Reducing Environmental Risk to Rural Low Income Families

描述（由申请人提供）：超过1700万儿童参与了Title资助的公共卫生项目。《社会保障法》第5条。向这些家庭提供家庭环境风险信息是将降低风险纳入现有方案的一种常识性方法。然而，这种努力的成功将取决于能够在家庭和诊所环境中提供的检测干预措施。拟议的研究将通过提供证据来解决护理科学中的两个空白：1)农村儿童环境健康（EH）风险的测量，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。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，西部农村地区的儿童与该国其他地区的儿童接触的环境不同。研究目的包括：1)描述影响低收入农村儿童健康的EH风险和风险认知；2)检验ERR干预的有效性：a) ERR知识，b) ERR自我效能，c)行动阶段，d)生物标志物（如可汀宁，铅）和家庭污染物水平（如氡，一氧化碳，水污染物），3)测试ERR干预的效果是否持续一段时间，4)探索风险关键指标，风险感知，家庭特征和ERR之间的关联。本研究采用双臂平行组随机对照试验设计。受试者将在4次家访期间接受包含10个标准模块和5个量身定制的教育模块的ERR干预。量身定制的教育材料将来自家庭测试结果。决策软件的使用将确保裁剪过程的一致性。控制将得到通常和惯常的照顾；将收集两组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。培训和可持续性计划到位，以确保在不同科目、地点和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。了解因素是必要的，但在制定干预措施以使低收入家庭能够作出合理的误读决定方面是不够的。拟议的研究通过纳入影响儿童环境健康的上下文变量的广泛观点，采取护理的观点。这种观点与国家的建议是一致的，即翻译性EH研究应以对家庭、边缘人群和高风险亚群体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.