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Community based interventions—less than perfect?
  1. L Fisher
  1. Safety/Management Consultant (Archivist, American Public Health Association, ICEHS Section: see related commentaries at: www.icehs.org), 97 Union Avenue, South, Delmar, NY 12054, USA; fisher166juno.com

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    Thanks to Nixon et al1 and Moller2 for opening a dialogue on community based interventions. As learning organizations,3 we must continue to critically share evidence based and less than perfect experiments that face real world constraints. I describe here how a “successful” but imperfect start up enterprise4 enhanced that field.

    From 1976–84, my co-investigators and I received piecemeal funding for community based childhood poison prevention demonstration projects. (Two of the 12 resulting publications were cited in Medline.) Our Monroe County Project (MCP) intervention did not meet Nixon’s inclusion protocols as a true community study with cases and controls. Ours used a quasiexperimental design with school and parent education and the media to promote purchasing and using safer products. It was associated with a 66% decrease in hospital emergency department visits for those age 0–5 and 60% reduction in admissions compared with two pre-intervention years and to non-experimental comparison sites. Fewer accessible household toxic products and increased observed use of safety latches in homes of children under 6 were linked to significant knowledge gain and increased calls to the poison control center.

    MCP findings of significant cost-containment: $25 dollars per project dollar spent, prompted an amendment to New York State Public Health Laws resulting in a State Regional Poison Prevention Network. This provided $4 million per year of Medicaid funding to designated regional poison control centers. It established regulations, annual reports, and an advisory committee.5 The MCP final report guided the Centers for Disease Control and Prevention’s Poison Control Advisory Group’s 1996 report for enacting a US regional poison control center enhancement funding law.

    Experimental creative leadership during a period of downsizing resources can lead to significant scientific contributions to intervention systems tomorrow.6

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