PUBH 6036 Week 11 Methods Proposal Example

Bed Bugs, Broken Sleep and Empty Desks: A Methods Proposal for a One-Year Cohort Study of Children Aged 6 to 12 in a Composite Housing Authority's Family Buildings, With Each Limit Placed Beside the Decision That Created It

Student Name

Walden University

PUBH 6036: Public Health Research Methods

Instructor Name

Month Day, Year

Bed Bugs, Broken Sleep and Empty Desks: A Methods Proposal for a One-Year Cohort Study of Children Aged 6 to 12 in a Composite Housing Authority's Family Buildings, With Each Limit Placed Beside the Decision That Created It

Background

Bed bugs have returned to American housing over the past two decades, and low-income multifamily buildings carry a large share of the burden. In 43 low-income buildings across four New Jersey cities, one apartment in eight was infested, with building rates as low as 3.8% and as high as 29.5% (Wang et al., 2016). The insects do not transmit disease, but they disturb sleep. Montreal tenants living with infestations reported sleep problems about five times as often, by odds, and anxiety symptoms at similarly raised odds compared with unexposed neighbors, although that study measured both at one moment and could not order them (Susser et al., 2012). Children's sleep is tied to attention and attendance, yet no study we found has followed children in infested homes to see whether they miss more school. Resident services staff at Cedar Hollow, an invented authority running nine family buildings, hear the concern often from caregivers asking for letters to schools.

Research Question and Hypothesis

For children between 6 and 12 who live in the authority's family buildings, is an infestation confirmed in the home in September linked to how many school days the child misses from September through June? We expect children in infested homes to miss more days, after accounting for age, chronic illness, household size and building.

Limit placed here: The question asks about association, not cause. It was narrowed from a broader worry about bed bugs and children's lives, and adult outcomes, children under 6 and school grades were left for later work. A reader should not take a null result as evidence that infestations are harmless to families.

Design

A prospective cohort will classify each enrolled child's home by infestation status at a fall visit and follow attendance through the school year. A cohort was chosen over a case-control design because only a forward design measures the infestation before anyone knows which children struggled at school (Grimes & Schulz, 2002). Starting from the attendance office and asking caregivers to recall insects would be faster, but recall is weak for an exposure that many residents never notice.

Limit placed here: The cohort takes a full year to report and cannot rule out confounding by conditions that travel with infestation, such as crowding or a caregiver's night work. A January visit will reclassify homes whose status has changed, but infestations that come and go between visits will be missed. An experiment assigning the timing of building-wide monitoring was designed during the term and is proposed as a second phase, not part of this study.

Sample

The frame is the authority's lease file, which listed 860 households declaring a child of eligible age at the last extract. Buildings are split into two strata by pest work orders in the past year. All 300 households in the three high-history buildings and a random 270 of the 560 households in the six others will be invited. Under assumed visit and infestation rates, that should produce about 400 completed visits and close to 100 children in infested homes. Authority-wide estimates will weight each household by how many frame households it stands for in its stratum. At screening, caregivers are asked who usually sleeps in the home, and any child aged 6 to 12 sleeping there at least four nights a week is eligible, whether declared on the lease or not.

Limit placed here: Families who decline cannot be described beyond the lease file's few fields, and families who moved out because of severe infestations before September are absent from the start. Findings describe children in one authority's family buildings, not private rentals.

Measures

Exposure

A home counts as infested if a trained inspector finds live insects, eggs or cast skins at the first visit, or if interceptor cups placed under bed and sofa legs for seven days trap any bed bug. In New Jersey, interceptors detected 89% of infestations and brief inspection 72%, and the two together missed only 2 of 291 (Wang et al., 2016). Caregiver awareness of bed bugs is recorded separately.

Outcome

The outcome is total days absent from September to June, from district records released with written caregiver consent. Excused and unexcused absences are both counted, and a secondary outcome marks any child absent for at least 10% of enrolled days.

Covariates

Covariates are the child's age and sex, caregiver-reported asthma or other chronic illness, the number of people sleeping in the home, the building and the stratum.

Limit placed here: The exposure is measured in the apartment, not in the child's bed or in a second home the child stays in. Absence records show that a child was missing, not why. Sleep itself is not measured objectively, so the study cannot show that sleep is the path between insects and absence.

Analysis

Days absent are counts and are likely to be overdispersed, so the main model will be a negative binomial regression with the log of enrolled days as an offset, reporting the rate ratio for infested versus uninfested homes with a 95% confidence interval. Standard errors will account for children clustered within households and buildings. A sensitivity analysis will reclassify homes using the January visit. Caregivers' awareness of the infestation will be examined as a secondary comparison.

Limit placed here: With roughly 100 exposed children, the study can detect a moderate difference in absence rates but not a small one. A confidence interval that includes no difference will be described as an unsettled result rather than evidence of no harm.

Protection of Participants

The landlord partners in this study, so the protections are designed around the lease. Only university staff hold the data. The authority receives building summaries with no household identifiers and none based on fewer than 10 apartments. A Certificate of Confidentiality will be sought. Caregivers give written permission for home visits and for release of attendance records under the federal student privacy law; children aged 7 and older are asked for their own agreement, and a refusal is honored. When cups or inspection reveal an infestation the family did not know about, the worker tells the caregiver privately and offers help requesting free treatment; the authority hears nothing about that apartment from the study. The study is judged minimal risk under the Common Rule's provisions for children (45 C.F.R. § 46.404), and the Belmont principles of respect, beneficence and justice guide each choice (National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, 1979).

Limit placed here: Keeping household data from the authority means the study cannot verify whether families who learned of infestations received treatment, which would have been useful for the planned second phase.

Companion Qualitative Study

A small descriptive phenomenological study will interview 12 to 15 caregivers from infested homes about nights and school mornings, analyzed through descriptive phenomenological thematic analysis (Sundler et al., 2019). It explains what the cohort counts; it does not estimate how common any experience is.

Timeline

The study runs over about eighteen months from approval to the final report.

Table 1

Timeline for the First Study Year

Note. The report to families is written first and in plain language.

Conclusion

The proposal answers one question with one design, and every place it gives something up is marked where the choice was made. If children in infested homes miss more school, the authority will have reason to fund early detection, and the second-phase trial can test whether it helps.

References

Grimes, D. A., & Schulz, K. F. (2002). Cohort studies: Marching towards outcomes. The Lancet, 359(9303), 341-345. https://doi.org/10.1016/S0140-6736(02)07500-1

National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. (1979). The Belmont report: Ethical principles and guidelines for the protection of human subjects of research. U.S. Department of Health, Education, and Welfare. https://www.hhs.gov/ohrp/regulations-and-policy/belmont-report/index.html

Protection of Human Subjects, 45 C.F.R. § 46 (2018).

Sundler, A. J., Lindberg, E., Nilsson, C., & Palmér, L. (2019). Qualitative thematic analysis based on descriptive phenomenology. Nursing Open, 6(3), 733-739. https://doi.org/10.1002/nop2.275

Susser, S. R., Perron, S., Fournier, M., Jacques, L., Denis, G., Tessier, F., & Roberge, P. (2012). Mental health effects from urban bed bug infestation (Cimex lectularius L.): A cross-sectional study. BMJ Open, 2(5), Article e000838. https://doi.org/10.1136/bmjopen-2012-000838

Wang, C., Singh, N., Zha, C., & Cooper, R. (2016). Bed bugs: Prevalence in low-income communities, resident's reactions, and implementation of a low-cost inspection protocol. Journal of Medical Entomology, 53(3), 639-646. https://doi.org/10.1093/jme/tjw018