The Head-off Environmental Asthma in Louisiana (HEAL) study--methods and study population.
BACKGROUND
In the city of New Orleans, Louisiana, and surrounding parishes (NOLA), children with asthma were perilously impacted by Hurricane Katrina as a result of disrupted health care, high home mold and allergen levels, and high stress.


OBJECTIVE
The Head-off Environmental Asthma in Louisiana (HEAL) study was conducted to examine relationships between the post-Katrina environment and childhood asthma in NOLA and assess a novel asthma counselor intervention that provided case management and guidance for reducing home mold and allergen levels.


METHODS
Children (4-12 years old) with moderate-to-severe asthma were recruited from NOLA schools. Over 1 year, they received two clinical evaluations, three home environmental evaluations, and the asthma intervention. Quarterly end points included symptom days, medication use, and unscheduled emergency department or clinic visits. A community advisory group was assembled and informed HEAL at all phases.


RESULTS
Of the children (n = 182) enrolled in HEAL, 67% were African American, and 25% came from households with annual incomes < $15,000. HEAL children were symptomatic, averaging 6.6 symptom days in the 2 weeks before baseline, and had frequent unscheduled visits to clinics or emergency departments (76% had at least one unscheduled visit in the preceding 3 months). In this report, we describe study design and baseline characteristics of HEAL children.


CONCLUSIONS
Despite numerous challenges faced by investigators, study staff, and participants, including destroyed infrastructure, disrupted lives, and lost jobs, HEAL was successful in terms of recruitment and retention, the high quality of data collected that will provide insight into asthma-allergen relationships, and the asthma intervention. This success was attributable to using an adaptive approach and refining processes as needed.
Clinical Research Program, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, North Carolina, USA. patriciachulada@westat.com
Patricia C
PC
Chulada
Suzanne
S
Kennedy
Mosanda M
MM
Mvula
Katy
K
Jaffee
Jeremy
J
Wildfire
Eleanor
E
Thornton
Richard D
RD
Cohn
L Faye
LF
Grimsley
Herman
H
Mitchell
Jane
J
El-Dahr
Yvonne
Y
Sterling
William J
WJ
Martin
LuAnn
L
White
Kevin U
KU
Stephens
Maureen
M
Lichtveld
D000485:Allergens / Q000032:analysis / Q000633:toxicity; D001249:Asthma / Q000453:epidemiology* / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D055867:Cyclonic Storms; D004190:Disasters; D004781:Environmental Exposure; D005260:Female; D006306:Health Surveys / Q000379:methods*; D006798:Housing; D006801:Humans; D008297:Male; D009017:Morbidity; D055820:New Orleans / Q000453:epidemiology; D012107:Research Design; D012959:Socioeconomic Factors
D000485:Allergens