A community-based participatory research study of multifaceted in-home environmental interventions for pediatric asthmatics in public housing

Harvard School of Public Health, Boston, MA 02215, USA.
Social Science & Medicine (Impact Factor: 2.56). 11/2006; 63(8):2191-203. DOI: 10.1016/j.socscimed.2006.05.006
Source: PubMed

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.

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Available from: Jonathan Levy, Aug 09, 2015
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    • "n 2002 and 2003 prior to an integrated pest management intervention from 42 homes of pediatric asthmatics living in public housing in Boston , MA , as part of the Healthy Public Housing Initiative , a large - scale collaboration focused on pediatric asthma and indoor allergens in public housing ( Clougherty et al . , 2006 ; Julien et al . , 2008 ; Levy et al . , 2006 ; Peters et al . , 2007 ) . Homes where the concentrations were measured were urban apartments that had a square footage of approximately 65 – 84 m 2 ( Zota et al . , 2005 ) , and with bedrooms and living areas in relatively close proximity to kitchens and bathrooms . Details about the sampling protocol are available in Julien et al . ("
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    ABSTRACT: Pesticide exposure in urban low-income residential environments may be elevated as a result of persistent application due to severe pest infestation. Children living in this environment may be a sensitive subpopulation for these non-dietary exposures, due to their physiological and behavioral differences. In this study, we provide an exposure modeling framework to simulate exposures for children in this environment and assess dominant exposure routes and sources of exposure variability, in order to characterize factors that influence risk. We use a dataset of pesticide measurements collected in 42 low-income dwellings, including vacuum dust and floor wipe samples from kitchens and living rooms. We fit distributions to the concentration measurements for the organophosphates measured, chlorpyrifos and diazinon, and the most prevalent pyrethroids (permethrin, cypermethrin, and cyfluthrin), and simulated 1000 homes from the distributions. Concentration measurements were then connected with activity pattern data, short-term dermal and ingestion exposures and absorbed doses were simulated for children ages 1-5 years. For both pesticide groups, exposure values ranged widely, with concentration values contributing most significantly to exposure variability, although approximately 20-fold variability was attributable to exposure factors alone. In addition, upper percentile exposed children usually had both higher concentrations as well as greater influences from exposure and dose factors. Differences were also seen across pesticide groups in dominant exposure pathways. Our analyses indicate a profile of factors that describe individuals likely to receive high doses of one or multiple pesticides and could allow for more targeted intervention strategies. More generally, this work provides a standard framework to evaluate and describe exposures to prevalent residential pesticides via multiple pathways.
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    • "The CBPR model has been utilized for nearly 25 years and has served as an important tool to advance environmental health sciences in the United States (Arcury et al., 2001; Brody et al., 2005; Brugge and Cole, 2003; Cook, 2008; Cummins et al., 2010; Downs et al., 2010; Horn et al., 2008; Israel et al., 2001; Kegler et al., 1998; Latowsky, 2003; Levy et al., 2006; Minkler et al., 2006; Parker et al., 2003; Petersen et al., 2006; Schell et al., 2005; Schulz et al., 2001; Wier et al., 2009). More recently, the CBPR model proved a useful approach in children's environmental health and disease prevention research (Israel et al., 2005; Kegler et al., 2000; Moodie et al., 2010; Parker et al., 2008; Petersen et al., 2007; Schetzina et al., 2009). "
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    • "The study was an offshoot of the Healthy Public Housing Initiative (HPHI), a long-running collaboration that also included Tufts University and the West Broadway Task Force. HPHI was a multiyear, multimillion-dollar CBPR project (Hynes et al., 2003) that has recently reported key findings (Levy et al., 2006). The West Broadway Task Force is a tenant organization representing residents of an urban public housing development in South Boston and is composed of staff and volunteer community residents. "
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