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Basnet S, Wroblewski K, Hansen E, Perez E, Lyu R, Abid Z, Roach A, Latham C, Salibi N, Battle B, Giles L. Collaborative Integration of Community Health Workers in Hospitals and Health Centers to Reduce Pediatric Asthma Disparities: A Quality Improvement Program Evaluation. J Community Health 2024; 49:682-692. [PMID: 38388809 PMCID: PMC11306379 DOI: 10.1007/s10900-024-01331-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2024] [Indexed: 02/24/2024]
Abstract
To address pediatric asthma disparities on the South Side of Chicago, a community health worker (CHW) home visiting intervention was implemented collaboratively by academic institutions and community based health centers. This evaluation assessed the effectiveness of this longitudinal quality improvement CHW intervention in reducing asthma morbidity and healthcare utilization. All patients aged 2-18 who met the high-risk clinical criteria in outpatient settings or those who visited the ED due to asthma were offered the program. A within-subject study design analyzed asthma morbidity and healthcare utilization at baseline and follow-up. Multivariable mixed-effects regression models, adjusted for baseline demographic and asthma characteristics, were used to assess changes over time. Among 123 patients, the average age was 8.8 (4.4) years, and 89.3% were non-Hispanic black. Significant reductions were observed in the average daytime symptoms days (baseline 4.1 days and follow-up 1.6 days), night-time symptoms days (3.0 days and 1.2 days), and days requiring rescue medication (4.1 days and 1.6 days) in the past two weeks (all p < 0.001). The average number of emergency department visits decreased from 0.92 one year before to 0.44 one year after program participation, a 52% reduction (p < 0.001). No significant difference was found in hospital admissions. These results support the use of a collaborative approach to implement the CHW home visiting program as part of standard care for pediatric asthma patients in urban settings. This approach has the potential to reduce asthma disparities and underscores the valuable role of CHWs within the clinical care team.
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Affiliation(s)
- Sweta Basnet
- Urban Health Initiative, University of Chicago Medical Center, 5841 S. Maryland Ave, Chicago, IL, 60637, USA
| | - Kristen Wroblewski
- Department of Public Health Sciences, The University of Chicago, Chicago, IL, USA
| | - Elizabeth Hansen
- Urban Health Initiative, University of Chicago Medical Center, 5841 S. Maryland Ave, Chicago, IL, 60637, USA
| | - Ernestina Perez
- Urban Health Initiative, University of Chicago Medical Center, 5841 S. Maryland Ave, Chicago, IL, 60637, USA
| | - Ruobing Lyu
- Urban Health Initiative, University of Chicago Medical Center, 5841 S. Maryland Ave, Chicago, IL, 60637, USA
| | - Zain Abid
- Urban Health Initiative, University of Chicago Medical Center, 5841 S. Maryland Ave, Chicago, IL, 60637, USA
| | - Alexis Roach
- Urban Health Initiative, University of Chicago Medical Center, 5841 S. Maryland Ave, Chicago, IL, 60637, USA
| | - Catina Latham
- Harris School of Public Policy, The University of Chicago, Chicago, IL, USA
| | - Nadia Salibi
- Urban Health Initiative, University of Chicago Medical Center, 5841 S. Maryland Ave, Chicago, IL, 60637, USA
| | - Brenda Battle
- Urban Health Initiative, University of Chicago Medical Center, 5841 S. Maryland Ave, Chicago, IL, 60637, USA.
| | - Louise Giles
- Department of Pediatric Medicine, The University of Chicago, Chicago, IL, USA
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Talis N, Lewis N, Doraiswamy P, Wu Z, Boakye B. From Research to Roach Traps: Practical Considerations for a Home-Based Asthma Program. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2024; 30:E94-E101. [PMID: 38603759 DOI: 10.1097/phh.0000000000001890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
CONTEXT Home-based asthma interventions have a significant evidence base as an effective means to address moderate and severe breathing concerns triggered by home conditions. However, the literature lacks logistical and staffing considerations necessary to successfully implement such a program at a governmental level. This practice report and process evaluation outlines practical details and lessons learned during a healthy homes pilot, and how they were addressed in the design of a permanent program. OBJECTIVE To inform the creation of a permanent home-based asthma intervention at the Alexandria Health Department (AHD) (City of Alexandria, Virginia) and understand the tools and resources necessary for success. INTERVENTION Participating households received a health and environmental assessment, followed by cleaning supplies, relevant education, and referrals to partners for services. AHD staff tracked challenges and insights at each step of the intervention. At the end of the pilot, staff worked with the community to identify solutions and design a permanent program. CONCLUSIONS Although the pilot model was constructed based on existing case studies, technical assistance from national experts, and guidance documents, the team still experienced challenges around recruitment, staff support, home visit implementation, and impact evaluation. While pilots and existing literature can be instructive for identifying issues, work with residents and partners to develop a uniquely tailored community program was essential for practical success. IMPLICATIONS ON POLICY AND PRACTICE Health departments developing new initiatives should consider both the staff and participant experience throughout the creation of administrative and programmatic processes. Testing out draft versions of these processes and materials using internal and external focus groups can identify potential bottlenecks and solutions upfront.
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Affiliation(s)
- Natalie Talis
- Author Affiliations: Alexandria Health Department, Alexandria, Virginia (Mss Talis and Boakye and Mr Lewis); and RTI International, Research Triangle Park, North Carolina (Drs Doraiswamy and Wu)
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Aldem Budak M, Geckil E. The effect of home environment modification nursing intervention on symptom control, quality of life, and number of triggers in children with allergic rhinitis: A randomized controlled trial. J Pediatr Nurs 2024; 74:e28-e37. [PMID: 37996355 DOI: 10.1016/j.pedn.2023.10.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/30/2023] [Accepted: 10/30/2023] [Indexed: 11/25/2023]
Abstract
PURPOSE The study was conducted to investigate the effects of a nursing intervention aimed at home environment modification on symptom control, quality of life, and the number of triggers in children with allergic rhinitis. DESIGN AND METHODS This one-to-one, parallel-arm, randomized controlled trial was conducted with a pre-test/post-test design. The study used stratified sampling method. A total of 52 participants were randomly assigned to the intervention group (n = 26) and the control group (n = 26). The intervention group received education on home environment modification and the child was provided with anti-allergic bedding set. The control group continued with routine practices. Statistical significance was set at p < 0.05. RESULTS After the nursing intervention for home environment modification, a significant difference was found between the groups in terms of the number of home environment triggers (p < 0.05). According to the mean scores of the Pediatric Rhinoconjunctivitis Quality of Life Questionnaire, no significant difference was found between the groups (p > 0.05). There was no significant difference between the groups in terms of the mean scores for nasal discharge, nasal congestion, sneezing, nasal itching, and eye itching (p > 0.05) after the nursing intervention for home environment modification. CONCLUSION The findings indicate that the nursing intervention for home environment modification is an effective method in reducing the number of triggers in the home environment. However, no significant impact was observed on symptom control and quality of life. PRACTICAL IMPLICATIONS Awareness can be increased by educating children with allergic rhinitis and their families about triggers in the home environment.
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Affiliation(s)
| | - Emine Geckil
- Necmettin Erbakan University, Faculty of Nursing, Konya, Turkey
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Pham DL, Le KM, Truong DDK, Le HTT, Trinh THK. Environmental allergen reduction in asthma management: an overview. FRONTIERS IN ALLERGY 2023; 4:1229238. [PMID: 37868650 PMCID: PMC10587592 DOI: 10.3389/falgy.2023.1229238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 09/12/2023] [Indexed: 10/24/2023] Open
Abstract
Asthma is a prevalent non-communicable disease that affects both children and adults. Many patients with severe, uncontrolled asthma could not achieve total control despite using anti-asthmatic drugs. There is increasing evidence that allergy to environmental allergens, including both indoor and outdoor allergens, is associated with asthma symptoms and severe asthma. Frequently reported sensitized allergens were dust mites, cockroaches, grass pollens, molds, pets, and rodents in allergic asthma patients, although the patterns of widespread allergens differed from each country. Allergen avoidance is the cornerstone of asthma management, especially in sensitized subjects. This review summarizes environmental allergen avoidance and clarifies their effects on asthma control. Despite contrasting results about the impact of allergen exposure reduction on asthma control, several studies supported the beneficial effects of reducing asthma-related symptoms or risk of exacerbations as a nondrug therapy. Identifying environmental allergens is helpful for asthma patients, and further studies on clinically effective avoidance methods are required.
