Impact of a Household Environmental Intervention Delivered by Lay Health Workers on Asthma Symptom Control in Urban, Disadvantaged Children With Asthma

Abstract

Objectives. We examined whether a home-based educational and environmental intervention delivered by lay health educators would improve asthma symptom control in inner-city children with asthma. Methods. Children 2 to 16 years of age with diagnosed asthma and at least 1 asthma-related hospitalization or 2 emergency visits in the prior year were randomly assigned into 2 groups (immediate and delayed intervention) in a crossover study. Each group participated in the active phase (intervention) and the inactive phase. Outcomes included asthma symptoms, albuterol use, emergency department visits, hospitalizations, and trigger reduction. Results. A total of 264 primarily Black (94%) children were enrolled. The mean number of emergency visits decreased by 30% and inpatient visits decreased by 53% (P < .001) after the intervention. Reductions were seen in pests, presence of carpets in bedrooms, and dust. Nighttime wheezing was significantly reduced after the intervention in both groups (P < .001). Conclusions. Lay health educators effectively reduced asthma triggers and increased caregiver asthma knowledge, which resulted in reduced emergency department visits, hospitalizations, and asthma symptoms. The relationships formed between the caregivers and the lay health educators appeared to positively impact asthma outcomes in this disadvantaged population.

Impact of Community Health Workers on Use of Healthcare Services in the United States: A Systematic Review

“…48 There were three cohort studies that examined ED use, two of which showed significant decreases in ED use in the intervention group. 49,50 Hospitalizations Seventeen studies (50%) assessed the effect of the CHW intervention on hospitalizations, primarily during the CHW intervention. Of the seven RCTs, six showed no significant decrease in hospitalizations relative to a control or a randomized observation group.…”

“…One showed a decrease in costs without significance given 52 ; two indicated a significant decrease relative to an observation cohort. 5,49 Urgent Care Visits…”

“…40,54,59 Three pre-post studies found a decrease in preventable use relative to baseline. 43,45,46 One cohort study found no change in emergency medication use, 49 while another (the only study that measured medication costs) noted a significant decrease in nonnarcotic prescription costs for the control cohort relative to the CHW group. 5 …”

Homes of low-income minority families with asthmatic children have increased condition issues

“…4,11,12 Cracks allow pests such as rodents and bugs to enter the home. 12 Inadequate ventilation can result in high concentrations of environmental tobacco smoke, allergens, carbon dioxide, radon, and volatile organic compounds. 12 The effects of these household airborne exposures on asthma are very complex.…”

“…12 Inadequate ventilation can result in high concentrations of environmental tobacco smoke, allergens, carbon dioxide, radon, and volatile organic compounds. 12 The effects of these household airborne exposures on asthma are very complex. They can be further modified by many coexposures such as endotoxin and nitrogen oxides further complicating the relationships between indoor environmental parameters and asthma-related outcomes.…”