Where You Live Matters: Combating Asthma Morbidity by Reducing Home Environmental Triggers

Environmental triggers are prevalent in poor, urban communities and negatively impact health outcomes for residents. With funding from the Department of Housing and Urban Development, the Sinai Urban Health Institute partnered with the Chicago Housing Authority to implement its Community Health Worker (CHW) asthma and healthy homes intervention in six public housing developments. The home-based intervention addresses asthma disparities by educating families to better manage asthma, while addressing the presence of indoor environmental exposures. These exposures, including cockroaches, rodents, mold, dust-mites, tobacco smoke, and pets, create physical stressors that can lead to airway inflammation, resulting in increased asthma morbidity. Adults enrolled in the program received four visits over six months and children received six visits over one year. A thorough home assessment was conducted at the beginning and end of the program for 60 children and 55 adults who completed the intervention. With the objective of reducing asthma triggers, CHWs helped resolve 60% of the children’s homes that had evidence of cockroaches present at baseline. Furthermore, 83% of children and 73% of adults with evidence of mold in their home at baseline no longer had mold at the end of the intervention. Forty-two percent of adult participants with evidence of tobacco smoke in their home during the baseline visit were smoke-free by their final visit. These improvements in home triggers parallel improvements in asthma severity and health resource utilization. Children realized an 83% decrease in asthma-related emergency department visits while adults saw a 44% decrease.  Daytime asthma symptoms were reduced from 4.1 in the past two weeks to 0.8 among children, and adult symptoms decreased from 5.0 to 2.0. These outcomes indicate the effectiveness of the CHW model in empowering families to reduce the presence of in-home asthma triggers, which in turn reduces asthma morbidity among those most profoundly impacted.