Babies and the environment : conducting focus groups to determine priority pediatric environmental health issues on a Northwest American Indian reservation
Grandchamp, Milissa Renee.
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American Indian/Alaska Native infant mortality rate is disproportionately higher than the dominant culture. Excess mortality and morbidity for this population may be linked to exposures such as environmental tobacco smoke (ETS), metal contaminants; outdoor air pollution, pesticides, and polychlorinated biphenyls (Karr 2010). Health care providers (HCPs) are positioned to identify, prevent and treat environmental exposures (EE). However, HCPs often lack basic and continuing education on pediatric environmental health (PEH) topics. The purpose of this study was to work with community partners to offer PEH training via a HCP conference on one northwest reservation. A descriptive, qualitative research design utilized focus groups to query HCP about their perceptions of local PEH issues. Moderators were trained via a written protocol to lead focus group discussions using a 12-question instrument. Discussions were audio recorded and transcribed. Content analyses were completed to identify the most frequent themes and question inter-rater reliability was established. The results of this study found that health care providers perceived environmental health (EH) as prevention of both physical toxins and behavioral aspects of population health. Excess infant/child mortality and morbidity were linked to sudden infant death syndrome (SIDS), and a lack of family/community education and resources. Substance abuse (drugs, alcohol, ETS) was recognized as a priority EH issue. Health care providers described their role in PEH as serving as and referring caregivers to resources. A barrier to implementing PEH into practice included the low priority of silent and unseen issues versus conditions with visible acuity. Resources were identified as potential interventions needed to protect the fetus, infant and child from harmful EE. Lack of coordination among agencies creates gaps in policies. Local tribal groups were recognized as entities to advocate for PEH issues. Health care provider identified ways to enhance their knowledge of PEH. In conclusions focus groups are a valuable approach to community-based participatory research. Local HCPs find PEH to be an important topic and are interested in increasing their knowledge. The recommendations are future focus groups on this topic should reorder the tool questions. The findings of this study should be returned to community groups for further action.