Residential IPM Strategies in Rural Native American Communities

Project Coordinator

James W. Burnette, Jr.
North Carolina Department of Agriculture and Consumer Services
1090 Mail Service Center
Raleigh, NC 27699-1090
919-733-3556
919-733-9796 (fax)
james.burnette@ncmail.net

Executive Summary

The goals of this project are to increase the use of residential integrated pest management (IPM) strategies and to decrease the use of pesticides among rural Native Americans in the southeast U S. This project will focus on the Lumbee, a non-federally recognized tribe located largely in rural Robeson County, North Carolina. It will address three specific aims: (1) develop and disseminate culturally and educationally appropriate educational materials to teach rural Native Americans about residential IPM and pesticide safety; (2) reduce the use of residential pesticides and increase the use of residential IPM among members of the Lumbee Tribe; and (3) decrease the exposure to residential pesticides and decrease the risk of health effects of pesticide exposure among Lumbee children.

The project team includes individuals with expertise in IPM, Native American health, and the production of culturally and educationally appropriate education materials for minority and low literacy populations. They will develop a video and novella for adults and a workbook for children that provide basic instruction on residential IPM and pesticide safety. These educational approaches will include mutually reinforcing language and graphics. Stories, with characters to whom the audience can relate, are useful tools to hold the attention of the target audience/learner. They will use focus groups to gather formative data to ensure that the content of these materials are culturally and educationally appropriate. The materials will be developed with input from advisors with expertise in IPM and pesticide safety, and the Native American community. The materials will be disseminated through agencies that serve the Lumbee Tribe, particularly the LRDA Head Start and Day Care program. Assessment of the effectives of the educational materials will be measured using a telephone survey of adults to whom they were distributed. All materials will be made available to state lead agencies in EPA Region 4 through the North Carolina Department of Agriculture & Consumer Services.

Objectives

The goals of this project are to increase the use of residential integrated pest management (IPM) strategies and to decrease the use of pesticides among rural Native Americans in the southeast U S. Because these communities are largely low-income, have high proportion of sub-standard housing, and live in a semi-tropical climate, their members must often cope with large numbers of insects and small animal pests. Community members regularly use significant amounts of pesticides to control these pests. This project has three specific aims:

Develop and disseminate culturally and educationally appropriate educational materials to teach rural Native Americans about residential IPM and residential pesticide safety.
Reduce the use of residential pesticides and increase the use of residential IPM among members of the Lumbee Tribe living in Robeson County, North Carolina.
Decrease the exposure to residential pesticides and decrease the risk of health effects of pesticide exposure among Lumbee children.

These specific aims will be accomplished over a 12 month period. To ensure that the educational materials are culturally and educationally appropriate, formative research will be conducted during the first two project months to obtain information about the pesticide use and safety experiences of Native Americans living in rural communities. During project months three through six, we will develop an educational video and print materials that provide information about residential IPM and pesticide safety. These educational materials will be disseminated to members of the Lumbee Tribe during project months seven through ten. During the final two months of the project, we will assess how the materials have increased knowledge about residential IPM among Lumbee, and how they have changed behavior as a result of the increased knowledge. These materials will be incorporated into future education programs directed at environmental health in rural Native American communities. North Carolina is home to eight state-recognized tribes, with a total Native American population of approximately 100,900. This program will provide needed educational materials that will reduce the unnecessary use and exposure to pesticides to this large population.

Justification

This project will focus on the Lumbee tribe, whose members live largely in south central North Carolina, particularly in Robeson County. This is a predominately rural area. Like many Native American populations, Lumbee have suffered discrimination, which has resulted in widespread poverty and low educational attainment. Educational materials must reflect the cultural and educational background of the target audience to be effective in increasing knowledge and changing behavior. The IPM educational materials we develop will be based on adult education principles for low educational attainment adults (Doak et al. 1996). These materials will include a short cartoon video, novella and workbook that integrate words with graphic images to relate information, and a story with familiar images to hold the attention of the audience.
The residents of rural communities are exposed to residential as well as agricultural residential pesticides. Emerging evidence suggests that residential pesticides are as great a threat to health as are agricultural pesticides. Members of the Lumbee Tribe, with a high proportion of substandard housing located in a rural, semi-tropical area, must contend with insect and small animal pests throughout the year. A viable alternative to pesticides must be provided for them to decrease their use of residential pesticides. Residential IPM is this alternative. However, there is little knowledge of IPM methods among Native Americans or others living in rural communities. Educational materials that are culturally and educationally appropriate for Native Americans will enhance their acceptability and increase the likelihood that IPM methods will be adopted.
Targeting children for pesticide exposure reduction is extremely important. The immediate health effects (e.g., rashes, nausea, headache) and delayed health effects (e.g. impaired neurological status, respiratory symptoms) of pesticide exposure can be severe for adults and children (Reigart & Roberts 1999). However, children are at greater risk than adults for the long term effects of pesticide exposure because they are not as able to detoxify as adults, their cholinergic receptors are more sensitive, and pesticides can interfere with their on going development ( Eskenazi et al. 1999). Therefore, it is extremely important that a program of residential IPM and pesticide safety target the safety of children. This is particularly critical for children in vulnerable populations such as rural Native American communities.

