Recorded presentation

Jane E. Clougherty, MSc¹, Steve Melly, MA¹, H. Patricia Hynes, MA, MS², Brent Coull, PhD³, Laura Kubzansky, PhD⁴, John Spengler, ScD¹, and Jonathan Levy, ScD⁵. (1) Environmental Health, Harvard University School of Public Health, P. O. Box 15677, Landmark Center, Room 406 WEST, Boston, MA 02115, 617/384-8811, jcloughe@hsph.harvard.edu, (2) Environmental Health, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, (3) Dept.of Biostatistics, Harvard University School of Public Health, 665 Huntington Ave., Boston, MA 02115, (4) Department of Human Development and Health, Harvard University School of Public Health, Landmark Center, PO Box 15677, 401 Park Drive, Boston, MA 02215, (5) Harvard School of Public Health, Harvard University, P.O. Box 15677, Landmark Center, Room 404 K, Boston, MA 02215

Severe asthma disproportionately impacts lower-income urban children, in communities where complex environmental and social exposures exacerbate this disease. The Boston Healthy Public Housing Initiative (HPHI) investigated environmental interventions to alleviate asthma symptoms. Seventy-eight children aged 4 through 17 were recruited from 3 Boston Housing Authority developments; 58 were retained for longitudinal follow-up. Cockroach and dust mite antigens, mouse urinary protein, and pesticides were sampled before and after interventions (intensive cleaning, Integrated Pest Management, mattress replacement, and air cleaners) to estimate pollutant reductions. Outcomes data, collected monthly by Community Health Advocates, included Juniper Asthma Quality of Life (AQLQ) questionnaires for child and caregiver, reports of symptoms, unplanned ED/clinic visits, and medication use. Allergy testing and spirometry were performed. Social exposures (stress, violence, social support), associated with immune function, were collected monthly.Baseline data indicate only 36% of the intake group used maintenance medication. Allergy testing on a subset of children indicated high prevalence of cockroach (59%) and dust mite (61%) allergies. Prevalent atopy and under-medication suggest potential for health improvements with environmental intervention. Cross-sectional analysis suggest that time spent around smokers (p=.08) and household size (p=.02) predict symptoms, which in turn predict child's AQLQ score (p=.0002). Caregiver AQLQ is associated with child's respiratory symptoms (p<.0001), perceived stress (p=.002), and NICU treatment (p=.09). Longitudinal analysis of AQLQ scores will be used to evaluate intervention efficacy, accounting for seasonality and autocorrelation. Differential response by medical, social, and environmental risk factors will be examined. Pre- and post-intervention spirometry scores should corroborate longitudinal results.

Learning Objectives:

• Participants will be able to list several indoor environment interventions that can reduce exposure to key asthma triggers (i.e., cockroach and mouse antigen).
• Attendees will be able to describe differential response to environmental interventions as a function of participant characteristics and social/environmental exposures.

Keywords: Asthma, Housing

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Recorded presentation