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Affiliation(s)
- Duy Le Pham
- Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
- University Medical Center Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Kieu-Minh Le
- Center for Molecular Biomedicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Diem D. K. Truong
- Center for Molecular Biomedicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Huyen T. T. Le
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Tu H. K. Trinh
- Center for Molecular Biomedicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
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Harper LJ, Kidambi P, Kirincich JM, Thornton JD, Khatri SB, Culver DA. Health Disparities: Interventions for Pulmonary Disease - A Narrative Review. Chest 2023; 164:179-189. [PMID: 36858172 PMCID: PMC10329267 DOI: 10.1016/j.chest.2023.02.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/17/2023] [Accepted: 02/18/2023] [Indexed: 03/02/2023] Open
Abstract
There is expansive literature documenting the presence of health disparities, but there are disproportionately few studies describing interventions to reduce disparity. In this narrative review, we categorize interventions to reduce health disparity in pulmonary disease within the US health care system to support future initiatives to reduce disparity. We identified 211 articles describing interventions to reduce disparity in pulmonary disease related to race, income, or sex. We grouped the studies into the following four categories: biologic, educational, behavioral, and structural. We identified the following five main themes: (1) there were few interventional trials compared with the breadth of studies describing health disparities, and trials involving patients with asthma who were Black, low income, and living in an urban setting were overrepresented; (2) race or socioeconomic status was not an effective marker of individual pharmacologic treatment response; (3) telehealth enabled scaling of care, but more work is needed to understand how to leverage telehealth to improve outcomes in marginalized communities; (4) future interventions must explicitly target societal drivers of disparity, rather than focusing on individual behavior alone; and (5) individual interventions will only be maximally effective when specifically tailored to local needs. Much work has been done to catalog health disparities in pulmonary disease. Notable gaps in the identified literature include few interventional trials, the need for research in diseases outside of asthma, the need for high quality effectiveness trials, and an understanding of how to implement proven interventions balancing fidelity to the original protocol and the need to adapt to local barriers to care.
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Affiliation(s)
- Logan J Harper
- Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH.
| | - Pranav Kidambi
- Michigan State University College of Human Medicine, Grand Rapids, MI; Division of Pulmonary and Critical Care Medicine, Corewell Health Medical Group, Grand Rapids, MI
| | - Jason M Kirincich
- Department of Internal Medicine, Community Care Institute, Cleveland Clinic, Cleveland, OH
| | - J Daryl Thornton
- Center for Reducing Health Disparities, The MetroHealth Campus of Case Western Reserve University, Cleveland, OH; Population Health Research Institute, The MetroHealth Campus of Case Western Reserve University, Cleveland, OH; Division of Pulmonary, Critical Care, and Sleep Medicine, The MetroHealth Campus of Case Western Reserve University, Cleveland, OH
| | - Sumita B Khatri
- Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH
| | - Daniel A Culver
- Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH
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Gill I, Shah A, Lee EK, Sommer R, Ross K, Bole A, Freedman D. Community Interventions for Childhood Asthma ED Visits and Hospitalizations: A Systematic Review. Pediatrics 2022; 150:189494. [PMID: 36102121 DOI: 10.1542/peds.2021-054825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/12/2022] [Indexed: 11/24/2022] Open
Abstract
UNLABELLED A systematic review of interventions in community environments found significant reductions in childhood asthma exacerbations leading to emergency department visits and hospitalizations. BACKGROUND AND OBJECTIVES Structural and social determinants of childhood asthma inequities manifest within geographic communities that are often segregated. Childhood asthma disproportionately affects Black, Hispanic, and low-income populations. Community interventions have the potential to improve inequities in emergency healthcare. This systematic review was conducted to assess the effectiveness of childhood asthma community interventions and provide a conceptual model to inform implementation of future community interventions. METHODS Publications from PubMed, ScienceDirect, CINAHL, Cochrane Library, Web of Science, and hand searched references were examined from 2010 to 2021. Community intervention studies among children with asthma were included. Main outcomes were emergency department visits and hospitalizations. Community interventions exclusively focusing on schools or hospitals were excluded. Two reviewers independently assessed eligibility for final inclusion. Emergency healthcare findings were extracted in addition to co-benefits (eg, fewer missed school days and caregiver workdays). RESULTS Out of 1856 records, 26 publications met the inclusion criteria. Community interventions were categorized by care coordination (n = 8), policy and environmental changes (eg, smoke-free legislature, traffic reduction models, and green housing) (n = 8), home-based (n = 6), and community-based health services (n = 4). Selected studies indicated that community interventions significantly reduced childhood asthma emergency department visits and hospitalizations through increased caregiver self-efficacy, home environmental trigger reduction, and increased access to healthcare. Because of heterogeneity among studies, we were unable to conduct a meta-analysis. CONCLUSIONS Findings show significant associations between community interventions and the reduction of emergency healthcare, suggesting a protective effect for severe cases of childhood asthma.
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Affiliation(s)
- India Gill
- Mary Ann Swetland Center for Environmental Health, Department of Population and Quantitative Health Sciences
| | - Aashna Shah
- Mary Ann Swetland Center for Environmental Health, Department of Population and Quantitative Health Sciences.,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Eun Kyung Lee
- Mary Ann Swetland Center for Environmental Health, Department of Population and Quantitative Health Sciences.,Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts
| | - Rachael Sommer
- Mary Ann Swetland Center for Environmental Health, Department of Population and Quantitative Health Sciences
| | - Kristie Ross
- Division of Pediatric Pulmonology, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, Ohio.,Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Aparna Bole
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio.,Division of General Academic Pediatrics, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, Ohio
| | - Darcy Freedman
- Mary Ann Swetland Center for Environmental Health, Department of Population and Quantitative Health Sciences
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Lemire E, Samuels EA, Wang W, Haber A. Unequal Housing Conditions And Code Enforcement Contribute To Asthma Disparities In Boston, Massachusetts. Health Aff (Millwood) 2022; 41:563-572. [PMID: 35377754 DOI: 10.1377/hlthaff.2021.01403] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Housing quality is a primary determinant of asthma disparities by race and social class in the US. We sought to assess how housing code enforcement systems in Boston, Massachusetts, address tenants' reports of asthma triggers. After adjustment for income and other neighborhood characteristics, racial demographics were significantly associated with asthma trigger incidence. For each 10 percent decrease in neighborhood proportion of White residents, trigger incidence increased by 3.14 reports per thousand residents. These disparities persisted during the study period (from 2011 through 2021), and for mold, which is an established asthma trigger, regressions showed that racial disparities are widening. The municipal response also demonstrated disparities: In neighborhoods with the fewest White residents compared to neighborhoods with the most White residents, adjusted models showed a 17 percent (3.51 days) slower median time until cases (tenant requests for inspections to the Inspectional Services Department) were closed, a 14 percent higher probability of being flagged as overdue, and a 54.4 percent lower probability of a repair. We found evidence that in Boston, despite several healthy housing initiatives, current regulatory systems are insufficient to address disparities in access to healthy housing. To reduce disparities in asthma burden, stronger inspectional standards and further enforcement policies to increase landlords' accountability and support tenants' rights to have repairs made are essential.
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Affiliation(s)
- Evan Lemire
- Evan Lemire, Harvard University, Boston, Massachusetts
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Tyris J, Keller S, Parikh K. Social Risk Interventions and Health Care Utilization for Pediatric Asthma: A Systematic Review and Meta-analysis. JAMA Pediatr 2022; 176:e215103. [PMID: 34870710 PMCID: PMC8649910 DOI: 10.1001/jamapediatrics.2021.5103] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Social determinants of health (SDOH) correlate with pediatric asthma morbidity, yet whether interventions addressing social risks are associated with asthma outcomes among children is unclear. OBJECTIVE To catalog asthma interventions by the social risks they address and synthesize their associations with asthma-related emergency department (ED) visits and hospitalizations among children. DATA SOURCES PubMed, Scopus, PsycINFO, SocINDEX, CINAHL, and references of included full-text articles were searched from January 1, 2008, to June 16, 2021. STUDY SELECTION Included articles were US-based studies evaluating the associations of interventions addressing 1 or more social risks with asthma-related ED visits and hospitalizations among children. The systematic review included 38 of the original 641 identified articles (6%), and the meta-analysis included 19 articles (3%). DATA EXTRACTION AND SYNTHESIS Data extraction followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline. The SDOH intervention clusters were identified by grouping studies according to the social risks they addressed, using the Healthy People 2020 SDOH framework. Random-effects models created pooled risk ratios (RRs) as the effect estimates. MAIN OUTCOMES AND MEASURES Patients with ED visits or hospitalizations were the primary outcomes. Subgroup analyses were conducted by an SDOH intervention cluster. Sensitivity analyses were conducted for each, removing outlier studies and studies failing to meet the minimum quality threshold. RESULTS In total, 38 studies were included in the systematic review, with 19 of these studies providing data for the meta-analysis (5441 participants). All interventions addressed 1 or more of the health, environment, and community domains; no interventions focused on the economy or education domains. In the primary analysis, social risk interventions were associated with decreased ED visits (RR, 0.68; 95% CI, 0.57-0.81; I2 = 70%) and hospitalizations (RR, 0.50; 95% CI, 0.37-0.68; I2 = 69%). In subgroup analyses, the health, environment, and community intervention cluster produced the lowest RR for ED visits (RR, 0.53; 95% CI, 0.44-0.64; I2 = 50%) and for hospitalizations (RR, 0.33; 95% CI, 0.20-0.55; I2 = 71%) compared with other intervention clusters. Sensitivity analyses did not alter primary or subgroup effect estimates. CONCLUSIONS AND RELEVANCE The results of this systematic review and meta-analysis indicate that social risk interventions are associated with decreased asthma-related ED visits and hospitalizations among children. These findings suggest that addressing social risks may be a crucial component of pediatric asthma care to improve health outcomes.