Literature Review

A. Rural Native Americans

While there are several Native American groups in the southeast U S(e.g., Cherokee, Seminole), we are focusing on the Lumbee. The Lumbee are a non-federally recognized tribe located largely in southeastern North Carolina, with headquarters in Robeson County. Robeson County is a rural, low-income area, with an unemployment rate nearly three times the state average. Robeson County's 2000 poverty rate was 23.6%, compared to 11.7% for the state and 11.3% for the US. An estimated 58% of Robeson County residents age 25 and older have at least a high school education compared to 78.1% for the state and 84% nationally (USCensus). With high poverty rates, the semi-tropical climate and large areas of swamplands, residents of Robeson County are particularly vulnerable to residential pesticide exposure.

The Lumbee is the largest tribe in North Carolina; with over 40,000 members, they constitute approximately 40% of the state's Native American population. About 80% of Lumbees live in Robeson County, which has the largest concentration of American Indians east of the Mississippi River, and the sixth largest in the U S. Health data specific to Lumbees are limited, but North Carolina Native Americans are largely reflective of the Lumbee tribe. Rates of no health care coverage and inability to pay for health care are more than twice as high for Native Americans compared to whites. Hospitalizations for asthma among children ages 0 - 14 years are nearly three times higher for Native Americans compared to whites (Office of Minority Health and State Center for Health Statistics 1999).

B. Pesticide exposure in rural communities

The residents of rural communities are exposed to residential as well as agricultural pesticides. With good reason, the general focus of pesticide exposure in rural communities has been on agricultural pesticides. There is strong evidence that the non-agricultural residents as well as agricultural residents of rural communities are exposed to high levels of agricultural pesticides (Kock et al. 2002; Lee et al. 2002; Woltz et al. 2003). For example, Fenske and colleagues (2000) reported that a majority of urine samples collected from children (reference children from nonagricultural families; children from agricultural families) living in an agricultural region during the spray season had measureable dialkyphosphates, and a substantial fraction (56% children for agricultural families, 44% from nonagricultural families) "had doses that exceeded the reference values for azinphos-methyl."

Research examining residential pesticide exposure in rural communities is sparse, but there is growing evidence that this exposure exists. In a sample of 41 Latino farmworker households in rural North Carolina, Quandt et al. (2004) found a greater number and amount of residential pesticides than agricultural pesticides. Studies of dwellings in suburban and inner-city locales across the U Shave found non-agricultural pesticides (Berkowtiz et al. 2003; Curl et al. 2003).

The mechanisms for residential exposure are several, and include home application by residents and by commercial applicators, as well as pesticides tracked into homes from yards and gardens ( Morgan et al. 2001; Nishioka et al. 2001).

C. Health effects of pesticide exposure

The immediate health effects of pesticide exposure depend on the dose, but can include rashes, nausea, headache, shock, coma, and death (Reigart & Roberts 1999). The delayed health effects can include impotence, birth defects, impaired neurological status, respiratory symptoms, depression, and cancer (Engel et al. 2000; Flower et al. 2003; Garcia et al. 1999; Hoppin et al. 2002; Mills & Yang 2003; Nurminen 1995).

Children and adults are at different risks for the long term consequences of pesticide exposure ( Eskenazi et al. 1999; Faustman et al. 2000). Children are of greater concern because their hand-to-mouth behavior and ground-playing behavior increase their risk of exposure. Their low surface-to-volume ratio increases the relative size of any exposure dose they receive.

Children are more vulnerable than adults to the toxic effects of pesticide because they are not as able to detoxify as adults, and their cholinergic receptors are more sensitive. They are still developing; pesticides can interfere with this development.

