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11/29/2012
Submittted by Luis Olmedo, Excecutive Director
COMITE
CIVICO
DEL VALLE
REDUCING CHILDREN’S ENVIRONMENTAL HEALTH
RISK (LEAD, ASTHMA AND PESTICIDES)
2
ABSTRACT
Reducing Children’s Environmental Health Risk (Lead, Asthma, and Pesticides)
Along the US Mexican Border
Project Period: April 2012-November 2012
Funded by the Border Environment Cooperation Commission (BECC) and the
Environmental Protection Agency, Clinicas de Salud del Pueblo, Inc, and Comite Civico del Valle,
Inc. independently yet collaboratively implemented a community health program aimed at reducing
the risk of environmental toxins derived from lead, pesticides, and cleaning products. The programs
used intervention strategies unique to each organization and tailored to specific sub-populations
along the US/Mexican border. While CSP and CCV both utilized individual and group platforms
from which to launch their educational campaign using a “promotora” or community healthcare
model, each owned a captive audience. For example, CSP was able to capitalize on the use of its
lobby and waiting rooms to recruit participants while CCV was forced to take stock in prior project
participant roster and agency partners. Whereas CCV employed a home visitation model, CSP was
limited to conducting intervention activities at community events. There are substantial benefits to
working in the “home” versus public events that may include logistical and practical complications.
However, community events provide a venue for disseminating information to large numbers where
a consideration for quantity over quality is appropriate. Both organizations employed similar
outreach strategies, however each executed them in a complementary fashion. In addition,
intervention activities varied. For example CCV conducted Green Cleaners demonstrations
exclusively as CSP implemented the Safe and Healthy Children’s Curriculum.
When raw data sets were compared, interesting findings were observed. Whereas both
organizations measured identical performance variables, frequencies were dissimilar. 17% of CSP
respondents reported pesticide drift, nearly double of the respondents from CCV reported that
pesticide application reached their home. Over 30% of CCV respondents stated they had at least
one child living with them who had asthma while 22% of CSP respondents stated the same. CCV
had a higher percentage (54%) of families living near agricultural fields while CSP had nearly 32%.
With respect to smoke reaching their homes, CCV reported 38% and CSP 1%. Overall knowledge
gains were comparable in that both cohorts experienced substantial cognitive gains post-intervention
indicating that both organizations experienced program effectiveness.
3
Reducing Children’s Environmental Health Risk (Lead, Asthma, and Pesticides)
Along the US Mexican Border
Project Period: April 2012-November 2012
Introduction
Children are often more heavily exposed to toxics in the environment. Pound for pound, children
breathe more air, drink more water, and eat more food than adults. Their behavior patterns, such as
playing close to the ground and hand-to-mouth activity, increase their exposure to potential toxics.
In addition, they may be more vulnerable to environmental hazards because their systems are still
developing, often making them less able than adults to metabolize, detoxify, and excrete toxics.
Environmental risks to children include asthma-exacerbating air pollution, lead-based paint in older
homes, treatment-resistant microbes in drinking water, and persistent chemicals that may cause
cancer or induce reproductive or developmental changes (Environmental Protection Agency).
Comite Civico del Valle is a non-profit organization that is dedicated to improving the living conditions of Imperial County through advocacy, education, capacity building and civic participation. Comité Cívico Del Valle, Inc. (CCV) was founded in 1987 in Imperial County, California, as an organization striving to improve the lives of low-income families in Imperial County. Our mission is: “Improving access to healthcare and provide education and prevention programs for low income, underserved, Imperial County families.” Their work includes environmental justice, community organizing, policy development in areas of air quality, water contamination, and hazardous dumping. Implementing a “Promotora Model,” CCV has made numerous strides in advancing public health especially among migrant farmworkers along California’s US/Mexico Border Region.
Under this project, the objectives were as follows:
Visit at least 10 households per month with children 0-5 utilizing the “Tool Kit”
Visit 5 childcare providers per month utilizing the “Tool Kit”
Coordinate with Clinicas to participate in health fairs and Asthma Walk
Provide 2 workshops to Clinicas staff on 1) non-toxic green products, 2) IVAN web-based environmental reporting database
Meet bi-weekly with Clinicas staff to measure progress and coordinate project activities
Methods
4
A total of 184 individuals participated in the program which administered by promotoras/health
education specialists who were trained by Comite Civico del Valle. Participants were recruited from
a list of local child care providers that was acquired through the local resource and referral agency as
well as key informant interviews. Of those, 41 respondents reported providing child care from
nearly 20 different distinct sites. Nearly 100 children and 133 were single family households
(Appendix A) caring for over 120. After scheduling a mutually appealing time for an educational
visit, staff visited each childcare provider facility or household during both day and evening hours.
A variety of local activities were identified in a number of communities across the Imperial County
where the majority of participants were derived from the main county seat of El Centro with
Brawley and Calexico having a significant segment of the sample. The activities included health
fairs, buddy referrals, community venues, and early childhood partnership opportunities.
A substantial segment of the sample consisted of caregivers who provided care for children under
the age of 6. One particular childcare center had 60 children in their care. A total of 129 children
under the age of 6 were accounted for by caregiver report under the household segment (not under
facilty). A total of 55 household reported at least one child with 74 reporting two or more under age
6. In addition, over a dozen staff members from a Federal Head Start program were trained as a
component in their staff development protocol.
