Grantee Research Project Results

2002 Progress Report: Asthma in Children: A Community-based Intervention Project

EPA Grant Number: R826708C001
Subproject: this is subproject number 001 , 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: Asthma in Children: A Community-based Intervention Project
Investigators: Gong, Henry , McConnell, Rob Scot , Jones, Craig
Current Investigators: Gong, Henry , McConnell, Rob Scot , Jones, Craig , Diaz-Sanchez, David
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 Period Covered by this Report: January 1, 2001 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:

Asthma is the most common chronic disease in childhood. Asthma is now associated with increasing frequency, hospitalization, and mortality, especially in nonwhite, poor, inner-city children. Research is needed to develop and evaluate comprehensive community-based programs designed to reduce asthma triggers in the home environment, such as house dust mites and cockroaches. In this study, inner-city, primarily minority, children with asthma are being identified through a school-based mobile asthma clinic, the Breathmobile, which delivers high quality asthma care to these children. Working with school nurses and community organizations and 3 Breathmobile units. The major goal of this study is to determine whether a comprehensive environmental health education program, enhanced by least-toxic integrated pest management for cockroach control, will result in reduction of dust mites or cockroaches in children's homes and clinical improvement in asthma.

The long-term goal of this study is to reduce asthma incidence, prevalence, severity and mortality among inner city children. We are developing and evaluating a comprehensive community intervention aimed at reducing environmental asthma triggers in the homes of children with persistent asthma who are already receiving high quality, continuous asthma care from the Los Angeles County-University of Southern California Breathmobile, a novel, school based mobile asthma clinic. Specific aims are:

1. To determine whether a community based, family-oriented, comprehensive environmental health education program will result in reduction in concentrations of house mite and cockroach antigens in household dust;
2. To determine whether the environmental health education program results in clinical improvement in childhood asthma;
3. To determine whether a professional integrated pest management and cleaning program provides greater reduction in exposure to household antigen or improvement in clinical status than health education alone.
4. To expand coverage of successful indoor air pollutant reduction strategies at low cost by the agencies and community groups participating in the study.

Progress Summary:

Phase 1
Investigators completed a study of repeated measurements of cockroach allergen in a study of 49 homes of allergic children with cockroaches, which were treated and professionally cleaned and had repeated subsequent professional treatment during up to one year of follow-up. In the kitchens of homes heavily infested with cockroaches, the intervention produced a marked reduction in allergen (Bla g 2), large enough that effects on health might be expected, based on other studies which have evaluated health outcomes. However, concentrations which have been associated with health effects in other studies continued to be observed in many homes. In less heavily infested homes, there was minimal effect of the intervention. Important experience about sampling strategy and design were gained, which have been applied to the educational intervention. A manuscript is under review

In a sample of homes, repeated measurements have been made of allergen levels at co-located sites within the home, at different time intervals, and using different methods of collection (wipe and vacuum methods). They have demonstrated adequate recovery of allergen from vacuumed samples of bedding, even when covered with allergen impermeable covers, and of accessible dust within the kitchen (on counters and floors, but not behind or under appliances), even in homes where subjects are encouraged to clean to reduce allergen levels. Within home correlations exceeding .40 (similar to reports from other studies) are as good or better using a wipe collection technique, which is suitable for subjects to collect themselves, as from vacuum collected dust by a technician. The wipe test would be suitable for large-scale epidemiologic studies, in which it would be too expensive to make home visits. A manuscript is under preparation. Based on these analyses, an appropriate strategy has been finalized to assay 2 archived dust samples from each visit. These analysis have been a joint effort with the CEHC at the University of Iowa (Peter Thome), rather than at USC, as originally proposed. Dr. Thome has unique expertise in the analysis of endotoxin, which is being assayed as part of a complementary research effort.

Investigators have 160 subjects. Fourteen have been lost to follow-up and eight have completed the study. We have examined the knowledge of caretakers of their children's allergies from their physicians (by skin test), a key intermediate variable in the intervention to control exposure to allergens. Caretakers accurately report those allergens to which their children are allergic (although there are many false positive reports). A manuscript is under preparation. Analysis of the relationship of intervention to health outcomes from the first two home visits is nearing completion, and a manuscript is under preparation. Data for the third visit is available and being prepared for analysis.

Phase II (expansion to broader community) and Health Education
The core of the educational effort is a flip chart and accompanying training manual for families in a comic book style format. Other tools developed include a coloring book for children and reinforcement messages on magnets for refrigerators. During the past year Investigators have refined reinforcement educational messages for the final two visits to participants' homes, tailored to the problems in individual homes. A brief video demonstrating the impact of house dust mite allergen on the lung has been adapted from materials available in the public domain (with permission). They have posted to the Center web site our educational manual and review of indoor allergen health education materials In Spanish and English. We described last year a (now county wide) community based asthma coalition, in which Center investigators are active participants, which includes some of our community partners to the CEHC, and which also uses community health workers for teaching families. The CEHC organized jointly with the coalition a series of workshops for community health educators on how to better control indoor allergens (house dust mite, mold, and cockroach). The development of a research component to this growing effort has been slow, because the coalition has focused during this year on developing a proposal for a large grant, which was recently awarded by the California Endowment, and which relies heavily on our curriculum for training community outreach workers and for teaching subjects. Center investigators and staff are largely responsible for the design of the environmental intervention, including the proposed research evaluation, which the coalition has asked be expanded to include community concerns around the effect of air pollution on asthmatic children.

Future Activities:

Urgent tasks are to complete the manuscripts described above and to complete and incorporate the allergen assay results into the health analyses. Investigators will extend the analysis to subsequent visits as families complete the study and data become available. They will complete the design and collect preliminary data from the research evaluation of the broader intervention by the community asthma coalition.

Journal Articles:

No journal articles submitted with this report: View all 11 publications for this subproject

Supplemental Keywords:

Allergens, Asthma, Biochemistry, Children's Health, Disease & Cumulative Effects, Ecological Risk Assessment, Human Health Risk Assessment, airway disease, airway inflammation, community-based intervention, environmental health, epidemiology, human exposure, endotoxin, California, Los Angeles., Health, RFA, Air, Scientific Discipline, Susceptibility/Sensitive Population/Genetic Susceptibility, Health Risk Assessment, Risk Assessments, Biology, genetic susceptability, Environmental Chemistry, Allergens/Asthma, Children's Health, indoor air, Atmospheric Sciences, air quality, health effects, Human Health Risk Assessment, indoor air quality, sensitive populations, minority population, childhood respiratory disease, allergen, asthma, harmful environmental agents, indoor environment, dust , asthma indices, asthma triggers, human exposure, respiratory, biological response, Breathmobile, dust mites, adolescents, children, exposure, sensitive population, cockroaches, dust mite, toxics, children's vulnerablity, air pollution, community-based intervention, exposure assessment

Relevant Websites:

The link to University of Southern California is:
https://cfpub.epa.gov/ncer_abstracts/index.cfm/fuseaction/outlinks.centers

Progress and Final Reports:

Original Abstract

1998

1999

2000 Progress Report

Final 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