2000 Progress Report: Indoor and Outdoor Air Contaminant Exposures and Asthma Aggravation Among Children (Asthma Exposure)

EPA Grant Number: R826710C001
Subproject: this is subproject number 001 , established and managed by the Center Director under grant R826710
(EPA does not fund or establish subprojects; EPA awards and manages the overall grant for this center).

Center: Michigan Center for the Environment and Children’s Health
Center Director: Israel, Barbara A.
Title: Indoor and Outdoor Air Contaminant Exposures and Asthma Aggravation Among Children (Asthma Exposure)
Investigators: Israel, Barbara A. , Keeler, Gerald J. , Remick, Daniel , Parker, Edith , Philbert, Martin , Brown, Randall , Robins, Thomas , Lin, Xihong
Current Investigators: Israel, Barbara A. , Keeler, Gerald J. , Remick, Daniel , Parker, Edith , Philbert, Martin , Brown, Randall , Robbins, Tom , Lin, Xihong
Institution: University of Michigan
EPA Project Officer: Klieforth, Barbara I
Project Period: January 1, 1998 through January 1, 2002
Project Period Covered by this Report: January 1, 1999 through January 1, 2000
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 , Health Effects , Health


The prevalence of asthma has increased markedly over the past 15 years. It is the most common chronic disease of childhood in the developed world, affecting about 10 million U.S. children under the age of 16. Asthma is most common among urban and minority populations. The causes of these increases and the greater risk for urban, minority populations are not well understood. The causation, and aggravation, of childhood asthma is complex and involves many factors including genetic disposition, demographic variables, psychosocial stresses, and environmental exposures. Environmental exposures include both ambient (outdoor) exposures as well as indoor exposures within the home and at school. The first specific aim of the Asthma Exposure research project is to determine the prevalence of questionnaire-defined asthma among the elementary age school children in African-American and Latino populations in Detroit. Students and their families from 10 to 12 elementary schools (approximately 6000 students) in two areas in which the investigators have pre-existing strong community ties (i.e., southwest Detroit and the east side of Detroit) will be asked to complete a short, well validated asthma screening questionnaire. The second specific aim is to identify which components of the outdoor air, of indoor air contaminants, and family and neighborhood characteristics are associated with increased risk for asthma in this population. The third specific aim is to examine whether seasonal and daily changes in outdoor air pollution and indoor air contaminants explain fluctuations in the severity of asthma. The last specific aim is to provide ambient (community/neighborhood level), micro-environmental (inside schools and homes), and personal monitoring data to investigate the relationships between various exposure metrics and activity patterns of asthmatic children living in the southwest and east sides of Detroit. This approach will improve on the design of prior studies by collecting detailed multiple daily measures of ambient air contaminants together with comprehensive assessment of indoor air contaminants in households and schools and individual family and neighborhood measures of psychosocial factors, and assessing the association of these with a comprehensive set of health status measures, including lung function testing (FEV1), also collected on a daily basis.

Progress Summary:

The Intervention and Exposure Cores of MCECH continue to have the same specific aims as stated in the proposal, but because the two are so integrated and have the same participants and current goals, their research teams and activities have been combined into one "meta"-project called: Community Action Against Asthma, or CAAA. A Steering Committee, which meets monthly and is comprised of the university and Detroit community partners involved in both projects, oversees and is directly involved in decision making and other activities regarding the implementation of the research protocol. A separate Research Work Group, comprised of the university-based faculty and staff for CAAA, oversees the technical aspects of research issues and works closely and in coordination with the CAAA Steering Committee.

There have been no changes in the specific aims. The asthma intervention core will test the ability of individually tailored interventions to reduce exposure to environmental contaminants and to improve asthma related health status. At the same time, the intervention will provide direct benefit to the children and families enrolled in the study. The central hypothesis being addressed in the asthma exposure core is that exposure to ambient air contaminants will aggravate the health status of asthmatic children largely through the potentiation of the adverse effects of common indoor air contaminants. Proving or refuting this hypothesis will lead to substantial advances in scientific knowledge and have a direct impact on public health recommendations.

The most critical element in the success of the project to date has been the establishment at the outset of a dynamic Steering Committee (SC) comprised of representatives from all of the partner organizations: Butzel Family Center, Community Health and Social Services, Inc. (CHASS Center), Detroit Health Department, Detroiters Working for Environmental Justice, Friends of Parkside, Henry Ford Health System, Kettering/Butzel Health Initiative, Latino Family Services, United Community Housing Coalition, Warren/Conner Development Coalition, and the University of Michigan Schools of Public Health and Medicine. The Detroit Public Schools also are collaborating with the project. The SC meets on at least a monthly basis. The SC has, through a process of consensus, been responsible for all major decisions regarding study design as well as numerous more specific decisions concerning, for example, recruitment strategies, wording of instruments, and hiring of personnel.

A screening questionnaire was distributed in the Fall of 1999 to identify children with asthma then ages 6 to 10. Over 7,500 questionnaires were successfully mailed and about 2,000 were distributed in elementary schools. A total of 3,342 screening questionnaires were completed and returned in 1999. Among the returned questionnaires, 1,655 (49.7 %) were consistent with probable or known asthma of any severity. Among these, 387 (11.5 % of the total returned) had probable or known moderate to severe asthma based on National Asthma Education and Prevention Program diagnostic guidelines and another 116 had mild persistent asthma severe enough for eligibility for the study. Calculated minimum population-based estimates of

figure 1

prevalence for any asthma (18.9 %) and moderate to severe asthma (4.4 %) substantially exceed national averages. Among those with known or probable moderate to severe asthma, over 30 percent had not been diagnosed by a physician, over one-half were not taking daily asthma medication, and approximately one-quarter had not taken any physician-prescribed asthma medication in the past 12 months.

