PROJECT SUMMARY/ABSTRACT (limit 30 lines of text) Cleaning and disinfection (C&D) activities pose work-related asthma (WRA) risks for nurses. C&D involves an inherent “risk-risk tradeoff”: increased C&D leading to increased WRA risks and simultaneous decreased occupational infection risks. Our preliminary data from a risk-risk tradeoff survey indicate that nurses are generally willing to increase infection risks to maintain lower asthma risks, if they think they think they will recover. Translating these concerns to C&D protocol changes is challenging due to logistical constraints and lack of awareness about asthma risks from C&D. My long-term goal is to advance methodologies for relating tolerable occupational respiratory disease risks to public health policy interventions. Specific training aims are proposed: 1) Develop independent competency in designing behavioral economic surveys for studying risk perceptions and risk tolerances of WRA, 2) Develop independent competency in conducting health policy analyses in intervention contexts with qualitative methods, 3) Apply bioethics and public health policy principles to risk-risk tradeoff methodologies for assessing evaluations of WRA risk and risk perception. These training aims will be accomplished through formal coursework, involvement in the American Thoracic Society, qualitative research and health policy trainings, and assigned readings and discussion with mentors. The University of Arizona is an ideal environment for the proposed training, offering opportunities for training through faculty at the Asthma & Airway Disease Research Center and the Southwest Environmental Health Sciences Center. This training will be applied through 3 specific research aims: 1) Administer a C&D risk-risk tradeoff survey to 1,000 nurses in the state of Arizona to collect data for microbial risk assessments, 2) Understand barriers to C&D policy changes in the workplace, 3) Identify, describe, and assess C&D policy options with health policy analysis. Aim 1 will involve adaption of a current risk-risk tradeoff survey and recruitment of 1,000 registered nurses. These data will be used in a microbial risk assessment to inform the needed frequency and intensity of C&D to achieve acceptable risks. Aim 2 will involve interviews with registered nurses (n=40) and key informant interviews with facilities management, legal and workers’ compensation staff, occupational health specialists, and infection preventionists (n=2-3/group). Aim 3 will involve the use of a policy Delphi method (n=75). Translating risk-risk tradeoff analysis to inform C&D policies will increase the impact of behavioral economics translation in respiratory occupational health research. Understanding barriers to C&D protocol changes and identifying feasible policy change strategies will inform future efforts (NHLBI R01) to quantify acceptable OA and infection risks, including the perspectives of patients, to implement and evaluate C&D policy changes nationally.

PROJECT NARRATIVE At the heart of cleaning and disinfection (C&D) conducted by nurses is a “risk-risk tradeoff”: increased C&D leading to increased work-related asthma risks and simultaneous decreased occupational infection risks. Translation of risk-risk tradeoff methods to respiratory health research and understanding barriers to C&D policy change will enable and identify feasible policy change strategies that protect nurses at their acceptable risk levels.