Improving Early Childhood Caries for American Indian 3- to 5-Year-Old Children Through Interprofessional Outreach: 2018-2022.

We sought to determine the effectiveness of an interprofessional health team in improving access to oral health care among American Indian children enrolled in Head Start. Our team provided preventive treatments and case management during 11 visits from 2018 to 2022. Case management reduced the time between referral and dental treatment from a median of 166 days to 58.3 days over four years. An interprofessional team is an effective way to improve access to oral health care among rural American Indian Head Start children. (Am J Public Health. 2023;113(4):368-371. https://doi.org/10.2105/AJPH.2022.307205).

Perspectives on Conducting Research in Indian Country.

BACKGROUND: Certain research principles, framed within an indigenous context, are helpful guideposts to practice ethical, relevant, and sensitive inquiries. It is essential to further adapt research approaches based on the unique geographical, sociopolitical, and cultural attributes of partnering tribal communities. These adaptations are largely shaped by trial and error. OBJECTIVES: The purpose of this article is to offer the prospective novice nurse researcher lessons that we learned when entering Indian country to conduct research for the first time. As indigenous and nonindigenous researchers, we are not seeking to set down a methodology but rather offer a list of processes, environments, timelines, and barriers that we never learned in didactic, seminar, clinical, practicum, or any other academic setting. METHODS: We organized a set of memories and thoughts through a series of semistructured iterative sessions specific to our first encounters as researchers in Indian country. We compiled our written responses and field notes from our dialogue, interpreted these data, and organized them into themes. We have reported what we felt would be the most surprising, frequent, or important information to note. RESULTS: We identified three overarching themes in our collective experience: orientation and negotiation, situating ourselves and our work, and navigating our way. Subthemes included perceiving ourselves as outsiders, negotiating distance and time realities, relying on the goodness of gatekeepers, shaping research questions per community priorities, honing our cross-cultural and intercultural communication skills, discovering the many layers of tribal approval processes, and developing sensibilities and intuition. DISCUSSION: Our previous experiences as novices leading research projects in Indian country have produced unique sensibilities that may serve to guide nurse researchers who seek to partner with tribal communities.

Interprofessional oral health initiative in a nondental, American Indian setting.

BACKGROUND AND PURPOSE: Tooth decay is the most common chronic childhood disease and American Indian (AI) children are at increased risk. Pediatric primary care providers are in an opportune position to reduce tooth decay. The purpose of this study was to integrate and evaluate a pediatric oral health project in an AI, pediatric primary care setting. METHODS: The intervention set included caregiver education, caries risk assessment, and a same-day dental home referral. All caregiver/child dyads age birth to 5 years presenting to the pediatric clinic were eligible (n = 47). CONCLUSIONS: Most children (n = 35, 91.1%) were scored as high risk for caries development. Of those with first tooth eruption (n = 36), ten had healthy teeth (27.8%) and seven had seen a dentist in the past 3 months (19.4%). All others were referred to a dentist (n = 29) and 21 families (72.4%) completed the referral. IMPLICATIONS FOR PRACTICE: In fewer than 5 min per appointment (x = 4.73 min), the primary care provider integrated oral health screening, education, and referral into the well-child visit. Oral health is part of total health, and thus should be incorporated into routine well-child visits.

Social Marketing Risk-Framing Approaches for Dental Sealants in Rural American Indian Children.

OBJECTIVE: To compare three variants of a culturally relevant and theoretically based message to determine the most influential risk-framing approach for improving intention to place dental sealants for preschool children. DESIGN AND SAMPLE: A convenience sample of adult, American Indian participants (n = 89) attending a community health fair were assigned to view a gain-framed, loss-framed, or mix-framed dental sealant message. MEASURES: We compared participants' scores on a 46-item survey to determine the relative effect of the frame assignment on seven indices of behavior change. RESULTS: The mean difference in participants' stage-of-change scores (x = 1.17, n = 89, SD = 1.90) demonstrated a significant improvement for all groups after watching the dental sealant message t88  = 5.81, p < .0001, 95% CI [0.77-1.57]. Self-efficacy was the only construct for which we detected a statistically significant difference as a function of frame assignment. Overall, the mix-framed message resulted in the highest scores. The gain-framed message was the least influential on four constructs. This finding is in contrast to findings that gain-framed oral health messages are most influential (Gallagher & Updegraff, 2012; O'Keefe & Jensen, 2007). CONCLUSIONS: Community advisory board members determined to use the mix-framed approach in an oral health social marketing campaign with a rural, American Indian audience.

The Montana Radon Study: social marketing via digital signage technology for reaching families in the waiting room.

OBJECTIVES: I tested a social marketing intervention delivered in health department waiting rooms via digital signage technology for increasing radon program participation among priority groups. METHODS: I conducted a tri-county, community-based study over a 3-year period (2010-2013) in a high-radon state by using a quasi-experimental design. We collected survey data for eligible participants at the time of radon test kit purchase. RESULTS: Radon program participation increased at the intervention site (t38 = 3.74; P = .001; 95% confidence interval [CI] = 4.8, 16.0) with an increase in renters (χ(2)1,228 = 4.3; P = .039), Special Supplementary Nutrition Program for Women, Infants, and Children families (χ(2)1,166 = 3.13; P = .077) and first-time testers (χ(2)1,228 = 10.93; P = .001). Approximately one third (30.3%; n = 30) attributed participation in the radon program to viewing the intervention message. The intervention crossover was also successful with increased monthly kit sales (t37 = 2.69; P = .01; 95% CI = 1.20, 8.47) and increased households participating (t23 = 4.76; P < .001; 95% CI = 3.10, 7.88). CONCLUSIONS: A social marketing message was an effective population-based intervention for increasing radon program participation. The results prompted policy changes for Montana radon programming and adoption of digital signage technology by 2 health departments.

