Children's Hospital Boston Community Asthma Initiative: Addressing environmental allergens and irritants in households of children with poorly controlled asthma

Objective: Substandard housing is one of the Social Determinants of Health contributing to pediatric asthma health disparities in Boston. The Community Asthma Initiative (CAI) provides home visiting and moderate home environmental remediation to reduce triggers as part of a comprehensive asthma program. Methods: Home environmental interventions include provision of dust mite proof bedding encasements and a HEPA vacuum cleaner, plus additional filters and bags, for all families; Integrated Pest Management (IPM) educational materials and supplies; advocacy with landlords; and referral to city housing inspectors, or IPM contractors. Green cleaning and smoke-free housing education, and counseling and referrals for smoking cessation are provided. Results: CAI conducted home environmental assessments for 496 out of 647 (76.7%) children enrolled in the program with 92.6% African American or Latino and 70.6% Medicaid recipients. Assessments showed: significant dust (51%), rodents (37.6%), pets (25.3%), mold (20%), cockroaches (13.4%), and 18.2% were living with someone who smokes. Based on these home environmental findings, 8.3% of families received professional IPM services and 9.1% were referred to Boston Inspectional Services. The percentage of families receiving at least one home visit and environmental assessment has increased from 69.6% in 2006 to 79.2% in 2009. Families enrolled in the program receive on average, 2 home visits; however, the needs of each family vary, with the number of home visits per family ranging from 1 to 13 in some cases. In the program overall, patients experienced significant reductions in symptoms: 27.3% daytime (p=0.008) and 35.5% nighttime (p<0.001) from baseline to 1 year. Conclusion: Identification, education and remediation of home environmental triggers as part of a comprehensive asthma management program can contribute to significant reductions in asthma symptoms. Overall acceptance of home visits by families was high. Many triggers need to be addressed on a larger scale through policies that address healthy housing.