文章基本信息

标题：Healthy Homes: In-Home Environmental Asthma Intervention in a Diverse Urban Community
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作者：David A. Turcotte ; Heather Alker ; Emily Chaves 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2014
卷号：104
期号：4
页码：665-671
DOI：10.2105/AJPH.2013.301695
语种：English
出版社：American Public Health Association
摘要：Objectives. We evaluated health outcomes associated with in-home interventions in low-income urban households with children with asthma. Methods. A comprehensive health and environmental assessment and subsequent intervention were completed in 116 households with 170 enrolled children with asthma. Home health workers provided household safety, asthma prevention education, and targeted environmental intervention to decrease asthma triggers and improve household safety. We collected environmental data with questionnaire and dust samples and health information with a questionnaire incorporating the American Academy of Pediatrics Children’s Health Survey for Asthma and other instruments at baseline and at follow-up 11 to 12 months later to evaluate the impact of the intervention on the health of the child and family in Lowell, Massachusetts, from September 2009 to January 2012. Results. The diverse study population of low-income children showed a statistically significant health improvement from baseline to follow-up. The cost of the interventions (not including personnel) was $36 240, whereas the estimated medical savings over a 4-week assessment period was $71 162, resulting in an estimated annual savings of about $821 304. Conclusions. Low-cost, multicomponent interventions decrease all measures of asthma severity and health care utilization in a diverse population of urban children. The Lowell Healthy Homes Program in Massachusetts targeted asthma, the most common chronic childhood disease. Asthma has many known indoor environmental triggers, including dust, pests, smoke, and pets. Children are particularly vulnerable to home hazards and may develop lifelong health problems because of their home environment. 1 In-home interventions to decrease triggers of childhood asthma involving remediation and education provided by community health workers has been reported. 2–4 The federal government funded this initiative in Lowell, Massachusetts, in part because of its diverse demographic urban communities that have old, substandard housing and associated health risks. The project goal was to reduce the asthma burden and improve health outcomes for children with asthma and their families through home environmental assessments and individualized interventions focused on reducing indoor allergen levels and asthma triggers. Massachusetts is located in the Northeast, where asthma rates are higher than are those in other regions of the United States. 5 Lowell schoolchildren’s asthma prevalence (13.0%) is higher than the statewide average (10.9%). 6 The 2010 US Census showed that Lowell’s population was 106 519, of which 47.2% were minority residents and 11.3% were of Puerto Rican descent (the largest subset of the 17.3% Hispanic residents). 7 According to the National Health Statistics report on asthma prevalence in the United States, those of Puerto Rican descent have the highest asthma rate, twice the rate of the general population (16.6% vs 8.2%). 5 The local and state rates for emergency department discharges and inpatient hospitalizations for asthma reveal that the hospitalization rate for Lowell’s children with asthma is almost twice the state average for the composite years 2006 to 2008. 8 The University of Massachusetts, Lowell directed this community intervention with local collaborators, including a federally funded community health center, housing authority, community development corporation, multiservice community action agency, and first-time home buyers education program. The project drew on our team’s unique experience in developing cross-cultural healthy home interventions to improve the quality of housing in Lowell through a multitrigger, multicomponent, personalized home environmental intervention with home health assessment workers (HHAWs) and an environmental assessor.