Asthma and the home environment of low-income urban children: Preliminary findings from the seattle-king county healthy homes project

Krieger, James; Song, Lin; Takaro, Timothy; Stout, James

doi:10.1007/bf02350962

Cited by 86 publications

(54 citation statements)

References 56 publications

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“…Fiftythree percent of caretakers had completed high school, and 8% had completed college. We have reported additional characteristics and baseline findings elsewhere (69).…”

Section: Seattle-king County Healthy Homes Overviewmentioning

confidence: 99%

The Seattle-King County healthy homes project: implementation of a comprehensive approach to improving indoor environmental quality for low-income children with asthma.

Krieger

Takaro

Allen

et al. 2002

Environ Health Perspect

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127

102

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Pediatric asthma is a growing public health issue, disproportionately affecting low-income people and people of color. Exposure to indoor asthma triggers plays an important role in the development and exacerbation of asthma. We describe the implementation of the Seattle-King County Healthy Homes Project, a randomized, controlled trial of an outreach/education intervention to improve asthma-related health status by reducing exposure to allergens and irritants in the home. We randomly assigned 274 low-income children with asthma ages 4-12 to either a high- or a low-intensity group. In the high-intensity group, community health workers called Community Home Environmental Specialists (CHES) conducted initial home environmental assessments, provided individualized action plans, and made additional visits over a 12-month period to provide education and social support, encouragement of participant actions, provision of materials to reduce exposures (including bedding encasements), assistance with roach and rodent eradication, and advocacy for improved housing conditions. Members of the low-intensity group received the initial assessment, home action plan, limited education during the assessment visit, and bedding encasements. We describe the recruitment and training of CHES and challenges they faced and explain the assessment and exposure reduction protocols addressing dust mites, mold, tobacco smoke, pets, cockroaches, rodents, dust, moisture, and toxic or hazardous chemicals. We also discuss the gap between the practices recommended in the literature and what is feasible in the home. We accomplished home interventions and participants found the project very useful. The project was limited in resolving structural housing quality issues that contributed to exposure to indoor triggers.

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“…Fiftythree percent of caretakers had completed high school, and 8% had completed college. We have reported additional characteristics and baseline findings elsewhere (69).…”

Section: Seattle-king County Healthy Homes Overviewmentioning

confidence: 99%

The Seattle-King County healthy homes project: implementation of a comprehensive approach to improving indoor environmental quality for low-income children with asthma.

Krieger

Takaro

Allen

et al. 2002

Environ Health Perspect

Self Cite

127

102

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show abstract

“…Allergen sensitization is common among inner-city children with asthma, often as an extension or correlate of exposure to substandard housing (17)(18)(19). Skin prick testing for 14 common indoor and outdoor allergens, completed as part of the National Cooperative Inner-City Asthma Study with children aged 4-9 years recruited from emergency departments and inner-city clinics, demonstrated that 77% had at least one positive skin test and 47% had at least three (20).…”

mentioning

confidence: 99%

Allergen Sensitization Profiles in a Population-Based Cohort of Children Hospitalized for Asthma

Beck¹,

Huang

Kercsmar

et al. 2015

Annals ATS

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Rationale: Allergen sensitization is associated with asthma morbidity. A better understanding of allergen sensitization patterns among children hospitalized for asthma could help clinicians tailor care more effectively. To our knowledge, however, sensitization profiles among children hospitalized for asthma are unknown.Objectives: We sought to describe allergen sensitization profiles and the distribution of self-reported in-home exposures among children hospitalized for asthma. We also sought to assess how sensitization profiles varied by sociodemographic and clinical factors.Methods: This population-based cohort study includes data for 478 children, aged 4-16 years, hospitalized for an asthma exacerbation. Predictors included child age, race, sex, insurance status, reported income, salivary cotinine, exposure to traffic-related air pollution, asthma and atopic history, and season of admission. Outcomes included serum IgE specific to Alternaria alternata/A. tenuis, Aspergillus fumigatus, American cockroach, mouse epithelium, dust mite (Dermatophagoides pteronyssinus and farinae), cat dander, and dog dander (deemed sensitive if IgE > 0.35). Self-reported adverse exposures included mold/mildew, water leaks, cockroaches, rodents, and cracks or holes in the walls or ceiling. Presence of carpeting and furry pets was also assessed.Measurements and Main Results: More than 50% of included patients were sensitized to each of Alternaria, Aspergillus, dust mite, cat dander, and dog dander; 28% were sensitized to cockroach and 18% to mouse. Roughly 68% were sensitized to three or more allergens with evidence of clustering. African American children, compared with white children, were more likely to be sensitized to Alternaria, Aspergillus, cockroach, and dust mite (all P , 0.01). White children were more likely to be sensitized to mouse, cat, and dog (all P , 0.01). Lower income was associated with cockroach sensitization whereas higher income was associated with dog and cat sensitization (all P , 0.01). Atopic history was associated with sensitization to three or more allergens (P , 0.01). Although 42% reported exposure to at least one adverse in-home exposure (and 72% to carpet, 51% to furry pets), only weak relationships were seen between reported exposures and sensitizations.Conclusions: Most children admitted to the hospital for asthma exacerbations are sensitized to multiple indoor allergens. Atopy on the inpatient unit serves as a potential target for improvement in chronic asthma management.

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“…Despite this fact, even in the USA, where most of the research on this topic is conducted, parents or surrogates of asthmatic children associate the cause of asthma attacks with tobacco smoke, fungi, dust, and inhaled irritants, but not with cockroaches. 2 As exposure is chronic, and often goes unnoticed by household members because cockroaches hide from view most of the time, living in a parallel universe, there is usually no reference to the development of symptoms as a result of exposure to cockroaches.…”

Section: Dear Editormentioning

confidence: 99%

“…Sensitization to cockroach allergens, a problem that predominantly affects urban residents, has been more deeply implicated in the etiology of asthma, mainly regarding more severe clinical symptoms among socioeconomically underprivileged patients. 2 In a study carried out in São Paulo, which used skin tests to determine atopic sensitization, we observed the remarkable presence of sensitization to cockroach allergens (Blattella germanica and Periplaneta americana) in a group of asthmatic adolescents (22.3 and 16.5%, respectively) compared to non-asthmatic individuals (controls) (0 and 0%, respectively). In the asthmatic group, the rate of BHR was significantly higher among sensitized adolescents, compared to nonsensitized ones.…”

mentioning

confidence: 93%

Alergia a baratas: fator de risco para asma de maior gravidade

Camelo-Nunes¹,

Solé²

2006

J. Pediatr. (Rio J.)

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Asthma and the home environment of low-income urban children: Preliminary findings from the seattle-king county healthy homes project

Cited by 86 publications

References 56 publications

The Seattle-King County healthy homes project: implementation of a comprehensive approach to improving indoor environmental quality for low-income children with asthma.

The Seattle-King County healthy homes project: implementation of a comprehensive approach to improving indoor environmental quality for low-income children with asthma.

Allergen Sensitization Profiles in a Population-Based Cohort of Children Hospitalized for Asthma

Alergia a baratas: fator de risco para asma de maior gravidade

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