Asthma is one condition that disproportionately affects poor and minority children living in inner-city neighborhoods. African American children have some of the highest rates documented, and Chicago has been shown to be among the hardest hit cities. The proposed project, the Chicago Westside Partnership for Children's Asthma Initiative (CWPC-AI), aims to translate the Seattle-King County Healthy Homes (SKCHH) environmental intervention model into one that is culturally appropriate and effective for children with poorly controlled asthma living in the poor, African American Westside Chicago community of North Lawndale. A collaborative approach drawing on the strengths of several partners and incorporating full and meaningful participation by the community will be utilized. The initiative builds on the experiences of the Sinai Urban Health Institute (SUHI) and Sinai Children's Hospital (SCH) in conducting and evaluating home-based pediatric asthma interventions utilizing Community Health Workers (CHW). The Metropolitan Tenant's Organization (MTO) will provide support in training CHWs to conduct a thorough environmental assessment, and to work with families in modifying the home environment and behaviors in a way that will reduce exposure to asthma triggers. An MTO Housing Advocate will handle environmental situations beyond the expertise of the CHW. The initiative will also partner with SUHI's Breathing Freedom program, a North Lawndale community-based smoking cessation program, to reduce secondhand smoke exposure among children who have asthma. Attorneys working for Health & Disability Advocates (HDA) will provide pro bono assistance in resolving housing and other issues requiring legal intervention. The Sinai Community Institute (SCI) and Chicago Asthma Consortium (CAC) will build upon their strong community connections in assembling a Community Advisory Committee, which will be instrumental in guiding the intervention process and in developing key relationships necessary in ensuring the success of the initiative. Our goal is to enroll 360 children into CWPC-AI over an 18-month recruitment period, with the intention of completing the entire 12-month intervention with 250 (70%) of the enrolled participants. CHWs will make 5-6 home visits over the course of the intervention, during which they will comprehensively educate the family on asthma and its proper management, focusing heavily on both improving medical management (e.g., recognizing and reacting appropriately to asthma symptoms, medication techniques, etc.) and reducing exposure to home triggers. Referrals to MTO and HDA will be made as necessary. Evaluation activities will focus on documenting the process of the intervention and the associated outcomes (effectiveness). Monitoring of the process is particularly important as it will allow for an assessment of the intervention's translatability, documenting the successes and challenges of implementing the program within the target community, and paving the way for the translation of the initiative to other populations. Qualitative methods will supplement quantitative data collection in better documenting issues related to translatability, assessing both community strengths which facilitate implementation and challenges that impede upon it, and the process of addressing any barriers. One of the specific aims of the project is to significantly impact asthma-related measures of morbidity, urgent health resource utilization and quality of life. Therefore, progress will be monitored towards 2 primary goals (to decrease asthma-related morbidity and to improve quality of life) and 3 intermediate goals (to decrease the number of asthma triggers in the home environment, to improve asthma-related knowledge of the child's primary caregiver and to improve the caregiver's self-efficacy to properly manage asthma). In all instances, a pre-post study design will be utilized, with each participant serving as his/her own historical control. The study has more than adequate power to detect effect sizes that are clinically meaningful. Substantial attention will be paid to matters of fidelity, uptake and other issues that will influence translatability. Throughout, we will operate with the explicit goal of being able to sustain this project after the initial funding has expired. The community, Community Advisory Committee, and all partnering agencies, will work collaboratively to ensure that the approach and its effects are sustained. Through this collaborative approach and implementation of an evidence-based intervention it is believed that CWPC-AI will significantly impact asthma health disparities, ultimately helping to close the gap. ? ?
? ? African American children have been shown to have some of the highest rates of asthma documented, and Chicago has been demonstrated to be among the hardest hit cities. The Sinai Urban Health Institute (SUHI) and Sinai Children's Hospital (SCH) have sought to improve asthma management among inner-city children with asthma by providing individualized education in several interventions and published their results. The Chicago Westside Partnership for Children's Asthma Initiative (CWPC-AI), is an effort of translational intervention for pediatric asthma employing the Seattle-King County Healthy Homes model, an established intervention for pediatric asthma, as our foundation; and responding to two of the priority areas set forth in the FOA by the National Center for Environmental Health: (1) Healthy Homes and Communities - research to translate evidence-based interventions to address disparities in health outcomes related to environmental conditions in the home and/or communities; (2) Asthma - patient/guardian attitudes toward use of inhaled corticosteroids. ? ? ?
