A community-based participatory research study of multifaceted in-home environmental interventions for pediatric
Jonathan I Levy1, Doug Brugge, Junenette L Peters
1Harvard School of Public Health, Boston, MA 02215, USA. jilevy@hsph.harvard.edu
Insights
Integrated pest management (IPM) and cleaning reduced asthma symptoms in children living in public housing. These environmental interventions improved respiratory health and quality of life for pediatric asthma patients.
Area of Science:
- Environmental Health
- Pediatric Asthma Research
- Community-Based Participatory Research
Background:
- Pest infestations are prevalent in low-income urban housing, contributing to high rates of pediatric asthma.
- The effectiveness of integrated pest management (IPM) and its interaction with other factors in controlling childhood asthma remains poorly understood.
- Urban asthma is a complex, multifactorial condition requiring comprehensive intervention strategies.
Purpose of the Study:
- To evaluate the effectiveness of integrated pest management (IPM) and related interventions in reducing asthma symptoms and improving health outcomes in children.
- To explore the interactions among environmental interventions, social factors, and pediatric asthma exacerbations in public housing settings.
- To assess the impact of community-based participatory research on asthma management in urban low-income communities.
Main Methods:
- A longitudinal, single-cohort community-based participatory research intervention study was conducted in three Boston public housing developments.
- Fifty children (aged 4-17) with asthma participated, undergoing interventions including IPM, cleaning, education, and case management.
- Data collected included environmental, medical, social, and health outcome measures, analyzed using pre-post and longitudinal comparisons.
Main Results:
- Significant reductions in a 2-week recall respiratory symptom score (2.6 to 1.5) and decreased frequency of wheeze/cough, play limitation, and nighttime awakenings were observed.
- Longitudinal analyses showed significant improvements in asthma-related quality of life, with accelerated gains following pest management interventions.
- Allergen reduction, increased peak flow meter use, and improved social support were suggested as potential contributing factors, but not medication changes.
Conclusions:
- Aggressive pest management and allergen reduction efforts positively impact clinical health outcomes for pediatric asthma.
- Findings support the multifactorial nature of urban asthma, highlighting the need to study environmental and social factor synergies.
- Community-based participatory research and integrated interventions show promise for improving asthma control in vulnerable populations.
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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