Laura S. Larsson

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 sportsmans 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 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.

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 clients housing type when assessing families for environmental risks.

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.

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.

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.

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

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.

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.

A Response to: Deadly Radon in Montana?

Dr. Hart intended to answer the question of whether or not radon is deadly in Montana. Instead he answered the question, “Do Environmental Protection Agency (EPA) county zone designations correlate to statistically different rates of lung cancer deaths in Montana?” Based on a non-significant student t-test comparing mean cancer mortality for EPA zone 1 and 2 designated counties, Dr. Hart concluded the “notion” that radon is deadly in Montana should be questioned. Dr. Hart’s analysis is flawed. Dr. Hart used the age-adjusted mortality rates from the National Cancer Institute (2010a) but excluded lung cancer deaths for individuals 65 years and older. Excluding data from the full range required justification conceptually, clinically, and analytically. Figure 1 illustrates the Montana counties with non-suppressed cases when the age restriction was removed. In addition, the mortality rates were not adjusted for smoking rate, environmental tobacco smoke, air-pollution particulate matter days, use of wood as a primary indoor heating source, medical sources of ionizing radiation, or access to care—all confounders for a meaningful analysis. I would direct Dr. Hart to the “interpret” link on the National Cancer Institute webpage for their explanation for geographic variations in cancer mortality rates (National Cancer Institute, 2010b). Despite these analytical errors, Dr. Hart does raise an interesting question about the accuracy of the EPA zone designations. FIG. 1 The EPA zone designations were derived from a prediction model based on indoor radon measurements, local geology, aerial radioactivity, soil permeability, and foundation type. Assigning each county into one of three zones for radon potential was a process required by the Indoor Radon Abatement Act of 1988 (EPA 2010). Zone 1 is the highest designation with a predicted indoor radon screening level average of greater than 4 picocuries per liter (pCi/L); the current EPA action level. Zone 2 is defined as moderate potential with an average indoor radon concentration between 2 and 4 pCi/L. Zone 3 is defined as low potential with an average indoor radon concentration less than 2 pCi/L. Forty-nine of Montana’s 56 counties are designated as zone 1 and seven are designated as zone 2. Therefore, none of the counties in Montana could be described, as Dr. Hart did, as low radon counties. It is important to note that these designations are guidelines and the U.S. Surgeon General and the EPA recommended that every home should be tested regardless of geographic location (EPA 2010). The broader issue Dr. Hart engaged was the issue of lung cancer mortality from radon. The President’s Cancer Panel (2009) recently reported that the cancer risk attributable to residential radon exposure has been clearly demonstrated and must be better addressed (p. xiv). The Panel recommended the EPA consider lowering its current radon action level. It is noteworthy that the World Health Organization (WHO) recently set their recommended action level to the equivalent of 2.7 pCi/L (WHO 2009). I would direct Dr. Hart to the list of distinguished references provided by both the President’s Cancer Panel as well as the World Health Organization regarding the cumulative evidence in support of their recommendations. Lung cancer, and potentially leukemia (Smith et al. 2007), skin, stomach, and liver cancers, result from protracted radon exposure (Pawel and Puskin 2003). Lung cancer is now the leading cause of cancer death among American women and radon exposure is the leading cause of lung cancer for people who do not smoke (Centers for Disease Control and Prevention 2010). Reducing preventable radon exposure is a goal common to the Healthy People 2010 (U.S. Department of Health and Human Services 2010b) and 2020 Programs (U.S. Department of Health and Human Services 2010a), WHO (2009), the President’s Cancer Panel (2009) and the Montana Cancer Control Coalition (2009). It is time for the allied health-care community to quiet the debate about the carcinogenicity of radon and focus instead on initiatives to reduce or eliminate preventable, unintentional radon exposure.