ENVIRONMENTAL INTERVENTIONS TO IMPROVE CHILDRENS HEALTH

室内家居环境存在一系列健康风险， 包括哮喘的诱因和铅等有毒物质的暴露， 杀虫剂和挥发性有机物。少数民族和低收入人口 在许多情况下暴露的风险都会增加，儿童 对它们的影响最为敏感。哮喘是一种重要的健康 这些暴露的后果及其发病率和死亡率出现 稳步增长，特别是在低收入儿童中。我们 假设一套全面的干预措施提供了 由准专业社区家居环境专家 (CHES)和社区志愿者家庭环保大师 (MHEs)将降低哮喘发病率并减少总暴露 室内环境健康风险负担。CHES将进行一次 低收入家庭的初步家庭环境评估 2-17岁的哮喘儿童，随后在接下来的15年中进行9次就诊 几个月内，CHE将与租户合作，提供 全面的教育和社会支持方案， 鼓励改变行为，提供材料以减少 暴露(床罩、吸尘器、门垫、清洁工具包)和 帮助倡导改善住房条件。届时，MHEs将会 与家庭一起工作多一年。有效性将是 使用交叉设计的随机对照试验进行评估 并衡量为在增加知识、改变行为方面的成功 和改善室内环境质量导致减少 暴露、改善与哮喘相关的健康状况并降低健康水平 服务利用率。200户家庭将被随机分配到 最初收到了全面的CHES套餐，而200 更多的家庭将接受家庭环境评估 从MHE和床单上取下来的。15个月后，第一组 将接受医疗保险公司的跟进，而第二家将收到 全面的套餐。除了随机的、受控的 试验中，我们将进行一项观察性研究(前/后设计) MHE组件的影响。高度的社区化 在整个发展过程中，都有参与 求婚。该项目是由Low-Low合作开发的 收入租户、社区机构、环境正义 组织，当地卫生部门，疾控中心赞助的西雅图 城市研究中心和华盛顿大学。会是 总部设在多元文化健康中心，这是一个社区机构，拥有 社区外展的悠久历史。我们将使用参与式 确保社区真正参与的行动研究方法 这个项目的所有阶段。

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.