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Affiliation(s)
- Jordan Tyris
- Division of Hospital Medicine, Children’s National Hospital, Washington, DC,George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Susan Keller
- Division of Hospital Medicine, Children’s National Hospital, Washington, DC
| | - Kavita Parikh
- Division of Hospital Medicine, Children’s National Hospital, Washington, DC,George Washington University School of Medicine and Health Sciences, Washington, DC
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Shulhan-Kilroy J, Elliott SA, Scott SD, Hartling L. Parents' self-reported experiences and information needs related to acute pediatric asthma exacerbations: A mixed studies systematic review. PEC INNOVATION 2021; 1:100006. [PMCID: PMC10194336 DOI: 10.1016/j.pecinn.2021.100006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 10/29/2021] [Accepted: 10/29/2021] [Indexed: 05/30/2023]
Abstract
Objective To systematically review the scientific literature examining parents' experiences and information needs for the management of their child's asthma exacerbations. Methods We searched five databases for quantitative and qualitative studies in Canada and the United States from 2002 onwards. A convergent integrated approach and the Mixed Method Appraisal Tool were used to analyze and appraise the evidence, respectively. Results We included 84 studies (27 quantitative, 54 qualitative, 3 mixed methods). Some parents lacked confidence in recognizing or managing exacerbations. A few parents were uncertain when and where to seek medical help. The main barrier to accessing care was cost. Impacts on parents included poor sleep, distress, and lifestyle disruptions. Parents felt they lacked information and wanted education on treatments and how to recognize and manage exacerbations via education sessions, written materials, community outreach and online resources. Conclusion Improved education for parents may help reduce parents' stress, asthma-related morbidities for children and use of urgent health services. Innovation The development of tailored interventions and knowledge translation strategies with input from target audiences (e.g. parents, health care providers) is necessary to meet their information needs and support adherence to clinical recommendations. 84 studies reviewed and analyzed using the convergent integrated approach Parents lacked confidence in recognizing, treating or seeking care for exacerbations Cost was a barrier to care; parents affected by psychosocial impacts Parent's desired education on treatments and how to recognize and manage exacerbations Interventions and knowledge translation strategies must be developed with parents
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Affiliation(s)
- Jocelyn Shulhan-Kilroy
- Alberta Research Centre for Health Evidence (ARCHE), Department of Pediatrics, University of Alberta, Edmonton, Canada
| | - Sarah A. Elliott
- Alberta Research Centre for Health Evidence (ARCHE), Department of Pediatrics, University of Alberta, Edmonton, Canada
| | - Shannon D. Scott
- Evidence in Child Health to Enhance Outcomes (ECHO), Faculty of Nursing, University of Alberta, Edmonton, Canada
| | - Lisa Hartling
- Alberta Research Centre for Health Evidence (ARCHE), Department of Pediatrics, University of Alberta, Edmonton, Canada
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Avoidance of allergens as an environmental method in the prevention of inhaled allergy symptoms. Allergol Immunopathol (Madr) 2020; 48:745-752. [PMID: 31879043 DOI: 10.1016/j.aller.2019.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Accepted: 06/25/2019] [Indexed: 11/20/2022]
Abstract
Asthma and other inhaled allergies are some of the most common paediatric diseases. The association of exposure to allergens with induction and exacerbation of symptoms has been proven. The majority of allergens are permanently or periodically suspended in the air, which leads to impaired quality of life for sensitive patients. Therefore, many methods of prevention and therapy of allergic diseases have been developed. The method of allergen exposure avoidance is often the first and the most significant measure. The present research has been conducted to evaluate, based on scientific data, which measures have the most reliable evidence of effectiveness. Environmental allergen avoidance methods, despite limited evidence supporting their clinical efficacy, are listed as the main therapeutic approaches in most recommendations. The significance of the holistic approach is also emphasised: only simultaneous introduction of several avoidance methods can bring possibly beneficial effects for the patient.
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Everhart RS, Mazzeo SE, Corona R, Holder RL, Thacker LR, Schechter MS. A community-based asthma program: Study design and methods of RVA Breathes. Contemp Clin Trials 2020; 97:106121. [PMID: 32822827 DOI: 10.1016/j.cct.2020.106121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 08/06/2020] [Accepted: 08/16/2020] [Indexed: 11/15/2022]
Abstract
Disparities in pediatric asthma morbidity and healthcare utilization exist on the basis of race, ethnicity, environment, and income; interventions are needed to address these inequities. The following protocol describes an evidence-based intervention, RVA Breathes, designed to coordinate pediatric asthma care across family, home, community, and medical sectors. Community stakeholder feedback was utilized to refine the intervention specifically for the Richmond, Virginia community. The aims of this study are to assess the effect of RVA Breathes on asthma-related healthcare utilization, as well as secondary outcomes of asthma control, asthma symptoms, and quality of life. We will enroll 300 elementary school children from the Richmond City Public School system. Participants will be between the ages of 5-11, have a diagnosis of asthma, and have had an asthma exacerbation (as indicated by an asthma-related ED visit, hospitalization, unscheduled PCP visit, or use of systemic steroids) in the last two years. Participants will be randomized to one of three groups: asthma education + home environment remediation + school intervention, asthma education + home environment remediation, or a comparator condition. Data will be collected across one baseline research visit, four intervention sessions, and four follow-up research visits over the course of 18 months. A General Linear Mixed Model (GLMM) will be used to test primary aims. We expect the findings will provide support for coordination of asthma care across sectors. Further, we hope RVA Breathes will serve as a model of community-based pediatric asthma care.
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Affiliation(s)
- Robin S Everhart
- Virginia Commonwealth University, Richmond, VA, United States of America.
| | - Suzanne E Mazzeo
- Virginia Commonwealth University, Richmond, VA, United States of America
| | - Rosalie Corona
- Virginia Commonwealth University, Richmond, VA, United States of America
| | - Rachel L Holder
- Virginia Commonwealth University, Richmond, VA, United States of America
| | - Leroy R Thacker
- Virginia Commonwealth University, Richmond, VA, United States of America
| | - Michael S Schechter
- Children's Hospital of Richmond at VCU, Richmond, VA, United States of America
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Ezhova I, Sayer L, Newland R, Davis N, McLetchie-Holder S, Burrows P, Middleton L, Malone ME. Models and frameworks that enable nurses to develop their public health practice-A scoping study. J Clin Nurs 2020; 29:2150-2160. [PMID: 32246732 DOI: 10.1111/jocn.15267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 02/26/2020] [Accepted: 03/12/2020] [Indexed: 12/17/2022]
Abstract
AIMS AND OBJECTIVES This scoping review commissioned by the Public Health England, WHO collaborating Centre, aimed to explore the models and frameworks which enable nurses to develop their public health practice and deliver public health interventions to individuals, families and communities. BACKGROUND There is a plethora of literature regarding the role, activities and scope of practice undertaken by public health nurses across the world. However, only two reviews have explored the models and frameworks used for public health nursing practice. DESIGN The study drew upon an established framework with a narrative review drawing upon five methodological steps. METHODS A search of databases, Medline, PsycINFO, Embase, CINHAL and British Nursing Index, was undertaken. The search took place between April 2018 and June 2018 retrieving 9,513 peer-reviewed articles published from 2008. RESULTS Ninety-five studies were retrieved and analysed thematically. From an initial review of literature, two themes were identified: public health models used in practice and models used in public health education. Within the first theme, three subthemes were emerged: Characteristics of the interventions; Characteristics of the public health nurse; and Lack of measurable health benefits. Within the second theme, three subthemes were identified: Faculty and Students Working Together; The Experiential Academic Approach, and What works in Educating Nurses for Public Health. CONCLUSION The review identified that many models and frameworks are used in practice. However, within public health practice there is a limited evidence base and it fails to demonstrate that the frameworks and models developed for practice result in measurable health benefits on an individual or population level. However, within education innovative models were apparent with collaborative partnerships enabling preregistration nursing students to develop public health nursing competencies. RELEVANCE TO CLINICAL PRACTICE Innovative approaches to education of preregistration nursing students could point the way forward for the delivery of public health nursing practice.
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Affiliation(s)
- Ivanka Ezhova
- Florence Nightingale Faculty of Nursing, King's College London, London, UK
| | - Lynn Sayer
- Florence Nightingale Faculty of Nursing, King's College London, London, UK
| | | | - Nicola Davis
- Florence Nightingale Faculty of Nursing, King's College London, London, UK
| | | | - Patricia Burrows
- Florence Nightingale Faculty of Nursing, King's College London, London, UK
| | - Laura Middleton
- Florence Nightingale Faculty of Nursing, King's College London, London, UK
| | - Mary Ellen Malone
- Florence Nightingale Faculty of Nursing, King's College London, London, UK
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Bruhl RJ, Perkison WB, Hanania NA, McNeill LH, Oluyomi AO, Fiesinger EB, Minard CG, Solomon A, Hamilton WJ, Butler B, Caldwell J, Crosby E, Davis C, Galvan H, Harris R, Lacour-Chestnut F, Martin C, Pannell S, Phipps K, Richardson G, Solomon A, White W, Boles J, Rangel A, Virk R, Brock M, Guffey D, Ramamurthy U, Persse D, Maffei S, Chan W, Reyes B. Design of a home-based intervention for Houston-area African-American adults with asthma: Methods and lessons learned from a pragmatic randomized trial. Contemp Clin Trials 2020; 91:105977. [PMID: 32151753 DOI: 10.1016/j.cct.2020.105977] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 02/24/2020] [Accepted: 03/02/2020] [Indexed: 12/15/2022]
Abstract
A growing body of evidence demonstrates that home-based, multicomponent interventions can effectively reduce exposures to asthma triggers and decrease asthma symptoms. However, few of these studies have targeted adults. To address this and other research gaps, we designed and implemented a pragmatic randomized clinical trial, the Houston Home-based Integrated Intervention Targeting Better Asthma Control (HIITBAC) for African Americans, to assess the effectiveness of a home-based intervention to improve asthma control and quality of life in African-American adults-a population disproportionately affected by asthma. The primary goals were to help participants reduce allergens and irritants in their homes and better manage their disease through knowledge, improved medication use, and behavior change. HIITBAC had two groups: clinic-only and home-visit groups. Both groups received enhanced clinical care, but the home-visit group also received a detailed home assessment and four additional home visits spaced over roughly one year. We recruited 263 participants. Of these, 152 (57.8%) were recruited through electronic health record data, 51 (19.4%) through Emergency Medical Services data, and 60 (22.8%) through other efforts (e.g., emergency departments, community events, outreach). Seventy participants (26.6%) were lost to follow up, substantially more in the home-visit than in the clinic-only group. We describe the HIITBAC methodology and cohort, discuss lessons learned about recruitment and retention, and highlight adaptations we implemented to address these lessons.