D. Reducing the use of residential pesticides:

In order to diminish the risk of health effects among adults and children, pesticide exposure should be reduced. Exposure can be curtailed by reducing the use of residential pesticides, but reduction of residential pesticide application must be replaced with other pest control methods. Residential integrated pest management (IPM) offers a collection of alternative methods. There is little knowledge of these methods among Native Americans or others living in rural communities. The development of educational materials which are culturally and educationally appropriate for Native Americans will enhance their acceptability and increase the likelihood that residential IPM methods will be adopted to replace pesticide use.

E. Educational approaches for low literacy and low educational attainment communities :

A high proportion of Lumbee adults have low educational attainment and literacy. Educational approaches for these adult learners must take these factors into consideration (Doak et al. 1996). These educational approaches include video presentations and the use of print materials with mutually reinforcing language and graphics. Stories, with characters to whom the audience can relate, are also useful tools to hold the attention of the target audience/learner.

Video as an educational tool has several benefits. They can dramatize stories that keep viewers engaged while messages are delivered. Videos can embody issues, settings, and characters that are culturally acceptable to the target audience. They can be used individually or with groups. They trigger discussion that reinforces learning.

Print materials used with low literacy audiences must use graphics that reinforce written messages. They should limit their message to no more than a few facts, and reinforce these factors with repetition.

F. Our past experience

The project team has considerable experience in developing culturally and educationally appropriate educational materials focused on residential IPM and pesticide safety, and on health education programs with the Lumbee community. Arcury and Lane have collaborated on several projects to produce IPM and pesticide safety educational materials for Latino immigrant communities in North Carolina. Bell and Arcury have conducted health research and health education projects among the Lumbee. The residential IPM and pesticide safety educational materials have used print and video media. The print materials include an English and Spanish language comic books that introduce the basic components of residential IPM (Lane et al. 2003a, 2003b). They also include a series of 13 English and Spanish brochures that provide more detailed information about different aspects of residential IPM. These brochures include "Pest Mapping" ("Mapa De Plagas), "Pests: Keep Them Out" ("Plagas: ¡No Las Dejes Entrar!"), and " Pest : Stave them Out" (Plagas: ¡Mátelas de hambre!"). Each of the brochures uses graphics to reinforce the message.

Videos include a Spanish language cartoon, "Comó Controlar Plagas" ("How to Control Pests Videos"). This 6.5 minute video provides basic information about residential IPM (Lane & Arcury 2003). They have also produced a Spanish language farmworker pesticide safety education video that meets the US-EPA Worker Protection Standard training requirements for fieldworkers and pesticide handlers. This 53 minute video, "El Terror Invisible: Pesticide Safety for North Carolina " (Arcury et al. 2002), includes three sections that address fieldworker safety, pesticide handler safety, and green tobacco sickness.

Drs. Arcury and Bell have an extensive research history with the Lumbee population. Health education programs targeting Lumbees include cervical cancer prevention (Dignan, et al., 1994); breast cancer screening; and the "Your Heart, Your Life" cardiovascular disease prevention lay health education curriculum (Principal Investigator: Dr. Ronny Bell). Should this program be successful with members of the Lumbee tribe, the materials will be made available to North Carolina's eight organized tribes (Coharie, Eastern Band of Cherokee, Haliwa Saponi, Sappony, Meherrin, Occaneechi, Lumbee, Waccamaw Siouan), and four urban Indian centers (Cumberland County Association for Indian People, Guilford Native American Association, Metrolina Native American Association, Triangle Native American Society). Efforts will also be made to share the materials with other tribes located in the southeast U S. Finally, the materials will be made available through the North Carolina Department of Agriculture and Consumer Services to other state lead agencies in EPA Region 4.

Approach and Outcomes

We will develop a video and novella for adults, and a workbook for children that provide basic instruction on residential IPM and residential pesticide safety. We will use formative research to ensure that the content of these materials are culturally and educationally appropriate.

A. Formative Research

The research team will conduct four focus groups with Lumbee men and women to direct materials development. Focus groups will be convened in various settings in Robeson County and participants will be recruited from venues across the county (churches, places of employment, social organizations). Our experience has been very positive in recruiting Lumbees to participate in focus groups and structured interviews. Each focus group will include no more than ten participants, with equal representation from men and women (two groups of men and two groups of women).

