Utibe Effiong, MPH Student, Environmental Health Sciences
Background: Severe asthma disproportionately affects minority children in lower-income urban communities in the U.S. where complex environmental exposures and social challenges may play a role in the etiology and exacerbation of a highly multifactorial disease. A recent umbrella review conducted by the Centers for Disease Control and Prevention examined 42 reviews of asthma intervention studies carried out from 1990 to 2010 and found that only one review determined that comprehensive home-based interventions including the reduction of multiple indoor asthma triggers are effective among children with asthma. The Merck Childhood Asthma Network, Inc. (MCAN), a nonprofit, 501(c)(3) organization, is the only private foundation solely focused on addressing the complex and problem of childhood asthma in the United States. The Center for Managing Chronic Disease (CMCD) is conducting a cross-site qualitative and quantitative evaluation to assess both processes and outcomes associated with the MCAN work in four cities: Chicago, Los Angeles, Philadelphia and San Juan, Puerto Rico. This past summer, among other roles, I worked with the CMCD to format, code and analyze the environmental data obtained from the four MCAN sites.
Objectives: To evaluate the role of home environment interventions on pediatric asthma outcomes among inner city children and to identify the interventions that yield the most favorable outcomes.
Method: Over the past three years, the four MCAN, asthma programs enrolled children and families in comprehensive asthma management programs. As of early 2013, 980 children had been enrolled in one of the four programs. Standardized questionnaires were directly administered to caregivers at baseline and 12 months later. The questionnaires included items on inhaler use, daytime symptoms, nighttime symptoms, school absenteeism, work absenteeism (for caregivers), unscheduled clinic visits, emergency room visits and hospitalizations. The items also assesses home environment changes targeted at reducing the child’s exposure to known asthma triggers such as environmental tobacco smoke (ETS), roaches, molds, animal dander and dust mites. Using the statistical software SAS 9.3, I formatted, coded and analyzed the responses. A t-test was conducted to compare the means of the outcomes between families that undertook home environment changes meant to reduce exposure to known asthma triggers and those that did not.
Results: In this prospective cohort study we found significant improvements in measures of pediatric asthma morbidity among families that undertook home environment changes targeted at ETS, roaches, molds, animal dander and house dust mites. The improvements were seen in symptoms, school attendance and health care use. Thus, in combination with asthma management education and care coordination, home environment interventions targeting established asthma triggers yielded improvements in pediatric asthma outcomes amongst inner city children. Further work is being done to identify the interventions that produced the most favorable outcomes.