The aim of this study is to lower the risk of asthma in young African American and Hispanic children living in northern Manhattan through two interventions, one at the community level and one at the household level. For the Community Education Intervention (CEI) the Center and its community partners, coordinated by West Harlem Environmental Action, Inc (WE ACT) will join with other community based organizations, including Alianza Dominicana, to develop, implement, and evaluate a community wide intervention to increase awareness of environmental health hazards, particularly airborne pollutants and allergens, and educate community members to take action and events held throughout Northern Manhattan. The CEI will be delivered through a combination of written and audiovisual materials, and public meetings and events held throughout Northern Manhattan. The CEI will be evaluated with data from maternal questionnaires from the cohort of 400 mothers enrolled in the developmental studies (see Ford and Perera projects). Using a single group pre-test-post-test research design, we hypothesize that from baseline to follow-up 24 months later the CEI intervention will: 1.1 Reach 10% of the wp,em aged 18-35 living in Northern Manhattan; and 1.2 Increase the percentage pf wp,em aged 18-35 who take steps to prevent or reduce environmental hazards in their households or in the community. The household intervention will consist of an Indoor Pollution and Allergen Control childhood. When the cohort of 400 children research their second birthday, we will enroll the 120 children (30%) with the highest total IgE levels--the best predictor of asthma at any age--for a one year trial of environmental strategies to prevent asthma. Enrolled families will be randomly assigned to treatment or control studies, and we will intervene in treatment group households to (a) clean and seal the preparation that includes antioxidant vitamins A, C, and E and selenium (Se), and (c) provide the child's mother with written materials and one-to-one counseling by the health educator about the importance of and methods for reducing environmental tobacco smoke (ETS) in the home. Control group families will be given a placebo intervention that includes a multi- vitamin preparation for children that does not contain the anti-oxidant vitamins and written materials about reducing exposure to ETS. Baseline data will be collected at each child's second birthday (24 months) and follow up data will be collected at 30 months (household allergen levels) and 36 months (all measures). We hypothesize that from baseline to follow up the treatment group will have, relative to controls: 2.1 reduced plasma levels of cotinine in children; 2.2 reduced household levels of cockroach and dust mite allergen; 2.3 higher plasma levels of vitamins A, C, and E and Se in children; 2.4 lower sera levels of total, cockroach-specific, rodent-specific, and dust mite-specific IgE in children; 2.5 fewer clinical signs or symptoms of asthma or allergies in children.
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