Descriptive analysis of the respiratory health status of persons exposed to Libby amphibole asbestos.

OBJECTIVE: Describe respiratory health and quality of life in persons exposed to Libby amphibole asbestos (LAA) contaminated vermiculite. DESIGN: Cross-sectional descriptive. SETTING: Asbestos-related disease clinic in Libby, Montana USA. PARTICIPANTS: 329 individuals exposed to LAA; mostly men, married, between 50 and 69 years; two-thirds lived in the surrounding county; one-third lived elsewhere in the state and USA. PRIMARY OUTCOME MEASURES: Chest radiograph (CXR), pulmonary function data and the St George Respiratory Questionnaire (SGRQ). RESULTS: Exposure categories included vermiculite workers=7.6%; family/household contact of vermiculite worker=32%; and environmental exposure only=60%. Of the participants, 55% had only pleural abnormalities; 5.4% had only interstitial abnormalities; nearly 21% had both abnormalities and 18% had no lung abnormality on chest x-ray. Mean forced vital capacity (FVC) 95.3% (SD=18.7); forced expiratory volume (FEV(1)) mean 87% (SD=20.2); ratio of FEV1(1)/FVC 95.5% (SD=12.0); and diffusing capacity (DLCO) of 83% (SD=21.7) of the percent predicted. The mean total SGRQ (38.5; SD=22.1) indicated a lower quality of life than healthy persons and persons with other chronic conditions. SGRQ subscale means were Symptoms 52.1 (SD=24.9), activity 49.4 (SD=26.9) and impacts 27.5 (SD=21.9). Participants with normal CXR differed significantly from those with both interstitial and pleural abnormalities on total, activity and impacts scores. For activity alone, subjects with normal CXR differed significantly from those with pleural disease; no differences were found for those with interstitial disease. Significant findings were found for smoking history across all pulmonary measures, and for exposure status, radiographic findings, age and gender for select pulmonary parameters. Subjects with any smoking history had significantly worse average total and subscale scores on the SGRQ. CONCLUSIONS: Of 329 persons exposed to LAA, the majority (182) had pleural abnormalities identified on CXR. SGRQ scores for persons with abnormalities (pleural, interstitial or both) (269) differed significantly from those with a normal CXR.

Psychosocial health status of persons seeking treatment for exposure to libby amphibole asbestos.

A cross-sectional exploratory study was conducted to describe the psychosocial health status of persons seeking health care for exposure to Libby amphibole asbestos (LAA). Health indicators including depression, stress, acceptance of illness, and satisfaction with access and financial aspects of care were obtained via electronic and paper-pencil survey. The exposure pathway and demographic data were gleaned from the health record. Of the 386 participants, more than one-third (34.5%) demonstrated significant levels of psychological distress. The oldest group of women had the lowest levels of depression and stress and the highest acceptance of illness. Gender, age, and satisfaction with financial resources were significantly related to depression, stress, and acceptance of illness. Satisfaction with access to care was significant only for stress. No differences in depression, stress, and acceptance of illness were found based on residence, exposure pathway, or insurance status.

Barriers and facilitators to the incorporation of environmental health into public health nursing practice.

OBJECTIVES: To describe the environmental health (EH) demands placed on public health nurses (PHNs) as well as the barriers and facilitators to incorporating EH into PHN practice. DESIGN AND SAMPLE: A cross-sectional multimode (Web and pencil/paper) survey was used to collect data from PHNs in 1 rural western state. Research participants included 141 PHNs from a total of 228 survey invitations (61% response). MEASURES: A 39-item questionnaire was developed to measure the frequency of EH demands experienced by PHNs as well as the barriers and facilitators to the incorporation of EH into PHN practice and standard demographics. RESULTS: Significant numbers of PHNs reported less than baccalaureate preparation (29%), suggesting that EH competencies cannot be assumed. PHNs are often asked for basic EH information and cite lack of time and lack of interest on the part of the populations being cared for as barriers to incorporating EH into their practice. Facilitators included free or inexpensive continuing education programs offered via the Internet and additional Internet resources or staff resource people. CONCLUSION: PHNs represent a significant portion of the public health workforce and have implied and explicit mandates to address EH issues in their practice. Resources should be directed toward helping PHNs become better prepared to address the current and future EH needs of populations.

Communicating methylmercury risks and fish consumption benefits to vulnerable childbearing populations.