The goal of the focus groups will be to gain information that will be useful in the development of culturally and educationally appropriate IPM educational materials for Lumbee Indians. The focus groups will be designed to ascertain the following: (a) what problems do Native Americans in Robeson County encounter with pests; (b) what is currently used to manage pests; (c) what are the current beliefs related to the health effects of pesticides; and, (d) what symbols are important to Lumbee for conveying health messages. Focus groups will be designed and conducted by members of the project team. A focus group guide will be developed to assist the facilitator in leading the discussion toward the desired topics. Focus groups will be audiotaped and transcribed for analysis.

B. Materials Development

We plan to effect behavior change by providing mediated instruction for two target groups: adults and children. There are three instructional components:

A video presentation of information for adult audiences
A cartoon novella containing the same information in printed form
A workbook which introduces IPM concepts to children

Video: The video presentation will consist of information presented as a story illustrated with cartoon characters and supported by graphic elements. It will be enhanced by a sound track employing professional actors, music, and sound effects. The running time will be approximately five minutes. Video production is typically divided into three phases: preproduction, production, and postproduction. Following are descriptions of the activities within each phase.

Preproduction phase

Creation of a story and script using the information from subject experts and focus groups
Design of the general approach and graphic treatment of production
Assembling of voiceover talent, music and sound effects

Production phase

Recording of the sound track in the studio
Creation of art and graphics to illustrate the script

Postproduction phase

Editing of the sound track, incorporating music, sound effects, etc. as required
Editing of the video - assembling the visual materials; conforming them to the edited sound track; adding video transitions, effects, etc. as required

This basic process will result in the creation of a master copy of the video presentation, from which multiple duplicate copies will be made for distribution.

Cartoon Novella: The cartoon novella will contain the same information presented in the video. This will provide a reinforcing copy of the information for viewers of the video, and it will serve to provide the same information for situations in which it is not possible or practical to view the video. The print version of video content will be a booklet of approximately 20 pages, including covers. It will be printed in full color.

The activities required for production of the cartoon novella include, first, making any necessary changes to the script and content of the video that might be required for translation to a different medium. For example, transitions that might be done over time in video, or transitions and effects made through sound, must be re-interpreted through layout and design for the printed page. Dialog must be arranged within "balloons" on the page. Second, the graphic are scaled and modified for page layout. Third, master files for the printer are created. Finally, copies are printed for distribution.

Workbook: The model for the workbook is a two-color booklet that incorporates age appropriate information that is provided to adults in the video and cartoon novella. Some of the same graphic treatments may be used, revised and reinterpreted for this audience. Additional material will also be added, including puzzles, games and activities for children. The production is essentially the same as that for the cartoon novella, including: scaling and modifying the graphics for page layout; creating master files for the printer; and printing copies for distribution.

C. Implementation - Dissemination

IPM materials will be disseminated in several venues in Robeson County with large numbers of Native Americans. Parents of the Lumbee Regional Development (LRDA) Head Start and Day Care program will be targeted for participation (see Letter of Support from LRDA). Approximately 800 Lumbee children participate in these programs, so we anticipate that this will be a significant source of participants. We will also recruit from local pediatric practices with large numbers of American Indian patients, including Pembroke Pediatrics in Pembroke, North Carolina. Dr. Joey Bell, Medical Director of Pembroke Pediatrics, is an advisor on this project. The project team will also use other options for dissemination, including churches, social events (e.g., pow-wows, Pembroke Days), and community health screenings.

Impact Assessment

Assessment of the effectiveness of the IPM materials will be measured using a telephone survey of adults to whom materials were distributed. We will recruit 150 participants for this survey. We have had tremendous success in recruiting Lumbee study participants. Surveys will be conducted by local Lumbee residents, which will enhance our success in recruitment. The survey will be designed and pre-tested by the research team. The survey will be designed to assess knowledge, attitudes and behaviors related to residential pesticides. The survey will be brief (less than 20 minutes) to enhance participation. Data will be entered into a database management system (Epi Info 6.0, CDC) and exported for analyses into SP SS(version 11.0, Chicago, IL) format. Chi-square tests will be performed to determine differences among individuals in knowledge, attitudes and behaviors of various survey items.

Literature Cited

Arcury TA, Quandt SA, Lane, CM. Jr., Marìn T, Rao P. El Terror Invisible: Pesticide Safety for North Carolina. [ Spanish language pesticide safety education video.]

a. Safety with Pesticides: Pesticide Risk and the Invisible Terror ( Seguridad con pesticidas: Riesgos de los pesticidas y el terror invisible): 27 minutes

b. Pesticide Handler: What's Important to be a Pesticide Handler (Manipulador ¿Qué significa ser un manipulador de pesticidas?: 17.5 minutes

c. The Green Monster: Green Tobacco Sickness (El monstruo verde: Enfermedad del tabaco verde): 9 minutes

Winston- Salem, NC : Wake Forest University School of Medicine, 2002.

