Grantee Research Project Results

Final Report: Respiratory Disease and Prevention Center

EPA Grant Number: R826708C003
Subproject: this is subproject number 003 , established and managed by the Center Director under grant R826708
(EPA does not fund or establish subprojects; EPA awards and manages the overall grant for this center).
Center: Great Lakes Air Center for Integrative Environmental Research
Center Director: Harkema, Jack
Title: Respiratory Disease and Prevention Center
Investigators: Gong, Henry , Gilliland, Frank D. , McConnell, Rob Scot , Jones, Craig
Institution: Rancho Los Amigos Medical Center , University of California - Los Angeles
EPA Project Officer: Hahn, Intaek
Project Period: January 1, 1998 through January 1, 2002
Project Amount: Refer to main center abstract for funding details.
RFA: Centers for Children's Environmental Health and Disease Prevention Research (1998) RFA Text |  Recipients Lists
Research Category: Children's Health , Human Health

Objective:

Aim #1: To determine whether a community-based, family-oriented, comprehensive environmental health education program will result in reduction in concentrations of house dust mite and cockroach antigens in household dust.

Aim #2: To determine whether the environmental health education program results in clinical improvement in childhood asthma.

Aim #3: To determine whether the addition of a professional integrated pest management program to the health education intervention will result in (further) reduction in exposure to household antigen or improvement in clinical status.

Aim #4: To expand coverage of successful indoor air pollutant reduction strategies at low cost by the agencies and community groups participating in the study.

Summary/Accomplishments (Outputs/Outcomes):

As part of the first 5 years of the Children’s Environmental Health Center (CEHC), we have conducted the Los Angeles Controlling Asthma by Stopping Allergens (LA CASA) community-based intervention study. The study was designed to test an educational intervention to control indoor allergens with a focus on cockroach control among inner city, primarily Hispanic, children. Two hundred two allergic children were recruited from the Breathmobile, a school-based mobile asthma clinic serving Los Angeles public schools and randomized to early or late intervention. Families received home educational visits over a 2-year period in their homes. In a pilot study, we demonstrated that it is possible to control cockroaches in homes with short-term pest control and cleaning designed to denature allergen, using least toxic methods. Although allergen concentrations in homes with heavy infestation with cockroaches were reduced, they continued to exceed levels considered to be hazardous to children with asthma. Based on these results, the longer-term educational intervention using integrated pest management was designed. We found that although most caretakers did not speak English well, they were aware at study entry of their children’s skin test results to specific allergens, an important criterion for directing their efforts to control specific allergens. On follow-up, families in the early intervention group had better knowledge of methods for cockroach control, restricted access to space, food and shelter for cockroaches, and homes had significantly lower cockroach counts (McConnell, et al., 2005). The total load of cockroach allergen Bla g 1 in the child’s bedding was also significantly reduced in the early compared with the late intervention group. Children in these homes had fewer symptoms on an asthma control questionnaire, and this effect was more marked if the child’s caretaker had limited help from friends and relatives in managing the child’s asthma (P = 0.05 for interaction). We have found evidence of Hawthorne effects in the late intervention group, which have important general implications for the design of similar intervention studies (McConnell, et al., 2002a) and may explain why we have found little effect of the intervention on health outcome through the fourth home visit.

In related work, we have explored effects of markers of indoor allergen exposure on the development of asthma in another cohort and found pets, especially dogs, to be strongly associated with asthma incidence, which we hypothesized was due to the influence of dogs on indoor endotoxin exposures to children (McConnell, et al., 2002b). Furthermore, we showed that asthmatic children with dogs, but not cats, constituted a susceptible group to the effects of ambient air pollution, an effect potentially mediated by endotoxin and less likely to be mediated by allergen (McConnell, et al., 2003). In a collaboration with the University of Iowa CEHC, we hypothesized that endotoxin levels in house dust could be reduced using the same intervention tools we have developed for the LA CASA study to reduce allergen levels, and in a pilot study (of 100 stored samples randomly selected from LA CASA participants) we have shown reductions in endotoxin levels in house dust between the first and second home visit in the intervention group that were statistically significantly larger than in the control group (unpublished results). Finally, also with the University of Iowa, we have developed a wipe method for the collection of house dust by study participants for allergen and endotoxin assessment, which promises to reduce substantially the cost of such collections in population-based studies (Mueller-Anneling, et al., 2004; Avol, et al., 2001) .

There were multiple community research partners to this study, the most important of which have been the Long Beach Alliance for Children with Asthma (LBACA) and the Esperanza Community Housing Corporation. Esperanza trains approximately 30 inner-city, primarily immigrant, women as community health educators every year. Graduates of this program, who were trained in how to implement the comprehensive educational intervention, have been an important bridge between university and community research partners. They trained LBACA community health workers doing home visits to control indoor allergens in Long Beach. They teach the asthma module in Esperanza’s training program every year and in a similar program for community health workers run by Planned Parenthood. They have also played an important role in a key accomplishment of the study in supporting the development of a network of community organizations promoting best environmental practices for children with asthma. They have intensively trained other community health workers developing asthma services modeled after the LA CASA environmental intervention. These include the staff supported by a Housing and Urban Development “Healthy Homes” grant awarded to Esperanza and St. John’s clinic in Los A ngeles; staff supported by a California state grant awarded to Healthy African American Families, the Coalition for Community Health, the Asthma and Allergy Foundation of America in Los Angeles, and the Los Angeles County Health Department; community health workers in the Barrio Logan Family Health Center as part of Center support to a National Institute of Environmental Health Sciences environmental justice grant to the Environmental Health Coalition in San Diego; and community health workers conducting home visits with Latino Health Access in Santa Ana. The Center initiated a series of educational seminars to promote exchanges between organizations using community health workers to promote the control of environmental allergens, and through the outreach program for the Center our community health workers and co-investigators have made many presentations to groups of school nurses as part of programs of Communities for a Better Environment, including those in their Environmental Justice sponsored grant, to primary care clinicians, high school students, and at other community forums.

