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2001 Progress Report: Community-Based Intervention: Reducing Risks of Asthma
EPA Grant Number: R827027C001Subproject: this is subproject number 001 , established and managed by the Center Director under grant R827027
(EPA does not fund or establish subprojects; EPA awards and manages the overall grant for this center).
Center: CECEHDPR - Columbia University School of Public Health
Center Director: Perera, Frederica P.
Title: Community-Based Intervention: Reducing Risks of Asthma
Investigators: Perera, Frederica P.
Institution: Columbia University
EPA Project Officer: Fields, Nigel
Project Period: August 1, 1998 through July 31, 2001 (Extended to October 31, 2004)
Project Period Covered by this Report: November 1, 2000 through October 31,2001
Project Amount: Refer to main center abstract for funding details.
RFA: Centers for Children's Environmental Health and Disease Prevention Research (1998)
Research Category: Children's Health , Health Effects
Description:
Objective:The Community-Based Intervention consists of two projects, one focused on educating women living in Northern Manhattan about environmental risks to children’s health, and the other focused on integrated pest management to reduce pests and allergens in the home. The specific aims of the first project, the Community Education Intervention (CEI), remain unchanged. They are to: (1) determine community knowledge and attitudes about environmental health hazards and what can be done to prevent or reduce them; (2) develop and implement strategies to teach community residents and organizations in Northern Manhattan about environmental hazards and what can be done to prevent or reduce them; and (3) assess the degree to which the intervention reaches members of the community and changes the behavior of those exposed. The aims of the second project, the Indoor Pollution and Allergen Control Intervention (IPAC) have been changed. Originally, we had planned to enroll 120 children aged 2 years with the highest potential for asthma and allergic disease from the Mothers and Newborns Study cohort (see R827027C002 and R827027C003) into a randomized trial of integrated pest management (IPM). Our original hypothesis was that IPM would reduce pest populations and allergen levels, and these reductions would in turn lower or delay the development of cockroach specific IgE in the children. Several factors, however, have led us to change the design. First, Center investigators have reached the conclusion that it is important to continue the Mothers and Newborns Study until age five or beyond, and our original plan to intervene with some of these children at age 2 would conflict with that plan. Second, during a concurrent study of IPM (ES09142; Patrick Kinney, PI), we have encountered difficulties in reducing cockroach population and allergen levels in individual apartments in the aging housing stock of Northern Manhattan. We believe that this is partly due to our inability to intervene in the public spaces of the privately owned buildings in which the study participants live.
To address these issues, we have established a partnership with the New York City Department of Health’s (NYCDOH) Bureau of Community HealthWorks to evaluate the impact of a building-wide IPM program they have developed with the Hunter College Center for Occupational and Environmental Health and the New York City Housing Authority. This program is based on the EPA-funded pilot IPM project at Lehman Houses in East Harlem, and with new funding from New York City, will be extended to public housing located in Central and East Harlem, the South Bronx, and Northern Brooklyn. The program involves a community-based approach to providing IPM for entire buildings in both public spaces and private apartments. The intervention team hires and trains public housing residents to perform IPM under supervision of the program staff. By holding meetings and providing education for building residents and maintaining a constant presence in the building, the program has succeeded in reaching a majority of the residential apartments in the buildings. The IPM intervention includes: (1) repair of cracks, holes, and water leaks; (2) intensive cleaning to reduce existing allergen and pesticide levels; (3) use of low toxicity pest control measures (gels and bait stations) to reduce cockroach populations; and (4) education for the family about how to maintain the IPM intervention. The pilot program has shown promising results in reducing cockroach populations in kitchens and nearby areas, but the NYCDOH does not have the expertise or funding to conduct a full-scale evaluation of the intervention’s impact on pest populations, allergen levels, or pesticide levels in the home.