Berkowtiz G S, Obel J, Deych E, Lapinski R, Godbold J, Liu Z, Landrigan PJ, Wolff M S. Exposure to Indoor Pesticides During Pregnancy in a Multiethnic, Urban Cohort. Environmental Health Perspectives. 2003;111:79-84.

Curl CL, Fenske RA, Elgethum K. Organophosphorus pesticide exposure of urban and suburban preschool children with organic and conventional diets. Environmental Health Perspectives. 2003;111:377-382.

Dignan MB, Sharp P, Blinson K, Michielutte, R, Konen JC, Bell RA, Lane C. Development and implementation of an individualized health education program for cervical cancer prevention for Native American women. Journal of Cancer Education 1994;9:235-242.

Doak CC, Doak LG, Root JH. Teaching Patients with Low Literacy Skills, 2 nd edition. Philadelphia : J.B. Lippincott Company, 1996.

Engel L S, O'Meara E S, Schwartz SM. Maternal occupation in agriculture and risk of limb defects in Washington State, 1980-1993. Scandinavian Journal of Work and Environmental Health. 2000;26:193-198.

Eskenazi B, Bradman A, Castronia R. Exposures of children to organophosphate pesticides and their potential adverse health effects. Environmental Health Perspectives. 1999;107 ( Supple. 3): 409-419.

Faustman EM, Silbernagel SM, Fenske RA, Burbacher TM, Ponce RA. Mechanisms underlying children's susceptibility to environmental toxicants. Environmental Health Perspectives. 2000;108:13-21.

Fenske RA, Lu C, Barr D, Needham L. Children's exposure to chlorpyrifos and parathion in an agricultural community in central Washington State. Environmental Health Perspectives. 2002;110:549-553.

Flower KB, Hoppin JA, Lynch CF, Blair A, Knott C, Shore DL, Sandler DP. Cancer risk and parental pesticide application in children of Agricultural Health Study participants. Environmental Health Perspectives. 2004;112:631-635.

Garcia AM, Fletcher T, Benavides FG, Orts E. Parental agricultural work and selected congenital malformations. American Journal of Epidemiology. 1999;140:64-74.

Hoppin JA, Umbach DM, London SJ, Alavanja MC, Sandler DP. Chemical predictors of wheeze among farmer pesticide applicators in the Agricultural Health Study. American Journal of Respiratory and Critical Care Medicine. 2002;165:683-689.

Koch D, Lu C, Fisker-Andersen J, Jolley L, Fenske RA. Temporal association of children's pesticide exposure and agricultural spraying: report of a longitudinal biological monitoring study. Environmental Health Perspectives. 2002;110:829-833.

Lane CM. Jr., Arcury TA. Comó Controlar Plagas (How to Control Pests) Residential Pesticide Safety. [ Spanish language residential pesticide safety education video.] 6.5 minutes. Winston-Salem, NC : Department of Family and Community Medicine, Wake Forest University School of Medicine, 2003.

Lane CM. Jr., Arcury TA, Quandt SA, Marín A. Dígale Adios a las Plagas. [ Spanish residential pesticide safety education comic book]. Send Pests Packing. [English residential pesticide safety education comic book]. Winston- Salem, NC : Department of Family and Community Medicine, Wake Forest University School of Medicine, 2003a.

Lane CM. Jr., Arcury TA, Quandt SA, Marín A. Dígale Adios a las Plagas. [ Spanish residential pesticide safety education comic book]. Winston- Salem, NC: Department of Family and Community Medicine, Wake Forest University School of Medicine, 2003b.

Levin S, Lamar-Welch V, Bell RA, Casper M. Geographic variation in cardiovascular disease risk factors among American Indians and comparisons with the corresponding state populations. Ethnicity and Health 2002; 7:57 -67.

Lee S, McLaughlin R, Harnly M, Gunier R, Kreutzer R. Community exposures to airborne agricultural pesticides in California : ranking of inhalation risks. Environmental Health Perspectives. 2002;110:1175-1184.

Mills PK, Yang R. Prostate cancer risk in California farm workers. Journal of Occupational and Environmental Medicine. 2003;45:249-258.

