Asthma is the most common chronic disease in childhood, and prevalence, hospitalization and mortality are increasing. This increase is most commonly seen in non-white, poor, inner city children. Although the causes of this epidemic are not clearly understood, lack of access to medical care, indoor and outdoor pollutants, and indoor and outdoor antigens seem important. Recent small-scale community intervention to reduce exposure to dust mites and other antigens has been shown to result in clinical improvement. Further, research is needed to evaluate community based interventions which will control a variety of antigens and pollutants. Inner city, primarily minority, children with asthma are being identified through a school based mobile asthmatic clinic, the Breathmobile, which delivers high quality, continuous care to these children. Working with school nurses and community organizations and the 3 Breathmobile units, we propose a comprehensive community-based intervention aimed at reducing asthma triggers in the home. The major goal of this study is to determine whether a comprehensive environmental health education program, enhanced by least toxic integrated pest management for cockroach control, will result in reduction in concentrations of antigens in household dust and/or improvement in clinical status among these children. The study population will consist of 300 children with chronic persistent asthma randomly selected from the 3,000 asthmatics identified by the school-based Breathmobile program. Children will be randomized into three groups: (1) 100 children will continue to receive usual care from the Breathmobile; (2) 100 children will receive usual care plus a standardized antigen-reduction strategy (STARS), a community based, family oriented environmental health training program; and (3) 100 children children will receive usual Breathmobile care plus STARS, enhanced by professional pest control and home cleaning. Exposure to environmental asthma triggers in the home will be assessed by measuring concentrations of dust mite antigen, and cockroach antigen, in house dust. Outcomes of interest include change in knowledge, change in concentration of antigen in house dust, school absence, clinical assessment of asthma severity, and medication use. Co-variates to be considered include exposure to environmental tobacco smoke, indoor and outdoor air pollutants, housing characteristics (such as molds, mildew, air conditioning) and demographics (such as family size, gender, ethnicity). In years 4 and 5 of the intervention, the community based infrastructure developed in years 1-3 to support the evaluation of the strategies for reducing exposure to environmental asthma triggers will be transferred to cooperating community groups and greatly expanded to provide household asthma audits, education, and intervention service at low cost upon referral from school nurses and the Breathmobile program. To evaluate efficacy, 200 asthmatic children will be randomized into 2 groups. One will receive usual care, the other, community intervention services.
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