15%
15%
6%
37%
11%
2% 7%
0% 4% 3%
Geographic Location
Brawley
Calexico
Calipatria
El Centro
Heber
Holtville
Imperial
Niland
55 60
11 2 1
1 2 3 4 5
Number of Single Households with Children
under 6
5
Prior to each individual receiving a 1
hour, 34 slide presentation intervention, a
pre-test was administered (Appendix B).
A typical outreach and education session
consisted of a basic overview of asthma
and its triggers, pesticides and the
dangers of pesticides exposures along
with short and long term effects, what is
asthma and its triggers and an alternative
approach to harmful cleaning and
household chemicals used indoor, lead
poisoning education and alternatives to
harmful cleaning products. Each visit
will consisted of green cleaning products demonstration, toxics vs. green products education and
preparation of safe cleaning solutions as alternative to more toxic cleaning products.
Asthma Hospitalization Rates
Asthma Triggers
Pesticides Exposure
Lead Poisoning
Toxic vs. Green Cleaning Products
In addition, participants were asked to make
commitments to individual behaviors that put
them at less risk of exposure (Appendix C).
Caregivers were most likely to make commitments
to keeping children inside during poor air quality days than they were to run cool water as opposed
to hot water in order to reduce the risk of lead poisoning. They were more likely to engage in
simple behaviors such as handwashing versus more complex behaviors such as fixing leaks in the
plumbing system to prevent mold build-up.
Results
Elevated levels of lead were consistent with State levels at 2%. Twenty-two respondents
were unsure if anyone in their household or facility had elevated levels of lead.
Over 30% of the respondents stated they had at least one child living with them who had
asthma.
More than 70 respondents reported that smoke from burning fields had reached their home
or facility.
Over half the sample reported living in close proximity to an agricultural field and of those
almost 30% reported pesticide drift that reached their home
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Improved knowledge was demonstrated
across all measures as a result of the
intervention. The largest cognitive gains
were observed in relation to lead
poisoning and young children. Less
gains were observed with respect to
pesticide transmission with elevated
awareness about how pesticides enter
the body and how one can be exposed;
possibly lending itself to aggressive
educational campaigns launched over
the past few years. However, there
appeared to be some perception that
certain pesticides were safer than others. This might have been a result of the core content
highlighting household pest control measures such as roach or ant control that may have been
overlooked as hazardous.
Knowledge Item Pre (n) Post (n) % Change (+/-)
Imperial County has the highest asthma hospitalization rate in the state. (True)
162 180 +10
Asthma triggers like cockroaches, mold and dust can all make asthma worst. (True)
182 185 +2
Pesticides enter the body through the eyes, nose, skin and mouth. (True)
179 182 +1.7
All pesticides are poison. (True) 138 171 +24 My family can be affected by pesticides even if we don't work in the fields. (True)
177 183 +3.4
Children 6 years and older are at greater risk to lead poisoning. (True)
157 176 +12
A home built before 1978 may have lead based paint. (True) 169 184 +9 Lead is dangerous to small children because they put their hands and objects that may contain lead dust in their mouth. ( True)
101 135 +34
The more bleach or household products I use to clean my home the cleaner it is. (False)
77 63 +13
Nearly all participants found the information to be helpful and useful to their daily lives. Many
participants followed-up with qualitative comments and concerns that indicated the value conveyed
by project (Appendix D). We learned that caregivers are very concerned about living near
agricultural areas where pesticides are being applied and fields were being burned. Staff got the
sense that caregivers were better equipped to protect the children and themselves in both home and
work settings.
7
Discussion and Implications
There are many benefits to reaching out to caregivers of young children regarding the dangers of
environmental hazards such as lead, poor air quality, mold, pesticide exposure, and cleaning agents.
There appears to be great interest in reducing the risk in the home as well as the child care facility.
This is evident is the excess numbers of presentations documented during this short 6 month
period. Along the US/Mexican Border, there are many barriers that create a heightened risk for
exposure to toxins. A program such as the one highlighted here reduces families’ risk of being
exposed to dangerous levels of lead, pesticides, and harmful chemicals. In addition, it trained
caregivers to provide additional safeguards when caring for young children as well as improving
occupational health.