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Affiliation(s)
- Rebecca Jensen Bruhl
- Environmental Health Service, Department of Family & Community Medicine, Baylor College of Medicine, Houston, TX, United States.
| | - William Brett Perkison
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston, School of Public Health, Houston, TX, United States
| | - Nicola A Hanania
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Lorna H McNeill
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Abiodun O Oluyomi
- Section of Epidemiology and Population Science, Department of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Ellen Baskin Fiesinger
- Department of Management, Policy and Community Health, The University of Texas Health Science Center at Houston, School of Public Health, Houston, TX, United States
| | - Charles G Minard
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX, United States
| | - Abida Solomon
- College of Nursing, Prairie View A&M University, Houston, TX, United States
| | - Winifred J Hamilton
- Environmental Health Service, Department of Family & Community Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Brian Butler
- HIITBAC Patient/Stakeholder Advisory Board, Houston, TX, United States
| | - James Caldwell
- HIITBAC Patient/Stakeholder Advisory Board, Houston, TX, United States
| | - Eunice Crosby
- HIITBAC Patient/Stakeholder Advisory Board, Houston, TX, United States
| | - Cellie Davis
- HIITBAC Patient/Stakeholder Advisory Board, Houston, TX, United States
| | - Hope Galvan
- HIITBAC Patient/Stakeholder Advisory Board, Houston, TX, United States
| | - Rachel Harris
- HIITBAC Patient/Stakeholder Advisory Board, Houston, TX, United States
| | | | - Carol Martin
- HIITBAC Patient/Stakeholder Advisory Board, Houston, TX, United States
| | - Shereda Pannell
- HIITBAC Patient/Stakeholder Advisory Board, Houston, TX, United States
| | - Kathy Phipps
- HIITBAC Patient/Stakeholder Advisory Board, Houston, TX, United States
| | | | - Adriene Solomon
- HIITBAC Patient/Stakeholder Advisory Board, Houston, TX, United States
| | - William White
- HIITBAC Patient/Stakeholder Advisory Board, Houston, TX, United States
| | - Jamie Boles
- Environmental Health Service, Department of Family & Community Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Adriana Rangel
- Environmental Health Service, Department of Family & Community Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Ritupreet Virk
- Environmental Health Service, Department of Family & Community Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Melissa Brock
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Danielle Guffey
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX, United States
| | - Uma Ramamurthy
- Office of Research Information Technology, Baylor College of Medicine, Houston, TX, United States
| | - David Persse
- Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, United States; Emergency Medical Services, Houston Fire Department, City of Houston, TX, United States
| | - Salvador Maffei
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
| | - Wenyaw Chan
- Department of Biostatistics, The University of Texas Health Science Center at Houston, School of Public Health, Houston, TX, United States
| | - Brenda Reyes
- U.S. Department of Housing & Urban Development, Washington, DC, United States
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Swann JL, Griffin PM, Keskinocak P, Bieder I, Yildirim FM, Nurmagambetov T, Hsu J, Seeff L, Singleton CM. Return on investment of self-management education and home visits for children with asthma. J Asthma 2019; 58:360-369. [PMID: 31755329 DOI: 10.1080/02770903.2019.1690660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Priorities of the Centers for Disease Control and Prevention's 6|18 Initiative include outpatient asthma self-management education (ASME) and home-based asthma visits (home visit) as interventions for children with poorly-controlled asthma. ASME and home visit intervention programs are currently not widely available. This project was to assess the economic sustainability of these programs for state asthma control programs reimbursed by Medicaid. METHODS We used a simulation model based on parameters from the literature and Medicaid claims, controlling for regression to the mean. We modeled scenarios under various selection criteria based on healthcare utilization and age to forecast the return on investment (ROI) using data from New York. The resulting tool is available in Excel or Python. RESULTS Our model projected health improvement and cost savings for all simulated interventions. Compared against home visits alone, the simulated ASME alone intervention had a higher ROI for all healthcare utilization and age scenarios. Savings were primarily highest in simulated program participants who had two or more asthma-related emergency department visits or one inpatient visit compared to those participants who had one or more asthma-related emergency department visits. Segmenting the selection criteria by age did not significantly change the results. CONCLUSIONS This model forecasts reduced healthcare costs and improved health outcomes as a result of ASME and home visits for children with high urgent healthcare utilization (more than two emergency department visits or one inpatient hospitalization) for asthma. Utilizing specific selection criteria, state based asthma control programs can improve health and reduce healthcare costs.
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Affiliation(s)
- Julie L Swann
- Edward P. Fitts Department of Industrial and Systems Engineering, NC State University, Raleigh, North Carolina, USA
| | - Paul M Griffin
- School of Industrial Engineering, Purdue University, West Lafayette, Indiana, USA
| | - Pinar Keskinocak
- H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Ian Bieder
- Research Institute, Georgia Institute of Technology, Atlanta, Georgia, USA
| | | | - Tursynbek Nurmagambetov
- Air Pollution and Respiratory Health Branch, Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Joy Hsu
- Air Pollution and Respiratory Health Branch, Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Laura Seeff
- Office of the Chief of Staff, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Christa-Marie Singleton
- Office of the Associate Director for Policy and Strategy, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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15
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Indoor Environmental Interventions for Furry Pet Allergens, Pest Allergens, and Mold: Looking to the Future. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 6:9-19. [PMID: 29310769 DOI: 10.1016/j.jaip.2017.10.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 10/02/2017] [Accepted: 10/06/2017] [Indexed: 12/12/2022]
Abstract
Over the last 2 to 3 decades, significant advances have been made in understanding the role that indoor allergen exposures play with regard to respiratory health. Multiple studies have confirmed that sensitization and exposure to indoor allergens can be a risk factor for asthma morbidity. Environmental interventions targeting key indoor allergens have been evaluated with the aims of examining their causal effects on asthma-related outcomes and identifying clinically efficacious interventions to incorporate into treatment recommendations. Historically, it appeared that the most successful intervention, as performed in the Inner-City Asthma Study, was individually tailored, targeting multiple allergens in a predominantly low-income, minority, and urban pediatric population. Recent studies suggest that single-allergen interventions may be efficacious when targeting the most clinically relevant allergen for a population. In this article, we review recent literature on home environmental interventions and their effects on specific indoor allergen levels and asthma-related outcomes.
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Baek J, Huang K, Conner L, Tapangan N, Xu X, Carrillo G. Effects of the home-based educational intervention on health outcomes among primarily Hispanic children with asthma: a quasi-experimental study. BMC Public Health 2019; 19:912. [PMID: 31288792 PMCID: PMC6617892 DOI: 10.1186/s12889-019-7272-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 07/02/2019] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Childhood asthma is a significant health issue with 8.3% prevalence in the U.S. Its prevalence is particularly higher among low-income communities in the Texas-Mexico border region, as they often lack access to clinical care and health insurance. This study examines the impact of a home-based education led by Community Health Workers (CHWs) on health outcomes for asthmatic, predominantly Hispanic children in these communities. METHODS The study was a quasi-experimental design to learn the effectiveness of the asthma home-based education by comparing changes of health outcomes between baseline and follow-up of intervention and control groups. This study enrolled 290 participants, consisting of 130 in the intervention group and 160 in the control group. The educational intervention led by the CHWs referenced the Asthma and Healthy Homes curriculum and contents of the Seven Principles of Healthy Homes. The multiple linear regression analysis was conducted to estimate the associations between the intervention and each health outcome. RESULTS When comparing the intervention group with the control group, the intervention group showed a significantly greater decrease in asthma attacks than the control group (p = 0.049). Although all of the five Children's Health Survey for Asthma (CHSA) scores showed significant improvements between baseline and follow-up in both groups, we found that increases of CHSA scores in the intervention group were higher than the control group except for emotional health of children (EC) score. The multiple linear regression models demonstrated that the mean changes in asthma attacks (p = 0.036) and emotional health of families (EF) score (p = 0.038) were significantly better in the intervention group than the control group, adjusting for children's age of diagnosis, household income, use of steroids, family history of allergy, and type of insurance. CONCLUSIONS This study concluded that the home-based education by CHWs effectively improve health outcomes among children in communities lacking access to medical resources. The findings suggest the importance of the home-based education program in promoting emotional and medical care for children and their families in low-income communities like those in the Texas-Mexico border region.
