ENVIRONMENTAL INTERVENTIONS TO IMPROVE CHILDRENS HEALTH

室内家居环境存在一系列健康风险， 包括哮喘诱因和接触有毒物质如铅， 杀虫剂和挥发性有机物。 少数族裔和低收入人口 在许多这些暴露的风险增加，儿童 对它们的影响最敏感。 哮喘是一个重要的健康 这些接触的后果及其发生率和死亡率似乎 尤其是在低收入家庭的儿童中。 我们 假设提供的一揽子综合干预措施 由准专业社区家庭环境专家 （CHES）和社区志愿者Master Home Environmentalist （MHE）将降低哮喘发病率并减少总暴露量 室内环境健康风险的负担。 CHES将进行一次 低收入家庭的初步家庭环境评估 2-17岁哮喘儿童，随后在接下来的15年中进行9次访问 在这几个月里，CHES将与租户合作， 全面的教育和社会支助一揽子计划， 鼓励行为改变，提供材料，以减少 暴露（床罩、真空吸尘器、门垫、清洁工具包）和 帮助倡导改善住房条件。 MHE将 与家庭一起工作一年。 有效性将 采用交叉设计的随机对照试验进行评估 并以增加知识、改变行为 改善室内环境质量， 暴露，改善哮喘相关的健康状况， 服务利用率。 200个家庭将被随机分配到 最初收到全面的CHES包，而200 更多的家庭将获得家庭环境评估 和床上用品的痕迹 15个月后，第一组 第一个将接受MHE的随访，第二个将接受 综合配套。 除了随机、对照 试验，我们将进行一项观察性研究（前/后设计）， MHE组件的影响。 高度社区化 在整个开发过程中， 提议 该项目是由一个低- 收入租户，社区机构，环境正义 组织，当地卫生部门，疾病预防控制中心赞助的西雅图 城市研究中心和华盛顿大学。 将 总部设在多元文化健康中心，一个社区机构， 有着悠久的社区外展历史 我们将使用参与式 行动研究方法，以确保真正的社区参与 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.