Of the 503 initially considered eligible for the study, approximately 30 were excluded because of living or having moved to an address outside of the target area. Of the remaining approximately 470 eligible children, 302 have been successfully enrolled into at least one aspect of the study (skin testing, baseline questionnaire, and/or first seasonal intensive data collection). Most of those not yet enrolled have proved difficult to contact by phone or mail. Fewer than 20 families have refused participation.

Other important steps accomplished in 1999-2000 include:

  • Development and pilot testing of written instruments in both English and Spanish including the screening questionnaire, adult (caregiver) questionnaire, child questionnaire, a household environmental checklist, and a neighborhood environmental checklist.
  • Elaboration of study protocols for skin test "fairs", training on use of the Airwatch airway monitor and symptom diary, administration of adult and children baseline questionnaires, completion of household and neighborhood environmental checklists, collection of household dust for allergen analysis, and measurement of personal and indoor household PM levels.
  • Hiring and training of staff from the community to serve as interviewers, air monitor and diary trainers, environmental checklist administrators, household dust collectors, and community environmental specialists ("CESs", or Outreach Workers).
  • Allergen skin testing of 272 children at 17 skin test "fairs".
  • Completion with 279 of the 302 participating families of the adult baseline questionnaires, household walk-through, and household dust collection for allergen analysis.
  • Participation by 205 families in the first 2-week intensive seasonal assessment through daily use of airway monitors and diaries, and, in a subset of about 80 households, measurement of vapor phase nicotine.
  • Installation of two tapered element oscillating microbalance instruments (TEOMs), for continuous measurement of ambient PM, on the rooftops of two Detroit elementary schools.
  • Development and production of customized indoor air sampling pump units, which were used to collect PM levels in each of the two elementary schools and in participant households during the first 2-week intensive seasonal assessment.
  • Creation and distribution of a newsletter for households participating in the study.
  • Distribution of vacuum cleaners and mattress and pillow covers to all wave one study participants as part of the intervention, and development of personalized plans for each of the households in wave one.
  • Participation by project faculty and staff in a 2-day training on Integrated Pest Management conducted by the Michigan Department of Agriculture, with plans underway to begin working with Abell Pest Management Services as part of the intervention.
  • Establishment of a Dissemination Committee, comprised of university and community representatives, to make information about the work of the project known to Detroit and the academic community. The Committee has developed a protocol consisting of guidelines for dissemination activities (including authorship on articles and on presentations, participation at national conferences, and promotion of project activities and findings within the Detroit community).

Results of Allergen Skin Testing. Based on preliminary analyses, the proportion of children with positive response to skin prick testing for each allergen is shown below:


The substantial proportion of children positive for allergens of outdoor origin (ragweed, grass, and Alternaria) was somewhat unexpected, and may have important implications for the customization of intervention strategies beyond those that were already envisioned for children allergic to roach and dust mite.

Future Activities:

The intervention activities as described above for the wave one families will continue during the 2000-2001 year. In March 2001, families who have been randomized into wave two will begin to receive their intervention. In addition, the neighborhood-level community awareness and mobilization campaign will begin in the upcoming year. This phase of the intervention will include educational events on environmental triggers for asthma, working with neighborhood block clubs and associations, advocacy for families attempting to adopt new health behaviors, assisting with housing issues, and organizing and conducting activities to reduce physical environmental hazards in their neighborhoods. Air monitoring activities, as described above, will be ongoing throughout the upcoming year.

We will continue our investigations as planned. We should have completed our complete characterization of the most model within the next 6 months. We will then begin to assay for the pathogenic factors.

Publications and Presentations:

Refer to the main center 2000 Progress Report.

Journal Articles:

No journal articles submitted with this report: View all 3 publications for this subproject

Supplemental Keywords:

asthma, ambient air, indoor air, exposure, health effects, children, stressor, pathogens, community-based, social science, pathology, monitoring, Detroit. Children, health, asthma, exposure, home, indoor air, inner city, cockroach, chemokines, allergen., RFA, Health, Scientific Discipline, Air, Geographic Area, Environmental Chemistry, Health Risk Assessment, Epidemiology, State, Risk Assessments, Susceptibility/Sensitive Population/Genetic Susceptibility, Allergens/Asthma, Children's Health, genetic susceptability, indoor air, Biology, Gulf of Mexico, African American, asthma, health effects, minority population, school based study, sensitive populations, urban air, outdoor air, airway disease, biological response, latino, exposure, Human Health Risk Assessment, lung function testing, airway inflammation, children, assessment of exposure, childhood respiratory disease, children's vulnerablity, inhalation, minorities, epidemeology, indoor air quality, exposure assessment, Michigan (MI), indoor environment, air quality, environmental hazard exposures, toxics, air contaminant exposure

Relevant Websites:

http://www.sph.umich.edu/urc/ Exit

Progress and Final Reports:

Original Abstract
  • 1998
  • 1999 Progress Report
  • Final

  • Main Center Abstract and Reports:

    R826710    Michigan Center for the Environment and Children’s Health

    Subprojects under this Center: (EPA does not fund or establish subprojects; EPA awards and manages the overall grant for this center).
    R826710C001 Indoor and Outdoor Air Contaminant Exposures and Asthma Aggravation Among Children (Asthma Exposure)
    R826710C002 Chemokines in the Pathogenesis of Asthma (Asthma Chemokines)
    R826710C003 A Community-Based Intervention to Reduce Environmental Triggers for Asthma Among Children (Asthma Intervention)