Benchmark Measure Outcome Excess
60 Households 133 Presentations 73
30 Childcare Facilities 41 Presentations 11
2 Partner Workshops 2 Workshops met
Additional Activities: 1 staff development workshop 3 Community Health Fair
1 Summer In-Service 3 Green Product demonstrations
exceeded without measure
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APPENDIX A
Head Start Parent Meeting Presentations 1. Mckinley & Dr. Joseph Vogel Campesinos Unidos Head Start, El Centro 2. Claudio Carmona Campesinos Unidos Head Start, Calexico 3.Victor Jaime/K.M.M.M.C. Campesinos Unidos Head Start, El Centro 4. Claudio Carmona Campesinos Unidos Head Start, El Centro 5. Michael Aleksick Campesinos Unidos Head Start, Niland 6. Westmorland Campesinos Unidos Head Start, Westmorland 7. Imperial Campesinos Unidos Head Start, Imperial 8. Norah L. Sanchez Campesinos Unidos Head Start, Heber 9. United Families Salton City Preschool, Salton City 10. ICOE (IMPERIAL COUNTY OFFICE OF EDUCATION) Kids R Us Preschool, El Centro 11. ICOE Little Roadrunners Preschool, El Centro 12. United Families Calipatria Preschool, Calipatria Licensed Child Care Facilities 1. Lucero Altagracia Family Child Care, El Centro 2. Graciela Olivares Family Child Care, Brawley 3. Maria Olvera Family Child Care, Brawley 4.Valentina Soto Family Child Care, Brawley 5. Benitez Family Day Care, Calexico 6. Family Treehouse, Imperial 7. Alma Mercado Family Child Care, Calipatria 133 Households in El Centro and Imperial Health Fair 1. Family Treehouse Earth Day Celebration 2. 10th Annual Imperial Valley Housing & Supportive Service Fair (CalWorks and IVROP Project Work), El Centro 3. Imperial Valley Community Health Fair; Cool Kids Imperial Valley, Brawley Workshops 1. Non-Toxic Green Products to Clinicas de Salud del Pueblo 2.IVAN Website: Environmental Reporting Data Base to Clinicas de Salud del Pueblo Staff Development Campesinos Unidos Head Start Program (teacher's, supervisor's and other staff members)
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APPENDIX B
Pre-/Post- Test
City ? / ¿Ciudad?_____________________ Date/ Fecha___________
Are you a daycare provider? / ¿Es usted provedor de una guardería de
niños?_________________________________________
If answered yes, how many children do you provide care for? / Si contesto que sí a la pregunta anterior,
¿cuántos niños cuida?____________________________
How many children under the age of 6 live in your home? / ¿Cuántos niños menores de 6 años viven en
su hogar?______________________________________
How many children in your home or facility have asthma? / ¿Cuántos niños en su hogar o facilidad
tienen Asma? ___________________________________
Pre- Test TRUE/ Cierto
FALSE/ Falso
1. Imperial County has the highest asthma hospitalization rate in the state.
*El Condado de Imperial tiene el más alto porcentaje en hospitalizaciones por asma del estado.
2. Asthma triggers like cockroaches, mold and dust can all make asthma worst.
*Causantes del asma como cucarachas, moho y polvo pueden empeorar el asma.
3. A pesticide enters the body thru the eyes, nose, skin and mouth.
*Los pesticidas entran al cuerpo a través de los ojos, la nariz, piel y boca.
4. All pesticides are poison.
*Todos los pesticidas son venenosos.
5. My family can be affected by pesticides even if we don’t work in the fields.
*Mi familia puede ser afectada por los pesticidas, aún cuando no trabaje en los campos.
6. Children 6 years and under are at greater risk to lead poisoning.
*Niños de 6 años o menores están en mayor riesgo de envenenamiento por plomo.
7. A home built before 1978 may have lead based paint.
*Una casa construida antes de 1978, puede tener pintura a base de plomo.
8. Lead is dangerous to small children because their hands and objects in mouth that may contain lead dust.
*El plomo es solamente peligroso a niños pequeños, porque sus manos y los objetos que se colocan en la boca pueden contener polvo de plomo.
9. 9. The more bleach or household products I use when cleaning my home, the
the cleaner it is. *Mientras más productos de limpieza, como el blanqueador, utilice para
10
Limpiar mi hogar, más limpio estará.
10. Do you live close to an agriculture field?
¿Usted vive cerca de un campo de agricultura?
Yes
No
11. If answered yes to question 10: Does the pesticide applied in nearby fields
reach you home? ¿Si contesto si a la pregunta 10: Los pesticidas que se aplican en los campos
cercanos, alcanzan a su hogar?
Yes
No
12. Has anyone in your household had elevated levels of lead?
¿Alguien en el hogar tiene niveles elevados de plomo?
Yes
No
13. Has the smoke from burning fields ever reached your home?
¿El humo de los incendios en los campos alcanza llegar a su hogar?
Yes
No
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APPENDIX C
How can I protect children from asthma attacks?
I commit to dishing the childcare center often. 96 72%
I commit to vacuuming carpets and fabric-covered furniture regularly. 109 81%
Exposure to mold can trigger an asthma attack.
I commit to preventing mold by fixing leaks and other water problems as soon as
possible to prevent mold from growing. 121 65%
Cockroaches can trigger an asthma attack.
I commit to keeping counters, sinks, tables, and floors clean and free of clutter. 129 70%
Pet dander can trigger an asthma attack.
If there is a pet inside, I commit to vacuuming carpets and furniture often. 94 51%
Chemical irritants found in cleaning products, pesticides, and air freshmen's
can trigger an asthma attack.
I commit to not using products with chemical irritants (such as cleaning products,
pesticides, and air fresheners) when chidden are around. 110 87%
I commit to opening windows or doors, or using and exhaust fan if I must
uses product with chemical irritants. 102 80%
Outdoor air pollution can trigger asthma.
I commit to letting children play outdoors when air quality is good. 115 91%
I commit to limiting children's play time outdoors when air quality is poor. 98 78%
How I can protect children from pesticide exposure:
I commit to store pesticides and toxic chemicals where children cannot reach them. 125 93%
If I have to use a pesticide or other chemical, I commit to not use pesticides
or other chemical products when children are present and will remove
children's toys from the area. 104 78%
How can I protect children from lead poisoning?