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Affiliation(s)
- Juha Baek
- Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, 212 Adriance Lab Road, College Station, TX, 77843, USA
| | - Ke Huang
- Department of Statistics, Texas A&M University, Blocker Building, 3143, 155 Ireland St, College Station, TX, 77843, USA
| | - Lucia Conner
- Program on Asthma Research and Education, Healthy South Texas, Texas A&M School of Public Health, McAllen Campus, 2101 S. McColl Road, McAllen, TX, 78503, USA
| | - Niko Tapangan
- Hidalgo County Health and Human Services Department, 1304 S 25th Ave, Edinburg, TX, 78542, USA
| | - Xiaohui Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Texas A&M University, 212 Adriance Lab Road, College Station, TX, 77843, USA
| | - Genny Carrillo
- Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, 212 Adriance Lab Road, College Station, TX, 77843, USA.
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17
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Wu AC. The Promise of Improving Asthma Control Using Mobile Health. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 4:738-9. [PMID: 27393782 DOI: 10.1016/j.jaip.2016.04.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 04/09/2016] [Indexed: 11/25/2022]
Affiliation(s)
- Ann Chen Wu
- Department of Population Medicine, Center for Healthcare Research in Pediatrics, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Mass; Division of General Pediatrics, Department of Pediatrics, Children's Hospital, Boston, Mass.
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18
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Giese JK. Evidence-based pediatric asthma interventions and outcome measures in a healthy homes program: An integrative review. J Asthma 2018; 56:662-673. [PMID: 29722589 DOI: 10.1080/02770903.2018.1472279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Asthma disproportionately impacts and has poorer outcomes in low-income, minority, and inner-city children. The home environment has a profound impact on a child's asthma. Home-based asthma visits have the potential to positively impact a child's asthma, especially in targeted populations. The purpose of this integrative review is 1.) to explore the effectiveness of home-based education and environmental measures and 2.) to explore specific indicators and tools to measure pediatric asthma control and program effectiveness. DATA SOURCES Medline, CINHAL, and Ovid databases were searched from 2010 to 2017 utilizing the keywords healthy homes AND asthma and home based interventions AND asthma. STUDY SELECTIONS A total of 71 articles were retrieved of which 27 articles met the inclusion criteria of English language, human subjects, and the inclusion of pediatric populations. Three additional articles were hand-searched from previous references. In total, 30 articles were reviewed. A quality appraisal was conducted utilizing standardized appraisal tools. RESULTS Home-based asthma education and environmental interventions have proven to be effective. The programs reviewed varied in types of interventions, intensity and duration, the type of provider, length of follow-up, and outcome measures. Successful programs were patient-centered, included a home assessment and individualized education and interventions, and were collaborative. Multiple outcome indicators such as health care utilization, asthma control, missed days of school or productivity, asthma symptoms, and verification of environmental remediation have been utilized. CONCLUSION Home-based asthma programs can be beneficial to children with poorly controlled asthma and have the potential to be cost-effective.
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Affiliation(s)
- Jeannie K Giese
- a Belmont University School of Nursing , Nashville , Tennessee , United States
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19
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Leas BF, D'Anci KE, Apter AJ, Bryant-Stephens T, Lynch MP, Kaczmarek JL, Umscheid CA. Effectiveness of indoor allergen reduction in asthma management: A systematic review. J Allergy Clin Immunol 2018; 141:1854-1869. [DOI: 10.1016/j.jaci.2018.02.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 01/16/2018] [Accepted: 02/02/2018] [Indexed: 10/18/2022]
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An Evaluation of a State-Funded Healthy Homes Intervention on Asthma Outcomes in Adults and Children. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2018; 23:219-228. [PMID: 28121774 DOI: 10.1097/phh.0000000000000530] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CONTEXT Reducing exposure to environmental triggers is a critical part of asthma management. OBJECTIVE To evaluate the impact of a healthy homes intervention on asthma outcomes and assess the impact of different targeting strategies. SETTING The New York State (NYS) Healthy Neighborhoods Program (HNP) operates in select communities with a higher burden of housing-related illness and associated risk factors. PARTICIPANTS Residents with asthma were recruited through 3 mechanisms: door-to-door canvassing (CANVASSED), 752 residents in 457 dwellings; referrals from community partners (REFERRED), 573 residents in 307 dwellings; referrals of Medicaid enrollees with poorly controlled asthma (TARGETED), 140 residents in 140 dwellings. INTERVENTION The NYS HNP provides visual assessments and low-cost interventions to identify and address asthma triggers and trigger-promoting conditions in the home environment. Conditions are reassessed during a revisit conducted 3 to 6 months after the initial visit. MAIN OUTCOME MEASURE(S) The analysis compares improvements across the 3 groups for measures of asthma self-management, health care access, morbidity, and environmental conditions. An asthma trigger score characterizing the extent of multiple triggers in a dwelling was also calculated. RESULTS Among 1465 adults and children, there were significant improvements in environmental conditions and self-reported self-management, health care access, and asthma morbidity outcomes for each group. The improvement was greatest in the TARGETED group for most outcomes, but selected measures of self-management and health care access were greater in the other groups. The mean improvement was significantly greater in the TARGETED group. CONCLUSION Targeting the intervention to people with poorly controlled asthma maximizes improvements in trigger avoidance and asthma morbidity; however, other recruitment strategies are effective for impacting endpoints related to health care access and self-management. This evaluation demonstrates that a low-intensity home-based environmental intervention is effective as well as practical and feasible. Health care payers, state and local health departments, and others should consider investing in these home-based services as part of a comprehensive asthma care package.
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Wolf ZR, Bailey DN. Nursing center-Health Intervention Program in Philadelphia: Program evaluation and outcomes. Nurs Forum 2017; 53:161-172. [PMID: 29165828 DOI: 10.1111/nuf.12238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The La Salle Neighborhood Nursing Center provided the Health Intervention Program (HIP) for vulnerable children with special needs, and families in Philadelphia challenged by chronic physical, developmental, behavioral, and emotional conditions and low incomes. AIMS We evaluated the effectiveness of HIP for a 5-year period and the consistency of quarterly and annual reports as a quality improvement initiative. METHODS Using program evaluation, secondary analysis design, the effect of a city-wide, family support home visiting program was assessed. Consistency of documentation of program outcomes on annual reports was described. Data were obtained from reports, framed by program objectives submitted via the ETO® database to the Department of Public Health. Components of the HIP consisted of case management, supportive services, information, and referrals provided by a multidisciplinary healthcare team. RESULTS Family services, program outcomes, referrals, community meetings, and themes demonstrated program complexity and effectiveness. Reports showed inconsistent documentation on 19 outcomes for program objectives. CONCLUSIONS Children with special needs and their families shared challenges and barriers to their health. The institution staff should create a table to report outcomes on program objectives to evaluate trends across funding years and establish interrater reliability on quarterly and annual reports.
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22
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Dong Z, Nath A, Guo J, Bhaumik U, Chin MY, Dong S, Marshall E, Murphy JS, Sandel MT, Sommer SJ, Ursprung WWS, Woods ER, Reid M, Adamkiewicz G. Evaluation of the Environmental Scoring System in Multiple Child Asthma Intervention Programs in Boston, Massachusetts. Am J Public Health 2017; 108:103-111. [PMID: 29161061 DOI: 10.2105/ajph.2017.304125] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To test the applicability of the Environmental Scoring System, a quick and simple approach for quantitatively measuring environmental triggers collected during home visits, and to evaluate its contribution to improving asthma outcomes among various child asthma programs. METHODS We pooled and analyzed data from multiple child asthma programs in the Greater Boston Area, Massachusetts, collected in 2011 to 2016, to examine the association of environmental scores (ES) with measures of asthma outcomes and compare the results across programs. RESULTS Our analysis showed that demographics were important contributors to variability in asthma outcomes and total ES, and largely explained the differences among programs at baseline. Among all programs in general, we found that asthma outcomes were significantly improved and total ES significantly reduced over visits, with the total Asthma Control Test score negatively associated with total ES. CONCLUSIONS Our study demonstrated that the Environmental Scoring System is a useful tool for measuring home asthma triggers and can be applied regardless of program and survey designs, and that demographics of the target population may influence the improvement in asthma outcomes.
