“To our knowledge, this is the first study in the nation that used public health nurses to deliver a multi-risk focused program aimed at reducing environmental risks to rural low-income children,” said co-author Julie Postma, assistant professor at WSU.
The findings, published in the December issue of the American Journal of Public Health, demonstrated that rural low-income parents who received visits from public health nurses were more likely to take precautionary environmental health steps than those who only received published health literature.
“We designed our study from the perspective of a parent or guardian who needed to be vigilant about risks in water, air and soil,” said lead author Patricia Butterfield, professor and dean of the WSU College of Nursing.
The study was funded by the National Institute of Nursing Research, part of the National Institutes of Health.
Rural families face increased potential hazards
The financial cost of environmental disease in U.S. children recently was estimated at more than $75 billion per year. However, the real costs come from seeing a child suffer from asthma, cancer or renal disease. Preventing some childhood diseases requires parents to know about risks in the home and how to take action to reduce these risks.
Low-income families, who often rent rather than own their homes, in particular may be unfamiliar with their environmental safety and what to do if related health problems arise.
Families living in rural areas are more likely to receive their drinking water from private wells or springs, which may be contaminated from nearby septic systems, agricultural runoff or heavy metals. Improperly ventilated wood or gas stoves may cause elevated carbon monoxide levels.
“Oftentimes environmental health research focuses on a single agent. In contrast, this study began with the premise that families live in a home and can act to reduce multiple risks to their children’s health,” said Susan Wilburn, occupational and environmental health officer for the World Health Organization. “It’s a subtle difference, but one that is important if we are to be as effective as possible in reducing the burden of environmentally associated disease in children.”
Determining how to best help parents
A total of 441 adults and 399 children under age 7 living in Whatcom County, Wash., and Gallatin County, Mont., participated in the study. Public health nurses and environmental health specialists from both counties delivered the intervention.
Homes were tested for multiple contaminants, including E. coli, nitrates and pesticides in drinking water. Participating families were randomly assigned to receive either four follow-up visits from public health nurses or a letter that detailed their test results and provided referrals to local public health services.
Three months later, adults in the public health nursing visit group had significantly improved outcomes related to precautionary adoption of environmental safety changes and self-efficacy. Self-efficacy improvements were observed for six of the six contaminants being studied; precautionary adoption improvements were seen for questions addressing five of the six contaminants.
“What we learned is that parents want to take steps to protect their children, but they often don’t know what to do,” Butterfield said. “Much of the environmental health information available is technical in nature and doesn’t provide them with the type of actionable advice they need.
“Our findings indicate that public health nursing interventions can be highly effective in helping parents understand more about common-sense actions in their home,” she said.
Taking the pulse of local rural health
The study also provided specific information about the frequency of household risks in a previously unstudied population of rural families. For example, findings revealed that 28 percent of the homes in Gallatin County had airborne radon levels above the threshold set by the U.S. Environmental Protection Agency. Elevated carbon monoxide levels were found in 9 percent of homes; a few homes had levels that posed immediate life-threatening risks to families.
Three percent of children were found to have elevated levels of cotinine in their saliva; this test identified children exposed to high levels of tobacco smoke. Seventeen percent of homes tested positive for total coliforms and two percent tested positive for E. coli, both indicators of contaminated drinking water.
“This study is a great example of the impact that local health departments have on the health of their counties,” Postma said. “Each case of disease prevented saves thousands of dollars in medical costs and untold human suffering.
“Many rural communities have relatively unique environmental health risks,” she said. “Local public health providers are experts in understanding those risks and knowing how to protect health at both the family and the community level.”
About the WSU College of Nursing
The Washington State University College of Nursing educates more than 1,000 students working toward their bachelor’s, master’s and doctoral degrees. It conducts patient-focused research aimed at transforming and improving health care for all.
The college is a leader in providing distance education, offering quality interdisciplinary care and teaching nurses with a hybrid of lecture and hands-on experiences.
WSU’s doctor of nursing practice (DNP) program will open in 2012, leading to certification as a family nurse practitioner or a psychiatric/mental health nurse practitioner.
Alli Benjamin, WSU College of Nursing, 509-324-7340