New England Research Institutes

Federal law requires property owners to disclose the presence of known lead-based paint and/or lead hazards to potential home buyers and renters in homes built before 1978. Using 2015-2016 randomized survey data, we measured lead and radon knowledge, awareness, and exposure avoidance practices. Home buyers from 4 US states (Illinois, Minnesota, North Carolina, and Ohio). 477 recent, single-family pre-1978 dwelling home buyers. Predictors of the home buyer decision to purchase the home during the entire home buying experience based on their understanding of health issues related to lead-based paint and radon exposure. Personal networks (22%) and real estate agents (21%) were the most common sources of health-related lead information. Many home buyers (77%) reported that their awareness of lead did not affect their purchasing decision, and 78% could not confirm that their homes were tested for lead. Respondents who understood lead-related health effects were 5.4 times more likely (95% CI, 1.7-17.5) to have their decision to buy a home affected when their real estate agent discussed lead-based paint issues. Many home buyers reported either they did not remember (37%) or did not sign (20%) the federal law requirement that property owners reveal known lead paint hazards to prospective buyers before a property is sold. Home buyers with awareness of health issues caused by radon were 1.7 times (95% CI, 1.4-2.1) more likely than those who understood lead-related health issues to have their decision to buy the home affected. Real estate agents play an important role to increase awareness of potential lead-based paint health issues when people buy older homes. Home buyer knowledge, awareness, and practice of radon exposure prevention was greater compared to lead exposure prevention. More than half of home buyers did not sign or remember signing lead disclosure paperwork.

Stephenson, Rebecca PT, DPT, MS, WCS; Miller, Jennifer PT, DPT, CLT, WCS Author Information

ObjectiveBurnout is widespread among behavioral health clinicians treating posttraumatic stress disorder (PTSD) among military populations. Intervention‐based strategies have shown some benefit in addressing clinician burnout. One Web‐based tool, the PTSD Clinicians Exchange, was designed to disseminate clinical best practices for the treatment of PTSD and facilitate self‐care to mitigate burnout. This study sought to determine whether this tool could reduce burnout among clinicians treating military populations.MethodsA total of 605 behavioral health clinicians from the U.S. Department of Veterans Affairs, the Department of Defense, and the community were enrolled in a randomized controlled trial to test the effectiveness of the PTSD Clinicians Exchange. Clinicians were assessed on demographic characteristics, practice patterns, and organizational support with an online survey at baseline and at 6 and 12 months. Burnout, secondary traumatic stress (STS), and compassion satisfaction were measured with the Professional Quality of Life Scale.ResultsAt baseline, no differences were observed in mean±SD burnout scores for the intervention (19.9±5.1) and control groups (20.2±5.4). Participation in the Exchange had no effect on burnout score at 12 months; burnout scores remained stable across the study period. In a multivariable stepwise regression model, older age, lower burnout at baseline, and lower STS scores and higher compassion satisfaction scores at 12 months were significantly associated with lower burnout scores.ConclusionsThe PTSD Clinicians Exchange did not mitigate burnout among clinicians, possibly because of the content provided, the dissemination mechanism, or participants’ limited use of the Web site. These results can be used to inform and enhance future interventions.

Web-based interventions hold great promise for the dissemination of best practices to clinicians, and investment in these resources has grown exponentially. Yet, little research exists to understand their impact on intended objectives. The Post-Traumatic Stress Disorder (PTSD) Clinicians Exchange is a website to support clinicians treating veterans and active duty military personnel with PTSD, evaluated in a randomized controlled trial (N=605). This manuscript explores how a subset of clinicians, those who utilized the intervention (N=148), engaged with it by examining detailed individual-level web analytics and qualitative feedback. Stanford University and New England Research Institutes Institutional Review Boards approved this study. Only 32.7% of clinicians randomized to the intervention ever accessed the website. The number of pages viewed was positively associated with changes from baseline to 12months in familiarity (P=0.03) and perceived benefit of practices (P=0.02). Thus, engagement with the website did predict an improvement in practice familiarity and benefit outcomes despite low rates of use. This study demonstrates the importance of methodologically rigorous evaluations of participant engagement with web-based interventions. These approaches provide insight into who accesses these tools, when, how, and with what results, which can be translated into their strategic design, evaluation, and dissemination.

The authors have disclosed no conflicts of interest.