A community-based participatory research study of multifaceted in-home environmental interventions for pediatric asthmatics in public housing.
ABSTRACT Pest infestation is a major problem in urban, low-income housing and may contribute to elevated asthma prevalence and exacerbation rates in such communities. However, there is poor understanding of the effectiveness of integrated pest management (IPM) efforts in controlling pediatric asthma, or of the interactions among various interventions and risk factors in these settings. As part of the Boston-based Healthy Public Housing Initiative, we conducted a longitudinal, single-cohort community-based participatory research intervention study. Fifty asthmatic children aged 4-17 from three public housing developments in Boston, Massachusetts, USA successfully completed interventions and detailed environmental, medical, social, and health outcome data collection. Interventions primarily consisted of IPM and related cleaning and educational efforts, but also included limited case management and support from trained community health advocates. In pre-post analyses, we found significant reductions in a 2-week recall respiratory symptom score (from 2.6 to 1.5 on an 8-point scale, p = 0.0002) and in the frequency of wheeze/cough, slowing down or stopping play, and waking at night. Longitudinal analyses of asthma-related quality of life similarly document significant improvements, with a suggestion of some improvements prior to environmental interventions with an increased rate of improvement subsequent to pest management activities. Analyses of potential explanatory factors demonstrated significant between-development differences in symptom improvements and suggested some potential contributions of allergen reductions, increased peak flow meter usage, and improved social support, but not medication changes. In spite of limitations with pre-post comparisons, our results are consistent with aggressive pest management and other allergen reduction efforts having a positive impact on clinical health outcomes associated with asthma. Our findings reinforce the multifactorial nature of urban asthma and suggest a need for further study of the relative contributions of and possible synergies between environmental and social factors in asthma intervention programs.
SourceAvailable from: Jo Anne Goot Balanay[Show abstract] [Hide abstract]
ABSTRACT: OBJECTIVE Asthma is the most common chronic childhood condition affecting 6.3 million (US) children aged less than 18 years. Home-based, multi-component, environmental intervention studies among children with asthma have demonstrated to be effective in reducing asthma symptoms. In this study, a local hospital and university developed an environmental intervention research pilot project, Eastern Carolina Asthma Prevention Program (ECAPP), to evaluate self-reported asthma symptoms, breathing measurements, and number of asthma-related emergency department (ED) visits among low-income, minority children with asthma living in rural, eastern North Carolina. Our goal was to develop a conceptual model and demonstrate any asthma respiratory improvements in children associated with our home-based, environmental intervention. METHODS This project used a single cohort, intervention design approach to compare self-reported asthma-related symptoms, breathing tests, and ED visits over a 6 month period between children with asthma in an intervention study group (n = 12) and children with asthma in a control study group (n = 7). The intervention study group received intense asthma education, three home visits, 2 week follow-up telephone calls, and environmental intervention products for reducing asthma triggers in the home. The control group received education at baseline and 2 week calls, but no intervention products. RESULTS At the end of the study period, significant improvements were observed in the intervention group compared with the control group. Overall, the intervention group experienced a 58% (46 ± SD 26.9) reduction in self-reported asthma symptoms; 76% (34 ± SD 29.7) decrease in rescue medicine; 12% (145 ± SD 11.3) increase in controller medicine; 37% decrease in mean exhaled nitric oxide levels and 33% fewer ED asthma-related visits. CONCLUSION As demonstrated, a combination of efforts appeared effective for improving asthma respiratory symptoms among children in the intervention group. ECAPP is a low cost pilot project that could readily be adapted and expanded into other communities throughout eastern North Carolina. Future efforts could include enhanced partnerships between environmental health professionals at local health departments and pediatric asthma programs at hospitals to carry out ECAPP.Environmental Health Insights 06/2014; 8:1-11. DOI:10.4137/EHI.S16430
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ABSTRACT: Distressed neighborhoods in North Charleston (SC, USA) are impacted by the cumulative effects of multiple environmental hazards and expansion of the Port of Charleston. The Low Country Alliance for Model Communities (LAMC) built an environmental justice partnership to address local concerns. This case study examines the process of building and sustaining a successful transformative and authentic community-university partnership. We apply the framework established by Community-Campus Partnerships for Health (CCPH), focusing on four of the nine principles of Good Practice of Community Campus Partnerships.
Article: PROFESSIONAL ROLES[Show abstract] [Hide abstract]
ABSTRACT: Given that this volume of the Handbook of Clinical Psychology focuses on children and adolescents, it seems fitting that a chapter be devoted to a discussion of the various professional roles assumed by psychologists who work with children and youth. While these psychologists are often referred to by various labels, such as clinical child psychologists and pediatric psychologists, professionals with other backgrounds, such as school psychologists, also work with children and adolescents. Child-oriented psychologists vary in the nature of their professional training (clinical psychology, school psychology, developmental psychology, specialty-specific training in clinical child or pediatric psychology); theoretical orientation (behavioral, cognitive-behavioral, interpersonal, psychodynamic, humanistic); the degree to which they focus on research, clinical activities, or both; the nature of the professional activities they engage in (teaching, research, assessment, therapy, consultation, advocacy); the types of child or adolescent problems they work with (mental health problems, physical health problems, school-related difficulties); and the settings in which they work (universities, medical centers, children's hospitals, pediatric clinics, private practice, mental health centers, schools). Given the diversity of training, theoretical orientation, professional activities, types of problems addressed, and settings, it should not be surprising that these professionals often function in multiple roles and engage in a range of professional activities in the context of these roles. This topic of professional roles is of special relevance given the rapid growth of clinical child and pediatric psychology in the past 25 years and the degree to which this growth has resulted in expanded role opportunities and, in some cases, significant changes in the nature of the activities engaged in by psychologists serving children and adolescents.