February 16, 2004


Linda Sobeck, a registered nurse studying at MSU to become a nurse practitioner, looks on while Megkian Penniman takes a water sample similar to those they do for the Environmental
In a sample of 24 homes with children who use public health services in Gallatin County, 29 percent had exposure to more than one major environmental risk factor for health. A majority of households surveyed had at least one environmental risk for health.

"The relationship between exposure and disease is very complicated," said Wade Hill of Montana State University's College of Nursing. This study quantifies the exposure to radon, tobacco smoke, contaminated well water, lead and carbon monoxide.

When combined, some environmental risks are known to increase the risk of disease, such as exposure to both radon and tobacco smoke increasing the risk of lung cancer, Hill said. In other cases, he said we do not know whether multiple exposures carry greater health risks.

This information on risk in rural Gallatin County homes that use public health services and well-water is the first to become available from a four-year research project aimed at reducing environmental risks to children.

The project is in three phases. In the first phase, researchers have worked with the Gallatin City-County Health Department to identify rural families that want to participate. In the second phase, a focus group of experts will convene to determine what types of education on risks are likely to work best with families. After that, the effect of that education will be assessed to see whether families minimized the risks to children.

The goal is to design information that helps families minimize risks and is practical for a health department nurse to deliver.

Hill, principal investigator on the study, is working with Stephanie Nelson and Rebecca Spear of the Gallatin City-County Health Department, and MSU graduate students Linda Sobeck and Megkian Penniman. Sobeck originally hailed from Detroit and Penniman from Havre.

So far, the team has found that 54 percent of homes had one major risk factor and only 17 percent had none of the five environmental risks.

"One of the strengths of this study is that we're not relying on self-reporting," Hill said. "This is one of the few studies that examines multiple environmental exposures in rural children, and use of biological markers strengthens the study."

The Gallatin City-County Health Department works with many clients who fit the parameters of the study, Spear said.

"Our department sees a lot of kids, both through home visits and our immunization clinic, who fit the needs of the study. We explain the research and then ask if the family is interested in participating," she said.

Once identified, Sobeck and Penniman visit the volunteers in their homes. They take well water samples to look for bacterial contamination, urine samples to check for cotinine (a chemical indicator of second-hand smoke), blood samples to check for lead levels, air samples to check for carbon monoxide, and, in addition, set up a radon test.

Getting the samples is not always easy. "Have you ever tried to get a urine sample from a toddler," quipped Sobeck.

The discrepancies between risk exposure as determined by a questionnaire and later as determined by measurement are interesting and sometimes point to a misunderstanding of what constitutes a risk, Penniman said.

"If we want to minimize risk for children and families, we have to understand what the barriers are to behavior change," Hill added. "If the parents don't understand that their child is affected by second-hand smoke, then they wouldn't change their behavior to minimize that child's exposure to smoke. If they do understand the risk but don't change their behavior, then public health nurses may need to explain the risk in a different way." (a sound bite of Wade Hill is available at: http://www.montana.edu/wwwpb/home/WadeHill.mp3

In one case, parents reported no risk from tobacco smoke, but their child had a high level of cotinine in its urine, Penniman said. That discrepancy triggered further questions and explanations, all aimed at reducing the risk to the household.

Nelson said that the research is an opportunity for the health department to integrate the science of environmental health with human services, with the benefits going to both the public and the system.

"This project is one that is trying to improve disease prevention and our health tracking system," she said. "We're trying to reduce risk to children and families, and we're adding raw data to the public health tracking system in a way that may eventually lead to our being better able to understand cause and effect of the environmental exposures on human health."

Sometimes people just don't understand the degree of risk, say the researchers.

Researchers have to keep in mind what is feasible for the health department to deliver," said Hill, adding that the health department is crucial to both the research project and the hope of improving the health of rural children. In the next phase, as means of communicating risk are evaluated for effectiveness, the health department will be even more crucial.

"We need to know how this will work in a health department setting and understand the realities they face with budget and time," he added. "Its critical that we know how things work. That will be even more important in the intervention phase."

These results from the pilot phase of the study will feed into a focus group of experts that probably will convene in Bozeman later this year. After that, a study will be made of what interventions work best with families with identified risk factors. The MSU program is funded by a $720,000 grant from the National Center for Research Resources, and is done in cooperation with the University of Montana. Originally, the project was developed by Pat Butterfield who is still a consultant on the project and is now at the University of Washington.

Contact: Wade Hill (406) 994-4011

February 12, 2004 -- By Carol Flaherty MSU News Service
Original article can be found at: http://www.montana.edu/commserv/csnews/nwview.php?article=1500