Morgan MK, Stout DM. II, Wilson NK. Feasibility study of the potential for human exposure to pet-borne diazinon residues following lawn application. Bulletin of Environmental Contamination and Toxicology. 2001;66:295-300.

Nishioka MG, Lewis RG, Brinkman MC, Burkholder HM, Hines CE, Menkedick JR. Distribution of 2,4-D in air and on surfaces inside residences after lawn applications: comparing exposure estimates from various media for young children. Environmental Health Perspectives. 2001;109:1185-91.

Nurminen T. Maternal pesticide exposure and pregnancy outcome. Journal of Occupational and Environmental Medicine. 1995;37:935-940.

Office of Minority Health and State Center for Health Statistics. North Carolina Minority Health Facts. North Carolina Division of Public Health, August 1999

( http://www.schs.state.nc.us/SCHS/pdf/AIFACTS.pdf )

Quandt SA, Arcury TA, Rao P, Snively BM, Camann DE, Doran AM, Yau AY, Hoppin JA, Jackson D S. Agricultural and residential pesticides in wipe samples from farmworker family residences in North Carolina and Virginia. Environmental Health Perspectives. 2004;112:382-387.

Reigart JR, Roberts JR. Recognition and Management of Pesticide Poisonings, 5th edition. Washington, DC: U SEnvironmental Protection Agency, Office of Pesticide Programs, 1999.

Wolz S, Fenske RA, Sincox NJ, Palcisko G, Kissel JC. Residential arsenic and lead levels in an agricultural community with a history of lead arsenate use. Environmental Research 2003;93:293-300.

U. S. Bureau of the Census. North Carolina Quick Facts.

(http://quickfacts.census.gov/qfd/states/37000.html )

Timetable

November	Prepare for formative research focus groups
December	Conduct formative research focus groups
January	Analysis of formative research focus group data Begin educational materials development
February	Complete initial draft of educational materials story boards and scripts
March	Complete advisory review of draft educational materials and make revisions
April	Finalize and reproduce educational materials
May-August	Disseminate educational materials
September	Conduct impact assessment data collection
October	Analyze impact assessment data and write final report

Major Participants

Thomas A. Arcury, PhD, is Professor and Research Director, Department of Family and Community Medicine, WFU SM. He is a cultural anthropologist and health educator who has directed several community-based projects on pesticide safety and IPM education. He is currently the principal investigator of National Institute of Environmental Health Sciences and National Institute of Occupational Safety and Health funded community-based participatory projects focused on pesticide exposure in the homes of Latino migrant and seasonal farmworkers.

Ronny A. Bell, PhD, MS, is Associate Professor, Department of Public Health Sciences, WFU SM. He is trained in epidemiology and nutrition. He is a member of the Lumbee tribe and has a long history of research in American Indian communities, particularly the Lumbee and Eastern Band of Cherokee Indians in North Carolina. He is a member of the Robeson Partnership for Community Health and the American Indian Health Task Force of the North Carolina Department of Health and Human Services.

C.M. Lane, Jr., MA, has more than thirty-five years of experience in the production of instructional materials for health and medical education. He was Coordinator for Audio Visual Instructional Design, and Instructor in the Department of Biomedical Communications, WFU SM, from 1986 to 2003. He has directed and produced the Spanish language agricultural pesticide safety video written by Arcury, a Spanish language residential IPM cartoon video and print materials. He has produced presentations for children and lay audiences as well as physicians and medical specialists. Recent projects have involved video productions, printed materials, and computer-based presentations. He is an expert in videotape production, curriculum design and materials production. A special skill is the use of computers in the creation of graphic and cartoon-based educational materials.

Project Advisors

Colleen Hudak-Wise, PhD, Certification, Licensing & Outreach Manager, North Carolina Department of Agriculture & Consumer Services Pesticide Section, Raleigh, NC.

James R. Van Kirk, Associate Director, Southern Regional IPM Center, Raleigh, NC.

Joey Bell, MD, Medical Director, Pembroke Pediatrics in Pembroke, Robeson County, North Carolina; Past President of the Association of American Indian Physicians; Member of the Committee on Native American Child Health of the American Academy of Pediatrics.

Project Budget

Funding Request
Budget Category	Funding Requested	Matching Non-Federal Funds	Matching Federal Funds
First Year Funding	$39,958	0	0
Second Year Funding	0	0	0
Total Funding	$39,958	0	0

Project Duration: 12 Months