Home Air In Agriculture - Pediatric Intervention Trial (HAPI)

描述（由申请人提供）：我们以社区为基础的参与性研究旨在减少居住在密集的乳制品和农作物农业生产地区的拉丁裔儿童的环境正义社区家庭中的哮喘暴露。这些患有哮喘的儿童发病率很高，我们的初步研究发现，环境中细颗粒物和氨的浓度对哮喘有显著影响。然而，孩子们大部分时间都呆在室内。在城市环境中进行的研究表明，室内颗粒物（PM）会影响哮喘结果，而高效微粒空气净化器（HEPA）可以减少室内和环境中产生的PM。关于农村地区哮喘的数据很少，并且缺乏使用HEPA便携式空气净化器的试验。这项研究试图描述居住在作物生产或乳制品操作400米范围内的[75名哮喘儿童]的主要室内污染物暴露特征。受试者招募利用现有的社区卫生工作者提供哮喘教育计划，该计划由该地区的联邦合格卫生中心运营。患有哮喘控制不佳的6-12岁儿童将被随机分配到通常的教育计划或增强版，其中包括2个便携式房间HEPA清洁剂（儿童睡眠区，客厅）[过滤器旨在减少PM和氨（NH3）]。常规项目组的孩子将在学年结束时获得高效微粒空气过滤器。优先选择参与者负担低且具有创新性的方法

DESCRIPTION (provided by applicant): Our community based participatory research seeks to reduce exposure to asthmagens in the homes of an environmental justice community of Latino children residing in an area of intense dairy and crop based agricultural production. These children with asthma experience high morbidity and our preliminary research finds significant effects of ambient concentrations of fine particulate matter and ammonia. Yet children spend the majority of their time indoors. Studies conducted in urban settings demonstrate that indoor particulate matter (PM) influences asthma outcomes and HEPA (high efficiency particulate air) cleaners can reduce indoor and ambient generated PM. Data on asthma in rural settings is sparse and trials incorporating HEPA portable air cleaners are lacking. This study seeks to characterize key indoor pollutant exposures for [75 children with asthma] who reside within 400 meters of crop production or dairy operations. Subject recruitment utilizes an existing community health worker delivered asthma education program operated by the region's federally qualified health center. Children aged 6-12 years with poorly controlled asthma will be randomized to the usual educational program or an enhanced version, which includes 2 portable room HEPA cleaners (child sleeping area, living room) [with filters designed to reduce PM and ammonia (NH3)]. Children in the usual program group will receive HEPA cleaners at the end of their study year. Prioritizing methods with low participant burden as well as innovative approaches, we will evaluate the effectiveness of the enhanced intervention on 1) Reducing indoor measures of PM and NH3 across seasons, 2. Improving clinically relevant measures of asthma health (Asthma Control Questionnaire, spirometer, oral steroid treatment, unscheduled clinical utilization), and 3. Reducing biomarkers of inflammation (urinary cysteine leukotriene - LTE4, exhaled nitric oxide). Caregiver psychosocial stress and behavioral components will be evaluated as mediators of these effects. The study design, procedures, translation of research results for multiple stakeholders and development of an environmental action plan to control/eliminate exposures are conducted within El Proyecto Bienestar, a longstanding UW-community research to action partnership. The project incorporates each of the NIEHS 2012-17 strategic themes and directly addresses 7 of the 11 sub goals.