A Community-Based Trial to Prevent Lead Poisoning and Injuries

预防铅中毒和伤害的社区试验

• 批准号: 7658278
• 负责人: BRUCE P LANPHEAR
• 金额: $ 57.23万
• 依托单位: CINCINNATI CHILDRENS HOSP MED CTR
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-07-13 至 2012-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7658278
• 关键词: 2 year old; 5 year old; Accounting; Adverse effects; Affect; African; African American; Age; Americas; Asthma; Attention; Attention deficit hyperactivity disorder; Birth; Blood; Cause of Death; Child; Child health care; Childhood; Childhood Injury; Clinic; Clinical Trials Design; Cognitive; Collaborations; Communities; Data; Death Rate; Disease; Dust; Enrollment; Failure; Family; Goals; Hazard Controls; Home environment; Home visitation; House Call; Housing; Impulsivity; Injury; Intervention; Language; Lead; Lead Poisoning; Learning; Life; Link; Measures; Meconium; Medical; Modification; Morbidity - disease rate; Outcome; Pediatric Hospitals; Persons; Policies; Pregnancy; Prevalence; Primary Prevention; Problem behavior; Public Health; Randomized; Randomized Controlled Clinical Trials; Readiness; Reading; Research; Research Personnel; Research Proposals; Risk; Safety; Sampling; Schools; Scientist; Secondary Prevention; Soil; Time; Translating; Treatment Efficacy; Umbilical Cord Blood; Upper arm; Visit; Water; base; blood Pb concentration; blood lead; cohort; community based participatory research; criminal behavior; disability; early childhood; efficacy testing; follow-up; hazard; high risk; improved; interest; lead exposure; mortality; motor vehicle injury; postnatal; prevent; programs; safety testing; skills; social disparities

DESCRIPTION (provided by applicant): The contribution of residential hazards to children's health is poorly defined, but it is clear that some of the most prevalent disease and disabilities among U.S. children - including injuries and lead poisoning - would decline if such hazards were eliminated. Residential hazards also contribute to social disparities in children's health. This revised community-based participatory research application - a partnership of the Cincinnati Children's Hospital and the National tenter for Healthy Housing - would extend the follow-up of an ongoing 402-person birth cohort (n=358 in the randomized trial) designed to test the efficacy of interventions to control residential hazards in children, from 2 years of age through 5 years. This extension is critical to fully evaluate the efficacy of reducing lead and injury hazards on children's intellectual abilities, behavioral problems and injuries during the peak vulnerability of early childhood. The central hypothesis of this application is that housing interventions will reduce the prevalence of lead toxicity and residential injuries in a racially diverse sample of children. The aims and hypotheses of this application are: 1.0 Determine the efficacy of lead hazard controls on children's blood lead levels and their risk for learning and behavioral problems. 1.1 Levels of lead in dust, soil and water will be significantly lower for housing units in the lead treatment arm compared with the injury control arm at 36, 48 and 60 month home visits. 1.2 Children who are assigned to the lead treatment arm will have lifetime blood lead levels that are >20% lower than children assigned to the injury treatment arm at 5 years. 1.3 Children in the lead treatment arm will have higher IQ scores at 5 years than children in the injury treatment arm. 1.4 Children in the lead treatment arm will have fewer behavioral problems at 5 years, especially measures related to ADHD, than children in the injury treatment arm. 1.5 Higher lead exposure, measured during pregnancy and early childhood using maternal blood, cord blood, meconium and children's blood, is inversely associated with IQ scores and directly associated with behavioral problems at 5 years in children with postnatal maximal blood lead levels < 5 /jg/dL 2.0 Determine the efficacy of comprehensive housing modifications on children's risk for injuries. 2.1 Children who are assigned to a multifactorial, housing intervention to prevent injuries will have 30% fewer unscheduled medical visits for housing injuries compared with children in the lead treatment arm. This is the first trial to test the efficacy of a multifactorial intervention for the primary prevention of two of the most prevalent causes of disease and disability in US children - lead toxicity and residential injuries. If efficacious, policy could be developed to reduce disease and disability linked with these hazards. It would also help resolve the ongoing controversy about the adverse consequences of low-level lead toxicity at blood lead levels previously thought to be safe. Our partnership with the National Center for Healthy Housing will enhance our ability to translate and disseminate the research results to affected communities locally and nationally.

描述（由申请人提供）：居住危害对儿童健康的贡献的定义很差，但是很明显，如果消除了这种危害，美国儿童中一些最普遍的疾病和残疾（包括伤害和铅中毒）将下降。住宅危害也导致儿童健康的社会差异。这项基于社区的经修订的参与性研究应用程序 - 辛辛那提儿童医院的合作伙伴关系和国家健康住房的伙伴关系 - 将扩大对正在进行的402人的出生队列（随机试验中的n = 358）的随访，旨在测试两岁的儿童的干预措施，从而测试干预措施的效率。这一扩展对于充分评估减少铅和伤害危害的智力能力，行为问题和伤害的障碍至关重要。该应用的核心假设是，住房干预措施将减少种族多样化的儿童样本中铅毒性和住院伤害的患病率。该应用的目的和假设是：1.0确定铅危害控制儿童血液铅水平及其学习和行为问题的风险的功效。与36、48和60个月的家庭访问相比，铅处理臂的住房单元的灰尘，土壤和水的铅水平将显着降低。 1.2分配给铅治疗部门的儿童的终生血铅水平比分配给伤害治疗部门的儿童在5年时低20％。 1.3个铅治疗部门的儿童在5岁时的智商分数要高于受伤治疗部门的儿童。 1.4铅治疗部门中的儿童在5岁时的行为问题，尤其是与ADHD有关的措施，比受伤治疗部门的儿童更少。 1.5较高的铅暴露在怀孕期间和幼儿期使用孕妇血液，脐带血，胎粪和儿童的血液均与智商分数成反比，并且与5岁儿童在5岁儿童的行为问题<5 /jg /jg /dl 2.0均与行为问题直接相关。 2.1被分配到多因素，住房干预以防止受伤的儿童的住房受伤的外观外观将减少30％，而与铅治疗部门的儿童相比。这是测试多因素干预措施的疗效的第一个试验，以预防美国儿童中两个最普遍的疾病和残疾原因 - 导致毒性和住院损伤。如果有效的话，可以制定政策来减少与这些危害联系在一起的疾病和残疾。这也将有助于解决关于先前认为是安全的血铅水平下低级铅毒性的不利后果的争议。我们与国家健康住房中心的合作伙伴关系将增强我们将研究结果转换和将研究结果传播给当地和全国受影响社区的能力。