I commit to having children was their hands before eating. 128 94%
I commit to washing children's bottles and toys and washing floors
and windowsills often. 110 81%
I commit to reducing lead in drinking water by running the cold water for at
least 30 seconds to flush lead from pipes. 93 68%
I commit to only use cold water for drinking, cooking, and making buy
formula because hot water is likely to contain higher levels of lead. 88 65%
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APPENDIX D
Qualitative Commentary
Respondents were asked to share additional thoughts, concerns, or commentary with the Project.
1. Imperial Valley air quality can affect if we dont learn the right precautions. 2. Very helpful and great info. 3. Great presentation, practical ideas. Especially to think twice when using cleaners around the house. 4. I want to know if is there any place or help grant to help the community to know if in the house have
lead in the paint 5. Very helpful. Thank you. I wasn't aware of lead in candy. 6. Loved the presentation 7. Very good information. 8. Very good presentation, to bad that we didn't had any more time 9. Good information 10. Thanks 11. Very good information, very useful 12. Very good information 13. Good presentation 14. I learned about what kind of items contain lead and can cause lead poisoning to my son. It was very
helpful. 15. Thank you for all the information 16. I live near to the agriculture field and I am worried that the pesticide can reach to my house. The
presentation that I receive it was very important for me and my family. 17. Its very important this information for us, because we live so near of the agriculture fields pesticides 18. We have the field near to us. Thanks for give us the information 19. Thanks for the information and concern for our kids 20. Thanks for the information it was very important to know. 21. Thank you! It was very helpful 22. No buy more candies at Mexico 23. I learn a lot 24. the information is helpful 25. devemos de tomar muchas pecauciones, con los que limpiamos, en nuestro hogar. Y mivimos aun
lado de campo y fumigan muy amenudo. 26. its bad 27. My son and I have asthma so this is very important and helpful to me. 28. Very helpful information 29. Please provide CD regarding environmental issues 30. This was very helpful. 31. This was good information
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BORDER 2012 PROJECT
FINAL REPORT
I. SUB-GRANTEE/CONTRACTOR Information:
Name: Clinicas de Salud del Pueblo, Inc.
Institution: N/A
Address: 1166 K Street, Brawley, CA 92227
E-mail: CynthiaD@cdsdp.org
II. Title of Project: Clinicas de Salud: Reducing Childhood Environmental Risks Along the US-Mexico Border
III. Starting date: April 17, 2012
IV. Total Project Duration: Six months
V. Date of Final Report: November 15, 2012
TABLE OF CONTENTS
VI. Introduction/ Background/Identified Problem Clinicas de Salud del Pueblo, Inc. (Clinicas) is based in the Imperial County, an international border community with an agricultural based economy. Residents in our area are exposed to the daily activities of the agriculture industry which includes ground and aerial application of pesticides and burning of fields. Although there are agencies and protocols in place to monitor and regulate these activities, residents are still vulnerable to exposure simply be virtue of proximity. The LA Times featured an article; Imperial County leads the state in treatment of children with asthma, by Ann Gorman, July 16, 2012, addressing the situation in our area and its impact children. “Doctors and public health officials said that a combination of whipping winds, pesticide-tinged farmland dust and large numbers of low-income families lacking health insurance contribute to high rates of asthma hospitalizations and ER visits… Asthma is so prevalent among the students at Barbara Worth Junior High School in Brawley that the principal sends air quality alerts to his teachers and regularly cancels outdoor activities.”
In fact, Clinicas Chief Medical Officer, Dr. Afshan Baig, and a pediatric patient of the Calexico clinic were cited in the article. Clinicas de Salud is a 501(C)3 non-profit community health center. The majority of 55,000 people served annually in our clinics are low-income, Medi-Cal patients. Many of the children suffering from asthma and other respiratory issues are patients of Clinicas. As a result, when Clinicas was offered consideration for the Border 2012 Project, we were pleased about the opportunity to: 1) increase awareness about childhood environmental risks; 2) educate patients, parents, and the public about minimizing risks for
15
children; and, 3) create linkages between patients and service providers, programs, and resources.
VII. Objectives Clinicas experience in health promotions and our network of community partners steered the outreach methodology to classroom presentations and community event outreach. These two forums provide an effective method to coordinate and deliver services to the public. Based on the program staffing and duration, and seasonal considerations, Clinicas de Salud projected serving 450 families and/or child care providers through the Border 2012 program as follows:
1. 200 (or more) parents and/or child care providers will participate in Educational Group Sessions; and,
2. 250 individuals will receive One-to-One Outreach at community events.
