Public Health Nursing Visits Associated with Improved Environmental Health Outcomes in Rural Low-Income Families

Recent study published in American Journal of Health finds nursing interventions
increase adoption of precautionary environmental improvements

Spokane, WA – The financial cost of environmental disease in U.S. children was recently estimated at more than $75 billion per year. However, parents know that the real costs of environmental disease are much more than financial; they come from seeing a child suffer from asthma, cancer, or renal disease. Preventing diseases like childhood asthma or cancer often require parents to know about risks in their home and how to take action to reduce these risks.

Researchers from Washington State University and Montana State University recently completed a study that revealed public health nursing interventions might help reduce environmental health risks. 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 similar published literature. The study was funded by the National Institute of Nursing Research (NINR), part of the National Institutes of Health (NIH).

Rural families face increased potential environmental hazards

Low-income families, who often rent rather than own their home, may be unfamiliar with the environmental safety of their residence and what to do if environmental health problems arise. Families living in rural areas face different living conditions compared to ones residing in urban areas. They are more likely to receive their drinking water from a private well or spring where water may be contaminated from nearby septic systems, agricultural run-off, or heavy metals. Families may also face additional risks from improperly ventilated wood or gas stoves, elevating carbon monoxide levels.

Testing water, air, and soil

A total of 441 adults and 399 children under the age of seven living in Whatcom County, Washington and Gallatin County, Montana participated in the study. Public health nurses and environmental health specialists from Gallatin City County Health Department (Bozeman, Montana) and Whatcom County Health Department (Bellingham, Washington) 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 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. “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, an 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.”

“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, PhD, RN. “What we learned is that parents want to take steps to protect their children, but they often don’t know what to do. Much of the environmental health information currently 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.”

The study also provided information about the frequency of household risks in a previously unstudied population of rural families. These findings revealed that 28% of the homes in Gallatin County had airborne radon levels above the threshold level set by the Environmental Protection Agency (EPA). Elevated carbon monoxide levels were found in 9% 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 in their homes. Seventeen percent of homes tested positive for total coliforms and two percent tested positive for E. coli, both indicators of contaminated drinking water.”

“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 Dr. Julie Postma, Assistant Professor at Washington State University. “This study is a great example of the impact that local health departments have on the health of their county. 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. Local public health providers are experts in understanding those risks and knowing how to protect health at both the family and the community level.”

The Washington State University College of Nursing educates more than 1,000 students working towards 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 also a leader in providing distance education, 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, offering a new program of study leading to certification as a family nurse practitioner or a psychiatric/mental health nurse practitioner.