EVALUATING THE EFFICACY OF ENVIRONMENTAL INTERVENTIONS FOR ALLEVIATING ASTHMA SYMPTOMS AND QUALITY OF LIFE AMONG CHILDREN IN URBAN PUBLIC HOUSING

Abstract

ISEE-330 Introduction: Asthma severity disproportionately impacts lower-income urban children, in communities where complex environmental, social, and economic exposures exacerbate this multifactorial disease. The Healthy Public Housing Initiative (HPHI), a community-based collaborative of university, government, and community partners, explored whether environmental interventions can be effectively introduced to alleviate asthma symptoms among children in this setting. Methods: Seventy-eight children aged 4 through 17 were recruited from three public housing developments; 58 were retained for longitudinal follow-up of 8 to 20 months. Cockroach and dust mite antigens, mouse urinary protein, and pesticides were sampled before and after interventions (which included intensive cleaning, Integrated Pest Management, mattress replacement, and air cleaners) to estimate pollutant reductions. Outcomes data, collected monthly before and after interventions by trained Community Health Advocates, included Juniper Asthma Quality of Life (AQLQ) questionnaires for both child and caregiver, reports of symptoms, unplanned ED/clinic visits, and changes in medication use. Allergy testing was conducted once, and spirometry was performed at multiple points in time. Information on social exposures associated with immune function (perceived stress, violence, and social support) was collected monthly. Results: Baseline data indicate that only 36% of persistent asthmatics in the intake group used maintenance medications. Allergy testing on a subset of children indicated high prevalence of cockroach (59%) and dust mite (61%) allergies. This prevalent atopy and under-medication suggest strong potential for health improvements with environmental intervention and increased social and medical support. Baseline cross-sectional multivariate regression suggests that time spent around smokers (p=.08) and household size (p=.02) predicts symptoms, which in turn predict child's AQLQ score (p=.0002). Caregiver AQLQ is associated with child's respiratory symptoms (p<.0001), perceived stress (p=.002), and child's having been treated in NICU (p=.09). Longitudinal analyses of AQLQ scores will be presented to evaluate intervention efficacy; the method accounts for seasonality and autocorrelation between repeated measures. Differential response by medical, social, and environmental risk factors related to susceptibility to environmental exposures (including allergy status and perceived stress levels) will be examined. Pre- and post-intervention spirometry scores will be used to corroborate longitudinal results. Discussion: The baseline HPHI results help to identify key factors that influence asthma severity in public housing developments (including time spent around smokers and household size), and to explore the multifactorial nature of the disease by considering many types of exposures (environmental, social, and economic). Longitudinal analysis will allow us to understand whether, and for which children, environmental interventions may reduce asthma severity. We extend our sincere thanks to the West Broadway Task Force, Committee for Boston Public Housing, Boston Housing Authority, Boston Public Health Commission, Tufts University School of Public Health, and many many others who worked long days on the HPHI effort.