VIII. Project’s Strategy Clinicas approach to the Border 2012 project was to utilize the network of community resources at our disposal and take into account the limitations of accessibility to events and the public due to seasonal impacts during the summer months, which represented half the program duration. We hired two part time staff members to coordinate and implement the program. Upon reporting to work, staff was provided a program orientation and training on the Safe and Healthy Children curriculum, IVAN website, the local Environmental Task Force, CALPACT Asthma webinar, Green Cleaning Products, and Community Advocacy. (The Safe and Healthy Children training was opened to our program partner’s staff and to local community health workers who were interested in acquiring knowledge and/or expanding their subject matter expertise.) The community Health Workers promoted the program by coordinating visits to coalition, advisory committee, and work group meetings that Clinicas belongs to throughout the valley, and announcing the services available. They also made telephone solicitations to agencies serving the program’s targeted population. Staff then responded to requests for details about the outreach activities and provided samples of materials to be disseminated to demonstrate the content of the program. At the same time staff was gathering/ordering the necessary materials and scheduling activities with various agencies. The scheduling of outreach activities kicked off about the time summer was starting, school was ending, and child care centers were preparing to close for two months. Here, in the desert southwest, the pace slows down significantly between June and August, and community activities come to a standstill. It was challenging getting through to the child care centers before they went dark; still, staff managed to schedule One-to-One outreach activities at child care center parent meetings, a children’s fair and a library event for parents during the months of May and June. Benchmarks
The One-to-One objective was met two months into the six month program, with 267 parents being contacted April and June
The Educational Group Session objective was met between July and September with 239 parents being contacted
16
Staff continued to promote One-to-One and Group Session activities after both objectives were met, and contacted an additional 564 parents during October
1,100 participants were served by the program in a six month period
IX. Methods or Work Description
Clinicas de Salud was to provide outreach to parents and/or child care providers of children ages 0-5 years of age through Educational Group Sessions and One-to-One Outreach. The Educational Group Sessions were presented in English and Spanish, as needed, throughout the Imperial Valley. The one-hour classes include a minimum of ten participants and were conducted from July through October. The classes were offered in cities though out the county; however, our largest responses came from organizations located in the county seat, El Centro. Clincas also performed One-to-One Outreach throughout the community at children’s fairs, health fairs, school events, a farm worker meeting, child care centers, a library, and clinic lobbies. The method of instruction for the educational group sessions included: facilitator instruction, group discussions, interactive activities, and demonstrations. The group sessions followed the Safe and Healthy Children’s curriculum and addressed the Unique Vulnerability of Children, Preventing and Reducing Exposure(s), Community Support and Collaboration, and Pre- and Post-Evaluation. The One-on-one Outreach covered the same content but in a condensed version. The same materials were distributed to all participants whether they were reached via a group session or one-on-one contact.
X. Results: One-to-One Outreach Objective: 250
753 parents received One-to-One contact overall One-to-One outreach objective was exceeded by 200% City of Calexico realized the 58% of participant contacts Community Fairs generated 62% of participant contacts
Geographic Location Number of Events
Participants Contacted
Percentage of People Served
Brawley 5 107 14%
Calexico 4 440 58%
Desert Shores 1 16 2%
El Centro 5 127 17%
Heber 1 17 2%
Holtville 1 13 2%
Westmorland 1 33 5%
Total 18 753 100%
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Outreach Forum Number of Events
Participants Contacted
Percentage
Library 1 13 2%
Grammar School 1 33 4%
Clinics 4 61 8%
Child Care Centers 6 179 24%
Community Fairs 6 467 62%
Total 18 753 100%
Educational Group Session Objective: 200
347 parents participated in Group Sessions overall Educational Group Session objective was exceeded by nearly 75% The Educational Group Sessions averaged 22 participants per session City of El Centro realized the 63% of participant contacts Child Care Centers generated 36% of participant contacts WIC followed closely with 32% on participant contacts
Geographic Location Number of Events
Participants Contacted
Percentage of People Served
Brawley 2 32 9%
Calexico 2 56 16%
El Centro 10 217 63%
Seeley 1 30 9%
Westmorland 1 12 3%
Total 16 347 100%
Outreach Forum Number of Events
Participants Contacted
Percentage
Community Fairs 1 21 6%
Clinics 2 25 7%
Training Centers 2 67 19%
WIC 5 109 32%
Child Care Centers 6 125 36%
Total 16 347 100%
Survey Responses Pre- and Post-Test Responses for Participants in the Educational Group Sessions
Nearly 3% of respondents (10 of 347) stated that a child in the home had tested positive for elevated level of lead
22% of respondents (79 of 347) indicated that a child in their home has asthma
Nearly 3% of respondents (10 of 347) reported that their child had had experienced pesticide exposure requiring medical attention
Nearly 33% of respondents (115 of 347) reported they live near and agriculture field
19% of respondents (55 of 288) said pesticide applications reach their home
18
Nearly 23% of respondents (66 of 288) said smoke from burning fields reaches their home
Knowledge Increase: respondent’s knowledge of lead poisoning, asthma triggers and pesticide exposure prior to and following educational group sessions:
Response Pre-presentation Post-presentation Outcome
Poor 95 8 92% Increase
Fair 148 51 66% Increase
Good 74 141 48% Increase
Very Good 20 101 80% Increase
Excellent 5 40 87% Increase
Non-response 5 6 N/A
Total 347 347 N/A
Commitment Forms All participants of the Educational Group Sessions completed Commitment Forms. Staff assisted participants in completing the forms and verified that each participant had in fact read and completed a Commitment Form. However, due to time constraints and access to photocopiers at each of the sites, we were not able to keep a copy of the Commitment Forms.