Methylmercury is a known neurotoxin especially harmful to the fetus, infant, and child. Preventing exposure to this environmental toxin is best accomplished through consumer messages specifically adapted for local populations. Health care providers play an important role in the dissemination of information. The purpose of this article is to review the benefits and risks of fish consumption and identify strategies for presenting effective risk communication messages to vulnerable groups, particularly women of childbearing age.

Householder status and residence type as correlates of radon awareness and testing behaviors.

OBJECTIVES: The primary aim of this research was to assess radon awareness and testing across 2 housing types. DESIGN AND SAMPLE: Cross-sectional prevalence study with time trends. National, probabilistic sample of 18,138 and 29,632 respondents from the 1994 and 1998 National Health Interview Surveys, respectively. RESULTS: Odds ratio (OR) estimates confirmed that occupants of single family homes/townhomes were twice as likely to have ever heard of radon (1994: OR=2.18; confidence intervals [CI]=2.01-2.36) (1998: OR=2.26; CI=2.09-2.44) and also more likely to know if their household air had been tested for radon (1994: OR=2.04; CI=1.57-2.65) (1998: OR=1.38; CI=1.19-1.59) as occupants of apartments/condominiums. Time trend analyses revealed that radon awareness improved from 69.4% to 70.7% and home testing among those with knowledge of radon increased from 9.7% to 15.5% over the 4-year period. CONCLUSIONS: Housing type provided fairly stable estimates of radon awareness and testing. Findings demonstrate that housing status may be a useful variable to differentiate risk for radon awareness and testing. Public health nurses should consider their client's housing type when assessing families for environmental risks.

Methylmercury risk and awareness among American Indian women of childbearing age living on an inland northwest reservation.

American Indian women and children may be the most overrepresented among the list of disparate populations exposed to methylmercury. American Indian people fish on home reservations where a state or tribal fishing license (a source of advisory messaging) is not required. The purpose of this study was to examine fish consumption, advisory awareness, and risk communication preferences among American Indian women of childbearing age living on an inland Northwest reservation. For this cross-sectional descriptive study, participants (N=65) attending a Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) clinic were surveyed between March and June 2006. An electronic questionnaire adapted from Anderson et al. (2004) was evaluated for cultural acceptability and appropriateness by tribal consultants. Regarding fish consumption, approximately half of the women surveyed (49%) indicated eating locally caught fish with the majority signifying they consumed medium- and large-size fish (75%) that could result in exposure to methylmercury. In addition, a serendipitous discovery indicated that an unanticipated route of exposure may be fish provided from a local food bank resulting from sportsman's donations. The majority of women (80%) were unaware of tribal or state fish advisory messages; the most favorable risk communication preference was information coming from doctors or healthcare providers (78%). Since the population consumes fish and has access to locally caught potentially contaminated fish, a biomonitoring study to determine actual exposure is warranted.

Rural public health policy models to address an evolving environmental asbestos disaster.

The health-related dangers of asbestos exposure were recognized early in the 20th century when occupational exposure was found to be associated with excess pneumoconiosis among asbestos industry workers. Today, the epicenter for examining the public health effects and the human toll that this toxin has had on a population is located in the rural community of Libby, MT. Rurality and multideterminants of health frame both the history of asbestos-related disease and the service/policy challenges within a community dealing with chronic illness and designation as a Superfund clean-up site. Despite efforts by public health advocates to address the lingering aftermath of an environmental disaster in this community, policy gaps exist that continue to impact the population's health. The purpose of this paper is to describe the history and outcomes of asbestos exposure in a rural community and discuss 3 models that provide public health policy insights related to rural health and health care for a community affected by both a sentinel and ongoing environmental event.

Negotiating three worlds: academia, nursing science, and tribal communities.

PURPOSE: The purpose of this article is to use a cross-cultural model to guide the exploration of common issues and the dynamic interrelationships surrounding entrée to tribal communities as experienced by four nursing research teams. METHOD: Members of four research teams discuss the primary lessons learned about successful strategies and challenges encountered during their projects' early stages. RESULTS: Understanding the cultural values of relationship and reciprocity is critical to the success of research projects conducted in Native American communities. DISCUSSION: Conducting cross-cultural research involves complex negotiations among members of three entities: academia, nursing science, and tribal communities. The lessons learned in these four research projects may be instructive to investigators who have the opportunity to conduct research with tribal communities.

Rural women, technology, and self-management of chronic illness.

