Household Environmental Health Risks to Rural Children – Risks and Perceptions of Risk
description
Transcript of Household Environmental Health Risks to Rural Children – Risks and Perceptions of Risk
![Page 1: Household Environmental Health Risks to Rural Children – Risks and Perceptions of Risk](https://reader035.fdocuments.in/reader035/viewer/2022070500/568168aa550346895ddf4c8b/html5/thumbnails/1.jpg)
Household Environmental Health Risks to Rural Children – Risks and Perceptions of Risk
Patricia Butterfield, DeanWashington State University College of NursingSpokane, Washington
OPHA October 2011
![Page 2: Household Environmental Health Risks to Rural Children – Risks and Perceptions of Risk](https://reader035.fdocuments.in/reader035/viewer/2022070500/568168aa550346895ddf4c8b/html5/thumbnails/2.jpg)
Multi-agent study of household environmental risks• Background• Risks• Intervention • Implications
![Page 3: Household Environmental Health Risks to Rural Children – Risks and Perceptions of Risk](https://reader035.fdocuments.in/reader035/viewer/2022070500/568168aa550346895ddf4c8b/html5/thumbnails/3.jpg)
Health Affairs May 2011
Reducing The Staggering Costs Of Environmental Disease In Children, Estimated At $76.6 Billion In 2008
Leonardo Trasande and Yinghua Liu
![Page 4: Household Environmental Health Risks to Rural Children – Risks and Perceptions of Risk](https://reader035.fdocuments.in/reader035/viewer/2022070500/568168aa550346895ddf4c8b/html5/thumbnails/4.jpg)
Environmental exposures in childhood
set the stage for illness over the lifespan
![Page 5: Household Environmental Health Risks to Rural Children – Risks and Perceptions of Risk](https://reader035.fdocuments.in/reader035/viewer/2022070500/568168aa550346895ddf4c8b/html5/thumbnails/5.jpg)
The child is the father of the manWilliam Wordsworth
![Page 6: Household Environmental Health Risks to Rural Children – Risks and Perceptions of Risk](https://reader035.fdocuments.in/reader035/viewer/2022070500/568168aa550346895ddf4c8b/html5/thumbnails/6.jpg)
![Page 7: Household Environmental Health Risks to Rural Children – Risks and Perceptions of Risk](https://reader035.fdocuments.in/reader035/viewer/2022070500/568168aa550346895ddf4c8b/html5/thumbnails/7.jpg)
![Page 8: Household Environmental Health Risks to Rural Children – Risks and Perceptions of Risk](https://reader035.fdocuments.in/reader035/viewer/2022070500/568168aa550346895ddf4c8b/html5/thumbnails/8.jpg)
![Page 9: Household Environmental Health Risks to Rural Children – Risks and Perceptions of Risk](https://reader035.fdocuments.in/reader035/viewer/2022070500/568168aa550346895ddf4c8b/html5/thumbnails/9.jpg)
![Page 10: Household Environmental Health Risks to Rural Children – Risks and Perceptions of Risk](https://reader035.fdocuments.in/reader035/viewer/2022070500/568168aa550346895ddf4c8b/html5/thumbnails/10.jpg)
Rural environmental health is different
![Page 11: Household Environmental Health Risks to Rural Children – Risks and Perceptions of Risk](https://reader035.fdocuments.in/reader035/viewer/2022070500/568168aa550346895ddf4c8b/html5/thumbnails/11.jpg)
Purdy Creek fire, September 2001
![Page 12: Household Environmental Health Risks to Rural Children – Risks and Perceptions of Risk](https://reader035.fdocuments.in/reader035/viewer/2022070500/568168aa550346895ddf4c8b/html5/thumbnails/12.jpg)
background
Bunker Hill Smelter Complex, Smelterville, Idaho
![Page 13: Household Environmental Health Risks to Rural Children – Risks and Perceptions of Risk](https://reader035.fdocuments.in/reader035/viewer/2022070500/568168aa550346895ddf4c8b/html5/thumbnails/13.jpg)
Background
Alberton chlorine spill
![Page 14: Household Environmental Health Risks to Rural Children – Risks and Perceptions of Risk](https://reader035.fdocuments.in/reader035/viewer/2022070500/568168aa550346895ddf4c8b/html5/thumbnails/14.jpg)
14
Aims
Identify frequency of household risks in unstudied communities
Test impact of a public health nursing intervention on
Parents’ self-efficacyParents’ precautionary adoption
![Page 15: Household Environmental Health Risks to Rural Children – Risks and Perceptions of Risk](https://reader035.fdocuments.in/reader035/viewer/2022070500/568168aa550346895ddf4c8b/html5/thumbnails/15.jpg)
Published online ahead of print Aug 11, 2011American Journal of Public Health,
10.2105/AJPH.2011.300164
Patricia Butterfield, Wade Hill, Julie Postma, Phillip Butterfield, Tamara Odom-Maryon
![Page 16: Household Environmental Health Risks to Rural Children – Risks and Perceptions of Risk](https://reader035.fdocuments.in/reader035/viewer/2022070500/568168aa550346895ddf4c8b/html5/thumbnails/16.jpg)
TERRA Framework:
Advances in Nursing Science , 2009.