Working with the NYCDOH-Hunter intervention team, we plan to enroll up to 150 households with children in a controlled study in buildings located in Harlem and the South Bronx ; 75 households will be in buildings assigned to receive immediate intervention and 75 households in buildings that will receive a delayed intervention, thus serving as controls. Data will be collected from each participating household at baseline, 3 months, and 6 months following the intervention. We will evaluate the impact of the program on pest populations by placing glue traps for cockroaches and census block baits to test for the presence of mice. Impact on allergen levels will be evaluated by collecting vacuumed dust samples from the kitchen, hallways, and bedrooms of the apartments. Impact on pesticide levels, which are expected to decrease as low toxicity gels and bait stations are used in place of sprays, will be assessed by urine samples collected from children and parents at baseline and 6-month follow-up. Impact on respiratory symptoms will be assessed through interviews with children’s caregivers. We will test the hypothesis that this innovative, community-based, building-wide intervention will reduce pest populations and allergen levels in intervention apartments, and will reduce pesticide levels and respiratory symptoms in children and adults residing in the apartments.
Progress Summary:CEI
The Healthy Home, Healthy Child campaign was launched in Northern Manhattan on June 26, 2000, with a public event at which materials were distributed to hundreds of commuters in Harlem. This event received excellent publicity. Our primary campaign strategy, however, has been to work with community organizations to deliver the campaign materials in group sessions that allow for exploration of campaign themes in greater depth than public leafleting activities. During the year, staff from WE ACT made presentations and distributed campaign materials at meetings of 26 different organizations, including community organizations, schools, churches, health care organizations, and local government community boards, reaching 852 community residents who attended the meetings. To expand our ability to reach the Northern Manhattan community, we have invited members of the Center’s Community Advisory Board (CAB) to participate in the campaign. CAB members are identifying health educators from their organizations to deliver presentations, and we are working collaboratively to develop training to help them master the environmental issues, and to develop evaluation procedures to assess the impact of their activities. Limited funding will be provided to each organization to pay for the educators’ time based on the scope of work agreed upon.
Significance
The primary significance from the results of the CEI focus groups and surveys held over the past years is the finding that community members define the “environment” broadly, including a variety of quality of life issues. The health and environmental concerns identified by the investigators and community residents overlap, but differ in important ways. The survey results show that women in Northern Manhattan have high levels of awareness of environmental risks, and take many appropriate actions to reduce them. There are, however, many important protective steps that are not widely used that create an opportunity for an educational campaign to improve the health of children and their families living in Northern Manhattan and the South Bronx. For the IPAC intervention, we anticipate that our revised design will enable us to determine whether a community-based, building-wide IPM intervention in public housing can reduce pest populations and allergen levels in the home, and whether these reductions have an impact on the frequency of respiratory symptoms in children. The study will also enable us to determine whether use of IPM reduces exposure to pesticides in the home.
Project-Generated Resources
The CEI study has generated written health education materials for distribution in the community. These materials are available on the Center Web site at http://www.mailman.hs.columbia.edu/ccceh/index.html 
.
The CEI Campaign will continue to be implemented throughout the year with evaluation occurring simultaneously. The IPAC intervention will begin enrolling families in August 2001.
Supplemental Keywords:children, exposure, asthma, PM, particulate matter, ETS, allergen, infants, community intervention. , Air, Scientific Discipline, Health, RFA, Susceptibility/Sensitive Population/Genetic Susceptibility, Biology, Risk Assessments, genetic susceptability, Health Risk Assessment, Children's Health, particulate matter, Environmental Chemistry, Allergens/Asthma, environmentally caused disease, environmental hazard exposures, low income community, allergen, health effects, inhalation, respiratory problems, dust , dust mite, assessment of exposure, dust mites, human health risk, outreach and education, toxics, cockroaches, community-based intervention, sensitive populations, biological response, airway disease, biological markers, children, school based study, asthma, human exposure, Human Health Risk Assessment, model, PM
Relevant Websites:
http://www.mailman.hs.columbia.edu/ccceh/index.html
Progress and Final Reports:
2000 Progress Report
Original Abstract
2002 Progress Report
Main Center Abstract and Reports:
R827027 CECEHDPR - Columbia University School of Public Health
Subprojects under this Center:
(EPA does not fund or establish subprojects; EPA awards and manages the overall grant for this center).
R827027C001 Community-Based Intervention: Reducing Risks of Asthma
R827027C002 Growth and Development/Evaluation of Carcinogenic Risks
R827027C003 Research Project on Asthma