Implementation of evidence-based asthma interventions in post-Katrina New Orleans: the Head-off Environmental Asthma in Louisiana (HEAL) study.
BACKGROUND
Childhood asthma morbidity and mortality in New Orleans, Louisiana, is among the highest in the nation. In August 2005, Hurricane Katrina created an environmental disaster that led to high levels of mold and other allergens and disrupted health care for children with asthma.


OBJECTIVE
We implemented a unique hybrid asthma counselor and environmental intervention based on successful National Institutes of Health asthma interventions from the National Cooperative Inner City Asthma (NCICAS) and Inner-City Asthma (ICAS) Studies with the goal of reducing asthma symptoms in New Orleans children after Hurricane Katrina.


METHODS
Children (4-12 years old) with moderate-to-severe asthma (n = 182) received asthma counseling and environmental intervention for approximately 1 year. HEAL was evaluated employing several analytical approaches including a pre-post evaluation of symptom changes over the entire year, an analysis of symptoms according to the timing of asthma counselor contact, and a comparison to previous evidence-based interventions.


RESULTS
Asthma symptoms during the previous 2 weeks decreased from 6.5 days at enrollment to 3.6 days at the 12-month symptom assessment (a 45% reduction, p < 0.001), consistent with changes observed after NCICAS and ICAS interventions (35% and 62% reductions in symptom days, respectively). Children whose families had contact with a HEAL asthma counselor by 6 months showed a 4.09-day decrease [95% confidence interval (CI): 3.25 to 4.94-day decrease] in symptom days, compared with a 1.79-day decrease (95% CI: 0.90, 2.67) among those who had not yet seen an asthma counselor (p < 0.001).


CONCLUSIONS
The novel combination of evidence-based asthma interventions was associated with improved asthma symptoms among children in post-Katrina New Orleans. Post-intervention changes in symptoms were consistent with previous randomized trials of NCICAS and ICAS interventions.
Rho Federal Systems Division, Inc., Chapel Hill, North Carolina 27517, USA. herman_mitchell@rhoworld.com
Herman
H
Mitchell
Richard D
RD
Cohn
Jeremy
J
Wildfire
Eleanor
E
Thornton
Suzanne
S
Kennedy
Jane M
JM
El-Dahr
Patricia C
PC
Chulada
Mosanda M
MM
Mvula
L Faye
LF
Grimsley
Maureen Y
MY
Lichtveld
LuAnn E
LE
White
Yvonne M
YM
Sterling
Kevin U
KU
Stephens
William J
WJ
Martin
D000485:Allergens / Q000633:toxicity*; D001249:Asthma / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control*; D002648:Child; D002675:Child, Preschool; D055867:Cyclonic Storms; D004190:Disasters; D004781:Environmental Exposure; D005260:Female; D006801:Humans; D008297:Male; D009017:Morbidity; D055820:New Orleans / Q000453:epidemiology
D000485:Allergens