Asthma and Pest Control Study: Demonstrating Return-on-Investment for In-Home Pest Control for Children With Persistent Asthma
Condition: Asthma
MeSH terms: Asthma
Study type: Interventional

Summary: 
      The New York City Department of Health and Mental Hygiene and Montefiore Medical Center, with
      the Fund for Public Health of New York (FPHNY), DOHMH's fiscal agent, are partnering on a
      study to evaluate the feasibility, health outcomes and return-on-investment of a single,
      integrated pest management (IPM) intervention for Bronx, Harlem, and Northern Manhattan
      children aged 5 to 12 with persistent asthma who are living in homes with pests. By
      demonstrating cost effectiveness, this study could provide the basis for health insurance
      coverage of an IPM visit embedded in clinical treatment plans for high-risk asthma patients
      living with pests.

      Asthma is the most common childhood disease in New York City, and both prevalence and
      hospitalization rates are highest in high-poverty neighborhoods. The greatest individual and
      community-level factor associated with asthma disparities is varying exposure to triggers in
      the home, most notably cockroaches and mice. Asthma health care costs are significant, and
      prevention efforts to reduce triggers could result in improved outcomes and significant cost
      savings. Unlike traditional pest control, which relies on pesticides, IPM eliminates pests
      and prevents re-infestation by addressing housing conditions conducive to pests and with
      safe, targeted use of pesticides. This project targets low-income children with the potential
      to significantly improve their health and well-being. A total of 400 families - 400+ children
      which includes screened and recruited siblings - will be recruited on to the study.

      The study is designed to evaluate an inexpensive and scalable environmental intervention for
      asthma that can be replicated in other New York City neighborhoods and incorporated into any
      urban healthcare setting in New York State and nationwide.
    

Detailed description: 
      The New York City Department of Health and Mental Hygiene (DOHMH) and Montefiore Medical
      Center, with the Fund for Public Health of New York, DOHMH's fiscal agent, have partnered on
      a study to evaluate the feasibility, health outcomes and return-on-investment of a single
      integrated pest management (IPM) intervention for Bronx, Harlem and Northern Manhattan
      children aged 5 to 12 with persistent asthma who are living in homes with pests. Principal
      Investigator (PI) Daniel Kass, MSPH, Deputy Commissioner of the DOHMH Division of
      Environmental Health, has extensive experience overseeing evaluation of program and policy
      initiatives, and co-PI Marina Reznik, MD, MS, Associate Professor of Pediatrics at
      Montefiore, has conducted research on evaluating the impact of a home-based asthma
      intervention on asthma-related outcomes in children with persistent asthma recruited from
      Montefiore clinics.

      Asthma is the most common childhood disease in New York City, and both prevalence and
      hospitalization rates are highest in high-poverty neighborhoods. The greatest individual and
      community-level factor associated with asthma disparities is varying exposure to triggers in
      the home, most notably cockroaches and mice. Asthma health care costs are significant, and
      prevention efforts to reduce triggers could result in improved outcomes and significant cost
      savings. Unlike traditional pest control, which relies solely on pesticides, IPM eliminates
      pests and prevents re-infestation by addressing housing conditions conducive to pests and
      with safe, targeted use of pesticides.

      The specific goals of the project are to:

        -  Demonstrate the feasibility of implementing a basic IPM intervention in the homes of
           children aged 5-12 years with persistent asthma or current prescription for controller
           medication and past-year history of asthma-related urgent care visits living in
           households with pest problems.

        -  Evaluate changes in asthma outcomes and asthma-related health system utilization
           associated with the IPM intervention.

        -  Assess the costs and return-on-investment (ROI) for the IPM intervention.

        -  Report findings and support policies to adopt insurance reimbursement for basic IPM
           interventions embedded in health service delivery to prevent asthma exacerbations due to
           pest triggers in the home.

      HealthFirst and Affinity, among the largest insurers of pediatric patients in the Bronx, are
      collaborating with the research team, providing support in recruitment and use of their data
      on health outcomes among study participants for the evaluation. The research team is also
      working with pest control experts to establish a well-priced and replicable protocol for IPM
      best practice. The protocol will build upon DOHMH's prior work to evaluate IPM in public
      housing, which demonstrated significant reductions in pest populations and allergens in
      kitchens and bedrooms, with sustained effects. The study aims to contribute to a
      best-practice model for one-time IPM service in the home that is not only effective in
      reducing asthma triggers but also practical and readily adoptable in the pest control
      industry, replacing the current pesticides-only approach. This groundwork is critical to
      efforts to scale up to meet demand, should IPM intervention become a reimbursable service in
      asthma care for high-risk children.

      This two-year research project will employ a prospective, randomized controlled study design
      with the random assignment of 400 participants to two groups: intervention and control.
      Participants in both groups will be followed for a 12-month period with three assessments: at
      baseline (when recruited), 6 months, and 12 months after-recruitment. The intervention group
      will receive the IPM service within 2-4 weeks of completion of the baseline assessment. In
      addition to the intervention, the family will be provided with basic information about good
      pest-control practices, such as appropriate food storage, and be given a set of food storage
      containers. The control group will be provided basic pest control information at baseline and
      will be offered the equivalent intervention, information, and food storage containers after
      completion of their 12-month assessment. The primary clinical outcome measures will be:
      asthma-related urgent care (unscheduled ambulatory) visits, asthma-related emergency
      department (ED) visits, and asthma-related hospitalizations.

      The evaluation of this proposed initiative will assess the intervention implementation and
      costs, its impact on health outcomes, healthcare cost savings or ROI.

      This project targets low-income children with the potential to significantly improve their
      health and well-being. The study has been designed to evaluate an inexpensive and scalable
      environmental intervention for asthma that can be replicated in other New York City
      neighborhoods and incorporated into any urban healthcare setting in New York State and
      nationwide. By demonstrating cost effectiveness, this study could provide the basis for
      health insurance coverage of an IPM visit embedded in clinical treatment plans for high-risk
      asthma patients living with pests.
    

Intervention name(s): Integrated Pest Management
Intervention type(s): Other
Intervention description(s): One-time, in-home, pest intervention for children with persistent asthma living in homes with parent-reported cockroach and/or mouse infestation.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Investigator)
Primary purpose: Prevention
Keywords: asthma; pest management