Children, Only, Environmental Exposure, Risk Reduction
Conditions
Keywords
integrated pest management, environmental health, child care, preschool children, pesticides
Brief summary
A randomized control study was conducted to reduce the exposure to pesticides in child care centers. A 7-month child care health consultant-led integrated pest management (IPM) intervention was conducted in 85 child care centers serving preschool-age children in five California counties. Changes in IPM knowledge, self-efficacy, policies, IPM practices, pests, and pesticide exposure were assessed in the IPM centers and the control centers.
Detailed description
The goal of the study was to reduce children's exposure to pesticides in child care centers to improve their long-term health. A randomized-control trial in five northern California counties compared changes in director's IPM knowledge and self-efficacy, written IPM policies, IPM practices, number of pests and concentration of pesticides between child care centers assigned to an IPM intervention versus an attention control intervention on physical activity. Eighty-five child care center directors working in centers serving preschool-age children were enrolled. The child care health consultant-led intervention included an educational workshop, materials and tools, and center-specific consultation over seven months. In addition, the study included novel methods of measuring pesticide concentrations in child care centers (dust) and individual children (silicone wristbands). The study aims were to determine if an IPM intervention (1) increases child care center's director's IPM knowledge and self-efficacy, (2) improves center's IPM practices and policies, (3) reduces the number of pests present, (5) reduces pesticide exposures in child care center environments in the intervention IPM child care centers compared to the control centers.
Interventions
BEHAVIORALChanges in pesticide exposure
In the IPM centers the child care health consultant reviews the IPM baseline assessments and provides 7 monthly consultation visits to decrease the centers exposure to pesticides. Pre- and post- carpet dust samples and children's individual silicone wristbands are collected to identify changes in pesticide detection limits and concentrations at the child care center-level in both the IPM and PA centers pre- and post-intervention.
BEHAVIORALIPM Practices
In the IPM centers, a research assistant completed the IPM Checklist which identifies the IPM practices that the center meets and doesn't meet. The child care health consultant reviews the IPM Checklist findings with the child care center director after the baseline Checklist is completed. The IPM Checklist is completed pre- and post-intervention in the IPM and PA centers. The post-intervention IPM Checklist findings are compared to the baseline IPM Checklist findings to identify changes in IPM practices in both the IPM and PA centers.
BEHAVIORALEducational Workshops
The IPM center directors and providers attend an IPM workshop and complete a survey to assess their knowledge of IPM practices pre- and post-workshop. The level of knowledge change is assessed by comparing the number of correct responses on the post-workshop survey compared to the pre-workshop survey.
Sponsors
University of California, San Francisco
National Institute of Environmental Health Sciences (NIEHS)
University of California, Berkeley
Oregon State University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Intervention model description
This randomized control study included 85 child care centers in five CA counties and was conducted in 9-month cycles over six years. The counties were matched and randomized to the intervention group (integrated pest management) or attention control group (physical activity). Each study cycle included Recruitment, Baseline Assessments, Intervention, and Post-Intervention Assessments. Baseline Assessments were completed as director interviews and surveys, child care provider surveys, research assistant-completed objective observations using standardized Checklist, center dust samples to measure pesticides, and silicone wristband personal samplers worn by 5 children per center for 30 hours. During the 7-month Intervention phase, CCHCs conducted one workshop per center on the intervention topic (IPM or physical activity) and provided monthly consultations with the center directors. The Post-Intervention stage repeated all the baseline assessments.
