1999 Progress Report: A Community-Based Intervention to Reduce Environmental Triggers for Asthma Among Children (Asthma Intervention)

EPA Grant Number: R826710C003
Subproject: this is subproject number 003 , 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: A Community-Based Intervention to Reduce Environmental Triggers for Asthma Among Children (Asthma Intervention)
Investigators: Parker, Edith
Current Investigators: Israel, Barbara A. , Keeler, Gerald J. , Remick, Daniel , Parker, Edith , Philbert, Martin , Brown, Randall , Robins, Thomas , 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, 1998 through January 1, 1999
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 first specific aim of this household and neighborhood level community-based intervention research project is to reduce exposure of children to environmental contaminants within their homes and neighborhoods that trigger asthma, thereby improving asthma-related health status and reducing asthma-related medical care utilization. Asthmatic children will be identified through elementary school screenings and their parents will be asked to enroll in a household intervention in which outreach workers will visit each household 12 times in 2 years (9 times in the intensive first year, and 3 times in the second year). Outreach workers will work with the family to reduce indoor household exposure factors identified as excerbating asthma, such as cockroach mites, cat dander, environmental tobacco smoke, and mold. Each household will also be supplied with educational materials and other resources to reduce indoor asthma triggers such as vacuum cleaners, bedding covers, cleaning kits, and mats. In the neighborhood component of the intervention, community organizers will work with neighborhood groups on asthma awareness and reduction of environmental threats to children’s respiratory health. The second specific aim is to conduct a randomized, staggered design community-based intervention to test the following hypotheses: (1) The household level intervention will improve asthma-related health status (and other mental and physical health outcomes), and increase behaviors to reduce home environmental hazards; (2) A neighborhood level intervention when combined with a household level intervention will provide an enhanced effect on the outcomes at the household level; (3) A less intensive household intervention following an initial intensive intervention will maintain similar level effects; and (4) A long-term neighborhood intervention, when combined with a household-level intervention, will result in greater intervention effects than a household level intervention with a short-term neighborhood component. The third specific aim is to conduct a process and context evaluation in addition to the outcome evaluation of both components of the intervention.

Progress Summary:

The Intervention and Exposure Cores 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 coordinated 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.

Specific Aims: A Screening Questionnaire, along with incentives and a descriptive brochure, was developed and mailed and/or delivered through the schools to over 11,000 families in the target area of southwest and east side Detroit. Follow-up mailings and a community awareness campaign to encourage participation was also conducted. Currently, 439 children between the ages of 6-10, who have either moderate to severe asthma (336) or mild persistent asthma (103), have been identified who are eligible to participate in the study. Of those, 175 families have already attended a Skin Testing Fair where they received an orientation to the project, signed an informed consent form, and received training on use of a breathing monitor. Participants were also weighed and measured, and received a skin test for nine different allergens and two controls. Additional Skin Testing Fairs are planned with the goal of enrolling 450 families.

In addition to the Screening Questionnaire, a Baseline Questionnaire, a Child Baseline Questionnaire, and an Environmental Walk-Through Check-list have also been developed. Training has been completed for Community Interviewers who will conduct interviews in the homes of families this fall using these instruments. Purchase of equipment and development of protocols for collection of dust in the homes is in progress. Based on the advice of the MCECH External Advisory Committee, the only significant modification to the study is a decision to focus enrollment efforts on children with moderate to severe asthma instead of both moderate to severe and mild asthma.

Significance: 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.

Future Activities:

Completion of study enrollment will occur in the next budget year. Baseline interviews, environmental walk-throughs, and dust collection in the homes of families will be conducted in fall 1999. After the baseline, the study population will be split into two on a random basis. One group will begin to receive the household intervention provided by the Community Environmental Specialists starting in the fall. The other group will begin to receive the intervention a year later. As a part of the Exposure Study, all participants will be asked to use the Airwatch monitors to measure their child’s breathing during a 2-week period each season. Parents will also complete a daily diary about their child’s symptoms during this time period. This information will be collected and analyzed. A sub-group will also have air-monitoring devices installed in their homes and the children will be asked to wear a personal monitoring device. Air quality information will also be collected in two representative schools in the target area.

Journal Articles on this Report : 1 Displayed | Download in RIS Format

Other subproject views: All 3 publications 1 publications in selected types All 1 journal articles
Other center views: All 45 publications 24 publications in selected types All 22 journal articles
Type Citation Sub Project Document Sources
Journal Article Clark NM, Brown RW, Parker E, Robins TG, Remick Jr. DG, Philbert MA, Keeler GJ, Israel BA. Childhood asthma. Environmental Health Perspectives 1999;107(Suppl 3):421-429. R826710 (Final)
R826710C001 (1999)
R826710C002 (1999)
R826710C003 (1999)
  • Full-text from PubMed
  • Abstract from PubMed
  • Associated PubMed link
  • Full-text: EHP - Full Text HTML
  • Supplemental Keywords:

    asthma, ambient air, indoor air, exposure, health effects, children, stressor, pathogens, community-based, social science, pathology, monitoring, Detroit., RFA, Health, Scientific Discipline, Air, Environmental Chemistry, Health Risk Assessment, Risk Assessments, Susceptibility/Sensitive Population/Genetic Susceptibility, Allergens/Asthma, Children's Health, genetic susceptability, indoor air, Biology, asthma, dust mite, school based study, asthma triggers, dust mites, health effects, dander, sensitive populations, environmental triggers, community-based intervention, exposure, second hand smoke, airway disease, biological response, airway inflammation, children, Human Health Risk Assessment, household, inhalation, assessment of exposure, childhood respiratory disease, mold, human exposure, cigarette smoke, environmental health hazard, epidemeology, environmentally caused disease, tobacco smoke, dust , allergic response, environmental tobacco smoke, indoor air quality, cockroaches, indoor environment, allergen, disease, exposure assessment, respiratory, environmental hazard exposures, toxics

    Progress and Final Reports:

    Original Abstract
  • 1998
  • 2000 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)