ENVIRONMENTAL INTERVENTIONS TO IMPROVE CHILDRENS HEALTH

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The indoor home environment presents a range of health risks, including asthma triggers and exposures to toxics such as lead, pesticides and volatile organics. Minority and low income populations are at increased risk for many of these exposures and children are most sensitive to their effects. Asthma is an important health consequence of these exposures and its incidence and mortality appear to be steadily increasing, especially among low-income children. We hypothesize that a comprehensive package of interventions delivered by paraprofessional community home environmental specialists (CHES) and community volunteer Master Home Environmentalists (MHEs) will decrease asthma morbidity and reduce the total exposure burden of indoor environmental health risks. CHES will conduct an initial home environmental assessment in low-income households with asthmatic children ages 2-17, followed by nine visits over the next 15 months in which CHES will work with tenants, offering a comprehensive package of education and social support, encouragement of behavior changes, provision of materials to reduce exposures (bedding covers, vacuums, door mats, cleaning kits) and help in advocating for improved housing conditions. MHEs will then work with households for an additional year. Effectiveness will be assessed using a randomized, controlled trial with a crossover design and measured as success in increasing knowledge, changing behaviors and improving indoor environmental quality leading to reduced exposures, improved asthma-related health status and decreased health services utilization. 200 households will be randomly assigned to initially received the comprehensive CHES package while 200 additional households will receive a home environmental assessment from a MHE and bedding covers. After 15 months, the first group will receive follow-up from MHEs while the second will receive the comprehensive package. In addition to the randomized, controlled trial, we will conduct an observational study (pre/post design) of the impact of the MHE component. A high degree of community participation has been present throughout the development of this proposal. The project has been developed by a partnership of low- income tenants, community agencies, environmental justice organizations, the local health department, the CDC -sponsored Seattle Urban Research Center and the University of Washington. It will be based at the Center for Multicultural Health, a community agency with a long history of community outreach. We will use participatory action research methods to assure genuine community participation in all phases of this project.