Community health worker (CHW)-delivered, home-based environmental interventions for pediatric asthma were systematically reviewed. Seven PubMed/MEDLINE listed randomized controlled trials that encompassed the following intervention criteria were identified: (1) home-based; (2) delivered by a CHW; (3) delivered to families with children with asthma; and (4) addressed multiple environmental triggers for asthma. Details of research design, intervention type, and setting, interventionist, population served, and the evaluated outcomes were abstracted. Outcome assessment was broad and non-uniform. Categories included direct mediators of improved health outcomes, such as trigger-related knowledge, trigger reduction behaviors and allergen or exposure levels, and asthma-related health outcomes: change in lung function, medication use, asthma symptoms, activity limitations, and health care utilization. Indirect mediators of health outcomes, or psychosocial influences on health, were measured in few studies. Overall, the studies consistently identified positive outcomes associated with CHW-delivered interventions, including decreased asthma symptoms, daytime activity limitations, and emergency and urgent care use. However, improvements in trigger reduction behaviors and allergen levels, hypothesized mediators of these outcomes, were inconsistent. Trigger reduction behaviors appeared to be tied to study-based resource provision. To better understand the mechanism through which CHW-led environmental interventions cause a change in asthma-related health outcomes, information on the theoretical concepts that mediate behavior change in trigger control (self-efficacy, social support) is needed. In addition, evaluating the influence of CHWs as clinic liaisons that enhance access to health professionals, complement clinic-based teaching, and improve appropriate use of asthma medications should be considered, alongside their effect on environmental management. A conceptual model identifying pathways for future investigation is presented.

The intervention yielded significant improvements in both outcomes. This evidence supported the need for a policy discussion addressing the added value that broadbased public health nurse interventions might bring to children's environmental health.

Purpose: Implementing the recent American Academy of Pediatrics' (AAP) policy for annual well water testing will impact pediatric healthcare providers, who will be called upon for advice regarding testing, interpretation, and mitigation. We report findings from a study of low‐income rural families' participation in household well water testing. Data sources: We collected data from 188 rural low‐income households inclusive of 320 children under the age of seven. Participating families lived in one of two western U.S. counties and received water from a well with < 15 connections. Household water samples and questionnaire data were collected for analysis. Conclusions: Twenty‐seven percent of households tested positive for at least one contaminant, including total coliforms (18%), arsenic (6%), synthetic organic chemicals (6%), nitrates (2%), fluoride (2%), and E. coli (<1%). Eighty‐nine percent of households testing positive for total coliforms were positive at re‐test. Respondents expressed greatest concern for biological contamination and took multiple precautionary actions, although only 31% had ever tested their water for contaminants. Higher levels of education, income, and age, as well as homeowner status, were significantly associated with previous testing. Implications for practice: Recommendations for communicating abnormal results, mitigating risks, and overcoming logistical challenges are presented.

Parents are well-positioned to build trust with childcare providers, assess asthma triggers, and recommend practical mitigation strategies.

Results support the need for active partnerships between caregivers and providers. Photographs can serve as the basis for reciprocal education between patient and provider, especially in the area of environmental triggers. Provider visits should include assessment, strategies and resources to maximize IAQ. Photovoice facilitates caregivers' ability to advocate for improved asthma management and health equity.