In summary, the LA CASA study has provided valuable experience in the design and conduct of Community- Based Participatory Research (CBPR), has promoted active research collaboration between partners, and has fostered trust between research partners and the broader network of community groups participating in the Community Outreach and Translation Core (COTC) and an environment for learning from each other. Analysis of the data from the study is ongoing. However, we have elected to seek support for new community-based research questions about indoor allergen control in a later grant proposal and have not continued intervention studies of indoor allergens in the second cycle of the CEHC. This decision was motivated largely by the interest of the primary community research partners in the health effects of ambient air pollution on asthma, which is the theme for all other studies in the second cycle of the CEHC. We continue to incorporate the lessons of the LA CASA study into COTC activities; community health workers and other LBACA members continue to be involved; and LA CASA staff have trained the community health workers of our other community partners including the Center for Community Action and Environmental Justice. The director of the Esperanza community health worker program serves on both the COTC and the Center’s External Advisory Committees.

References:

McConnell R, Jones C, Avol E, Cozen W, Milam J, Cahero J, Richardson J. Cockroach allergen intervention: some considerations for intervention and exposure assessment. Epidemiology 2002a;13:S135.

McConnell R, Berhane K, Gilliland F, Islam T, Gauderman WJ, London SJ, Avol E, Rappaport EB, Margolis HG, Peters JM. Indoor risk factors for asthma in a prospective study of adolescents. Epidemiology 2002b;13(3):288-295.

Mueller-Anneling L, Avol E, Peters JM, Thorne PS. Ambient endotoxin concentrations in PM₁₀ from Southern California. Environmental Health Perspectives 2004;112(5):583-588.

Avol E, Cozen W, Diaz-Sanchez D. A novel antigen/dust collection method performed by residents for use in field investigations. Presented at the International Society for Exposure Analysis Annual Meeting, Charleston, SC, November 4-8, 2001.

Journal Articles on this Report : 2 Displayed | Download in RIS Format

Publications Views

Other subproject views:	All 10 publications	10 publications in selected types	All 10 journal articles
Other center views:	All 104 publications	74 publications in selected types	All 72 journal articles

Publications

Type	Citation	Sub Project	Document Sources
Journal Article	McConnell R, Berhane K, Gilliland F, Molitor J, Thomas D, Lurmann F, Avol E, Gauderman WJ, Peters JM. Prospective study of air pollution and bronchitic symptoms in children with asthma. American Journal of Respiratory and Critical Care Medicine 2003;168(7):790-797.	R826708 (2000) R826708 (2001) R826708 (2002) R826708 (Final) R826708C003 (Final) R827352 (2004) R827352 (Final) R827352C007 (Final) R827352C009 (Final) R831861 (2004) R831861 (2005)	Abstract from PubMed Full-text: ATS Journals-Full Text HTML Exit Abstract: ATS Journals-Abstract Exit Other: ATS Journals-Full Text PDF Exit
Journal Article	McConnell R, Milam J, Richardson J, Galvan J, Jones C, Thorne PS, Berhane K. Educational intervention to control cockroach allergen exposure in the homes of hispanic children in Los Angeles: results of the La Casa study. Clinical & Experimental Allergy 2005;35(4):426-433.	R826708 (2000) R826708 (2001) R826708 (2002) R826708 (Final) R826708C003 (Final) R831861 (2004) R831861 (2005) R831861 (2006) R831861C001 (2005) R831861C001 (2006)	Abstract from PubMed Abstract: Wiley Online-Abstract Exit

Supplemental Keywords:

children’s health, respiratory health, allergic airway disease, secondhand smoke, air pollution, diesel exhaust particles, integrated pest management, community-based participatory research, susceptibility, genetics, gene expression, inflammation,, RFA, Scientific Discipline, Health, Geographic Area, Health Risk Assessment, State, Risk Assessments, Biochemistry, Disease & Cumulative Effects, Children's Health, health effects, air toxics, vulnerability, air pollutants, infants, lung disease, age-related differences, airway disease, gene-environment interaction, respiratory problems, second hand smoke, pulmonary disease, lead, air pollution, children, Human Health Risk Assessment, childhood respiratory disease, children's vulnerablity, genetic risk factors, lung dysfunction, disease resistance, human exposure, environmental health hazard, exposure pathways, harmful environmental agents, indoor air, California (CA), dietary exposure, tobacco smoke, dietary factors, environmental tobacco smoke, disease, genetic susceptibility, exposure assessment, cancer risk

Relevant Websites:

http://www.usc.edu/schools/medicine/departments/preventive_medicine/divisions/occupational/occ_environmental/cehc/index.html Exit

Progress and Final Reports:

Original Abstract

1998

1999

2000 Progress Report

Main Center Abstract and Reports:

R826708    Great Lakes Air Center for Integrative Environmental Research

Subprojects under this Center: (EPA does not fund or establish subprojects; EPA awards and manages the overall grant for this center).
R826708C001 Asthma in Children: A Community-based Intervention Project
R826708C002 Children's Exposure to Environmental Tobacco Smoke: Changes in Allergic Response
R826708C003 Respiratory Disease and Prevention Center