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King County Housing Authority
600 Andover Park W
Tukwila, WA 98188

Sharon Bogan, Communications
Public Health - Seattle & King County
(206) 263-8770

Jill Breysse, Program Manager
National Center for Healthy Housing
(443) 539-4155

New evidence supports innovative approach to reduce asthma in poor children

Study published in American Journal of Public Health concludes that combining public health worker home visits with weatherization interventions results in greater improvement in the control of asthma in children than public health work home visits alone

Feb. 5, 2014

Asthma is the most common chronic condition of childhood, especially among low-income families.  New evidence shows that combining in-home support to families with physical home improvements can have meaningful results to better control the chronic lung disease.

So concluded a recent study initiated by the King County Housing Authority and conducted by the National Center for Healthy Housing. The study, “Effect of Weatherization Combined with Community Health Worker In-Home Education on Asthma Control”, was published online in the January edition of the American Journal of Public Health.

“Asthma can be significantly mitigated by a combination of family education and home repairs,” said Stephen Norman, executive director of the King County Housing Authority.  “Teaming up with Public Health− Seattle & King County enabled us to achieve better outcomes for families than either agency could have accomplished by itself. The results of the study point to exciting future possibilities for joint program design between housing authorities and local public health departments,” Norman said.

In addition to the public health problem, asthma significantly disrupts the lives of children and their families in other ways. The most common cause of school absenteeism due to chronic conditions, for example, is asthma. A body of previous scientific research has documented an increased risk to academic performance and social adjustment among children with asthma as compared with well children.

Patricia Gonzales of SeaTac, who participated in the study, experienced first-hand the benefits of this twofold approach, which greatly alleviated the suffering of her son, Abraham.

In 2011, Gonzales usually had to take then- 11-year-old Abraham to the doctor or the hospital once a week because of his severe asthma and allergies.

Under the pilot program called Highline Communities Healthy Homes, Public Health – Seattle & King County community health workers helped to identify asthma triggers and counseled families about how to control asthma through effective use of medication and access appropriate medical care when needed.

The King County Housing Authority made weatherization improvements to the homes which, for the Gonzales family, also included the installation of ventilation fans to improve indoor air quality. These fans reduce moisture in the air which reduces asthma triggers like mold and dust mites, which need moisture to grow. Additionally, carpeting, which traps dust and other allergens, was removed and leaking faucets, which were causing mold, were replaced.

Now, when Gonzales and Abraham visit the health clinic just once a year for routine care, the doctor smilingly asks her, “Why don’t you come and see me anymore?”

It’s been nearly three years since the Gonzales family participated in the program and Abraham continues to be “doing great” according to Gonzales.

Gonzales attributes the success equally to both strategies. “Getting rid of the carpet and reducing the moisture in our home with better ventilation and a new furnace made a big difference,” said Patricia Gonzales.  “Also, how I used to clean the house has completely changed – no more chemicals, no more fragrance. Now I use baking soda and vinegar.”

Jill Breysse, program manager with the National Center for Healthy Housing, worked with KCHA and Public Health to design and manage the research study.

“We have long known that trained community health workers can successfully work with families to improve a child’s asthma,” said Breysse. “This study’s findings show that even greater benefits can be achieved when community health programs are coupled with weatherization programs that repair the home itself.  This project also shows that partnerships between weatherization and public health agencies are feasible and effective.”

How the study was conducted

Between October 2009 and September 2010, KCHA completed weatherization work and healthy home repairs for 40 low-income households living in Southwest King County, each with at least one asthmatic child. Public Health – Seattle & King County provided community health workers to provide in-home education to improve asthma self-management skills and help participants implement action plans that addressed multiple asthma triggers. Interested families with at least one child with moderate to severe asthma attending Highline District schools or Head Start were referred by school nurses or health care workers to Public Health – Seattle & King County to assess their eligibility to participate in the study.

The link with schools was critical because inability to manage asthma in children strongly correlates with school absenteeism which is a significant cause of academic underachievement and other problems in school.

“Like other chronic health problems, preventing and controlling asthma is not just about individual behavior,” said Dr. James Krieger, chief of the chronic disease and injury prevention section of Public Health ­ Seattle & King County. “It takes changing the unhealthy environments where people live, and supporting them to develop the knowledge and skills to make meaningful differences in their health.”

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