Grantee Research Project Results

2006 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: Center for the Study of Childhood Asthma in the Urban Environment
Center Director: Hansel, Nadia
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)
Project Period Covered by this Report: November 1, 2005 through October 31, 2006
RFA: Centers for Children's Environmental Health and Disease Prevention Research (2003) RFA Text | Recipients Lists
Research Category: Children's Health , Human Health

Objective:

The original goals of this community-base prevention project were to conduct a randomized controlled trial of the effectiveness of an environmental intervention based on home air filters and a smoking behavior modification behavioral intervention on reducing hazardous exposures and their adverse health effects.

We conducted a randomized controlled trial of methods to reduce home environmental exposure in the homes of asthmatic children living in the inner city.

Progress Summary:

Progress on the New Intervention study: During this year, a protocol has been developed to extend the results of the completed RCT conducted in years 01-05. In the first intervention, PM was reduced substantially (38%) by a combination of a HEPA air filter in the child’s bedroom, mattress and pillow covers on the child’s bed, cockroach extermination and education for the family. The new intervention trial will compare increased filtration (two HEPA air filters) and an intensive behavioral intervention to reduce ETS exposure (a major source of Particulate Matter in the home). After baseline evaluation, and morbidity assessment, children with persistent asthma will be randomized into three groups: filtration plus ETS behavior change, filtration alone and standard care (delayed filtration). The trial will last 6 months. Families will be interviewed monthly to assess frequency of asthma symptoms, medication use, ER and hospitalizations as well as smoking behavior. Home visits will be conducted at baseline and 6 months to inspect the home, collect dust from the child’s bedroom for allergen analysis, and to sample airborne particulates (PM10, PM2.5, TSP. MIE) NO2, nicotine and O3. Clinic visit evaluation will be conducted at baseline and 6 months to administer questionnaires, perform spirometry and collect urine for cotinine and creatinine measurements. The primary outcome with be indoor PM10, PM2.5 and MIE. Secondary outcomes with be child’s heath and cotinine measurements. We will monitor the HEPA air filters by using passive monitors.

Airborne pollutants and indoor allergens increase asthma morbidity in inner city children;so reducing exposure, if feasible, should improve asthma morbidity.

After completion of questionnaires, FEV1 and allergen skin tests, home inspection and measurement of home air pollutants and allergens, 100 asthmatic children aged 6-12 years were randomized to a treatment (home based education, cockroach and rodent extermination, mattress and pillow encasings, and HEPA air cleaner) and control (treated at the end of the 1 year trial). Outcome was assessed with home evaluations at 6 and 12 months, clinic evaluation at 12 months and repeated telephone interviews.

Future Activities:

The newly planned intervention will begin starting 9/1/2006. We are currently conducting recruitment and training of new staff. Recruitment will be made easier by the existence of a recruitment database maintained by the Data Core. This database has been approved by the Johns Hopkins University IRB and includes families who have completed other research projects conducted by Center personnel, then have signed a HIPAA waiver and have signed their consent to be included on this database. Periodic mailings serve to both maintain interest and to determine that the present address is active.

Journal Articles on this Report : 3 Displayed | Download in RIS Format

Publications Views
Other subproject views:	All 31 publications	31 publications in selected types	All 30 journal articles
Other center views:	All 117 publications	116 publications in selected types	All 113 journal articles

Publications
Type	Citation	Sub Project	Document Sources
Journal Article	Butz AM, Tsoukleris MG, Donithan M, Hsu VD, Zuckerman I, Mudd KE, Thompson RE, Rand C, Bollinger ME. Effectiveness of nebulizer use--targeted asthma education on underserved children with asthma. Archives of Pediatric and Adolescent Medicine 2006;160(6):622-628.	R832139 (2007) R832139C002 (2006) R832139C002 (2007)	Full-text from PubMed Abstract from PubMed Associated PubMed link Abstract: Unbound Medicine - abstract Exit
Journal Article	Eggleston PA, Butz A, Rand C, Curtin-Brosnan J, Kanchanaraksa S, Swartz L, Breysse P, Buckley T, Diette G, Merriman B, Krishnan JA. Home environmental intervention in inner-city asthma:a randomized controlled clinical trial. Annals of Allergy, Asthma & Immunology 2005;95(6):518-524.	R832139 (2004) R832139 (2005) R832139 (2006) R832139 (2007) R832139 (Final) R832139C001 (2006) R832139C002 (2005) R832139C002 (2006) R832139C003 (2005)	Abstract from PubMed Full-text: Hopkins-Full Text PDF Exit Abstract: AAAI-Abstract Exit Other: ScienceDirect - Abstract Exit
Journal Article	Winkelstein ML, Quartey R, Pham L, Lewis-Boyer L, Lewis C, Hill K, Butz A. Asthma education for rural school nurses: resources, barriers, and outcomes. Journal of School Nursing 2006;22(3):170-177.	R832139 (2007) R832139C002 (2006) R832139C002 (2007)	Abstract from PubMed Full-text: Sage Publications - full text html Exit Abstract: Sage Publications Exit Other: Sage Publications - abstract Exit

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

Progress and Final Reports:

Original Abstract

Main Center Abstract and Reports:

R832139 Center for the Study of 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

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The perspectives, information and conclusions conveyed in research project abstracts, progress reports, final reports, journal abstracts and journal publications convey the viewpoints of the principal investigator and may not represent the views and policies of ORD and EPA. Conclusions drawn by the principal investigators have not been reviewed by the Agency.