![Page 17: Household Environmental Health Risks to Rural Children – Risks and Perceptions of Risk](https://reader035.fdocuments.in/reader035/viewer/2022070500/568168aa550346895ddf4c8b/html5/thumbnails/17.jpg)
Conceptualization based on:- Thinking upstream- Multiple-exposures multiple effects (MeMe) framework from World Health Organization (Briggs)
![Page 18: Household Environmental Health Risks to Rural Children – Risks and Perceptions of Risk](https://reader035.fdocuments.in/reader035/viewer/2022070500/568168aa550346895ddf4c8b/html5/thumbnails/18.jpg)
EH risks
Risk perception Proximaloutcomes
Distaloutcomes
interventions
Macro-determinants: Ecologic- or societal- level antecedents• Physical-spatial• Economic-resources• Cultural-ideologic
The TERRA framework: Translational Environmental Research in Rural Areas
EH Inequities: Differential distribution of resources available at the family level
![Page 19: Household Environmental Health Risks to Rural Children – Risks and Perceptions of Risk](https://reader035.fdocuments.in/reader035/viewer/2022070500/568168aa550346895ddf4c8b/html5/thumbnails/19.jpg)
•Team:•Patricia Butterfield. WSU. R01.•Wade Hill. MSU. K01.•Laura Larsson. OHSU dissertation. •Phil Butterfield. WSU. EPA and water analysis work.•Julie Postma. UW T32. •Public health personnel at Gallatin City County Health Department and Whatcom County Health Department.
•Thank you to all….
![Page 20: Household Environmental Health Risks to Rural Children – Risks and Perceptions of Risk](https://reader035.fdocuments.in/reader035/viewer/2022070500/568168aa550346895ddf4c8b/html5/thumbnails/20.jpg)
Possibleparticipants
Assesseligibility O1
Randomassignment
O3O2X
O3O2C
Month1* 4 8
O = observation; * = observations at 1, 4 and 8 months; C = control; X = intervention
![Page 21: Household Environmental Health Risks to Rural Children – Risks and Perceptions of Risk](https://reader035.fdocuments.in/reader035/viewer/2022070500/568168aa550346895ddf4c8b/html5/thumbnails/21.jpg)
Sites included Gallatin County, Montana, and Whatcom County, Washington
Whatcom
Gallatin
![Page 22: Household Environmental Health Risks to Rural Children – Risks and Perceptions of Risk](https://reader035.fdocuments.in/reader035/viewer/2022070500/568168aa550346895ddf4c8b/html5/thumbnails/22.jpg)
22
Inclusion Criteria
Child age 7 or younger
Potable water from a non-municipal source
Income <250% of poverty
![Page 23: Household Environmental Health Risks to Rural Children – Risks and Perceptions of Risk](https://reader035.fdocuments.in/reader035/viewer/2022070500/568168aa550346895ddf4c8b/html5/thumbnails/23.jpg)
testingHousehold tests Biomarkers
Airborne radon Blood lead
Carbon monoxide Salivary cotinine
In wall humidity as a proxy for mold growth riskWater
![Page 24: Household Environmental Health Risks to Rural Children – Risks and Perceptions of Risk](https://reader035.fdocuments.in/reader035/viewer/2022070500/568168aa550346895ddf4c8b/html5/thumbnails/24.jpg)
Testing child for blood lead
![Page 25: Household Environmental Health Risks to Rural Children – Risks and Perceptions of Risk](https://reader035.fdocuments.in/reader035/viewer/2022070500/568168aa550346895ddf4c8b/html5/thumbnails/25.jpg)