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Affiliation(s)
- Zhao Dong
- Zhao Dong and Gary Adamkiewicz are with the Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA. Anjali Nath is with the Division of Healthy Homes and Community Supports, Community Initiatives Bureau, Boston Public Health Commission. Jing Guo is with the Asthma Prevention and Control Program, Massachusetts Department of Public Health, Boston. Urmi Bhaumik is with the Division of Adolescent/Young Adult Medicine and Office of Community Health, Boston Children's Hospital. May Y. Chin is with the Asthma Prevention and Management Initiative, Tufts Medical Center, Boston. Sherry Dong is with the Community Health Improvement Programs, Tufts Medical Center. Erica Marshall is with the Division of Prevention and Wellness, Massachusetts Department of Public Health. Johnna S. Murphy is with the Boston Medical Center and Boston Public Health Commission. Megan T. Sandel is with the Boston Medical Center and Boston University Schools of Medicine and Public Health. Susan J. Sommer is with the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital. W. W. Sanouri Ursprung is with the Office of Statistics and Evaluation, Bureau of Community Health and Prevention, Massachusetts Department of Public Health. Elizabeth R. Woods is with the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, and Harvard Medical School, Boston. Margaret Reid is with the Office of Health Equity, Boston Public Health Commission
| | - Anjali Nath
- Zhao Dong and Gary Adamkiewicz are with the Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA. Anjali Nath is with the Division of Healthy Homes and Community Supports, Community Initiatives Bureau, Boston Public Health Commission. Jing Guo is with the Asthma Prevention and Control Program, Massachusetts Department of Public Health, Boston. Urmi Bhaumik is with the Division of Adolescent/Young Adult Medicine and Office of Community Health, Boston Children's Hospital. May Y. Chin is with the Asthma Prevention and Management Initiative, Tufts Medical Center, Boston. Sherry Dong is with the Community Health Improvement Programs, Tufts Medical Center. Erica Marshall is with the Division of Prevention and Wellness, Massachusetts Department of Public Health. Johnna S. Murphy is with the Boston Medical Center and Boston Public Health Commission. Megan T. Sandel is with the Boston Medical Center and Boston University Schools of Medicine and Public Health. Susan J. Sommer is with the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital. W. W. Sanouri Ursprung is with the Office of Statistics and Evaluation, Bureau of Community Health and Prevention, Massachusetts Department of Public Health. Elizabeth R. Woods is with the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, and Harvard Medical School, Boston. Margaret Reid is with the Office of Health Equity, Boston Public Health Commission
| | - Jing Guo
- Zhao Dong and Gary Adamkiewicz are with the Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA. Anjali Nath is with the Division of Healthy Homes and Community Supports, Community Initiatives Bureau, Boston Public Health Commission. Jing Guo is with the Asthma Prevention and Control Program, Massachusetts Department of Public Health, Boston. Urmi Bhaumik is with the Division of Adolescent/Young Adult Medicine and Office of Community Health, Boston Children's Hospital. May Y. Chin is with the Asthma Prevention and Management Initiative, Tufts Medical Center, Boston. Sherry Dong is with the Community Health Improvement Programs, Tufts Medical Center. Erica Marshall is with the Division of Prevention and Wellness, Massachusetts Department of Public Health. Johnna S. Murphy is with the Boston Medical Center and Boston Public Health Commission. Megan T. Sandel is with the Boston Medical Center and Boston University Schools of Medicine and Public Health. Susan J. Sommer is with the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital. W. W. Sanouri Ursprung is with the Office of Statistics and Evaluation, Bureau of Community Health and Prevention, Massachusetts Department of Public Health. Elizabeth R. Woods is with the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, and Harvard Medical School, Boston. Margaret Reid is with the Office of Health Equity, Boston Public Health Commission
| | - Urmi Bhaumik
- Zhao Dong and Gary Adamkiewicz are with the Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA. Anjali Nath is with the Division of Healthy Homes and Community Supports, Community Initiatives Bureau, Boston Public Health Commission. Jing Guo is with the Asthma Prevention and Control Program, Massachusetts Department of Public Health, Boston. Urmi Bhaumik is with the Division of Adolescent/Young Adult Medicine and Office of Community Health, Boston Children's Hospital. May Y. Chin is with the Asthma Prevention and Management Initiative, Tufts Medical Center, Boston. Sherry Dong is with the Community Health Improvement Programs, Tufts Medical Center. Erica Marshall is with the Division of Prevention and Wellness, Massachusetts Department of Public Health. Johnna S. Murphy is with the Boston Medical Center and Boston Public Health Commission. Megan T. Sandel is with the Boston Medical Center and Boston University Schools of Medicine and Public Health. Susan J. Sommer is with the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital. W. W. Sanouri Ursprung is with the Office of Statistics and Evaluation, Bureau of Community Health and Prevention, Massachusetts Department of Public Health. Elizabeth R. Woods is with the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, and Harvard Medical School, Boston. Margaret Reid is with the Office of Health Equity, Boston Public Health Commission
| | - May Y Chin
- Zhao Dong and Gary Adamkiewicz are with the Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA. Anjali Nath is with the Division of Healthy Homes and Community Supports, Community Initiatives Bureau, Boston Public Health Commission. Jing Guo is with the Asthma Prevention and Control Program, Massachusetts Department of Public Health, Boston. Urmi Bhaumik is with the Division of Adolescent/Young Adult Medicine and Office of Community Health, Boston Children's Hospital. May Y. Chin is with the Asthma Prevention and Management Initiative, Tufts Medical Center, Boston. Sherry Dong is with the Community Health Improvement Programs, Tufts Medical Center. Erica Marshall is with the Division of Prevention and Wellness, Massachusetts Department of Public Health. Johnna S. Murphy is with the Boston Medical Center and Boston Public Health Commission. Megan T. Sandel is with the Boston Medical Center and Boston University Schools of Medicine and Public Health. Susan J. Sommer is with the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital. W. W. Sanouri Ursprung is with the Office of Statistics and Evaluation, Bureau of Community Health and Prevention, Massachusetts Department of Public Health. Elizabeth R. Woods is with the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, and Harvard Medical School, Boston. Margaret Reid is with the Office of Health Equity, Boston Public Health Commission
| | - Sherry Dong
- Zhao Dong and Gary Adamkiewicz are with the Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA. Anjali Nath is with the Division of Healthy Homes and Community Supports, Community Initiatives Bureau, Boston Public Health Commission. Jing Guo is with the Asthma Prevention and Control Program, Massachusetts Department of Public Health, Boston. Urmi Bhaumik is with the Division of Adolescent/Young Adult Medicine and Office of Community Health, Boston Children's Hospital. May Y. Chin is with the Asthma Prevention and Management Initiative, Tufts Medical Center, Boston. Sherry Dong is with the Community Health Improvement Programs, Tufts Medical Center. Erica Marshall is with the Division of Prevention and Wellness, Massachusetts Department of Public Health. Johnna S. Murphy is with the Boston Medical Center and Boston Public Health Commission. Megan T. Sandel is with the Boston Medical Center and Boston University Schools of Medicine and Public Health. Susan J. Sommer is with the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital. W. W. Sanouri Ursprung is with the Office of Statistics and Evaluation, Bureau of Community Health and Prevention, Massachusetts Department of Public Health. Elizabeth R. Woods is with the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, and Harvard Medical School, Boston. Margaret Reid is with the Office of Health Equity, Boston Public Health Commission
| | - Erica Marshall
- Zhao Dong and Gary Adamkiewicz are with the Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA. Anjali Nath is with the Division of Healthy Homes and Community Supports, Community Initiatives Bureau, Boston Public Health Commission. Jing Guo is with the Asthma Prevention and Control Program, Massachusetts Department of Public Health, Boston. Urmi Bhaumik is with the Division of Adolescent/Young Adult Medicine and Office of Community Health, Boston Children's Hospital. May Y. Chin is with the Asthma Prevention and Management Initiative, Tufts Medical Center, Boston. Sherry Dong is with the Community Health Improvement Programs, Tufts Medical Center. Erica Marshall is with the Division of Prevention and Wellness, Massachusetts Department of Public Health. Johnna S. Murphy is with the Boston Medical Center and Boston Public Health Commission. Megan T. Sandel is with the Boston Medical Center and Boston University Schools of Medicine and Public Health. Susan J. Sommer is with the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital. W. W. Sanouri Ursprung is with the Office of Statistics and Evaluation, Bureau of Community Health and Prevention, Massachusetts Department of Public Health. Elizabeth R. Woods is with the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, and Harvard Medical School, Boston. Margaret Reid is with the Office of Health Equity, Boston Public Health Commission
| | - Johnna S Murphy
- Zhao Dong and Gary Adamkiewicz are with the Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA. Anjali Nath is with the Division of Healthy Homes and Community Supports, Community Initiatives Bureau, Boston Public Health Commission. Jing Guo is with the Asthma Prevention and Control Program, Massachusetts Department of Public Health, Boston. Urmi Bhaumik is with the Division of Adolescent/Young Adult Medicine and Office of Community Health, Boston Children's Hospital. May Y. Chin is with the Asthma Prevention and Management Initiative, Tufts Medical Center, Boston. Sherry Dong is with the Community Health Improvement Programs, Tufts Medical Center. Erica Marshall is with the Division of Prevention and Wellness, Massachusetts Department of Public Health. Johnna S. Murphy is with the Boston Medical Center and Boston Public Health Commission. Megan T. Sandel is with the Boston Medical Center and Boston University Schools of Medicine and Public Health. Susan J. Sommer is with the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital. W. W. Sanouri Ursprung is with the Office of Statistics and Evaluation, Bureau of Community Health and Prevention, Massachusetts Department of Public Health. Elizabeth R. Woods is with the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, and Harvard Medical School, Boston. Margaret Reid is with the Office of Health Equity, Boston Public Health Commission
