The Head-off Environmental Asthma in Louisiana (HEAL) Study—Methods and Study Population

Abstract

Background: In the city of New Orleans, Louisiana, and surrounding parishes (NOLA), children with asthma were perilously impacted by Hurricane Katrina as a result of disrupted health care, high home mold and allergen levels, and high stress.Objectives: The Head-off Environmental Asthma in Louisiana (HEAL) study was conducted to examine relationships between the post-Katrina environment and childhood asthma in NOLA and assess a novel asthma counselor intervention that provided case management and guidance for reducing home mold and allergen levels.Methods: Children (4–12 years old) with moderate-to-severe asthma were recruited from NOLA schools. Over 1 year, they received two clinical evaluations, three home environmental evaluations, and the asthma intervention. Quarterly end points included symptom days, medication use, and unscheduled emergency department or clinic visits. A community advisory group was assembled and informed HEAL at all phases.Results: Of the children (n = 182) enrolled in HEAL, 67% were African American, and 25% came from households with annual incomes < $15,000. HEAL children were symptomatic, averaging 6.6 symptom days in the 2 weeks before baseline, and had frequent unscheduled visits to clinics or emergency departments (76% had at least one unscheduled visit in the preceding 3 months). In this report, we describe study design and baseline characteristics of HEAL children.Conclusions: Despite numerous challenges faced by investigators, study staff, and participants, including destroyed infrastructure, disrupted lives, and lost jobs, HEAL was successful in terms of recruitment and retention, the high quality of data collected that will provide insight into asthma-allergen relationships, and the asthma intervention. This success was attributable to using an adaptive approach and refining processes as needed.

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

“…The study design and methods, approved by the National Institute of Environmental Health Sciences and the Tulane and Louisiana State Universities' Institutional Review Boards, are described in detail elsewhere [9]. The objective of the study was to investigate the relationships between childhood asthma morbidity and asthma triggers, including environmental exposures, in a postdisaster setting.…”

“…Afterward, the children underwent an extensive clinical evaluation to confirm eligibility and collect baseline data using survey instruments adopted from NCICAS and ICAS and modified for HEAL [9]. Procedures included the collection of medical histories (emphasizing respiratory symptoms and asthma medications), pulmonary function testing, and blood assays.…”

Adapting and implementing an evidence-based asthma counseling intervention for resource-poor populations

“…However, after six months only 77 children were enrolled necessitating a study redesign which included recruiting only children with known diagnosed asthma, extending the recruitment period, and changing to a pre-post intervention all while retaining the study’s original objectives. Additional details on this change are previously reported [8]. …”

Decreased Pulmonary Function Measured in Children Exposed to High Environmental Relative Moldiness Index Homes

“…Many previous publications have describe the HEAL study, the methods used, the population demographics, the exposures measured, and the outcomes [9-12]. No attempt will be made to repeat this background but it is briefly summarized below.…”