Incorporate test results into an intervention:--multi-agent focus-addressed low to medium literacy levels--focus on practical actions
![Page 26: Household Environmental Health Risks to Rural Children – Risks and Perceptions of Risk](https://reader035.fdocuments.in/reader035/viewer/2022070500/568168aa550346895ddf4c8b/html5/thumbnails/26.jpg)
![Page 27: Household Environmental Health Risks to Rural Children – Risks and Perceptions of Risk](https://reader035.fdocuments.in/reader035/viewer/2022070500/568168aa550346895ddf4c8b/html5/thumbnails/27.jpg)
![Page 28: Household Environmental Health Risks to Rural Children – Risks and Perceptions of Risk](https://reader035.fdocuments.in/reader035/viewer/2022070500/568168aa550346895ddf4c8b/html5/thumbnails/28.jpg)
![Page 29: Household Environmental Health Risks to Rural Children – Risks and Perceptions of Risk](https://reader035.fdocuments.in/reader035/viewer/2022070500/568168aa550346895ddf4c8b/html5/thumbnails/29.jpg)
Child’s photo is inserted to personalize the intervention;“windows” include information and test results
![Page 30: Household Environmental Health Risks to Rural Children – Risks and Perceptions of Risk](https://reader035.fdocuments.in/reader035/viewer/2022070500/568168aa550346895ddf4c8b/html5/thumbnails/30.jpg)
“Window” open with text results provided to mother
![Page 31: Household Environmental Health Risks to Rural Children – Risks and Perceptions of Risk](https://reader035.fdocuments.in/reader035/viewer/2022070500/568168aa550346895ddf4c8b/html5/thumbnails/31.jpg)
Local public health nurses delivered intervention during 4 home visitsContracted with environmental health personnel at health department
![Page 32: Household Environmental Health Risks to Rural Children – Risks and Perceptions of Risk](https://reader035.fdocuments.in/reader035/viewer/2022070500/568168aa550346895ddf4c8b/html5/thumbnails/32.jpg)
Gallatin City County Health Department Board Meeting
![Page 33: Household Environmental Health Risks to Rural Children – Risks and Perceptions of Risk](https://reader035.fdocuments.in/reader035/viewer/2022070500/568168aa550346895ddf4c8b/html5/thumbnails/33.jpg)
235 parents (households) participatedIntervention group = 119Control group = 116
399 children ages 0-7
![Page 34: Household Environmental Health Risks to Rural Children – Risks and Perceptions of Risk](https://reader035.fdocuments.in/reader035/viewer/2022070500/568168aa550346895ddf4c8b/html5/thumbnails/34.jpg)
93% female91% non-Hispanic WhiteMean age =32.9yrsMean years education=15.260% owned home
![Page 35: Household Environmental Health Risks to Rural Children – Risks and Perceptions of Risk](https://reader035.fdocuments.in/reader035/viewer/2022070500/568168aa550346895ddf4c8b/html5/thumbnails/35.jpg)
Many homes looked like this
Sylvia Fragner and Megkian Penniman, Ferndale, Washington
![Page 36: Household Environmental Health Risks to Rural Children – Risks and Perceptions of Risk](https://reader035.fdocuments.in/reader035/viewer/2022070500/568168aa550346895ddf4c8b/html5/thumbnails/36.jpg)
26% of families did part of their primary job in their home or yard
Yard activities included automotive repair (61.9%), wood working (50.0%), and cleaning and aging wild game (31.8%).
