摘要：Objectives. We tested the effectiveness of a community-based lay health advisor intervention for primary prevention of lead poisoning among Native American children who lived in a former mining area. Methods. We conducted cross-sectional population-based blood lead assessments of Native American and White children aged 1 to 6 years and in-person caregiver interviews before (n=331) and after (n=387) a 2-year intervention. Results. Mean childhood blood lead levels decreased and selected preventive behaviors improved for both Native American and White (comparison) communities. Several short-term outcomes also improved from pre- to postintervention, but only knowledge and hand-washing self-efficacy increased more among Native Americans than among Whites. Conclusions. Our findings provide limited support for the effectiveness of lay health advisor interventions as a primary lead poisoning prevention strategy for Native American communities. Lead exposure among young children is a serious environmental health problem in the United States, despite substantial reductions in both environmental sources of lead and blood lead levels over the past 20 years. 1– 6 Recent estimates suggest that 2.2% of US children aged 1 to 5 years have blood lead levels greater than or equal to 10 micrograms per deciliter (μg/dL). 7 In addition to the cognitive and neurobiological deficits associated with moderately increased blood lead levels (10–15 μg/dL), evidence suggests there are deleterious effects associated with blood lead levels that are even below 5 μg/dL. 8, 9 Community education is a recommended component of a comprehensive childhood lead poisoning prevention program 10– 12 ; unfortunately, the effectiveness of education for the primary prevention of lead poisoning has rarely been assessed. 13 In one of the few such studies, Lanphear et al. found that home visits by a dust-control advisor, the provision of cleaning supplies, and lead exposure education were not effective in preventing lead poisoning. 14 Studies that examined education as a secondary prevention strategy for reducing lead exposure among children who had documented elevated blood lead levels have yielded mixed results. 11, 15 For example, Lanphear et al. found no significant reduction in children’s blood lead levels after families were educated on cleaning strategies to reduce household lead exposures, 16 whereas others have documented decreases in mean blood levels after an educational intervention. 17, 18 No published studies have evaluated the effectiveness of education as a primary or a secondary lead poisoning prevention strategy among Native Americans. The purpose of our study was to assess whether community education provided by lay health advisors through existing Native American social networks was an effective strategy for the primary prevention of childhood lead poisoning.