Risk-reduction strategies to expand radon care planning with vulnerable groups.

OBJECTIVES: Radon is the second leading cause of lung cancer in the United States and the leading cause of lung cancer among nonsmokers. Residential radon is the cause of approximately 21,000 U.S. lung cancer deaths each year. Dangerous levels of radon are just as likely to be found in low-rise apartments and townhomes as single-family homes in the same area. The preferred radon mitigation strategy can be expensive and requires structural modifications to the home. The public health nurse (PHN) needs a collection of low-cost alternatives when working with low-income families or families who rent their homes. METHOD: A review of the literature was performed to identify evidence-based methods to reduce radon risk with vulnerable populations. RESULTS: Fourteen recommendations for radon risk reduction were categorized into four strategies. Nine additional activities for raising awareness and increasing testing were also included. DISCUSSION: The results pair the PHN with practical interventions and the underlying rationale to develop radon careplans with vulnerable families across housing types. The PHN has both the competence and the access to help families reduce their exposure to this potent carcinogen.

Nurse's Desk: food bank-based outreach and screening to decrease unmet referral needs.

The Nurse's Desk health screening project used the Intervention Wheel model to conduct outreach, screening, education, and referral for food bank clients (n = 506). Blood glucose, blood pressure, health care utilization, and unmet referral needs were assessed. Screening results identified 318 clients (62.8%) with 1 or more unmet referral needs, including 6 clients (3.16%) with capillary blood glucose more than 199 mg/dL and 132 (31.9%) with hypertension. Clients had higher-than-average systolic and diastolic blood pressures and undiagnosed diabetes than in the general population. A client-approved method for tracking completed referrals is needed for this potentially high-risk population.

Exploring scope of practice issues for correctional facility nurses in Montana.

The research aims were to (a) explore how correctional facility nurses in Montana perceived the balance between the autonomy required in their field and their scope of practice rights, and (b) contrast the correctional nursing specialty from the more traditional nurse setting. Twenty percent of Montana correctional nurses surveyed said there are times where they simply have to work beyond their state scope of practice boundaries. Respondents were most likely to report that the greatest differences in nursing process related to assessment and interventions. Nurses emphasized their feelings of safety, noting that in this practice setting safety takes the highest priority. Participants also said that correctional nursing had a stigma compared to other specialties.

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.

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 community leaders' perceptions of environmental health risks: improving community health.

Qualitative description was used to explore how rural community leaders frame, interpret, and give meaning to environmental health issues affecting their constituents and communities. Six rural community leaders discussed growth, vulnerable families, and the action avoidance strategies they use or see used in lieu of adopting health-promoting behaviors. Findings suggest intervention strategies should be economical, use common sense, be sensitive to regional identity, and use local case studies and "inside leadership." Occupational health nurses addressing the disparate environmental health risks in rural communities are encouraged to use agenda-neutral, scientifically based risk communication efforts and foster collaborative relationships among nurses, planners, industry, and other community leaders.

Mapping the future of environmental health and nursing: strategies for integrating national competencies into nursing practice.

:Nurses are increasingly the primary contact for clients concerned about health problems related to their environment. In response to the need for nursing expertise in the field of environmental health, the Institute of Medicine (IOM), Agency for Toxic Substances and Disease Registry (ATSDR), and National Institute of Nursing Research (NINR) have designed core competencies for the nursing profession. The IOM competencies focus on four areas: (1) knowledge and concepts; (2) assessment and referral; advocacy, ethics, and risk communication; and (4) legislation and regulation. The competencies establish a baseline of knowledge and awareness in order for nurses to prevent and minimize health problems associated with exposure to environmental agents. To address the known difficulties of incorporating new priorities into established practice, nurses attending an environmental health short course participated in a nominal group process focusing on the question, "What specific actions can we take to bring environmental health into the mainstream of nursing practice?" This exercise was designed to bring the concepts of the national initiatives (IOM, NINR, ATSDR) to the awareness of individual nurses involved in the direct delivery of care. Results include 38 action items nurses identified as improving awareness and utilization of environmental health principles. The top five ideas were: (1) get environmental health listed as a requirement or competency in undergraduate nursing education; (2) improve working relationships with interdepartmental persons-a team approach; (3) strategically place students in essential organizations such as NIOSH, ATSDR, or CDC; (4) educate nurse educators; and (5) create environmental health awards in nursing. The 38 original ideas were also reorganized into a five-tiered conceptual model. The concepts of this model include: (1) developing partnerships; (2) strengthening publications; (3) enhancing continuing education; (4) updating nursing practice; and (5) strengthening schools of nursing. The model serves as a road map for action in building environmental health capacity within mainstream nursing.

Utilization and scope of practice of Nurse Practitioners and physician assistants in Montana.

PURPOSE: To explore the licensing, certification, governance and education requirements of nurse practitioners (NPs) and physician assistants (PAs) in the state of Montana. Services provided and privileges retained in employment were also analyzed. DATA SOURCES: This was a descriptive study using a survey of rural hospital administrators (N = 34). CONCLUSIONS: Survey results show that 92.5% of PAs in Montana meet their supervision requirement by a telephone contact provision outlined by the state board of medicine. In contrast, 54.2% of NPs, who are autonomous by legal definition, have a telephone supervision requirement imposed on them by their employers. IMPLICATIONS FOR PRACTICE: These findings have implications for the current and prospective professionals and the businesses for which they work. Nurse practitioners and their professional organizations need to consider the implications these findings have on the professional image and marketability of all NPs.