Does a multifaceted environmental intervention alter the impact of asthma on inner-city children?
OBJECTIVE
To evaluate the impact of a multifaceted environmental and educational intervention on the indoor environment and health in 5-12-year-old children with asthma living in urban environments.


METHODS
Changes in indoor allergen levels and asthma severity measurements were compared between children who were randomized to intervention and delayed intervention groups in a 14-month prospective field trial. Intervention group households received dust mite covers, a professional house cleaning, and had roach bait and trays placed in their houses.


RESULTS
Of 981 eligible children, 410 (42%) were enrolled; 161 (40%) completed baseline activities and were randomized: 84 to intervention and 77 to delayed intervention groups. At the study's end, dust mite levels were 163% higher than at baseline for the delayed intervention group. Overall asthma severity scores did not change. However, the median functional severity score (FSS) component of the severity score improved more in the intervention group (33% vs. 20%) than in the delayed intervention group. At the study's end, the median FSSs for the intervention group improved 25% compared with the delayed intervention group, (p<0.01). Differences between groups for medication use, emergency department (ED) visits or hospitalization were not significant.


CONCLUSIONS
Despite low retention, the intervention resulted in decreased dust mite allergen levels and increased FSSs among the intervention group. The interventions probably contributed to the improvements, especially among the more severely affected children. This study highlights the complexities of designing and assessing the outcomes from a multifaceted asthma intervention.
Williams
Seymour G
SG
National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. sjw9@cdc.gov
Brown
Clive M
CM
Falter
Kenneth H
KH
Alverson
Clinton J
CJ
Gotway-Crawford
Carol
C
Homa
David
D
Jones
Donna S
DS
Adams
E Kathleen
EK
Redd
Stephen C
SC
D000485:Allergens; D001249:Asthma / Q000276:immunology / Q000517:prevention & control*; D002648:Child; D002675:Child, Preschool; D003150:Community Health Workers; D004781:Environmental Exposure; D005260:Female; D005845:Georgia; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007073:Immunoglobulin E; D008297:Male; D010353:Patient Education as Topic; D011446:Prospective Studies; D039981:Pyroglyphidae; D011795:Surveys and Questionnaires; D014504:Urban Health
D000485:Allergens; D007073:Immunoglobulin E