title: A single intervention for cockroach control reduces cockroach exposure and asthma morbidity in children.
abstract: BACKGROUND
  Exposure to cockroaches is an important asthma trigger, particularly for children with asthma living in inner cities. Integrated pest management is the recommended approach to cockroach abatement; however, it is costly and difficult to implement. The impact of reducing cockroach exposure on asthma outcomes is not known.
  
  
  OBJECTIVE
  We sought to test the use of a single intervention, insecticidal bait, to reduce cockroach exposure in the home of children with asthma in New Orleans and to examine the impact of cockroach reduction on asthma outcomes.
  
  
  METHODS
  One hundred two children aged 5 to 17 years with moderate to severe asthma were enrolled in a 12-month randomized controlled trial testing the use of insecticidal bait on cockroach counts and asthma morbidity. Homes were visited 6 times and asthma symptoms were assessed every 2 months.
  
  
  RESULTS
  After adjustment, intervention homes had significantly fewer cockroaches than did control homes (mean change in cockroaches trapped, 13.14; 95% CI, 6.88-19.39; P < .01). Children in control homes had more asthma symptoms and unscheduled health care utilization in the previous 2 weeks (1.82, 95% CI, 0.14-3.50, P = .03; 1.17, 95% CI, 0.11-2.24, P = .03, respectively) and a higher proportion of children with FEV1of less than 80% predicted (odds ratio, 5.74; 95% CI, 1.60-20.57; P = .01) compared with children living in intervention homes.
  
  
  CONCLUSIONS
  Previous research has demonstrated improvement in asthma health outcomes using multifaceted interventions. The strategic placement of insecticidal bait, which is inexpensive, has low toxicity, and is widely available, resulted in sustained cockroach elimination over 12 months and was associated with improved asthma outcomes. This single intervention may be an alternative to multifaceted interventions currently recommended to improve asthma morbidity.
authors.affiliation: Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, La. Electronic address: rabito@tulane.edu.
authors.forename: Felicia A
authors.initials: FA
authors.lastname: Rabito
authors.affiliation: Department of Pediatrics, School of Medicine, Tulane University, New Orleans, La.
authors.forename: John C
authors.initials: JC
authors.lastname: Carlson
authors.affiliation: Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, La.
authors.forename: Hua
authors.initials: H
authors.lastname: He
authors.affiliation: Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, La.
authors.forename: Derek
authors.initials: D
authors.lastname: Werthmann
authors.affiliation: Department of Entomology, North Carolina State University, Raleigh, NC.
authors.forename: Coby
authors.initials: C
authors.lastname: Schal
mesh_terms: D000293:Adolescent; D000553:Ambulatory Care / Q000706:statistics & numerical data; D000818:Animals; D001249:Asthma / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D003058:Cockroaches; D004781:Environmental Exposure / Q000517:prevention & control*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007306:Insecticides; D008297:Male; D009017:Morbidity; D010571:Pest Control / Q000379:methods*
chemical_list: D007306:Insecticides
keywords: Asthma; FEV(1); Feno; cockroach; indoor allergens; integrated pest management; intervention studies