Eligibility
Sex/Gender
ALL
Age
3 Years to 75 Years
Healthy volunteers
Yes
Inclusion criteria
The centers must meet the following criteria: 1. Be a licensed child care center with a child care director who speaks English 2. Used pesticides (i.e., baits or sprays) in the last year 3. Operated for at least two years with no plans to close in the next 12 months 4. Enroll children between three to five years of age of diverse ethnic and racial backgrounds 5. Have at least 25% of enrolled children receiving a government subsidy (e.g., Child and Adult Care Food Program (CACFP), Head Start, Child Care Development Fund, Alternative Payment program). 6. Have a carpet or couch on-site. The child care providers must meet the following criteria: 1. Work in the participating child care centers 2. Work in the classroom of the participating children 3. Work at least 30 hours a week 4. Plan to work at the center over the next 9 months The families must have a preschool-age child enrolled in the participating child care center and meet the following criteria: 1. Three or four years of age 2. The child spends at least six hours per day in the center 3. Will be enrolled in the center for the next nine months 4. Has a parent present during enrollment who speaks either English or Spanish 5. Parents will complete surveys or interviews in English or Spanish in the Fall and Spring
Exclusion criteria
1. Centers that participated in an IPM intervention and training project 2. Families that have children who have special health care needs or disabilities who can not participate in physical activity at the child care center. 3. Center directors who do not read and write in English. 4. Child care providers who do not read and write in English.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Decrease in Child Care Center Pesticides | Pre-intervention, 9 months after the workshop | Change in the levels of pesticide exposures collected in carpet dust samples in the child care centers from baseline to 9 months later. Pesticides are summarized as geometric mean concentration (ng/g) and then the log10 is applied to the data. Carpet dust samples were collected in each child care center at pre-intervention and post-intervention. A decrease in pesticide concentration from pre-intervention to post-intervention is represented as a negative value. A negative change score would be a positive finding with a decrease in pesticide concentration post-intervention. |
| Decrease in Children's Exposure to Pesticides | Pre-intervention and 9 months later (post-intervention) | Change in the levels of pesticide exposures collected in personal silicone wristbands worn by 3 to 5 of the preschool-age children in each child care center. They wore the wristbands for \~30 hours pre-intervention/baseline and 9 months later. Pesticides are summarized as geometric mean concentration (ng/mL) and then log10 is applied to the data. A decrease in pesticide concentration from pre-intervention to post-intervention is represented as a negative value. A negative change score would be a positive finding with a decrease in pesticide concentration post-intervention. |
| Increase in Integrated Pest Management (IPM) Practices | Pre-Intervention and 9 months later | The IPM practices were measured objectively with a standardized IPM Checklist during a 2-hour observational assessment at baseline/pre-intervention and then 9 months later using a standardized measure (Alkon etal, JPHC, 2016). The IPM practices observed included having garbage cans with liners and lids, using bait stations if there are pests, having window screens with no holes, no water leaks, and outside garbage bins on cement surfaces. Each item on the Checklist is marked as 1 (yes) or O (no). The mean ranged from 0 (no practices observed) to 1 (all of the items were observed). An increase in IPM practices would be positive change in the mean score post-intervention compared to pre-intervention. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Decrease in the Presence of Pests | Pre-intervention and 9 months later | The # of pests were observed as part of the IPM Checklist assessment in different places in the child care center: kitchen, outside garbage area, playground, landscape outdoor area, and classroom at the pre-intervention period and 9 months later. Pre- and post-intervention, the # of pests observed is a number on a scale of 0 to infinity. A positive outcome would be a negative change score showing be a decrease in the # of pests observed post-intervention compared to pre-intervention. |
| Director's Self-Efficacy | The Self-Efficacy Survey is completed by the directors pre-intervention and after the intervention (7 to 9 months later). | The director's sense of self-efficacy provides information about their sense of control of their work environment and impact on the families and children that they serve. The intervention is designed to help the director's feel empowered (e.g., increase in self-efficacy) to make changes in their work environment and provide a healthy environment for children and families served in their center. The Self-Efficacy survey was modified from a standardized measure by Bandura, A (1977) to fit the intervention and child care center's environments. There are 8 items with responses rated on a likert scale from 1 to 4 as strongly disagree (1) to strongly agree (4). Mean self-efficacy scores were calculated for each director. The minimum and maximum mean scores were 2.8 to 4.0. Higher mean score shows higher self-efficacy. |
| Number of Child Care Centers With Written IPM Policies | 9 months | The presence of IPM policies was reviewed as (1 for "Yes") and (0 for "No") no both pre- and post-intervention in the IPM centers. Licensed child care centers are required to have written policies, but a specific policy on IPM is not required. Policies provide best practices for the child care administrators, providers and parents to follow when working or spending time in the center. |
Countries
United States
Contacts
STUDY_CHAIRThaddeus Schug, PhD
National Institute for Environmental Health Sciences
Participant flow
Recruitment details
The study was conducted in 85 child care center and consent form were obtained from 85 child care center directors, 134 child care providers, 393 children, and 375 parents. The intervention and outcome measures included the child care directors and children. The parents completed a demographic survey pre-intervention and the child care providers completed demographic surveys and pre- and post-workshop knowledge surveys.