The objective of this study was to determine the differences in the psychosocial status of 3 groups of chronically ill rural women participating in a computer intervention. The 3 groups were: intense intervention, less-intense intervention, and control. At baseline and following the intervention, measures were taken for social support, self-esteem, empowerment, self-efficacy, depression, stress, and loneliness. ANCOVA results showed group differences for social support and self-efficacy among the overall group. The findings differed for a vulnerable subgroup, with significant between-group differences for social support and loneliness. It was concluded that a computer-delivered intervention can improve social support and self-efficacy and reduce loneliness in rural women, enhancing their ability to self-manage and adapt to chronic illness.

Does Dixon's Integrative Environmental Health Model inform an understanding of rural parents' perceptions of local environmental health risks?

A qualitative study of parents' perceptions of local environmental health risks was conducted to assess the fit between concepts from Dixon's Integrative Environmental Health Model (DIEH model) and field-generated data. This research was part of a prospective study addressing environmental exposures of rural low-income children. Home visit data from 11 parents were analyzed (1) thematically and (2) according to DIEH concepts. These complementary analyses allowed the researchers to examine perceptions that were congruent with or diverged from the DIEH model. Findings revealed that participants were concerned about children's exposure to pathogenic molds and cigarette smoke and felt uninformed about risks and prevention strategies. Barriers to preventive actions included families' lack of time and a disinterest in brochures. Participants reported being "stuck" in substandard housing by poverty and family demands. They expressed concern about risks, but were unsure "what to worry about." Results provided the researchers with confidence that the DIEH model aligned with participants' cognitive constructions of risk. As a result, the DIEH model was incorporated into the conceptualization for the clinical trial phase of the study. This type of check between a theoretical approach and field data can be a helpful intermediate step for researchers involved in multiyear studies.

Rural parents' perceptions of risks associated with their children's exposure to radon.

OBJECTIVES: To examine the level of awareness of radon issues, correlates of elective testing behaviors, and the accuracy of risk perception for radon exposures among rural residents receiving public health services. DESIGN: A cross-sectional design was used in which questionnaire data and household analytic data for radon levels were collected from a nonprobabilistic sample of rural households. SAMPLE: Thirty-one rural households with 71 adults and 60 children participated in the study. Primary household respondents were female (100%), Caucasian (97%), and primarily (94%) between 21 and 40 years of age. MEASUREMENT: Questionnaire data consisted of knowledge and risk perception items about radon and all homes were tested for the presence of radon. RESULTS: The prevalence of high airborne radon (defined as> or=4 pCi/l) was 32%. More than a third of the sample underestimated the seriousness of health effects of radon exposure, 39% disagreed that being around less radon would improve the long-term health of their children, and 52% were unsure whether radon could cause health problems. After adjusting for chance, only 21% of the subjects correctly understood their risk status. CONCLUSIONS: This study provides preliminary evidence that low-income rural citizens do not understand their risk of radon exposure or the deleterious consequences of exposure.

Rural women with chronic illness: computer use and skill acquisition.

Chronically ill rural women must manage complex illness without easy access to health care resources including support and health information. The Women to Women project is a technology-based program with an overarching aim to assist rural women in the day-to-day management of their illnesses. An important aspect of the Women to Women program is teaching the women how to use the Internet to meet their support and informational needs. The purposes of this article are to examine changes in 1) the level of computer skills, 2) degree of comfort in using the computer, and 3) knowledge of Internet functions for the participants in the Women to Women computer-based intervention. Results of the initial analysis of data from 63 women (intervention group n = 29, control group n = 34) indicate that women participating in the intervention reported greater computer skills and computer comfort and greater knowledge of specific aspects of Internet use than women in the control group. These findings were further strengthened considering that intervention and control group differentials were sustained 8 months after the end of the women's participation in the computer intervention. With the attainment of computer and Internet skills, it is expected that these rural women will have a sustained ability to access quality Internet information that will allow them to better manage and adapt to their chronic illnesses.

An evaluation of an online intervention to provide social support and health education.

Managing chronic illness in the isolation of rural environments is challenging for women who lack access to personal sources of social support and health information. The Women to Women project was designed to provide chronically ill rural women access to support and health information via electronic means. This article reports on the acquisition of computer skills, the perceptions of importance of various aspects of the intervention, and an assessment of women's overall satisfaction with participation in the research project. Findings indicate that the women's self-ratings of computer skills improved significantly over the 22-week intervention and that highly interactive features of the project were rated as most important by the participants. Overall, women found the program beneficial in assisting them to better manage their chronic illness.