![Page 37: Household Environmental Health Risks to Rural Children – Risks and Perceptions of Risk](https://reader035.fdocuments.in/reader035/viewer/2022070500/568168aa550346895ddf4c8b/html5/thumbnails/37.jpg)
Risks: Radon
Airborne radon tested in Gallatin County only
28% of households above the threshold; homes above threshold were re-tested with a 90 day test
2-day levels ranged from 0-92 pCi/L
![Page 38: Household Environmental Health Risks to Rural Children – Risks and Perceptions of Risk](https://reader035.fdocuments.in/reader035/viewer/2022070500/568168aa550346895ddf4c8b/html5/thumbnails/38.jpg)
Risk: MoldIndoor signs of water damage
74 (31%) homes
Elevated wood moisture equivalent (>18%) readings in 38 of these 74 homes
![Page 39: Household Environmental Health Risks to Rural Children – Risks and Perceptions of Risk](https://reader035.fdocuments.in/reader035/viewer/2022070500/568168aa550346895ddf4c8b/html5/thumbnails/39.jpg)
Risk: Carbon Monoxide
20 (9%) of households
40-264ppm
![Page 40: Household Environmental Health Risks to Rural Children – Risks and Perceptions of Risk](https://reader035.fdocuments.in/reader035/viewer/2022070500/568168aa550346895ddf4c8b/html5/thumbnails/40.jpg)
Risk: Blood lead
3 of 350 (<1%)
5.5-9.2 μ/dL
![Page 41: Household Environmental Health Risks to Rural Children – Risks and Perceptions of Risk](https://reader035.fdocuments.in/reader035/viewer/2022070500/568168aa550346895ddf4c8b/html5/thumbnails/41.jpg)
Risk: environmental tobacco smokeSpecimen: salivary cotinine
12 of 388 children (3%) above threshold5.1-86.3mg/L
![Page 42: Household Environmental Health Risks to Rural Children – Risks and Perceptions of Risk](https://reader035.fdocuments.in/reader035/viewer/2022070500/568168aa550346895ddf4c8b/html5/thumbnails/42.jpg)
Risk: biologic and chemical contaminants in drinking water
![Page 43: Household Environmental Health Risks to Rural Children – Risks and Perceptions of Risk](https://reader035.fdocuments.in/reader035/viewer/2022070500/568168aa550346895ddf4c8b/html5/thumbnails/43.jpg)
Total coliforms in 39 (17%) of water samples
E.coliin 2% of samples
![Page 44: Household Environmental Health Risks to Rural Children – Risks and Perceptions of Risk](https://reader035.fdocuments.in/reader035/viewer/2022070500/568168aa550346895ddf4c8b/html5/thumbnails/44.jpg)
4 homes with elevated nitrate levels
(12.8-15.4mg/L)
![Page 45: Household Environmental Health Risks to Rural Children – Risks and Perceptions of Risk](https://reader035.fdocuments.in/reader035/viewer/2022070500/568168aa550346895ddf4c8b/html5/thumbnails/45.jpg)
4 households with detectable levels of VOCs (e.g., toluene,
chloroform)
![Page 46: Household Environmental Health Risks to Rural Children – Risks and Perceptions of Risk](https://reader035.fdocuments.in/reader035/viewer/2022070500/568168aa550346895ddf4c8b/html5/thumbnails/46.jpg)
Child’s photo is inserted to personalize the intervention;“windows” include information and test results
![Page 47: Household Environmental Health Risks to Rural Children – Risks and Perceptions of Risk](https://reader035.fdocuments.in/reader035/viewer/2022070500/568168aa550346895ddf4c8b/html5/thumbnails/47.jpg)
“Window” open with text results provided to mother
![Page 48: Household Environmental Health Risks to Rural Children – Risks and Perceptions of Risk](https://reader035.fdocuments.in/reader035/viewer/2022070500/568168aa550346895ddf4c8b/html5/thumbnails/48.jpg)
• Outcomes of RCTself efficacyprecaution adoption
![Page 49: Household Environmental Health Risks to Rural Children – Risks and Perceptions of Risk](https://reader035.fdocuments.in/reader035/viewer/2022070500/568168aa550346895ddf4c8b/html5/thumbnails/49.jpg)
EH risks
Risk perception Proximaloutcomes
Distaloutcomes
interventions
Macro-determinants: Ecologic- or societal- level antecedents• Physical-spatial• Economic-resources• Cultural-ideologic
The TERRA framework: Translational Environmental Research in Rural Areas
EH Inequities: Differential distribution of resources available at the family level
![Page 50: Household Environmental Health Risks to Rural Children – Risks and Perceptions of Risk](https://reader035.fdocuments.in/reader035/viewer/2022070500/568168aa550346895ddf4c8b/html5/thumbnails/50.jpg)
Proximal outcome: Self-efficacy “I know how to reduce my family’s risk
to carbon monoxide.”
