A community-based participatory research study of multifaceted in-home environmental interventions for pediatric asthmatics in public housing
A community-based participatory research study of multifaceted in-home environmental interventions for pediatric asthmatics in public housing
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DOI：
10.1016/j.socscimed.2006.05.006
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发表时间：
2006-10-01
影响因子：
5.4
通讯作者：
Saddler, Shawnette S.
中科院分区：
文献类型：
--
作者：
Levy, Jonathan I.;Brugge, Doug;Saddler, Shawnette S.
害虫侵扰是城市低收入住房的一个主要问题，可能导致这些社区哮喘患病率升高和病情加重。然而，人们对综合病虫害管理（IPM）在控制儿童哮喘方面的有效性，以及这些环境中各种干预措施和风险因素之间的相互作用了解甚少。作为波士顿健康公共住房倡议的一部分，我们进行了一项纵向、单队列、基于社区的参与性研究干预研究。来自美国马萨诸塞州波士顿三个公共住房开发项目的50名4-17岁哮喘儿童成功地完成了干预措施和详细的环境、医疗、社会和健康结果数据收集。干预措施主要包括IPM和相关的清洁和教育工作，但也包括有限的病例管理和训练有素的社区卫生倡导者的支持。在前后分析中，我们发现两周回忆呼吸症状评分（8分制从2.6降至1.5,p = 0.0002）和喘息/咳嗽、减慢或停止游戏以及夜间醒来的频率显著降低。与哮喘相关的生活质量的纵向分析同样记录了显著的改善，表明在环境干预之前有一些改善，在病虫害管理活动之后改善的速度增加。潜在的解释因素分析表明，在症状改善方面存在显著的发育差异，并提出过敏原减少、峰值流量仪使用增加和社会支持改善的一些潜在贡献，但不是药物改变。尽管前后比较存在局限性，但我们的结果与积极的害虫管理和其他减少过敏原的努力对哮喘相关的临床健康结果产生积极影响是一致的。我们的研究结果强调了城市哮喘的多因素性质，并建议需要进一步研究哮喘干预计划中环境和社会因素的相对贡献和可能的协同作用。(c) 2006 Elsevier Ltd.版权所有。
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. (c) 2006 Elsevier Ltd. All rights reserved.