Toxic waste sites typically contain multiple chemicals, yet the vast majority of epidemiologic studies focus only on the health effects of a single chemical, rather than joint exposures. The role of chronic stress in modifying the toxicity of metal exposure is another issues which may be relevant to community health, as the presence of a Superfund site has been demonstrated to be associated with increased chronic stress. The problem of environmental exposure on contaminated lands is also particularly acute for Native Americans whose traditional way of life has close ties to the environment. Because the land and what's grown on it is central to individual and community life, not only are tribal populations disproportionately exposed to environmental toxicants, but the usual preventive measures, such as recommendations to reduce consumption of game or fish threaten to diminish their culture. Such a situation mandates a different approach to exposure assessment, education, and health-care intervention for communities in which subsistence lifestyles predispose to environmental contaminant exposure. In this Community Based Participatory research project, the Harvard School of Public Health, Local Environmental Action Demanded (a community advocacy group), and Integris Baptist Regional Health Center will partner to utilize the culture-based exposure assessment conducted in Project 2 to develop a multi-component intervention program to reduce toxic metal exposures among children living on or near the Tar Creek Superfund Site in northeast, Oklahoma. The project will comprise both observational specific aims on metal mixtures and psychological stress in predicting child development, as measured by Bayley Scale Assessment, as well as nutritional interventions to promote increased dietary iron and calcium intake to reduce toxic metal absorption, home visits to develop social supports, and community level interventions to promote targeted remediation of contaminated lands. This unique multi-faceted approach to environmental risk reduction will maximize the likelihood of compliance and reduce exposure to toxic metals among children, as well as determine the modifying influence of joint exposures to metals and stress on neurologic outcomes (Bayley Scales of Child Development).
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