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以乳制品和农作物为基础的农业生产密集地区的拉美裔儿童的环境正义社区家庭中的哮喘风险。这些哮喘儿童的发病率很高，我们的初步研究发现，环境中细颗粒物和氨的浓度会产生显著影响。然而，孩子们的大部分时间都在室内度过。在城市环境中进行的研究表明，室内颗粒物(PM)影响哮喘的结果，HEPA(高效颗粒空气)清洁剂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，而且缺乏使用HEPA便携式空气净化器的试验。这项研究试图确定[75名哮喘儿童]的关键室内污染物暴露的特征，这些儿童居住在离农作物生产或奶制品生产400米以内的地方。受试者招募利用现有的社区卫生工作者提供的哮喘教育计划，由该地区具有联邦资格的卫生中心运营。6-12岁哮喘控制不佳的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清洁器(儿童睡眠区、起居室)[配有旨在减少PM和氨(NH3)的过滤器]。通常项目组的孩子将在学年结束时接受HEPA清洁剂。具有低参与者负担和创新性的优先排序方法 我们将评估加强干预的有效性：1)减少室内跨季节PM和NH3的测量；2.改善哮喘健康的临床相关措施(哮喘控制问卷、肺活量计、口服类固醇治疗、非计划临床应用)；3.减少炎症的生物标志物(尿半胱氨酸白三烯-LTE4、呼出的一氧化氮)。照顾者的心理社会压力和行为因素将被评估为这些影响的中介因素。研究设计、程序、为多个利益攸关方转换研究结果以及制定控制/消除暴露的环境行动计划都是在El Proyecto Bienestar内进行的，El Proyecto Bienestar是一个长期的华盛顿大学社区从研究到行动的伙伴关系。该项目纳入了NIEHS 2012-17年的每一个战略主题，并直接涉及11个次级目标中的7个。

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.