Home and allergic characteristics of children with asthma in seven U.S. urban communities and design of an environmental intervention: the Inner-City Asthma Study.
Most published environmental remediation interventions have been directed at single allergens and have employed demanding strategies; few have been performed in the homes of inner-city children disproportionately burdened by asthma. Our objective was a) to describe the allergen sensitivities, environmental tobacco smoke (ETS) exposure, and home environmental characteristics of a national sample of inner-city children with moderate to severe asthma and b) to develop and implement a multifaceted, home-based comprehensive intervention to reduce home allergens and ETS, tailored to the specific sensitization and exposure profiles of those children. Allergen skin testing and a home evaluation were performed to determine the presence of ETS and factors known to be associated with increased indoor allergen levels. Based on published remediation techniques, a home environmental intervention, organized into modules, each addressing one of five specific allergen groups or ETS, was designed. Of 994 allergic children from seven U.S. urban communities, 937 successfully completed baseline interviews and home allergen surveys and were enrolled. More than 50% of children had positive skin tests to three or more allergen groups. Cockroaches were reported in 58% of homes, wall-to-wall carpeting in the child's bedroom in 55%, a smoker in 48%, mice or rats in 40%, and furry pets in 28%. More than 60% of enrolled families received four or more modules, and between 94% and 98% of all modules were completed. We conclude that most inner-city children with moderate to severe asthma are sensitized to multiple indoor allergens and that environmental factors known to be associated with asthma severity are commonly present in their homes. The intervention developed for the Inner-City Asthma Study employs accepted methods to address an array of allergens and ETS exposure while ensuring that the intervention is tailored to the specific sensitization profiles and home characteristics of these children.
Department of Pediatrics (Emergency Medicine), Albert Einstein College of Medicine/Jacobi Medical Center, Bronx, New York, USA. ellencrain@worldnet.att.net
Ellen F
EF
Crain
Michelle
M
Walter
George T
GT
O'Connor
Herman
H
Mitchell
Rebecca S
RS
Gruchalla
Meyer
M
Kattan
George S
GS
Malindzak
Paul
P
Enright
Richard
R
Evans
Wayne
W
Morgan
James W
JW
Stout
D000328:Adult; D016902:Air Pollution, Indoor / Q000009:adverse effects*; D000485:Allergens / Q000009:adverse effects*; D001249:Asthma / Q000453:epidemiology / Q000209:etiology*; D002648:Child; D004781:Environmental Exposure; D005260:Female; D006306:Health Surveys; D006798:Housing; D006801:Humans; D008297:Male; D011203:Poverty; D018570:Risk Assessment; D014028:Tobacco Smoke Pollution / Q000009:adverse effects*; D014481:United States / Q000453:epidemiology; D014505:Urban Population
D000485:Allergens; D014028:Tobacco Smoke Pollution