Chronic, low level indoor pesticide exposures are associated with adverse health outcomes in children, including cancer and cognitive, neurological, and respiratory problems. Recent studies show that pesticides applied as sprays are used in child care facilities exposing young children and staff to harmful chemicals. Thirteen million children in the United States and one million children in California under six years of age attend child care programs. Compared with adults, young children are more vulnerable to pesticides since their developing organs and bodily systems can be damaged during critical windows of development. Interventions to reduce pesticide exposure in child care centers have focused on teaching child care staff about integrated pest management (IPM) and providing hands-on technical assistance and follow-up consultation. IPM is an approach to managing pests that focuses on preventing infestations, monitoring for pests, and limiting the use of harmful pesticides. Pesticides are used as a last resort and primarily as self-contained baits, which do not contaminate indoor environments. IPM intervention programs led by nurses trained as child care health consultants have shown positive changes in staff knowledge, policies, and practices; however, these studies did not include control groups or assess whether the intervention reduced pesticide exposures to the children. The goal of this study is to reduce children’s exposure to pesticides in child care centers to improve their long- term health. A randomized-control trial in four northern California counties will compare changes in pesticide exposure among child care centers assigned to an IPM intervention versus an attention control intervention on physical activity. One hundred child care centers serving socio-economically and ethnically diverse preschool- age children will be enrolled. This study will be modeled on a successful nurse-led child care health consultation intervention comprised of an educational workshop, materials and tools, and center-specific consultation over seven months. In addition, the study will include novel methods of measuring pesticide concentrations in child care centers (dust) and to individual children in the child care settings (silicone wristbands). The study aims are to determine if a nurse-led IPM intervention (1) increases child care center staff’s IPM knowledge, (2) improves center’s IPM policies and practices, (3) reduces pest problems (i.e., pests present, pest residue), (4) increases director’s self-efficacy, (5) reduces pesticide exposures in child care center environments, and (6) reduces child-level pesticide exposures in the intervention child care centers compared to the control centers. This study contributes to public health goals set by Healthy People 2020 to improve environmental health through educational and community-based programs and will inform state and national programs promoting environmental health policy changes in child care. Improving children’s physical environment and reducing harmful exposures to pesticides will support young children’s growth and development so they are healthy and ready to learn as they enter kindergarten.

NARRATIVE To reduce the risk of adverse health problems associated with chronic exposure to pesticides, a randomized control study will evaluate a nurse-led integrated pest management (IPM) intervention in 100 child care centers serving socio-economically and ethnically diverse preschool-age children in four California counties. Positive changes in IPM knowledge, policies, practices, pests, and pesticide exposure will be assessed.