疾（包括伤害和铅中毒）将会减少。住宅危害也会造成儿童健康方面的社会差异。这项修订后的基于社区的参与性研究应用程序（辛辛那提儿童医院和国家健康住房组织的合作伙伴）将扩大对正在进行的 402 人出生队列（随机试验中的 n=358）的随访，该队列旨在测试控制 2 岁至 5 岁儿童居住危险的干预措施的有效性。这一扩展对于全面评估减少铅和伤害危害对儿童智力能力、行为问题和幼儿期最脆弱时期伤害的效果至关重要。该应用的中心假设是，住房干预措施将减少不同种族儿童样本中铅中毒和居住伤害的发生率。本应用的目的和假设是： 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，与伤害控制组相比，铅治疗组的住房单元中灰尘、土壤和水中的铅含量将显着降低。 1.2 分配到铅治疗组的儿童在 5 岁时终生血铅水平将比分配到损伤治疗组的儿童低 20% 以上。 1.3 主导治疗组中的儿童在 5 岁时的智商得分将高于损伤治疗组中的儿童。 1.4 与伤害治疗组中的儿童相比，主导治疗组中的儿童在 5 岁时出现的行为问题较少，尤其是与 ADHD 相关的问题。 1.5 在怀孕期间和幼儿期使用母血、脐带血、胎便和儿童血液测量的铅暴露水平较高，与出生后最大血铅水平 < 5 /jg/dL 的儿童的 IQ 分数呈负相关，并与 5 岁时的行为问题直接相关。 2.0 确定全面的住房改造对儿童受伤风险的效果。 2.1 与主要治疗组的儿童相比，被分配进行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就诊次数将减少 30%。这是第一个测试多因素干预对美国儿童疾病和残疾的两个最常见原因（铅中毒和住宅伤害）一级预防效果的试验。如果有效，可以制定政策来减少与这些危害相关的疾病和残疾。它还将有助于解决关于低水平铅毒性在以前被认为是安全的血铅水平下的不良后果的持续争议。我们与国家健康住房中心的合作将增强我们向当地和全国受影响社区转化和传播研究成果的能力。