Indoor Environmental Exposures for Children with Asthma Enrolled in the HEAL Study, Post-Katrina New Orleans

Abstract

Background: Rain and flooding from Hurricane Katrina resulted in widespread growth of mold and bacteria and production of allergens in New Orleans, Louisiana, which may have led to increased exposures and morbidity in children with asthma.Objectives: The goal of the Head-off Environmental Asthma in Louisiana (HEAL) study was to characterize post-Katrina exposures to mold and allergens in children with asthma.Methods: The homes of 182 children with asthma in New Orleans and surrounding parishes were evaluated by visual inspection, temperature and moisture measurements, and air and dust sampling. Air was collected using vacuum-pump spore traps and analyzed for > 30 mold taxa using bright field microscopy. Dust was collected from the children’s beds and bedroom floors and analyzed for mouse (Mus m 1), dust mite (Der p 1), cockroach (Bla g 1), and mold (Alternaria mix) allergens using ELISA.Results: More than half (62%) of the children were living in homes that had been damaged by rain, flooding, or both. Geometric mean indoor and outdoor airborne mold levels were 501 and 3,958 spores/m3, respectively. Alternaria antigen was detected in dust from 98% of homes, with 58% having concentrations > 10 µg/g. Mus m 1, Der p 1, and Bla g 1 were detected in 60%, 35%, and 20% of homes, respectively, at low mean concentrations.Conclusions: Except for Alternaria antigen in dust, concentrations of airborne mold (ratio of indoor to outdoor mold) and dust allergens in the homes of HEAL children were lower than measurements found in other studies, possibly because of extensive post-Katrina mold remediation and renovations, or because children moved into cleaner homes upon returning to New Orleans.

From Design to Dissemination: Implementing Community-Based Participatory Research in Postdisaster Communities

“…ajph.org) describes the methods standards deployed and the accompanying strategy to achieve those standards; many of these pertain to the overall HEAL Study components described extensively in previous publications. 7,8,19 Methods most directly applicable to the current investigation are discussed more specifically in the following subsections, in the context of the specific aims outlined in this section.…”

“…Home evaluators were told by parents and caretakers that they were welcomed into their homes because they were concerned about environmental (mold) exposure after Hurricane Katrina, and this was also demonstrated by the high number of participants agreeing to the environmental assessment in their home. 7 Strategy F: flexibility in study implementation; robust scheduling infrastructure. The robust scheduling infrastructure was generally reasonably successful, albeit extremely resource intensive.…”

“…8,[11][12][13] This is likely attributable to extensive remediation taking place after Hurricane Katrina and people moving into cleaner homes. 7 In fact, 94% of HEAL families had moved at least once since Katrina, 68% had initiated renovations that continued during the study, and 47% had completed home renovations before enrollment. 9 In this article, we describe our experience applying CBPR principles in conducting the study, assess their utility in the context of specific strategies we employed, and thereby provide an important perspective for future environmental public health studies conducted in postdisaster communities.…”

“…Results from home assessments and a successful environmental asthma counselor intervention are reported elsewhere and are summarized in the following paragraph. [7][8][9] HEAL demonstrated that an evidencebased environmental asthma counselor intervention can be implemented in a postdisaster setting to improve asthma management and assess environmental exposures. We used a novel combination of the efficacious National Cooperative Inner-City Asthma Consortium (NCICAS) asthma counselor intervention 10 and the Inner-City Asthma Study (ICAS) environmental intervention 11 to intervene on 182 participants enrolled in the HEAL Study.…”

Few Associations Found between Mold and Other Allergen Concentrations in the Home versus Skin Sensitivity from Children with Asthma after Hurricane Katrina in the Head-Off Environmental Asthma in Louisiana Study

“…Dust samples were collected from the child's bedroom floor and bed using standardized methods [13]. Bed dust was analyzed for the presence of German cockroach (Bla g 1), dust mite (Der p 1), mouse (Mus m 1), and Alternaria (Alt a 1) [17]. Samples with insufficient quantities of bed dust were supplemented or replaced with bedroom floor dust.…”