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Healthy Homes for All: Improving Children’s Health in Diverse Communities University of Massachusetts Lowell UMass Med

Healthy Homes for All: Improving Children’s Health in Diverse Communities University of Massachusetts Lowell UMass Medical School David Turcotte, ScD Heather Alker , MD, MPH Emily Chaves, MA Susan Woskie, PhD Worcester State University

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Healthy Homes for All: Improving Children’s Health in Diverse Communities University of Massachusetts Lowell UMass Med

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  1. Healthy Homes for All: Improving Children’s Health in Diverse Communities University of Massachusetts LowellUMass Medical School David Turcotte, ScD Heather Alker, MD, MPH Emily Chaves, MA Susan Woskie, PhD Worcester State University Rebecca Gore, PhD Stephanie Chalupka, EdD Fred Youngs, PhD Joann Vaillette, MA Lowell Community Health Center Carla Caraballo BophamonyVong

  2. Presenter Disclosures David Turcotte, ScD Joann Vaillette, MA Emily Chaves, MA Susan Woskie, PhD Rebecca Gore, PhD Fred Youngs, PhD Heather Alker, MD, MPH Carla Caraballo Bophamony Vong “No relationships to disclose”

  3. Funded by the U.S. Department of Housing and Urban Development Why asthma? Why Lowell? • High asthma rate • Diverse community • Poor housing stock • Community health partners

  4. U.S. Asthma Rates • General Population 8.2% • Puerto Rican 16.6% (National Health Statistics report on asthma prevalence in the United States, 2011) • Hospitalization rates for asthmatic children age 0-4 • Massachusetts 430 per 100,000 • Lowell 805 per 100,000 (Asthma report for Lowell mortality and hospital data. Massachusetts DPH, 2007-2009)

  5. Project Goals: FamiliesFirst time home buyers Home assessmentsEducation Home interventions Education Partners Education

  6. Partners & Roles • University of Massachusetts Lowell • Lowell Community Health Center • Coalition for a Better Acre • Community Teamwork, Inc. • Lowell Housing Authority • Merrimack Valley Housing Partnership

  7. Families – who are they? • Live in Lowell, MA • Have at least one child with asthma (<=14) • Low-moderate income • 165 families enrolled (245 children)

  8. What is Asthma? • A serious & sometimes life-threatening respiratory disease • Affects the quality of life for millions of Americans • No cure for Asthma yet • Can be controlled through medical treatment & management of environmental triggers

  9. Indoor Environment and Asthma • Americans spend up to 90% of their time indoors • Indoor concentrations of most pollutants are higher than outdoor

  10. Indoor Environment and Asthma • Indoor allergens and irritants can play significant roles in triggering asthma attacks • Ex: pet dander, mice, cockroaches, dust mites, harsh chemicals, fragrances, smoke, moisture/mold, pollen • Important to recognize potential asthma triggers & reduce exposure

  11. Home Intervention - Assessment • Health/environmental assessments • Health questionnaire with parent • Environmental walk-through assessment • Environmental questionnaire with parent • Dust sampling

  12. Education, Supplies, Remediation Based on findings from assessment: • Education • Dust mites and healthy cleaning practices • Pets • Avoiding pests • Moisture/mold control • Smoking • Air pollution (indoor & outdoor) • Safety • Supplies • HEPA vacuum • Allergen-proof mattress and pillow covers • Trash can with lid • Food containers • Non-toxic cleaner • Baits and traps for pests • Safety items

  13. Education, Supplies, Remediation Cont. • Remediation • Carpet removal • Install ventilation • Integrated Pest Management (IPM) • Industrial cleaning

  14. Mid-term Assessment • Health questionnaire (abbreviated) • Environmental questionnaire (abbreviated) • More supplies if needed • Reinforce education

  15. Final Assessment • Health questionnaire • Environmental questionnaire • Environmental walk-through • Gift certificate

  16. Accomplishments • Conducted 178 home assessments • Completed 160 interventions • Evaluation of intervention effectiveness (midterms & final assessments) • Trained 75 partner staff in HH practices • Provided HH education to 1,537 community members

  17. Results

  18. Housing conditions at baseline – Outdoor sources of pollution Trucks drive on street Often – 42% Occ. – 25%

  19. Change in housing conditions

  20. Change in housing conditions

  21. Changes in housing conditions - Mold

  22. Change in Asthma Trigger Activities

  23. Health Results – Asthma Severity

  24. Health Results – Change in CHSA Scores (scores range from 0-100)

  25. Health Results – Med use • Reduced use of asthma medication (Reported use in prior 4 weeks) • Baseline: 145 of 164 using meds (88%) • Final: 101 of 164 using meds (62%)

  26. Cost Savings from Health Outcome Improvements *The hospitalization and ER data was provided by the MA Department of Public Health assessment of average charges in Lowell in 2010 due to usage because of asthma.  **The $100 per doctor visits is an estimated average cost based on discussions with local doctors’ offices.

  27. Which components of our interventions had the biggest impact on health outcomes? • No component was associated with health improvements on its own • Asthma Trigger indices: • Allergen Risk Index • Chemical Risk Index • Cleaning Risk Index • No statistically significant associations • Conclusion: Single-component interventions or interventions of smaller scope may not result in positive health outcomes for asthmatics.

  28. Allergen Risk Index • Any pet • Pet in bedroom • Rug (wall to wall or area) • Mold • Rodents • Cockroach • Feather bedding • No allergen pillow cover • No allergen mattress cover Chemical Risk Index • Use air freshener • Use candles • Use cleaning chem. most days • Used pesticides in past month • Smoking • Professional rug cleaning* • Gas stove* Cleaning Risk Index • Infrequent dusting in child’s room • Infrequent mopping in child’s room • Wash linens • Does not wash linens in hot water • Does not dry linens with hot air • Food debris in kitchen*

  29. Conclusions • Prevalence of Environmental Asthma Triggers • Multi-trigger, multi-component interventions improve health and emotional well-being • Decrease in healthcare utilization & medication use • Incentive for medical providers/insurers to fund interventions • Importance of lay community health outreach workers • Involve key stakeholders to increase impact • Research needed on optimal intervention design to maximize ROI

  30. Contact Information David Turcotte, Sc.D. University of Massachusetts Lowell Email: David_Turcotte@uml.edu Telephone: (978) 934-4682 Emily Chaves, M.A. University of Massachusetts Lowell Email: Emily_Vidrine@uml.edu Telephone: (978) 934-4778

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