2004 Progress Report: A Randomized Controlled Trial of Behavior Changes in Home Exposure Control

EPA Grant Number: R832139C002
Subproject: this is subproject number 002 , established and managed by the Center Director under grant R832139
(EPA does not fund or establish subprojects; EPA awards and manages the overall grant for this center).

Center: Johns Hopkins Center for Childhood Asthma in the Urban Environment
Center Director: Breysse, Patrick N.
Title: A Randomized Controlled Trial of Behavior Changes in Home Exposure Control
Investigators: Breysse, Patrick N.
Current Investigators: Butz, Arlene
Institution: The Johns Hopkins University
EPA Project Officer: Callan, Richard
Project Period: November 1, 2003 through October 31, 2008 (Extended to October 31, 2010)
Project Period Covered by this Report: November 1, 2003 through October 31, 2004
RFA: Centers for Children's Environmental Health and Disease Prevention Research (2003) RFA Text |  Recipients Lists
Research Category: Children's Health , Health Effects , Health

Objective:

The objectives of this community-based prevention project are to: (1) conduct a randomized controlled trial of the effectiveness of current intervention methods to reduce hazardous exposures and their adverse health effects; and (2) complete the analysis of the intervention trial conducted under EPA Agreement No. R826724 and publish the results.

Progress Summary:

At randomization, the mean age of the children was 8.4 years (6.1-11.9), and there were 46 boys in the study. Twenty-one percent of the children were born at least 3 weeks before their due date, and 18 percent were placed on a ventilator at birth. Daily asthma symptoms were reported by 52 percent (mean 2.6 days), and 39 percent had nighttime symptoms 1 or more days in the 2 weeks before the interview. Thirty-four percent had a health care visit for an asthma attack in the previous 3 months. Forced expiratory volume in 1 second (FEV1) was 98 percent of the predicted (48). Sixty-eight percent had one or more positive skin tests, with the most common positive tests being cockroach (42%), pollen (47%), house dust mite (29%), and mold (25%). Mothers of 36 percent of children smoked during pregnancy, and 67 percent of the households contained at least one smoker. Ninety-one percent of the children’s homes were row houses. Inspection detailed a general state of disrepair, with 24 percent having a leaky roof, 69 percent with broken plaster, and 66 percent with cracks or holes on walls and doors. In the kitchen, 22 percent had moisture or leaks, 31 percent had living cockroaches, 38 percent had evidence of mice, and 70 percent had food exposed on the countertops. Twenty-nine percent of children’s bedrooms had food or food debris, 8 percent had cockroaches, and 7 percent had mice. Sixty-nine percent of children were exposed to tobacco smoke in their homes. Twenty-six percent of the families had cats, and 20 percent had dogs. Dust collected from the children’s bedrooms contained a mixture of allergens including cockroach allergen (Bla g 1), house dust mite (Der p 1, Der f 1), dog (Can f 1), cat (Fel d 1), and mouse (Mus m 1).

Airborne pollutants were measured during a 3-day sampling period. Except in the case of ozone, most samples contained measurable amounts of each pollutant. The maximum measured particulate matter (PM) were 275.7 g/m3 for PM10 and 191.7 g/m3 for PM2.5. Two percent of the PM10 values and 17 percent of the PM2.5 values exceeded the U.S. Environmental Protection Agency’s proposed National Ambient Air Quality Standards (NAAQS). Most samples contained detectable NO2, with a median level of 19.1 ppb. None exceeded the NAAQS annual limit of 53 ppb. A large percentage of the indoor ozone samples were below the limit of detection, which ranged from 0.89 to 2.52 ppb. Fifty-six samples were collected during Baltimore’s ozone season (April through October), but even here 62 percent of samples were below the limit of detection. Thus the pollutant found at levels that might be expected to be associated with respiratory disease was PM. The most important indoor contributor to these high levels of indoor PM is environmental tobacco smoke. Considering that 69 percent of homes reported at least one person that smoked cigarettes, we examined this factor more carefully. The household activity questionnaires contained questions that allowed us to estimate the total number of cigarettes smoked during the 72-hour sampling period. There was a shallow but statistically significant (p = 0.02) relationship between smoking behavior in the home and measured PM2.5 concentration. The mean PM2.5 and PM10 concentrations (SD) in nonsmoking households were 25.8 (14.9) and 37 (18.8) g/m3, compared to 58.5 (42.7) and 70.2 (46.7) g/m3, respectively, in smoking households, suggesting that almost one-half of indoor air particulates in homes of persons smoking cigarettes can be attributed to cigarette smoke.

Ninety-seven families completed the study; three families dropped out. Many of the participants changed their living arrangements or telephone numbers during the course of the study; 23 families moved at least once, one of them three times, and 49 changed their telephone numbers. Despite this, followup has been successful, with 91 percent of contacts completed so far.

