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APHA Scientific Session and Event Listing

Recorded presentation

James Krieger, MD, MPH¹, Tim Takaro, MD, MS, MPH², Kristine Edwards, RN, MN, MPH¹, Lin Song, PhD¹, Nancy Beaudet, MS, CIH³, and LisaCarol Ross, MPH¹. (1) Epidemiology, Planning and Evaluation Unit, Public Health - Seattle & King County, 999 Third Avenue, Suite 1200, Seattle, WA 98104, 206-296-6817, james.krieger@metrokc.gov, (2) Faculty of Health Sciences, Simon Fraser University, #2200 West Mall Centre, 8888 University Drive, Burnaby, BC V5A 1S6, Canada, (3) Occupational and Environmental Medicine Program Pediatric Environmental Health Specialty Unit, University of Washington, Harborview Medical Ctr. Box 359739, 325 9th Ave, Seattle, WA 98104

BACKGROUND: Asthma morbidity among low-income, urban children remains high. Provision of home visits by community health workers to support asthma self-management and indoor trigger reduction is a promising strategy.

OBJECTIVES: This presentation will summarize current understanding of the effectiveness and cost-effectiveness of in-home asthma interventions, emphasizing the findings of our Healthy Homes I and II programs in Seattle/King County in the context of other studies and programs.

Healthy Homes I: METHODS: We conducted a randomized controlled trial with 1-year follow-up among 274 low-income households containing a child aged 4–12 years who had asthma. Community health workers provided in-home environmental assessments, education, support for behavior change, and resources. Participants were assigned to either a high-intensity group receiving 7 visits and a full set of resources or a low-intensity group receiving a single visit and limited resources. RESULTS. The high-intensity group improved significantly more than the low intensity group in its pediatric asthma caregiver quality-of-life score (P=.005) and asthma-related urgent health services use (P=.026). Asthma symptom days declined more in the high-intensity group, although the across-group difference did not reach statistical significance (P= .138). Participant actions to reduce triggers and measures of exposure to asthma triggers generally improved in the high-intensity group. The projected 4-year net savings per participant among the high-intensity group relative to the low-intensity group were $189–$721.

Healthy Homes II: METHODS: We conducted a randomized controlled trial with 1-year follow-up among 309 low-income households containing a child aged 3–13 years who had asthma. Half of the participants were randomly assigned to community health workers who provided asthma self-management support in addition to the environmental interventions included in Healthy Homes I. All participants received clinic-based asthma education and case management from a nurse. RESULTS: Preliminary analysis shows that symptom days decreased more in the home visit group, and caretaker quality of life improved asthma-related urgent health services use improved equally. Final analysis will be presented at this session.

CONCLUSIONS: HH I suggests that home visits focused on reduction of indoor asthma triggers reduce urgent health services, improve caregiver quality-of-life and decrease asthma symptoms. Other studies (e.g. the Inner City Asthma Study) have reached similar conclusions. HH-II suggests that the addition of home visits to clinic-based education and case management may bring a small marginal benefit.

Learning Objectives:

• 1. Participants will learn about the implementation of in-home asthma interventions.
• 2. Participants will understand the effectiveness of the in-home approach and its limitations.

Keywords: Asthma, Home Visiting

Related Web page: www.metrokc.gov/health/asthma/healthyhomes/

Presenting author's disclosure statement:

Any relevant financial relationships? No

Recorded presentation