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7 Researchers' Responsibilities
Pages 124-144

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From page 124...
... . For example, researchers described to the committee sometimes observing housing code violations, illegal drug use, firearms, and even suspected child abuse or neglect.
From page 125...
... Hence, the process of understanding and responding to the views of community representatives as described in Chapter 5 is also important for helping researchers clarify their ethical responsibilities. RESEARCH DESIGN A variety of study designs are used in housing health hazards research to obtain information on hazards and to test methods to reduce health risks.
From page 126...
... Rather, research equipoise requires approximate equality in the relation between the risks and potential benefits of the study and control interventions." The committee believed that in clinical trials expert practitioners should make judgments about research equipoise. In housing health hazards research, however, the assessments of risks and benefits by researchers may differ from those of community representatives or the parents of potential child subjects, as discussed in Chapter 5.
From page 127...
... Determining whether a particular clinical trial is ethically acceptable requires value judgments about the weight of the evidence, the level of uncertainty, and the potential effects of the research study on changing housing standards or policies. A weight-of-evidence approach is often used by expert panels or regulatory bodies to analyze data from experimental or quasi-experimental studies to assess the strength of association between a specific exposure and health outcome or to test the efficacy of an intervention designed to reduce mortality, morbidity, or exposure.
From page 128...
... Innovative study designs can offer a benefit to both the intervention and control groups and thereby resolve some of the ethical concerns about housing health hazards research. First, as done in the Seattle project, the control group might receive the study intervention in a delayed manner, although there still may be objections to delaying an intervention that is believed to be effective (Krieger et al., 2002b)
From page 129...
... REPORTING OF TEST RESULTS Researchers commonly carry out experimental tests on samples collected from child subjects or their environments. Unlike tests used in routine clinical practice, the significance of experimental test results may be unknown.
From page 130...
... For clinical tests, there are standardized testing methods, age-specific normal ranges, predictive value for various diagnoses or conditions, and levels at which clinical interventions should be instituted. Blood lead measurements are an example of a clinical test often used in housing health hazards research: test results can be obtained from certified laboratories within days or weeks of sample collection and have established health benchmarks (Centers for Disease Control and Prevention, 1991)
From page 131...
... As a first step, they should discuss with parents of potential child subjects and community representatives what tests they will be conducting, explaining the limitations of the experimental tests and the potential misinterpretation of results. They also need to discuss whether test results should be made available.
From page 132...
... . Third, the researchers need to make clear during the informed consent process whether, when, and how the results of experimental tests will be offered to parents.
From page 133...
... Researchers should also take reasonable steps to provide information to landlords about possible public resources for helping to correct housing hazards and code violations, particularly if such hazards might be reported to authorities. Neighbors may also experience adverse consequences of research.
From page 134...
... The appropriate actions regarding third parties will vary according to the particular study and need to be determined on a case-by-case basis, following the general ethical guidelines of respect for persons, beneficence, and justice. Consulting with community representatives and parents of potential child subjects will help researchers understand the full range of a project's potential effects, as well as what those people believe researchers need to do to fulfill their ethical obligations (see Chapter 5)
From page 135...
... To take steps to protect the patient or third parties, the physician would have to breach confidentiality; the ethical issue is whether it is appropriate to do so. In housing health hazards research, a researcher who has permission to enter a home to collect research data might incidentally observe evidence of child abuse or domestic violence, even though these are not the topic of the research.
From page 136...
... In clinical medicine and public health, confidentiality may be overridden in certain situations to protect a person or third party from harm without legal repercussions; in some situations confidentiality must or may be overridden. For instance, confidentiality must be overridden in some circumstances to protect someone from child abuse, domestic violence, or elder abuse.
From page 137...
... In addition, researchers may be in a special position to prevent harms from housing health hazards because they have expertise about housing hazards and a unique opportunity to intervene because they are in subjects' homes. If researchers do not act, an opportunity to prevent serious harm may be lost because no one else with similar expertise observes the conditions.
From page 138...
... Risks That Are Imminent and Serious In cases of suspected child abuse and neglect, where there is evidence of "imminent risk of serious harm," such as clearly excessive force in disciplining children, the situation should be reported to child protective services for appropriate action. Each state has a child abuse and neglect reporting law and an agency designated to receive such reports; see Box 7-2.
From page 139...
... However, even when legal obligations don't exist, there is an ethical obligation to act in cases when the risk is imminent and serious. Researchers who conduct housing health hazards research will likely also encounter situations when they need to determine on an individual basis if the presence of physical hazards in the home present an imminent risk of serious harm and therefore warrant reporting the situation to child protective services.
From page 140...
... . Physicians have given several reasons for not reporting suspected child abuse and neglect: lack of sufficient evidence that abuse had occurred; belief that the abuse was not serious enough; belief that the case had already been reported; belief that the report would disrupt current treatment; belief that the situation had already resolved itself; belief that they could help the child better themselves; and belief that child protective services agencies were of poor quality or that the agencies overreacts to reports (Kerns et al., 1994)
From page 141...
... Staff also need to understand why parents may be reluctant to accept a recommended action for reducing risk. Parents will often have legitimate concern that the intervention will not be as effective as expected or that the risk of unintended adverse consequences is greater than the researcher appreciates.
From page 142...
... Ideally, researchers and parents can agree on a course of action that resolves the risk without requiring a breach in confidentiality. However, this may not be possible in the case of suspected child abuse and neglect, particularly if the staff person is a neighbor and does not feel responsible for correcting the situation.
From page 143...
... Recommendation 7.1: Researchers designing intervention studies on housing health hazards involving children should consider using inno vative designs in which all child subjects receive a prospect of direct benefit. Recommendation 7.2: Researchers carrying out research on housing health hazards involving children should discuss in their protocols and IRB submissions their legal and ethical obligations to potential third parties affected by their research.
From page 144...
... 144 ETHICAL CONSIDERATIONS and respond to risks when they are identified, and educate their staffs about the plan. Recommendation 7.4: Institutional review boards that review housing health hazards research should examine the researchers' plans for re sponding to risks observed in the home and require that they be appro priate in the context of the research and the affected community.


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