Environmental Health: Advancing Emancipatory Policies for the Common Good.

Human health is substantially impacted by the state of the environment, and environmental degradation has a disproportionate impact on persons with less immediate access to financial and social power. This article calls for upstream nursing action to address the natural environment in order to turn about health injustices and improve health for all. Such action would move nursing towards a greater actualization of the nursing environmental domain. The health impacts of climate change, air and water quality, and toxic chemical exposure are substantiated and specific policy leadership recommendations are proposed. Recommended actions include work to build environmental health literacy and empowerment, advocacy for regulatory protection and enforcement, and environmental engagement within health care systems.

Thinking Upstream: A 25-Year Retrospective and Conceptual Model Aimed at Reducing Health Inequities.

Thinking upstream was first introduced into the nursing vernacular in 1990 with the goal of advancing broad and context-rich perspectives of health. Initially invoked as conceptual framing language, upstream precepts were subsequently adopted and adapted by a generation of thoughtful nursing scholars. Their work reduced health inequities by redirecting actions further up etiologic pathways and by emphasizing economic, political, and environmental health determinants. US health care reform has fostered a much broader adoption of upstream language in policy documents. This article includes a semantic exploration of thinking upstream and a new model, the Butterfield Upstream Model for Population Health (BUMP Health).

Effectiveness of a household environmental health intervention delivered by rural public health nurses.

OBJECTIVES: Parents need meaningful and actionable information if they are to reduce household environmental health risks to their children. To address this issue, we tested the effectiveness of a multi-risk social/cognitive intervention on rural low-income parents' (1) environmental health self-efficacy and (2) stage of environmental health precautionary adoption. METHODS: Biomarker (lead, cotinine) and household samples (carbon monoxide, radon, mold/mildew, and drinking water contaminants) were collected from 235 families (399 adults, 441 children) in Montana and Washington states. Families were randomly assigned to intervention or control groups; intervention families received 4 visits from public health nurses who provided tailored information and guidance to parents; controls received usual and customary public health services. RESULTS: At 3 months, the intervention group had significantly higher scores on (1) all 6 risk-specific self-efficacy subscales (P < .01), (2) general environmental health self-efficacy (P < .001), (3) 5 of 6 risk-specific precaution adoption subscales (P < .05), and (4) general environmental health precaution adoption (P < .001). CONCLUSIONS: The intervention yielded significant improvements in both outcomes. This evidence supported the need for a policy discussion addressing the added value that broadbased public health nurse interventions might bring to children's environmental health.

Rural children's exposure to well water contaminants: implications in light of the American Academy of Pediatrics' recent policy statement.

PURPOSE: Implementing the recent American Academy of Pediatrics' (AAP) policy for annual well water testing will impact pediatric healthcare providers, who will be called upon for advice regarding testing, interpretation, and mitigation. We report findings from a study of low-income rural families' participation in household well water testing. DATA SOURCES: We collected data from 188 rural low-income households inclusive of 320 children under the age of seven. Participating families lived in one of two western U.S. counties and received water from a well with <15 connections. Household water samples and questionnaire data were collected for analysis. CONCLUSIONS: Twenty-seven percent of households tested positive for at least one contaminant, including total coliforms (18%), arsenic (6%), synthetic organic chemicals (6%), nitrates (2%), fluoride (2%), and E. coli (<1%). Eighty-nine percent of households testing positive for total coliforms were positive at re-test. Respondents expressed greatest concern for biological contamination and took multiple precautionary actions, although only 31% had ever tested their water for contaminants. Higher levels of education, income, and age, as well as homeowner status, were significantly associated with previous testing. IMPLICATIONS FOR PRACTICE: Recommendations for communicating abnormal results, mitigating risks, and overcoming logistical challenges are presented.

Overcoming subject recruitment challenges: strategies for successful collaboration with novice research agencies.

In most studies, the investigator reaches out to locate potential research subjects using direct strategies such as targeted radio advertising, recruitment posters, and newspaper advertisements. However, other studies may depend on indirect methods of locating potential subjects and work through intermediary contacts in clinics and hospital outpatient departments. Some agency personnel may not have had prior experience with clinical research protocols and may be unfamiliar with screening potential subjects; these personnel are likely to be employed in agencies unaffiliated with academic health sciences centers. In cases in which agency staff members are new to clinical research, special attention is required to keep agency personnel updated about the status of the research and subject recruitment efforts. This article provides an overview of practical tips designed to engage and sustain the interest of novice research agencies in subject recruitment. The article concludes with a case overview of recruitment issues that occurred during a clinical trial addressing occupational low back pain.

Upstream reflections on environmental health: an abbreviated history and framework for action.

Upstream thinking considers the social, economic, and environmental origins of health problems that manifest at the population level. The upstream thinking perspective is applied to an examination of environmentally associated health problems and the opportunities that citizens have (or do not have) to access information and resources to make health-promoting choices in response to environmental health risks. A proposed framework for nurses to reduce environmental health risks includes distributive and strategic actions. Distributive actions include tracking, embedding, and translating; strategic actions include discovering through etiologic research, discovering through community-based research, advocating, and reframing. Together these actions can help formalize nursing's role in responding to citizens' concerns about environmental health problems.