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Tribal Environmental Improvements for Children’s Asthma

Tribal Environmental Improvements for Children’s Asthma. Jill Heins Nesvold, MS Director Respiratory Health American Lung Association of the Upper Midwest Jill.Heins@Lung.Org. Structure. Multi-state partnership Pine Ridge Reservation, SD Cheyenne River Reservation, SD

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Tribal Environmental Improvements for Children’s Asthma

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  1. Tribal Environmental Improvements for Children’s Asthma Jill Heins Nesvold, MSDirector Respiratory Health American Lung Association of the Upper Midwest Jill.Heins@Lung.Org

  2. Structure • Multi-state partnership • Pine Ridge Reservation, SD • Cheyenne River Reservation, SD • Standing Rock Reservation, ND and SD • Little Earth of United Tribes, MN • N = 172 homes • 60% between 5-18 yo

  3. More extensive intervention onPine Ridge Reservation Assessed children’s environmental hazards Reviewed 10-years of public health ordinances Built coalition Developed strategic plan Built capacity of 97 tribal professionals, including experiential education

  4. Methods Initial home visit Follow-up visit with limited education Evaluation follow-up at 3 and 12 months Extensive triggers/remediations referred to housing authority

  5. Findings - Demographics 59% - smoking in the home 62% - pets in the home 67% - non-optimal heat source 81% - non-optimal odor source 91% - maintenance issues(but NOT statistically related to ACT)

  6. Findings - Impact • In school more = 6 days/year • Fewer symptoms: • Daytime = p=0.033 • Nighttime = p=0.1 • Improved control p=.0001 (at baseline, 62% had ACT score below 19) • Near “normal” activities = p.0032 • Less impact on family life p=0.09

  7. Prioritization of hazards/triggers Non-optimal heat source WAS linked to asthma control Maintenance (mold/pests) issues were NOT related to control Focus bedroom triggers (78% of severe persistent asthmatics moved to moderate or mild persistent at 12 months. 44% of moderate persistent asthmatics moved to mild at 12 months).

  8. Lessons Learned Skill of home visitor matters You will loose families to follow-up Build relationship with housing authority, but may loose opportunity for follow-up Difficult to prioritize when housing stock is poor

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