title: A school-based strategy to assess children's environmental exposures and related health effects in economically disadvantaged urban neighborhoods.
abstract: The School Health Initiative: Environment, Learning, Disease (SHIELD) study is a novel school-based investigation of children's environmental health in economically disadvantaged urban neighborhoods of Minneapolis. This article describes the study design and summarizes lessons learned about recruiting and monitoring this historically understudied population. The SHIELD study focused on measuring children's exposures to multiple environmental stressors [volatile organic chemicals (VOCs), environmental tobacco smoke, allergens, bioaerosols, metals, pesticides, polychlorinated biphenyls (PCB), phthalates] and exploring related effects on respiratory health (e.g., lung function) and learning outcomes (e.g., standardized test scores, academic achievement). It involved intensive exposure monitoring, including environmental measurements inside and outside the children's schools and inside their homes, personal measurements with passive dosimeters worn by the children, and biological marker measurements in blood and urine. The SHIELD participants comprised a stratified random sample of 153 "index" children and 51 of their siblings enrolled in grades 2-5 at two adjacent elementary schools. The Minneapolis Public Schools (MPS) assisted with identifying, contacting, recruiting, and monitoring this population, which traditionally is difficult to study because families/children are highly mobile, speak a diversity of languages, frequently do not have a telephone, endure economic hardships, often do not trust researchers, and have a spectrum of unconventional lifestyles and living arrangements. Using a school-based approach, the overall SHIELD enrollment (response) rate was 56.7%, with a wide disparity between English-speaking (41.7%) and non-English-speaking (71.0%) families/children. Most children remained involved in the study through both monitoring sessions and exhibited an acceptable degree of compliance with study protocols, including providing blood and urine samples. Results indicate that it is both practical and affordable to conduct probability-based exposure studies in this population, but that it is also important to improve our understanding of factors (e.g., cultural, economic, psychological, social) affecting the willingness of families/children to participate in such studies, with special emphasis on developing cost-effective recruitment methods.
authors.affiliation: School of Public Health, University of Minnesota, Minneapolis 55455, USA. ksexton@mail.eoh.umn.edu
authors.forename: K
authors.initials: K
authors.lastname: Sexton
authors.forename: I A
authors.initials: IA
authors.lastname: Greaves
authors.forename: T R
authors.initials: TR
authors.lastname: Church
authors.forename: J L
authors.initials: JL
authors.lastname: Adgate
authors.forename: G
authors.initials: G
authors.lastname: Ramachandran
authors.forename: R L
authors.initials: RL
authors.lastname: Tweedie
authors.forename: A
authors.initials: A
authors.lastname: Fredrickson
authors.forename: M
authors.initials: M
authors.lastname: Geisser
authors.forename: M
authors.initials: M
authors.lastname: Sikorski
authors.forename: G
authors.initials: G
authors.lastname: Fischer
authors.forename: D
authors.initials: D
authors.lastname: Jones
authors.forename: P
authors.initials: P
authors.lastname: Ellringer
mesh_terms: D016902:Air Pollution, Indoor / Q000009:adverse effects / Q000032:analysis; D015415:Biomarkers / Q000032:analysis; D002648:Child; D002669:Child Welfare; D004781:Environmental Exposure / Q000032:analysis*; D004784:Environmental Monitoring / Q000379:methods*; D005006:Ethnicity; D005260:Female; D006801:Humans; D008297:Male; D009930:Organic Chemicals / Q000009:adverse effects / Q000032:analysis; D010575:Pesticides / Q000009:adverse effects / Q000032:analysis; D011203:Poverty; D012107:Research Design; D012574:Schools; D014028:Tobacco Smoke Pollution / Q000009:adverse effects / Q000032:analysis; D014505:Urban Population; D014835:Volatilization
chemical_list: D015415:Biomarkers; D009930:Organic Chemicals; D010575:Pesticides; D014028:Tobacco Smoke Pollution