Pre-assignment details
The child care centers were assigned the intervention group (IPM vs. Physical activity) based on the county of their geographic location. The counties were matched and randomly assigned to an intervention group. All of the enrolled participants in each center were given the same intervention.
Baseline characteristics
| Characteristic | — |
|---|---|
| Age, Categorical Child care center directors <=18 years | 0 Participants |
| Age, Categorical Child care center directors >=65 years | 0 Participants |
| Age, Categorical Child care center directors Between 18 and 65 years | 85 Participants |
| Age, Categorical Child care providers <=18 years | 0 Participants |
| Age, Categorical Child care providers >=65 years | 0 Participants |
| Age, Categorical Child care providers Between 18 and 65 years | 64 Participants |
| Age, Categorical Children <=18 years | 393 Participants |
| Age, Categorical Children >=65 years | 0 Participants |
| Age, Categorical Children Between 18 and 65 years | 0 Participants |
| Age, Categorical Parent <=18 years | 0 Participants |
| Age, Categorical Parent >=65 years | 0 Participants |
| Age, Categorical Parent Between 18 and 65 years | 375 Participants |
| Ethnicity (NIH/OMB) Child care center directors Hispanic or Latino | 13 Participants |
| Ethnicity (NIH/OMB) Child care center directors Not Hispanic or Latino | 28 Participants |
| Ethnicity (NIH/OMB) Child care center directors Unknown or Not Reported | 0 Participants |
| Ethnicity (NIH/OMB) Child care providers Hispanic or Latino | 16 Participants |
| Ethnicity (NIH/OMB) Child care providers Not Hispanic or Latino | 46 Participants |
| Ethnicity (NIH/OMB) Child care providers Unknown or Not Reported | 0 Participants |
| Ethnicity (NIH/OMB) Children Hispanic or Latino | 80 Participants |
| Ethnicity (NIH/OMB) Children Not Hispanic or Latino | 93 Participants |
| Ethnicity (NIH/OMB) Children Unknown or Not Reported | 50 Participants |
| Ethnicity (NIH/OMB) Parent Hispanic or Latino | 69 Participants |
| Ethnicity (NIH/OMB) Parent Not Hispanic or Latino | 102 Participants |
| Ethnicity (NIH/OMB) Parent Unknown or Not Reported | 38 Participants |
| IPM Checklist | 0.75 units on a scale STANDARD_DEVIATION 0.1 |
| IPM Checklist_Pests Observed | 1.52 Mean number of pests STANDARD_DEVIATION 1.45 |
| IPM Knowledge Survey | 0.79 Score on a scale STANDARD_DEVIATION 0.12 |
| Pesticide concentrations on wristbands worn by children Bifenthrin | .50 log 10 (ng/g) STANDARD_DEVIATION 1.12 |
| Pesticide concentrations on wristbands worn by children Chlorpyrifos | -.21 log 10 (ng/g) STANDARD_DEVIATION 0.3 |
| Pesticide concentrations on wristbands worn by children Cis-Permethrin | .25 log 10 (ng/g) STANDARD_DEVIATION 1.19 |
| Pesticide concentrations on wristbands worn by children Cypermethrin | 1.03 log 10 (ng/g) STANDARD_DEVIATION 0.86 |
| Pesticide concentrations on wristbands worn by children Fipronil | .15 log 10 (ng/g) STANDARD_DEVIATION 0.49 |
| Pesticide concentrations on wristbands worn by children Trans-Permethrin | .68 log 10 (ng/g) STANDARD_DEVIATION 1.26 |
| Pesticides in Carpet Dust Samples Bifenthrin | 1.83 log 10 (ng/g) STANDARD_DEVIATION 0.98 |
| Pesticides in Carpet Dust Samples Chlorpyrifos | .52 log 10 (ng/g) STANDARD_DEVIATION 0.35 |
| Pesticides in Carpet Dust Samples Cis-Permethrin | 1.89 log 10 (ng/g) STANDARD_DEVIATION 0.56 |
| Pesticides in Carpet Dust Samples Cypermethrin | 2.30 log 10 (ng/g) STANDARD_DEVIATION 0.88 |
