Final 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: 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)
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:

[From Main Project # R832139-Final Report]: The long-term goal of the Center for Childhood Asthma in the Urban Environment was to examine how exposures to environmental pollutants and allergens may relate to airway inflammation and respiratory morbidity in children with asthma living in the inner city of Baltimore, and to search for new ways to reduce asthma morbidity by reducing exposure to these agents. 
 
Project 2 is a community-based participatory research project that is a randomized controlled clinical trial of 120 children of the effectiveness of behavioral methods to reduce pollutant and allergen exposures and their adverse health effects.

Summary/Accomplishments (Outputs/Outcomes):

Use of portable air cleaners in households with smokers has been suggested to improve indoor air quality and subsequent health outcomes for other household members exposed to second hand smoke (SHS). We hypothesized that the combination of air cleaners and a behavioral intervention to promote home smoking bans would be more successful than air cleaners alone or a control condition in reducing levels of particulate matter (PM), air nicotine, urine cotinine and asthma morbidity in inner city children with asthma residing with a smoker.
 
A total of 126 inner-city children with asthma (mean age 9 years; 55% male; 90% Medicaid insured; 95% African American) who lived with at least one smoker in their household were recruited from an urban pediatric emergency department (ED) and community based pediatric practices. All children were randomized into three groups: 1) delayed air cleaners (control), 2) air cleaners only or 3) air cleaners plus health coach for reduction of home SHS exposure. Caregivers were interviewed regarding child health status and child urine cotinine assessments were collected at baseline and 6 months. Indoor air quality measures of particulate matter and air nicotine were collected and analyzed prior to randomization and at the 6 month follow-up. Kruskal-Wallis, Wilcoxon rank-sum and Cuzik’s test for trend were used to test for differences in fine (PM2.5) and coarse (PM2.5-10) particulate matter, air nicotine and urine cotinine concentrations between baseline and 6 months by group.
 
Caregivers were the primary household smoker in the majority (68%) of homes. Asthma severity was high with 80% children categorized with persistent asthma. At follow-up, mean differences in PM2.5 and PM 2.5-10 concentrations between baseline and follow-up were significantly lower in the air cleaner groups as compared to the control group (p < 0.01) with no differences by group noted for air nicotine or urine cotinine. However, mean follow-up PM2.5 levels for all groups surpassed the U.S. EPA annual standard, 15 µg/m3, for outdoor air quality (Control: 38.9 µg/m3, Air cleaner only: 17.96 µg/m3, Air cleaner + Health Coach: 32.21 µg/m3). Mean differences in symptom free days and days without slowed activity due to asthma over the past 2 weeks were significantly lower in children assigned to the air cleaner groups as compared to control children. The addition of an intensive health coach intervention provided no additional reduction in PM concentrations or health effects when compared to the air cleaner only group.

 

Conclusions:

In conclusion, the use of air cleaners in homes of children with asthma was associated with a significant reduction in indoor PM concentrations and a modest increase in symptom free days. However, even the reduced indoor PM concentrations surpassed the US EPA standards for outdoor air quality. Implementing a smoke-free home policy is the only justifiable practice to be recommended for children with asthma residing in homes with a smoker to prevent exposure to SHS.

 


Journal Articles on this Report : 6 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 Butz AM, Tsoukleris M, Donithan M, Hsu VD, Mudd K, Zuckerman IH, Bollinger ME. Patterns of inhaled antiinflammatory medication use in young underserved children with asthma. Pediatrics 2006;118(6):2504-2513. R832139 (2007)
R832139 (Final)
R832139C002 (2007)
R832139C002 (Final)
  • Full-text from PubMed
  • Abstract from PubMed
  • Associated PubMed link
  • Full-text: Pediatrics-Full Text HTML
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  • Abstract: Pediatrics-Abstract
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  • Other: Pediatrics-Full Text PDF
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  • Journal Article Butz AM, Walker J, Land CL, Vibbert C, Winkelstein M. Improving asthma communication in high-risk children. Journal of Asthma 2007;44(9):739-745. R832139 (Final)
    R832139C002 (Final)
  • Full-text from PubMed
  • Abstract from PubMed
  • Associated PubMed link
  • Full-text: ResearchGate - Abstract & Full Text PDF
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  • Abstract: Informa Healthcare-Abstract
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  • Journal Article Butz AM, Thompson RE, Tsoukleris MG, Donithan M, Hsu VD, Mudd K, Zuckerman IH, Bollinger ME. Seasonal patterns of controller and rescue medication dispensed in underserved children with asthma. Journal of Asthma 2008;45(9):800-806. R832139 (Final)
    R832139C002 (Final)
  • Abstract from PubMed
  • Full-text: Hopkins - Full Text PDF
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  • Abstract: Informa Healthcare-Abstract
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  • Journal Article Butz A, Sellers MD, Land C, Walker J, Tsoukleris M, Bollinger ME. Factors affecting primary care provider and caregiver concordance for pediatric asthma medications. Journal of Asthma 2009;46(3):308-313. R832139 (Final)
    R832139C002 (Final)
  • Abstract from PubMed
  • Full-text: Hopkins-Full Text PDF
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  • Abstract: Taylor&Francis-Abstract
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  • Journal Article Mudd KE, Bollinger ME, Hsu VD, Manning A, Tsoukleris MG, Butz AM. Concordance of Medicaid and pharmacy record data in inner-city children with asthma. Contemporary Clinical Trials 2008;29(1):13-20. R832139 (Final)
    R832139C002 (Final)
  • Abstract from PubMed
  • Full-text: Hopkins - Full Text PDF
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  • Abstract: ScienceDirect-Abstract
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  • Journal Article Walker J, Lewis-Land C, Kub J, Tsoukleris M, Butz A. The effect of violence on asthma:are our children facing a double-edged sword? Journal of Community Health 2008;33(6):384-388. R832139 (Final)
    R832139C002 (Final)
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  • Full-text: Hopkins - Full Text PDF
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  • Abstract: Springer-Abstract
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  • Supplemental Keywords:

    , 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

    Relevant Websites:

    Progress and Final Reports:

    Original Abstract
  • 2004 Progress Report
  • 2005 Progress Report
  • 2006 Progress Report
  • 2007 Progress Report
  • 2008
  • 2009

  • 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