“I know where to find answers to my questions about risks in my home.”
![Page 51: Household Environmental Health Risks to Rural Children – Risks and Perceptions of Risk](https://reader035.fdocuments.in/reader035/viewer/2022070500/568168aa550346895ddf4c8b/html5/thumbnails/51.jpg)
![Page 52: Household Environmental Health Risks to Rural Children – Risks and Perceptions of Risk](https://reader035.fdocuments.in/reader035/viewer/2022070500/568168aa550346895ddf4c8b/html5/thumbnails/52.jpg)
![Page 53: Household Environmental Health Risks to Rural Children – Risks and Perceptions of Risk](https://reader035.fdocuments.in/reader035/viewer/2022070500/568168aa550346895ddf4c8b/html5/thumbnails/53.jpg)
![Page 54: Household Environmental Health Risks to Rural Children – Risks and Perceptions of Risk](https://reader035.fdocuments.in/reader035/viewer/2022070500/568168aa550346895ddf4c8b/html5/thumbnails/54.jpg)
Proximal outcome: Precaution adoption• I’m unaware….• I’ve decided to take action….• I’ve taken action…..
![Page 55: Household Environmental Health Risks to Rural Children – Risks and Perceptions of Risk](https://reader035.fdocuments.in/reader035/viewer/2022070500/568168aa550346895ddf4c8b/html5/thumbnails/55.jpg)
Precaution Adoption: Intervention and Control Groups at 3 months
Intervention
(n=119)
Control
(n=116)
Group Effect Odds Ratio (95% CI) p-value
3 or more EH risks 83 (69.8)
44 (37.9)
3.9 (2.2,6.7) <0.0001
![Page 56: Household Environmental Health Risks to Rural Children – Risks and Perceptions of Risk](https://reader035.fdocuments.in/reader035/viewer/2022070500/568168aa550346895ddf4c8b/html5/thumbnails/56.jpg)
Risk
Intervention
(n=119)
Control
(n=116)
Group Effect Odds Ratio (95% CI) p-value
Radon70 (58.8)
55 (47.4)
2.4 (1.1,5.2) 0.03
Carbon monoxide
61 (51.3)
35 (30.2)
2.4 (1.4,4.2) 0.001
Lead73 (61.3)
40 (34.5)
3.0 (1.8,5.1) <0.0001
2nd hand smoke
29 (24.4)
23 (19.8)
1.3 (0.7, 2.4) 0.40
![Page 57: Household Environmental Health Risks to Rural Children – Risks and Perceptions of Risk](https://reader035.fdocuments.in/reader035/viewer/2022070500/568168aa550346895ddf4c8b/html5/thumbnails/57.jpg)
Implications:
“no one thing” was found, but 64% of households had at least one risk above threshold levels.
![Page 58: Household Environmental Health Risks to Rural Children – Risks and Perceptions of Risk](https://reader035.fdocuments.in/reader035/viewer/2022070500/568168aa550346895ddf4c8b/html5/thumbnails/58.jpg)
The public health nursing intervention was effective compared with usual and customary practice.
1st study of a PHN intervention using a randomized controlled trial in rural communities
![Page 59: Household Environmental Health Risks to Rural Children – Risks and Perceptions of Risk](https://reader035.fdocuments.in/reader035/viewer/2022070500/568168aa550346895ddf4c8b/html5/thumbnails/59.jpg)
Limitations:-atypical rural communities-high educational levels
![Page 60: Household Environmental Health Risks to Rural Children – Risks and Perceptions of Risk](https://reader035.fdocuments.in/reader035/viewer/2022070500/568168aa550346895ddf4c8b/html5/thumbnails/60.jpg)
This 5 year study provided evidence that rural public health departments can have an impact on household environmental health in low income families.
![Page 61: Household Environmental Health Risks to Rural Children – Risks and Perceptions of Risk](https://reader035.fdocuments.in/reader035/viewer/2022070500/568168aa550346895ddf4c8b/html5/thumbnails/61.jpg)
We wish to inform public health funders and policy makers about the impact household environmental health interventions can have.