XI. Discussion Clinicas de Salud was extremely pleased with the outcome of the EPA childhood environmental risk program. Local community partners were grateful for the opportunity to provide educational presentations to their clients. We found that a number of agencies had health care focused programs of their own going on at the same time, so our program complimented their programs. Also, despite the challenges of conducting outreach in our area during the summer months, staff managed to meet the objectives in a timely manner. Classroom discussions revealed that parents are not only interested in the topic of childhood environmental risks, but that they also needed information on local resources regarding available services. Our program facilitated linkages between the staff of agencies partaking of our services, as well as their participants. The majority of requests for information were directed to the local Asthma Society, and the Imperial County Public Health Department, Agricultural Commissioner’s Office, and Air Quality Control office.
XII. Recommendations: Clinicas de Salud’s Community Health Workers will continue to promote awareness about childhood environmental risks at outreach events. As a result of this program, we now have a section of updated resources in our health topics inventory designated to environmental health risks. Although the program ended October 31, 2012, Clinicas continues to receive requests for presentations on childhood environmental risks and will continue to accommodate these requests so long as staff is available, through other funding sources, to promote the program.
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Although, many concerns were voiced regarding children’s respiratory issues during the outreach contacts, lead poisoning is something that most people are not aware of. The program participants repeatedly voiced concerns regarding their lack of knowledge, local resources and legislation to address the matter. Program participants repeatedly mentioned frustration with the availability of food products and cookware containing lead. Also, when parents find out that a child has been exposed to lead, other than taking the child to the pediatrician for an exam they are clueless of what to do to avoid further exposure or reduce risks. It would be extremely beneficial for the EPA to make additional funding available to address these concerns and increase awareness about these risks. Because of our natural environment and the agricultural based economy, residents of Imperial County are vulnerable to exposure to harmful elements that can be avoided or minimized if people were aware of basic things they can do to protect themselves and their families from these risks.
XIII. Project related Photos Please see the attached two pages of photos from the outreach events staff participated in. Also, the digital camera that was used to photograph events during the summer months was damaged and the pictures were not retrievable. As a result, we only have photos from our participation in events the months of April, May, September and October. References None. Appendixes
A. One-to-One Outreach Summary B. Educational Group Presentation Summary C. Community Health Outreach Staff Training Summary
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Clinicas de Salud del Pueblo, Inc. Community Health Outreach Photographs
EPA Border 2012 Project
Reducing Childhood Environmental Health Risks along the U.S. - Mexico
Border
April 28, 2012, Mexican Consulado Di del
Niño. Cecilia Cota, CHW, providing
information to the public.
May 15, 2012, Calexico Neighborhood House.
Cecilia Cota, CHW, addressing parents about
lead poisoning and testing.
September 12, 2012, United Families
Preschool, Westmorland. Cecilia Cota, CHW,
talking to parents at a monthly meeting.
October 3, 2012, Westmorland Walk-to-
School Day. CHW’s providing information to
parents and conducting educational activities
with children.
October 3, 2012, Walk-to-School Day in
Westmorland. CHW Ana Solorio, students
and care givers walking to school.
October 9, 2012, CET in El Centro. Celina
Cisneros, CHW, informing parents about
childrens vulnerability and exposure risk
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Clinicas de Salud del Pueblo, Inc. Community Health Outreach Photographs
EPA Border 2012 Project
Reducing Childhood Environmental Health Risks along the U.S. - Mexico
Border
October 9, 2012 CET Health in El Centro.
CHW’s Cecilia Cota, Celina Cisneros and Ana
Solorio teamed up for presntations.
October 10, 2012, Mental Health Fair in El
Centro. Mary Ramirez, Medical Assistant,
providing public with health information.
October 16, 2012, Desert Shores Health Fair.
Ana Solorio, CHW, providing asthma trigger
information to the parents.
October 19, 2012, Farm Worker Health Fair.
CHW’s Mireya & Ana providing educational
materials to all the attendees.
October 20, 2012 Down Syndrome Health
Fair. CHWs ready for the public, waiting for
event to kick-off and parents to arrive.
October 20, 2012, Down Syndrome event.
CHWs participating in a physical activity
demonstation with other presenters.
