Reducing Childhood Asthma Triggers in Public Housing: Implementation and Outcomes from an East Harlem Community Health Worker Program

Abstract

There are significant disparities in asthma prevalence and management in New York City (NYC). Children living in the low income, largely minority neighborhood of East Harlem are almost 13 times more likely to have an asthma related emergency department visit compared to children on the Upper East Side, an adjacent high income neighborhood. The disparities in asthma prevalence and control are in part attributable to environmental conditions, including housing, which in low-income communities is often poorly maintained, resulting in mold, pests, and other asthma triggers. Controlling Asthma through Home Remediation (CAHR), a program of LSA Family Health Service (LSAFHS), offers remediation and repair, training, and comprehensive case management to East Harlem families that have children with severe and/or persistent asthma and live in NYC Housing Authority (NYCHA) public housing. Preliminary findings, based on pre-post assessments of 60 CAHR children, include statistically significant reductions in nighttime awakenings, emergency department visits, and rescue medication use. There were reductions in daytime asthma symptoms and improvements in household conditions; however, they were not statistically significant. Recognizing the limited reach of individual level services, LSAFHS also advocates for system-wide changes across NYCHA. Citing the Americans with Disabilities Act and its relevance to individuals with asthma, LSAFHS, in partnership with other community-based organizations and public interest attorneys, reached a settlement with NYCHA in 2013 that resulted in policy changes mandating expedited repairs of leaks, mold, and related issues. Monitoring the impact of these changes is ongoing. A hope is for replication of advocacy efforts in other cities.