Whatcom County hosted a public-health study that yielded an unsurprising result: Home visits by nurses tended to work better than mailings to educate people on how to deal with health risks in their homes.
The timing of the study, however, is less than ideal from the point of view of the Washington State Association of Public Health Officials, a nonprofit that represents the goals of local public-health agencies such as the Whatcom Health Department.
In a 2006 report to the state Legislature, the association recommended expanding a nurse-visit programs to benefit children's health.
Written at a time when the economy was strong, the report recognized the additional cost of expanded programs but concluded they would "pay dividends in terms of stronger families for years to come."
Patricia Butterfield, College of Nursing professor at Washington State University and lead author of the Whatcom study, said the practical value of the study was significant, but it did not include a cost-benefit analysis.
"We didn't quantify the cost of four public health nursing visits (per family). Those are fairly modest costs," Butterfield said. "My work focused in on, 'What is the impact of public health nurses?'"
The study included 235 families with 399 children in Whatcom County and Gallatin County, Mont., chosen because they were fast-growing counties with a mix of urban and rural populations. Subjects were rural residents with low to moderate income.
People's wells were sampled for the presence of nitrates, coliform bacteria and pesticides. Children's blood was tested for lead, and their saliva was tested for exposure to tobacco smoke.
The study showed more awareness and responsiveness to environmental health risks among the families that were visited by nurses. The other group received a letter detailing the test results and directing them to health department resources.
"In the nursing group, the people ... knew what to worry about and what not to worry about, and they knew how to take action," Butterfield said.
Evidence of the program's efficacy may have been bolstered by the study, published in the December issue of the American Journal of Public Health, but its feasibility is less certain. A call for expanded home-visit programs is no longer being heard from the health officials association.
"The priorities of local health jurisdictions have changed significantly since 2006 due to the economic crisis we're in," said Elaine Conley, association chairwoman.
"Given the economic climate, it is going to be very difficult for many jurisdictions to keep even their current level of home visitation," she said.
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