22
Clinicas de Salud del Pueblo, Inc. One-to-One Outreach Summary
EPA Border 2012 Project
Reducing Childhood Environmental Health Risks along the U.S. - Mexico
Border
Project Activity: One-to-One Outreach
Event Date Parents
Contacted
Staff Trained
Rockwood Park
5th
and Mary Streets
Calexico, CA 92231
Mexican Consulado Día de los
Niños
04/28/12 75 participants
3 sign-in sheets
N/A
Neighborhood House
506 East 4th
Street
Calexico, CA 92231
Parent Meeting
05/15/12 70 participants
4 sign in sheets
7 Instructors
C.U.I. Head Start
1045 Heber Avenue
Heber, CA 92249
Parent Meeting
05/17/12 17 participants
1 sign in sheet
2 Instructors
United Families Pre-school
300 North Palm Avenue
Brawley, CA 92227
Parent Meeting
05/23/12 40 participants
3 sign in sheets
3 Instructors
United Families Preschool
1660 Smoketree Drive
El Centro, CA 92243
Parent Meeting
05/25/12 14 participants
1 sign in sheet
2 Instructors
United Families Pre-school
937 Heber Avenue
Calexico, CA 92231
Parent Meeting
06/06/12 15 participants
1 sign in sheet
2 Instructors
C.U.I Head Start
160 South Cesar Chavez
Brawley, CA 92227
Parent Meeting
06/14/12 23 participants
2 sign in sheets
2 Instructors
I.C. Free Library
101 E. 6th
Street
Holtville, CA 92250
Health Fair
06/15/12 13 participants
1 sign in sheet
2 Library Techs
1 Volunteer
Westmorland Elementary School
200 South C Street
Westmorland, CA 92281
Walk-to-School Day - Health Fair
10/3/12 33 Participants
4 sign in sheet
N/A
23
Women’s Center
651 Wake St. Suite A
El Centro, CA 92243
Patient Lobby
10/3/12 17 Participants
1 sign in sheet
N/A
Clínica de Salud
900 Main Street
Brawley, CA 92227
Patient Lobby
10/4/12 17 Participants
1 sign in sheet
N/A
Imperial County Behavioral Health
120 North 8th
Street
El Centro, CA 92243
Mental Health Fair
10/10/12 38 Participants
3 sign in sheet
N/A
Clínica de Salud
900 Main Street
Brawley, CA 92227
Patient Lobby
10/11/12 13 participants
1 sign in sheet
N/A
Desert Shores Community
Services
Hwy 86 & Monterey Avenue
Desert Shores, CA 92274
Health Fair
10/12/12 16 Participants
1 sign in sheet
N/A
Imperial County One Stop
1500 Main Street
El Centro, CA 92243
Farm Worker Coalition Event
10/17/2012 14 Participants
1 sign in sheet
N/A
Clínica de Salud
900 Main Street
Brawley, CA 92227
Patient Lobby
10/18/12 14 Participants
1 sign in sheet
N/A
Imperial County One Stop
Heber & 3rd
Avenue
Calexico, CA 92231 Bi-National Farmworker Health Fair
10/19/12 280 Participants
14 sign in sheet
N/A
Down Syndrome Association
Bucklin Park-Ross & 8th
Street
El Centro, CA 92227
9th
Annual Buddy Walk - Health
Fair
10/20/12 44 Participants
3 sign in sheet
N/A
Total Served through One-to-One Outreach: 753 Participants
24
Clinicas de Salud del Pueblo, Inc. Community Health Outreach
EPA Border 2012 Project
Reducing Childhood Environmental Health Risks along the U.S. - Mexico
Border
Project Activity: Educational Group Presentations
Event Date Participants
Sign-in Sheets
Pre and Post
Questionnaires
Commitment
Forms ICOE Head Start
280 S. Fairfield Drive
El Centro, CA 92243
Parent Meeting
07/12/12 17 participants
2 sign in sheets
17 Pre
17 Post
17
ICOE Head Start
937 Heber Avenue
Calexico, CA 92231
Parent Meeting
07/19/12 17 participants
2 sign in sheets
17 Pre
17 Post
17
Imperial Valley Mall
3451 S. Dogwood Rd.
El Centro, CA 92243
Health Fair
07/27/12 21 participants
2 sign in sheets
21 Pre
21 Post
21
WIC - El Centro
2600 Thomas Drive
El Centro, CA 92243
AGA-40 Presentation
08/15/12
08/16/12
43 participants
3 sign in sheets
43 Pre
43 Post
43
WIC - Brawley
561 E Street
Brawley, CA 92227
AGA-40 Presentation
09/05/12 18 participants
2 sign in sheets
18 Pre
18 Post
18
United Families
179 Southwind Drive
El Centro, CA 92243
Parent Meeting
09/06/12 10 participants
1 sign in sheet
10 Pre
10 Post
10
WIC El Centro
2600 Thomas Drive
El Centro, CA 92243
AGA-40 Presentation
09/17/12 15 participants
1 sign in sheet
15 Pre
15 Post
15
WIC - El Centro
2600 Thomas Drive
El Centro, CA 92243
AGA-40 Presentation
09/19/12 20 participants
2 sign in sheets
20 Pre
20 Post
20
IVROP
687 State Street
El Centro, CA 92243
Staff-Counselors Mtg.