Fifty children and their families were randomized to the Intervention Group and 50 to the Control Group. Baseline, the two groups were similar in important demographics.

Preliminary Data Evaluation

The hypothesis being tested is that the home environmental intervention could change allergen and pollutant exposure by 50 percent, and that this would be associated with a significant change in the health of the asthmatic child. The primary outcome variable of the study is environmental change, and the secondary is health outcomes. In the treatment group, cockroach allergen (Bla g 1) levels in the bedroom were reduced, but not significantly. Airborne particulates, both PM10 and PM2.5, were reduced significantly in the treatment group. All environmental changes were compared statistically by calculating baseline to 6-month differences for individual homes and comparing these differences between groups using a nonparametric statistical test.

Compare to Percentage of Project That Has Been Completed

We have completed the enrollment of 100 families in the original intervention trial. Data analysis continues, and several publications have resulted.

Findings, Relevance to Field

We believe that these findings are highly encouraging. It appears that education, combined with a few hundred dollars worth of physical equipment (mattress covers, air cleaner, pest control) can reduce substantially pollutant and allergen exposure in inner-city homes, and that these reductions are associated with significant reduction in asthma morbidity. The intervention could be carried out in a care network, and judging from the decrease in emergency department visits and hospitalizations that was seen in the treated group, might be economically advantageous. In addition, this outcome confirms our hypothesis that the interaction of pollutants and allergens in a home environment increases asthma morbidity.

Data cleaning and preliminary analyses are completed and are discussed in weekly data meetings. Several manuscripts have been accepted or are under review.

Future Activities:

The newly planned intervention will begin. Initial activities include revision of data collection forms, preparation of a manual of operations, recruitment and training of new staff to replace staff lost in the last year because of delayed funding, and initiation of participant recruitment. Recruitment will be easier because of a recruitment database maintained by the Data Management Core. This database has been approved by the Johns Hopkins University Institutional Review Board and includes families who have completed other research projects conducted by Center personnel, have signed a Health Insurance Portability and Accountability Act waiver, and consented to be included in this database. Periodic form mailings serve to both maintain interest and determine that the present address is active.


