DIFFERENTIAL EFFICACY OF ENVIRONMENTAL INTERVENTIONS FOR ALLEVIATING SYMPTOMS AMONG ASTHMATIC CHILDREN IN URBAN PUBLIC HOUSING

Abstract

ISEE-305 Introduction: Asthma disproportionately impacts children in lower-income urban communities where environmental, social, and economic exposures exacerbate this multifactorial disease. Aim: The Healthy Public Housing Initiative (HPHI), a collaboration of university, government, and community partners, explored whether indoor environmental interventions may alleviate asthma symptoms, and which factors may modify efficacy of interventions. Methods: Seventy-eight children, aged 4 through 17, were recruited from 3 public housing developments; 58 were retained for longitudinal follow-up of 8 to 20 months. Cockroach and dust mite antigen, mouse urinary protein, and pesticides were sampled before and after indoor environmental interventions (intensive cleaning, Integrated Pest Management, mattress replacement, and air cleaners) to estimate pollutant reductions. Health outcomes data, collected monthly by trained Community Health Advocates, included Juniper Asthma Quality of Life (QOL) questionnaires for child and caregiver, reports of symptoms, unplanned ED/clinic visits, and medication use. Allergy testing, and spirometry were performed before and after interventions. Data on social exposures associated with immune function (stress, violence, social support) were collected monthly. Longitudinal analysis with random intercepts was used to assess improvement. Spline models were used to differentiate improvements during pre-intervention, post-intervention (<4 months), and longer term follow-up periods (4–18 months post-intervention). Effect modification was explored by dichotomizing the cohort by demographic, medical, social, and environmental risk factors. Pre-post changes in lung function score and caretaker QOL will be assessed. Results: Longitudinal analyses indicate significant improvement in QOL scores over the course of study (p<.001). Significant improvement is shown in the pre-intervention phase, indicating potential benefits of case management and support. The most rapid improvement occurred in the first four months following intervention. Boys showed higher QOL at time of intervention (p=.039), but made less improvement overall (p=.008). Older children showed higher QOL scores (p=.008), no difference in improvement. Children not: allergic to cockroach antigen made marginally more improvement (p=.06), as did non-obese children (p=.05). Children of families reporting higher life stress showed significantly lower QOL scores (p=.004), and those with reporting higher fear of violence showed less improvement (p=.036). Children receiving interventions during spring (vs. fall) made more improvement (p=.08), as did children spending less time around smokers (p=.015). No effect modification was found by medical care indicators. Discussion: Results indicate that environmental interventions may significantly improve the health of asthmatic children in urban public housing. It is less clear whether benefits are largely atttributable to environmental or social aspects of intervention. We found interventions to be more effective for girls, and for children not allergic to cockroach antigen, not obese, with lower exposures to tobacco smoke, violence, and stress, and who received interventions during spring months. Results indicate a need for coordinated interventions in the physical, social, and medical environments to alleviate severe asthma among inner-city children.