09/20/12 10 participants
1 sign in sheet
10 Pre
10 Post
10
United Families
198 E. 3rd Street Westmorland, CA 92281
Parent Meeting
09/20/12 30 participants
3 sign in sheets
30 Pre
30 Post
30
Women’s Center
651 Wake St. Suite A
El Centro, Ca. 92243
Patient Lobby
09/27/12 11Participants
1 sign in sheets
11 Pre
11 Pro
11
25
WIC - El Centro
2600 Thomas Drive
El Centro, CA. 92243
AGA-40 Presentation
09/27/12 13 Participants
1 sign in sheets
13 Pre
13 Pro
13
Women’s Center
900 Main St.
Brawley, CA 92227
Patient Lobby
09/28/12 14 Participants
1 sign in sheets
14 Pre
14 Pro
14
United Families
Head Start
1813 Rio Vista
Seeley, CA 92273
10/4/12 12 Participants
1 sign in sheet
12
12
12
Center for Employment Training 204 South Third Street
El Centro, CA 92243
10/9/12 57 Participants
4 sign in sheets
57
57
57
Neighborhood House
Preschool
506 4th Street
Calexico, CA 92231
10/23/12 39 Participants
3 sign in sheets
39
39
39
Total served through Education Group Presentations: 347 Participants
26
Clinicas de Salud del Pueblo, Inc. Staff Training Summary
EPA Border 2012 Project
Reducing Childhood Environmental Health Risks along the U.S.-Mexico
Border Green Cleaning Products Training
July 20, 2012, 1:00 – 2:00 pm: CDSDP Corporate Conference Room, Lorraine Alexandra, presenter
The focus of the training was to provide information on how to prepare green cleaning products using
toxic free biodegradable products such as; Borax, vinegar, baking soda, and water. With the knowledge
gained from this training staff will be able to educate the community on ways to reduce asthma triggers in
their homes by eliminating the use of chemical irritants found in Pine-Sol, Clorox, Windex and other
cleaning products used in the home that may cause a child’s asthma to worsen. By using green cleaning
products the community is not only reducing children’s environmental health risks but they are also
helping our environment.
Presenter: Lorraine Alexandra, Comité Civico, Community Health Worker
Attendees: Cynthia Dagnino, CDSDP Director of Programs
Cecilia Cota, CDSDP Community Health Worker III
Ana Solorio, CDSDP Community Health Worker I
Celina Cisneros, CDSDP Community Health Worker I
Francisca Izaguirre, CDSDP CHW Volunteer
Elva King, CDSDP CHW Volunteer
Mireya Preciado, CDSDP CHW Volunteer
Sylvia Zendejas, CDSDP CHW Volunteer
IVAN and Environmental Task Force Training
July 20, 2012, 2:00 – 4:00 pm: CDSDP Computer Lab; Luis Olmedo, presenter.
Imperial Vision Action Network (IVAN) is the first community-based environmental reporting site in all
of California. The task force brought attention to environmental issues in Imperial County and ways to
work together to resolve them. These issues included water pollution, dumping and/or burying of toxic
materials, air quality, contaminated land, unsecured sites where chemicals are stored, illegal transport of
hazardous materials, etc. Other topics covered in training are as follow:
Environmental laws and regulations
How to navigate the IVAN website www.ivanonline.org
How to submit an environmental complaint and incident report
Bilingual task force meetings held the third Thursday of the month in El Centro to review
reports and discuss govt.’s progress in addressing verified environmental hazards/damage
Presenter: Luis Olmedo, Comité Civico, Executive Director
Attendees: Cynthia Dagnino, CDSDP Director of Programs
Cecilia Cota, CDSDP Community Health Worker III
Ana Solorio, CDSDP Community Health Worker I
Celina Cisneros, CDSDP Community Health Worker I
Francisca Izaguirre, CDSDP CHW Volunteer
Elva King, CDSDP CHW Volunteer
Mireya Preciado, CDSDP CHW Volunteer
Sylvia Zendejas, CDSDP CHW Volunteer
27
Asthma Webinar
July 31, 2012, 1:30 - 2:30 pm: CDSDP Corporate Office, online asthma webinar
Presented by the California Pacific Public Health Training Center (CALPACT), the focus of the Asthma
webinar was to address asthma in California as well as local strategies to help residents breathe easier.
The topics covered are as follows:
Pathophysiology of Asthma
Asthma by Race/Ethnicity statistics
Asthma triggers
Clinical care and public health interventions
Strategies for asthma prevention
Green cleaning products
Tots Breathe Freely Project
Strategic Plan Implementation Grants (SPIG)
Presenters: Deanna Rossi, MPH, Ass. Dir., CA Breathing Asthma Program, CA Dept. of Public
Health
Jacquelyn Komplin RN, PHN, MSN, Public Health Nurse Consultant, Child Start, Inc.
Attendees: Cecilia Cota, CDSDP Community Health Worker III
Ana Solorio, CDSDP Community Health Worker I
Celina Cisneros, CDSDP Community Health Worker I
Safe and Healthy Children Curriculum Training:
August 28, 2012, 9:00 am - 5:00 pm: CDSDP El Centro Women’s Center Conference Room
Presented by Health Outreach Partners, Oakland California, the focus of the training was to Train-the-
Trainer and review the Safe and Healthy Children Curriculum. The topics covered included:
Adult learning
Facilitation strategies
Demonstration of unique vulnerability of children
Preventing and reducing exposure
Program planning
Community support
Evaluation recommendations
Presenters: Alexis Wielunski, MPH, Project Manager, Health Outreach Partners Sonia Lee, MPH, Project Evaluation Analyst, Health Outreach Partners
Attendees: Cynthia Dagnino, CDSDP Director of Programs
Cecilia Cota, CDSDP Community Health Worker III
Ana Solorio, CDSDP Community Health Worker I
Celina Cisneros, CDSDP Community Health Worker I
Francisca Izaguirre, CDSDP CSW Volunteer
Elva King, CDSDP CSW Volunteer
Luz Moreno, CDSDP Community Health Worker Coordinator Mireya Preciado, CDSDP CSW Volunteer
Sylvia Zendejas, CDSDP CSW Volunteer
Lorraine Alexandra, Comite Civico Community Health Worker
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