A Community-based Participatory Research (CBPR) Intervention for Childhood Asthma Using Air Filters and Air Conditioners
Condition: Childhood Asthma
MeSH terms: Asthma
Study type: Interventional

Summary: 
      The burden of childhood asthma is borne disproportionately by children living in poverty and
      in urban centers, many of whom are from communities of color and are at greater risk for
      environmental exposures. Given the complex interaction of physical and social environmental
      factors on childhood asthma, there have been increasing calls for comprehensive efforts using
      a community-based participatory research (CBPR) approach. Community Action Against Asthma is
      a long standing CBPR partnership in Detroit, Michigan, composed of representatives from
      community-based organizations, health and human service agencies, and academia. All members
      of the partnership have been actively involved in the development of the CBPR project
      proposed here. The specific aims are: 1) to test the efficacy of air filters (AFs) separately
      and when combined with air conditioners (ACs) to reduce exposure to particulate matter (PM),
      over and above a standard community health worker home visit (standard) intervention; 2) to
      test the association between any reduction in PM exposure through the use of AFs separately
      and when combined with ACs over and above a standard intervention and health outcomes in
      children with asthma; 3) to elucidate the causal pathways by which any intervention-related
      improvements in children's asthma-related health status is occurring. One hundred and fifty
      households in Detroit, Michigan with at least one child with mild persistent or moderate to
      severe persistent asthma will be enrolled to participate in the study. Households will be
      randomly assigned to one of three groups: a standard household intervention (or control)
      group; an AF only intervention group; or an AF+AC intervention group. Extensive health and
      exposure measures will be undertaken during the course of the 12 -month intervention. Given
      the role of PM in children's asthma-related health and the higher concentrations of PM in
      microenvironments, there is a need to test the efficacy and efficiency of novel approaches to
      reducing indoor air pollutants. Doing so using a CBPR approach will enhance the relevance and
      ultimately the success of this proposed research.
    

Detailed description: 
      For the proposed study we will conduct a randomized controlled trial (RCT) comparing a
      standard community health worker home visit intervention (the standard intervention) to an
      Air Filter(AF) only intervention that adds the use of an AF in the child's bedroom to the
      standard intervention (AF only intervention) and an Air Filter(AF)+ Air Conditioner (AC)
      intervention that adds the use of an AF and AC in the child's bedroom to the standard
      intervention (AF+AC intervention) (Figure 1). We will test whether the addition of AFs (and,
      in the warmer months, ACs) to the standard intervention, as compared to the standard
      intervention will: (1) further lower children's exposure to PM (Specific Aims 1a, 1b), and
      (2) further improve asthma-related health status of children (Aims 2a, 2b). One hundred and
      fifty Detroit households with at least one child aged 6 to 12 with symptoms consistent with
      persistent asthma (mild, moderate, or severe) will be enrolled in the study . Following
      collection of baseline data, households will be randomly assigned to receive one of three
      interventions: the standard household intervention, the AF only intervention, or the AF+AC
      intervention. Participants assigned to the AF only intervention group will receive AFs at the
      start of the 12-month intervention (Summer/Fall 2008). Those assigned to the AF+AC
      intervention group will receive AFs at the start of the intervention period but ACs will not
      be in place during the first summer of the intervention, but will be installed in June 2009
      prior to the second summer of the intervention (Figure 2). Data will be collected across all
      seasons (Fall 2008 through Winter 2009) which will enable us to evaluate directly the
      exposure and health outcome effects (Specific Aims 1a and 2a, respectively) of the addition
      of AFs alone to the standard intervention as well as the exposure and health outcome effects
      of the AFs augmented by ACs (Aims 1b, 2b). This design will also allow for comparisons,
      adjusted for any changes in the exposure and health status of the intervention groups, of the
      combined effect of the AC and AF to that of the AF alone.
    

Intervention name(s): Community Health Worker Intervention; Air Filter; Air Filter and Air Conditioner
Intervention type(s): Behavioral; Other; Other
Intervention description(s): The Community Health Worker (CHW) intervention consists of visits by CHWS to help families reduce children's exposure to common asthma triggers (allergens and irritants) in the indoor environment. The content of the CHW visits and the materials distributed will follow NHLBI Expert Panel Report 2 recommendations. Each household will receive 6 visits over a 12-month period in which the CHW will provide education on environmental triggers (e.g., reduction of dust mites, cockroaches, cat and dog dander, and environmental tobacco smoke); materials including vacuum cleaners with HEPA filters, mattress and pillow covers, and cleaning supplies; social support to the caregivers; and, if indicated, referrals to other services.; Fifty households will receive an Air Filter, in addition to receiving the standard community health worker intervention. These households will receive a HEPA room AF (Whirlpool 510 or equivalent), a relatively high capacity unit that can be quietly operated. Similar to other studies the filter will be placed in the room where the child sleeps. The HEPA AF will be installed at the beginning of the intervention period.; Fifty households will receive the air filter and the air conditioner, in addition to receiving the standard community health worker intervention. The air filter will be installed at the beginning of the intervention, after baseline measurement. In the spring of the year (2009), a small window AC unit (Whirlpool Designer Style ACQ058MM or equivalent) will also be installed in the room where the child sleeps.
Other intervention name(s): community health workers; Air Conditioner; Air Filter
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: Pediatric Asthma; Air Filters; Indoor Particulate Matter