Journal Articles on this Report : 12 Displayed | Download in RIS Format

Other subproject views: All 31 publications 31 publications in selected types All 30 journal articles
Other center views: All 113 publications 113 publications in selected types All 110 journal articles
Type Citation Sub Project Document Sources
Journal Article Breysse PN, Buckley TJ, Williams D, Beck CM, Jo SJ, Merriman B, Kanchanaraksa S, Swartz LJ, Callahan KA, Butz AM, Rand CS, Diette GB, Krishnan JA, Moseley AM, Curtin-Brosnan J, Durkin NB, Eggleston PA. Indoor exposures to air pollutants and allergens in the homes of asthmatic children in inner-city Baltimore. Environmental Research 2005;98(2):167-176. R832139 (2004)
R832139 (2005)
R832139 (2006)
R832139 (2007)
R832139 (Final)
R832139C001 (2006)
R832139C002 (2004)
  • Abstract from PubMed
  • Full-text: ScienceDirect - Full Text - PDF
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  • Abstract: ScienceDirect-Abstract
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  • Other: ResearchGate - Abstract & Full Text - PDF
    Exit
  • Journal Article Butz AM, Riekert KA, Eggleston P, Winkelstein M, Thompson RE, Rand C. Factors associated with preventive asthma care in inner-city children. Clinical Pediatrics 2004;43(8):709-719. R832139 (2004)
    R832139 (2005)
    R832139 (2007)
    R832139C002 (2004)
  • Abstract from PubMed
  • Other: SAGE PDF
    Exit
  • Journal Article Callahan KA, Eggleston PA, Rand CS, Kanchanaraksa S, Swartz LJ, Wood RA. Knowledge and practice of dust mite control by specialty care. Annals of Allergy, Asthma & Immunology 2003;90(3):302-307. R832139 (2004)
    R832139 (2005)
    R832139 (2007)
    R832139C002 (2004)
  • Abstract from PubMed
  • Journal Article Eggleston PA. Cockroach allergen abatement in inner-city homes. Annals of Allergy, Asthma & Immunology 2003;91(6):512-514. R832139 (2004)
    R832139 (2005)
    R832139 (2007)
    R832139C002 (2004)
  • Abstract from PubMed
  • Journal Article Eggleston PA. Environmental control for fungal allergen exposure. Current Allergy and Asthma Reports 2003;3(5):424-429. R832139 (2004)
    R832139 (2005)
    R832139 (2007)
    R832139C002 (2004)
  • Abstract from PubMed
  • Journal Article Ferrari E, Tsay A, Eggleston PA, Spisni A, Chapman MD. Environmental detection of mouse allergen by means of immunoassay for recombinant Mus m 1. Journal of Allergy and Clinical Immunology 2004;114(2):341-346. R832139 (2004)
    R832139 (2005)
    R832139 (2007)
    R832139C002 (2004)
  • Abstract from PubMed
  • Full-text: Science Direct Full Text
    Exit
  • Other: Science Direct PDF
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  • Journal Article Matsui EC, Wood RA, Rand C, Kanchanaraksa S, Swartz L, Curtin-Brosnan J, Eggleston PA. Cockroach allergen exposure and sensitization in suburban middle-class children with asthma. Journal of Allergy and Clinical Immunology 2003;112(1):87-92. R832139 (2004)
    R832139 (2005)
    R832139 (2007)
    R832139C002 (2004)
  • Abstract from PubMed
  • Other: Science Direct PDF
    Exit
  • Journal Article Matsui EC, Wood RA, Rand C, Kanchanaraksa S, Swartz L, Eggleston PA. Mouse allergen exposure and mouse skin test sensitivity in suburban, middle-class children with asthma. The Journal of Allergy and Clinical Immunology 2004;113(5):910-915. R832139 (2004)
    R832139 (2005)
    R832139 (2007)
    R832139 (Final)
    R832139C001 (Final)
    R832139C002 (2004)
  • Abstract from PubMed
  • Full-text: JACI-Full Text HTML
    Exit
  • Abstract: JACI-Abstract
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  • Other: JACI-Full Text PDF
    Exit
  • Journal Article Perry T, Matsui E, Merriman B, Duong T, Eggleston P. The prevalence of rat allergen in inner-city homes and its relationship to sensitization and asthma morbidity. Journal of Allergy and Clinical Immunology 2003;112(2):346-352. R832139 (2004)
    R832139 (2005)
    R832139 (2007)
    R832139C002 (2004)
  • Abstract from PubMed
  • Other: Science Direct PDF
    Exit
  • Journal Article Phipatanakul W, Cronin B, Wood RA, Eggleston PA, Shih M-C, Song L, Tachdjian R, Oettgen HC. Effect of environmental intervention on mouse allergen levels in homes of inner-city Boston children with asthma. Annals of Allergy, Asthma & Immunology 2004:92(4):420-425. R832139 (2004)
    R832139 (2005)
    R832139 (2007)
    R832139C002 (2004)
  • Full-text from PubMed
  • Abstract from PubMed
  • Associated PubMed link
  • Journal Article Riekert KA, Butz AM, Eggleston PA, Huss K, Winkelstein M, Rand CS. Caregiver-physician medication concordance and undertreatment of asthma among inner-city children. Pediatrics 2003;111(3):e214-e220. R832139 (2004)
    R832139 (2005)
    R832139 (2007)
    R832139C002 (2004)
  • Abstract from PubMed
  • Full-text: Pediatrics Full Text
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  • Other: Pediatrics PDF
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  • Journal Article Schweitzer IB, Smith E, Harrison DJ, Myers DD, Eggleston PA, Stockwell JD, Paigen B, Smith AL. Reducing exposure to laboratory animal allergens. Comparative Medicine 2003;53(5):487-492. R832139 (2004)
    R832139 (2005)
    R832139 (2007)
    R832139C002 (2004)
  • Abstract from PubMed
  • Supplemental Keywords:

    asthma, allergens, smoke, smoking, pollutant exposure, particulate matter, PM, children’s health,, RFA, Health, Scientific Discipline, INTERNATIONAL COOPERATION, ENVIRONMENTAL MANAGEMENT, Health Risk Assessment, Risk Assessments, Disease & Cumulative Effects, Biochemistry, Children's Health, Environmental Policy, Atmospheric Sciences, Ecological Risk Assessment, Risk Assessment, asthma, environmental health, health effects, air pollutants, air toxics, community-based intervention, age-related differences, airway disease, children, Human Health Risk Assessment, air pollution, human exposure, children's environmental health, ambient particulates, disease, airborne urban contaminants

    Progress and Final Reports:

    Original Abstract
  • 2005 Progress Report
  • 2006 Progress Report
  • 2007 Progress Report
  • 2008
  • 2009
  • Final Report

  • Main Center Abstract and Reports:

    R832139    Johns Hopkins Center for Childhood Asthma in the Urban Environment

    Subprojects under this Center: (EPA does not fund or establish subprojects; EPA awards and manages the overall grant for this center).
    R832139C001 The Epidemiology of Susceptibility to Airborne Particulates and Allergens to Asthma in African Americans
    R832139C002 A Randomized Controlled Trial of Behavior Changes in Home Exposure Control
    R832139C003 Mechanisms of Particulate-Induced Allergic Asthma
    R832139C004 Dendritic Cell Activation by Particulate Matter and Allergen