| | - Megan T Sandel
- Zhao Dong and Gary Adamkiewicz are with the Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA. Anjali Nath is with the Division of Healthy Homes and Community Supports, Community Initiatives Bureau, Boston Public Health Commission. Jing Guo is with the Asthma Prevention and Control Program, Massachusetts Department of Public Health, Boston. Urmi Bhaumik is with the Division of Adolescent/Young Adult Medicine and Office of Community Health, Boston Children's Hospital. May Y. Chin is with the Asthma Prevention and Management Initiative, Tufts Medical Center, Boston. Sherry Dong is with the Community Health Improvement Programs, Tufts Medical Center. Erica Marshall is with the Division of Prevention and Wellness, Massachusetts Department of Public Health. Johnna S. Murphy is with the Boston Medical Center and Boston Public Health Commission. Megan T. Sandel is with the Boston Medical Center and Boston University Schools of Medicine and Public Health. Susan J. Sommer is with the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital. W. W. Sanouri Ursprung is with the Office of Statistics and Evaluation, Bureau of Community Health and Prevention, Massachusetts Department of Public Health. Elizabeth R. Woods is with the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, and Harvard Medical School, Boston. Margaret Reid is with the Office of Health Equity, Boston Public Health Commission
| | - Susan J Sommer
- Zhao Dong and Gary Adamkiewicz are with the Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA. Anjali Nath is with the Division of Healthy Homes and Community Supports, Community Initiatives Bureau, Boston Public Health Commission. Jing Guo is with the Asthma Prevention and Control Program, Massachusetts Department of Public Health, Boston. Urmi Bhaumik is with the Division of Adolescent/Young Adult Medicine and Office of Community Health, Boston Children's Hospital. May Y. Chin is with the Asthma Prevention and Management Initiative, Tufts Medical Center, Boston. Sherry Dong is with the Community Health Improvement Programs, Tufts Medical Center. Erica Marshall is with the Division of Prevention and Wellness, Massachusetts Department of Public Health. Johnna S. Murphy is with the Boston Medical Center and Boston Public Health Commission. Megan T. Sandel is with the Boston Medical Center and Boston University Schools of Medicine and Public Health. Susan J. Sommer is with the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital. W. W. Sanouri Ursprung is with the Office of Statistics and Evaluation, Bureau of Community Health and Prevention, Massachusetts Department of Public Health. Elizabeth R. Woods is with the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, and Harvard Medical School, Boston. Margaret Reid is with the Office of Health Equity, Boston Public Health Commission
| | - W W Sanouri Ursprung
- Zhao Dong and Gary Adamkiewicz are with the Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA. Anjali Nath is with the Division of Healthy Homes and Community Supports, Community Initiatives Bureau, Boston Public Health Commission. Jing Guo is with the Asthma Prevention and Control Program, Massachusetts Department of Public Health, Boston. Urmi Bhaumik is with the Division of Adolescent/Young Adult Medicine and Office of Community Health, Boston Children's Hospital. May Y. Chin is with the Asthma Prevention and Management Initiative, Tufts Medical Center, Boston. Sherry Dong is with the Community Health Improvement Programs, Tufts Medical Center. Erica Marshall is with the Division of Prevention and Wellness, Massachusetts Department of Public Health. Johnna S. Murphy is with the Boston Medical Center and Boston Public Health Commission. Megan T. Sandel is with the Boston Medical Center and Boston University Schools of Medicine and Public Health. Susan J. Sommer is with the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital. W. W. Sanouri Ursprung is with the Office of Statistics and Evaluation, Bureau of Community Health and Prevention, Massachusetts Department of Public Health. Elizabeth R. Woods is with the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, and Harvard Medical School, Boston. Margaret Reid is with the Office of Health Equity, Boston Public Health Commission
| | - Elizabeth R Woods
- Zhao Dong and Gary Adamkiewicz are with the Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA. Anjali Nath is with the Division of Healthy Homes and Community Supports, Community Initiatives Bureau, Boston Public Health Commission. Jing Guo is with the Asthma Prevention and Control Program, Massachusetts Department of Public Health, Boston. Urmi Bhaumik is with the Division of Adolescent/Young Adult Medicine and Office of Community Health, Boston Children's Hospital. May Y. Chin is with the Asthma Prevention and Management Initiative, Tufts Medical Center, Boston. Sherry Dong is with the Community Health Improvement Programs, Tufts Medical Center. Erica Marshall is with the Division of Prevention and Wellness, Massachusetts Department of Public Health. Johnna S. Murphy is with the Boston Medical Center and Boston Public Health Commission. Megan T. Sandel is with the Boston Medical Center and Boston University Schools of Medicine and Public Health. Susan J. Sommer is with the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital. W. W. Sanouri Ursprung is with the Office of Statistics and Evaluation, Bureau of Community Health and Prevention, Massachusetts Department of Public Health. Elizabeth R. Woods is with the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, and Harvard Medical School, Boston. Margaret Reid is with the Office of Health Equity, Boston Public Health Commission
| | - Margaret Reid
- Zhao Dong and Gary Adamkiewicz are with the Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA. Anjali Nath is with the Division of Healthy Homes and Community Supports, Community Initiatives Bureau, Boston Public Health Commission. Jing Guo is with the Asthma Prevention and Control Program, Massachusetts Department of Public Health, Boston. Urmi Bhaumik is with the Division of Adolescent/Young Adult Medicine and Office of Community Health, Boston Children's Hospital. May Y. Chin is with the Asthma Prevention and Management Initiative, Tufts Medical Center, Boston. Sherry Dong is with the Community Health Improvement Programs, Tufts Medical Center. Erica Marshall is with the Division of Prevention and Wellness, Massachusetts Department of Public Health. Johnna S. Murphy is with the Boston Medical Center and Boston Public Health Commission. Megan T. Sandel is with the Boston Medical Center and Boston University Schools of Medicine and Public Health. Susan J. Sommer is with the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital. W. W. Sanouri Ursprung is with the Office of Statistics and Evaluation, Bureau of Community Health and Prevention, Massachusetts Department of Public Health. Elizabeth R. Woods is with the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, and Harvard Medical School, Boston. Margaret Reid is with the Office of Health Equity, Boston Public Health Commission
| | - Gary Adamkiewicz
- Zhao Dong and Gary Adamkiewicz are with the Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA. Anjali Nath is with the Division of Healthy Homes and Community Supports, Community Initiatives Bureau, Boston Public Health Commission. Jing Guo is with the Asthma Prevention and Control Program, Massachusetts Department of Public Health, Boston. Urmi Bhaumik is with the Division of Adolescent/Young Adult Medicine and Office of Community Health, Boston Children's Hospital. May Y. Chin is with the Asthma Prevention and Management Initiative, Tufts Medical Center, Boston. Sherry Dong is with the Community Health Improvement Programs, Tufts Medical Center. Erica Marshall is with the Division of Prevention and Wellness, Massachusetts Department of Public Health. Johnna S. Murphy is with the Boston Medical Center and Boston Public Health Commission. Megan T. Sandel is with the Boston Medical Center and Boston University Schools of Medicine and Public Health. Susan J. Sommer is with the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital. W. W. Sanouri Ursprung is with the Office of Statistics and Evaluation, Bureau of Community Health and Prevention, Massachusetts Department of Public Health. Elizabeth R. Woods is with the Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, and Harvard Medical School, Boston. Margaret Reid is with the Office of Health Equity, Boston Public Health Commission
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Noonan CW, Semmens EO, Smith P, Harrar SW, Montrose L, Weiler E, McNamara M, Ward TJ. Randomized Trial of Interventions to Improve Childhood Asthma in Homes with Wood-burning Stoves. ENVIRONMENTAL HEALTH PERSPECTIVES 2017; 125:097010. [PMID: 28935614 PMCID: PMC5915210 DOI: 10.1289/ehp849] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 06/13/2017] [Accepted: 06/16/2017] [Indexed: 05/24/2023]
Abstract
BACKGROUND Household air pollution due to biomass combustion for residential heating adversely affects vulnerable populations. Randomized controlled trials to improve indoor air quality in homes of children with asthma are limited, and no such studies have been conducted in homes using wood for heating. OBJECTIVES Our aims were to test the hypothesis that household-level interventions, specifically improved-technology wood-burning appliances or air-filtration devices, would improve health measures, in particular Pediatric Asthma Quality of Life Questionnaire (PAQLQ) scores, relative to placebo, among children living with asthma in homes with wood-burning stoves. METHODS A three-arm placebo-controlled randomized trial was conducted in homes with wood-burning stoves among children with asthma. Multiple preintervention and postintervention data included PAQLQ (primary outcome), peak expiratory flow (PEF) monitoring, diurnal peak flow variability (dPFV, an indicator of airway hyperreactivity) and indoor particulate matter (PM) PM2.5. RESULTS Relative to placebo, neither the air filter nor the woodstove intervention showed improvement in quality-of-life measures. Among the secondary outcomes, dPFV showed a 4.1 percentage point decrease in variability [95% confidence interval (CI)=-7.8 to -0.4] for air-filtration use in comparison with placebo. The air-filter intervention showed a 67% (95% CI: 50% to 77%) reduction in indoor PM2.5, but no change was observed with the improved-technology woodstove intervention. CONCLUSIONS Among children with asthma and chronic exposure to woodsmoke, an air-filter intervention that improved indoor air quality did not affect quality-of-life measures. Intent-to-treat analysis did show an improvement in the secondary measure of dPFV. TRIAL REGISTRATION ClincialTrials.gov NCT00807183. https://doi.org/10.1289/EHP849.
