摘要：Objectives. Parents need meaningful and actionable information if they are to reduce household environmental health risks to their children. To address this issue, we tested the effectiveness of a multi-risk social/cognitive intervention on rural low-income parents' (1) environmental health self-efficacy and (2) stage of environmental health precautionary adoption. Methods. Biomarker (lead, cotinine) and household samples (carbon monoxide, radon, mold/mildew, and drinking water contaminants) were collected from 235 families (399 adults, 441 children) in Montana and Washington states. Families were randomly assigned to intervention or control groups; intervention families received 4 visits from public health nurses who provided tailored information and guidance to parents; controls received usual and customary public health services. Results. At 3 months, the intervention group had significantly higher scores on (1) all 6 risk-specific self-efficacy subscales ( P < .01), (2) general environmental health self-efficacy ( P < .001), (3) 5 of 6 risk-specific precaution adoption subscales ( P < .05), and (4) general environmental health precaution adoption ( P < .001). Conclusions. The intervention yielded significant improvements in both outcomes. This evidence supported the need for a policy discussion addressing the added value that broadbased public health nurse interventions might bring to children's environmental health. In previous work in rural Montana and Washington states, low-income families reported that much of the environmental health information they received was neither meaningful nor actionable. 1 – 4 Parents viewed household environmental risks holistically, yet they almost always received agent (e.g., radon) or condition (e.g., asthma) specific educational pamphlets. Many parents reported being concerned about household risks, but felt “stuck” in their circumstances and unsure about what risk reduction steps to take; they asked for practical suggestions about what they could do to protect their children. 1 These findings were consistent with those from other behavioral scientists who found that context- and image-based environmental health messages (e.g., Centers for Disease Control and Prevention [CDC] Healthy Homes portal) were often perceived as more meaningful than agent-focused information. 5 – 10 This previous research also yielded evidence that when provided with detailed protocols, public health nurses had the requisite knowledge base to provide families with appropriate environmental risk reduction information. To further analyze these issues, a randomized controlled trial was designed to test the effectiveness of a household environmental health intervention on parents’ self-efficacy and precautionary actions. The study used county level public health nurses to deliver the intervention. Although many similarities exist between public health nurses practicing in rural versus urban health departments, those in rural settings are more likely to work across programs and settings. 11 , 12 In many places, rural public health nurse practice still involves an intimacy with the community that plays out in different ways across programs, initiatives, and stakeholder groups. 13 , 14 This study focused exclusively on rural public health nurses because of their generalist role and daily involvement with locally defined public health concerns. To our knowledge, this study represented the first effort nationally to examine the effectiveness of a multirisk environmental health intervention delivered exclusively by public health nurses employed in local health departments. The primary aim of the study was to analyze the effectiveness of a public health nurse delivered multiagent intervention on parents’ (1) environmental health self-efficacy and (2) stage of environmental health precaution adoption. We selected these 2 social/cognitive outcomes because they are both well-established correlates of improved health outcomes. 15 – 17 A secondary aim of the study was to report household (carbon monoxide, radon, mold/mildew, water contaminants) and biomarker (lead, cotinine) data, explicating the frequency and magnitude of household environmental health risks in a previously unstudied sample of rural low-income children. In this article, the household and biomarker findings are presented first because they inform the intervention analyses.