| Pesticides in Carpet Dust Samples Fipronil | 1.64 log 10 (ng/g) STANDARD_DEVIATION 0.7 |
| Pesticides in Carpet Dust Samples L-Cyhalothrin | 1.45 log 10 (ng/g) STANDARD_DEVIATION 0.76 |
| Pesticides in Carpet Dust Samples Piperonyl | 1.33 log 10 (ng/g) STANDARD_DEVIATION 0.74 |
| Pesticides in Carpet Dust Samples Trans-Permethrin | 2.02 log 10 (ng/g) STANDARD_DEVIATION 0.75 |
| Race (NIH/OMB) Child care center directors American Indian or Alaska Native | 1 Participants |
| Race (NIH/OMB) Child care center directors Asian | 2 Participants |
| Race (NIH/OMB) Child care center directors Black or African American | 14 Participants |
| Race (NIH/OMB) Child care center directors More than one race | 1 Participants |
| Race (NIH/OMB) Child care center directors Native Hawaiian or Other Pacific Islander | 0 Participants |
| Race (NIH/OMB) Child care center directors Unknown or Not Reported | 14 Participants |
| Race (NIH/OMB) Child care center directors White | 19 Participants |
| Race (NIH/OMB) Child care providers American Indian or Alaska Native | 0 Participants |
| Race (NIH/OMB) Child care providers Asian | 1 Participants |
| Race (NIH/OMB) Child care providers Black or African American | 6 Participants |
| Race (NIH/OMB) Child care providers More than one race | 6 Participants |
| Race (NIH/OMB) Child care providers Native Hawaiian or Other Pacific Islander | 1 Participants |
| Race (NIH/OMB) Child care providers Unknown or Not Reported | 27 Participants |
| Race (NIH/OMB) Child care providers White | 54 Participants |
| Race (NIH/OMB) Children American Indian or Alaska Native | 4 Participants |
| Race (NIH/OMB) Children Asian | 28 Participants |
| Race (NIH/OMB) Children Black or African American | 11 Participants |
| Race (NIH/OMB) Children More than one race | 36 Participants |
| Race (NIH/OMB) Children Native Hawaiian or Other Pacific Islander | 1 Participants |
| Race (NIH/OMB) Children Unknown or Not Reported | 95 Participants |
| Race (NIH/OMB) Children White | 141 Participants |
| Race (NIH/OMB) Parent American Indian or Alaska Native | 3 Participants |
| Race (NIH/OMB) Parent Asian | 37 Participants |
| Race (NIH/OMB) Parent Black or African American | 30 Participants |
| Race (NIH/OMB) Parent More than one race | 15 Participants |
| Race (NIH/OMB) Parent Native Hawaiian or Other Pacific Islander | 0 Participants |
| Race (NIH/OMB) Parent Unknown or Not Reported | 141 Participants |
| Race (NIH/OMB) Parent White | 61 Participants |
| Region of Enrollment United States Central Valley Counties | 21 Participants |
| Region of Enrollment United States San Francisco East Bay Counties | 21 Participants |
| Self-Efficacy | 3.68 Score on a scale STANDARD_DEVIATION 0.37 |
| Sex: Female, Male Child care center directors Female | 44 Participants |
| Sex: Female, Male Child care center directors Male | 0 Participants |
| Sex: Female, Male Child care providers Female | 70 Participants |
| Sex: Female, Male Child care providers Male | 0 Participants |
| Sex: Female, Male Children Female | 69 Participants |
| Sex: Female, Male Children Male | 65 Participants |
| Sex: Female, Male Parent Female | 163 Participants |
| Sex: Female, Male Parent Male | 12 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 309 | 0 / 303 |
| other Total, other adverse events | 0 / 309 | 0 / 303 |
| serious Total, serious adverse events | 0 / 309 | 0 / 303 |
Outcome results
None listed