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Affiliation(s)
- Curtis W Noonan
- School of Public and Community Health Sciences, University of Montana , Missoula, Montana, USA
| | - Erin O Semmens
- School of Public and Community Health Sciences, University of Montana , Missoula, Montana, USA
| | - Paul Smith
- School of Public and Community Health Sciences, University of Montana , Missoula, Montana, USA
- Community Medical Center , Missoula, Montana, USA
| | - Solomon W Harrar
- Department of Statistics, University of Kentucky , Lexington, Kentucky, USA
- Department of Mathematical Sciences, University of Montana , Missoula, Montana, USA
| | - Luke Montrose
- School of Public and Community Health Sciences, University of Montana , Missoula, Montana, USA
| | - Emily Weiler
- School of Public and Community Health Sciences, University of Montana , Missoula, Montana, USA
| | - Marcy McNamara
- School of Public and Community Health Sciences, University of Montana , Missoula, Montana, USA
| | - Tony J Ward
- School of Public and Community Health Sciences, University of Montana , Missoula, Montana, USA
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Lam W, Dawson A, Fowler C. Approaches to better engage parent-child in health home-visiting programmes: A content analysis. J Child Health Care 2017; 21:94-102. [PMID: 27313225 DOI: 10.1177/1367493516653260] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Home visiting is an evidence-based strategy used to enhance child and family health outcomes. Such primary healthcare endeavours demand the full participation of individual and families. We conducted a review to identify approaches to planning, executing and assessing home-visiting health promotion interventions to determine how parents and children can be best engaged. A structured search (2000-2015) was undertaken using a defined search protocol. The quality of the papers was assessed using standard appraisal tools. Sixteen studies were retrieved. A content analysis of the findings sections of the papers was undertaken and guided by the eight phases of the PRECEDE-PROCEED health promotion planning framework. The analysis found that while all the PRECEDE assessment areas were represented no studies included all phases. Parents and children did not appear to be actively involved in undertaking the assessments and evaluation of the home-visiting health promotion programmes. The findings suggest that there is a need to develop a consistent home-visiting approach that includes comprehensive assessments in the planning phases and parent and child involvement at each step of programme development, implementation and evaluation. This approach enables the development of tailored and sustainable health promotion intervention in order to achieve optimal child health outcomes.
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Affiliation(s)
- Winsome Lam
- 1 School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Angela Dawson
- 2 Faculty of Health, University of Technology, Sydney, Australia
| | - Cathrine Fowler
- 2 Faculty of Health, University of Technology, Sydney, Australia
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25
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Mankikar D, Campbell C, Greenberg R. Evaluation of a Home-Based Environmental and Educational Intervention to Improve Health in Vulnerable Households: Southeastern Pennsylvania Lead and Healthy Homes Program. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13090900. [PMID: 27618087 PMCID: PMC5036733 DOI: 10.3390/ijerph13090900] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Revised: 08/10/2016] [Accepted: 09/05/2016] [Indexed: 12/04/2022]
Abstract
This evaluation examined whether participation in a home-based environmental educational intervention would reduce exposure to health and safety hazards and asthma-related medical visits. The home intervention program focused on vulnerable, low-income households, where children had asthma, were at risk for lead poisoning, or faced multiple unsafe housing conditions. Home visitors conducted two home visits, two months apart, consisting of an environmental home assessment, Healthy Homes education, and distribution of Healthy Homes supplies. Measured outcomes included changes in participant knowledge and awareness of environmental home-based hazards, rate of children’s asthma-related medical use, and the presence of asthma triggers and safety hazards. Analysis of 2013–2014 baseline and post-intervention program data for a cohort of 150 families revealed a significantly lower three-month rate (p < 0.05) of children’s asthma-related doctor visits and hospital admissions at program completion. In addition, there were significantly reduced reports of the presence of home-based hazards, including basement or roof leaks (p = 0.011), plumbing leaks (p = 0.019), and use of an oven to heat the home (p < 0.001). Participants’ pre- and post- test scores showed significant improvement (p < 0.05) in knowledge and awareness of home hazards. Comprehensive home interventions may effectively reduce environmental home hazards and improve the health of asthmatic children in the short term.
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Affiliation(s)
- Deepa Mankikar
- Public Health Management Corporation, Centre Square East 1500 Market St., Philadelphia, PA 19102, USA.
| | - Carla Campbell
- Department of Public Health Sciences, University of Texas at El Paso, 500 W. University Ave., El Paso, TX 79968, USA.
| | - Rachael Greenberg
- National Nurse-Led Care Consortium, Centre Square East 1500 Market St., Philadelphia, PA 19102, USA.
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26
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Belice PJ, Becker EA. Effective education parameters for trigger remediation in underserved children with asthma: A systematic review. J Asthma 2016; 54:186-201. [PMID: 27304997 DOI: 10.1080/02770903.2016.1198374] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The prevalence of asthma is highest in minority children living in urban areas. Pediatric asthma research has focused on self-management education and trigger remediation using a multi-trigger, multi-component educational intervention approach. The purpose of this systematic review was to identify common educational parameters of these proposed interventions. The review also sought to identify which clinical outcomes improved with multi-trigger, multi-component educational interventions. DATA SOURCES PubMed, SCOPUS and ProQuest Dissertations were searched between 2000 to 2014 using the following terms: asthma; urban population or poverty area; environmental remediation; health education; allergens or dust mites or cockroaches or mold or mice or rats. STUDY SELECTIONS Studies were included if they met the following criteria: 1) participants were minority children identified as underserved; 2) there was a multi-trigger and multi-component intervention; 3) asthma severity was classified as persistent; and 4) asthma control was classified as not well controlled. RESULTS A total of 531 articles were retrieved of which 17 met the inclusion criteria. The interventions lacked consistency in their explanation. Most studies were vague in reporting pedagogical methods and educational content. Few studies reported a theoretical framework to guide their approach. Over half the studies did not report a learning assessment nor health literacy of the caregiver or the child with asthma. Yet all of the findings demonstrated statistically significant results in some or all of their primary outcomes. CONCLUSION Overall, the research lacked clarity in the approach to impact asthma outcomes and reduces the opportunity to substantiate the findings through replication.
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Affiliation(s)
- Paula Jo Belice
- a College of Health Sciences, Rush University Medical Center , Chicago , IL , USA
| | - Ellen A Becker
- b Department of Cardiopulmonary Sciences , Rush University Medical Center , Chicago , IL , USA
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27
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Sharpe RA, Thornton CR, Nikolaou V, Osborne NJ. Fuel poverty increases risk of mould contamination, regardless of adult risk perception & ventilation in social housing properties. ENVIRONMENT INTERNATIONAL 2015; 79:115-129. [PMID: 25829024 DOI: 10.1016/j.envint.2015.03.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Revised: 02/27/2015] [Accepted: 03/06/2015] [Indexed: 06/04/2023]
Abstract
INTRODUCTION Fuel poverty affects 2.4 million UK homes leading to poor hygrothermal conditions and risk of mould and house dust mite contaminations, which in turn increases risk of asthma exacerbation. For the first time we assess how fuel poverty, occupants' risk perception and use of mechanical ventilation mediate the risk of mould contamination in social housing. METHODS Postal questionnaires were sent to 3867 social housing properties to collect adult risk perception, and demographic and environmental information on occupants. Participant details were linked to data pertaining to the individual properties. Multiple logistic regression was used to calculate odds ratios and confidence intervals while allowing for clustering of individuals coming from the same housing estate. We used Structured Equation Modelling and Goodness of Fit analysis in mediation analyses to examine the role of fuel poverty, risk perception, use of ventilation and energy efficiency. RESULTS Eighteen percent of our target social housing populations (671 households) were included into our study. High risk perception (score of 8-10) was associated with reduced risk of mould contamination in the bedrooms of children (OR 0.5 95% CI; 0.3-0.9) and adults (OR 0.4 95% CI; 0.3-0.7). High risk perception of living with inadequate heating and ventilation reduced the risk of mould contamination (OR 0.5 95% CI; 0.3-0.8 and OR 0.5 95% CI; 0.3-0.7, respectively). Participants living with inadequate heating and not heating due to the cost of fuel had an increased risk of mould contamination (OR 3.4 95% CI; 2.0-5.8 and OR 2.2 95% CI; 1.5-3.2, respectively). Increased risk perception and use of extractor fans did not mediate the association between fuel poverty behaviours and increased risk of mould contamination. DISCUSSION Fuel poverty behaviours increased the risk of mould contamination, which corresponds with existing literature. For the first time we used mediation analysis to assess how this association maybe modified by occupant behaviours. Increased risk perception and use of extractor fans did not modify the association between fuel poverty and mould contamination. This suggests that fuel poor populations may not benefit from energy efficiency interventions due to ineffective heating and ventilation practices of those occupants residing participating households. Our findings may be modified by a complex interaction between occupant behaviours and the built environment. We found that participant age, occupancy, SES, pets, drying washing indoors, geographic location, architectural design/age of the property, levels of insulation and type of heating regulated risk of mould contamination. CONCLUSION Fuel poverty behaviours affected around a third of participating households and represent a risk factor for increased exposures to damp and mouldy conditions, regardless of adult risk perception, heating and ventilation practices. This requires multidisciplinary approach to assess the complex interaction between occupant behaviours, risk perception, the built environment and the effective use of heating and ventilation practices. STUDY IMPLICATIONS Our findings have implications for housing policies and future housing interventions. Effective communication strategies focusing on awareness and perception of risk may help address indoor air quality issues. This must be supported by improved household energy efficiency with the provision of more effective heating and ventilation strategies, specifically to help alleviate those suffering from fuel poverty.
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Affiliation(s)
- Richard A Sharpe
- European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall TR1 3HD, United Kingdom
| | - Christopher R Thornton
- College of Life and Environmental Sciences, University of Exeter, Stocker Road, Exeter EX4 4QD, United Kingdom
| | - Vasilis Nikolaou
- University of Exeter Medical School, The Veysey Building, Salmon Pool Lane, Exeter EX2 4SG, United Kingdom
| | - Nicholas J Osborne
- European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall TR1 3HD, United Kingdom; Department of Paediatrics, University of Melbourne, Flemington Road, Parkville, Melbourne, Australia; Department of Clinical Pharmacology, Sydney Medical School, University of Sydney, Australia.
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