摘要：Objectives. We assessed the benefits of adding weatherization-plus-health interventions to an in-home, community health worker (CHW) education program on asthma control. Methods. We used a quasi-experimental design to compare study group homes (n = 34) receiving CHW education and weatherization-plus-health structural interventions with historical comparison group homes (n = 68) receiving only education. Data were collected in King County, Washington, from October 2009 to September 2010. Results. Over the 1-year study period, the percentage of study group children with not-well-controlled or very poorly controlled asthma decreased more than the comparison group percentage (100% to 28.8% vs 100% to 51.6%; P = .04). Study group caregiver quality-of-life improvements exceeded comparison group improvements ( P = .002) by 0.7 units, a clinically important difference. The decrease in study home asthma triggers (evidence of mold, water damage, pests, smoking) was marginally greater than the comparison group decrease ( P = .089). Except for mouse allergen, the percentage of study group allergen floor dust samples at or above the detection limit decreased, although most reductions were not statistically significant. Conclusions. Combining weatherization and healthy home interventions (e.g., improved ventilation, moisture and mold reduction, carpet replacement, and plumbing repairs) with CHW asthma education significantly improves childhood asthma control. Asthma is a major public health and environmental justice issue associated with multiple interacting environmental and other factors. Asthma prevalence and morbidity among all US children have increased dramatically in the past 2 decades and remain high. 1 Asthma disproportionately affects disadvantaged populations, who have a higher prevalence of the disease 1–4 and experience more severe impacts. 5–12 Being poor or a person of color is associated with increased rates of sensitization to several asthma-associated allergens. 13–20 Sensitization to airborne allergens is one of the main risk factors for developing asthma and its complications. 21–23 Disparities in asthma morbidity and allergic sensitization may be due, in part, to disproportionate exposure to indoor environmental asthma triggers associated with substandard housing. 12,24,25 Moisture and dampness, poor ventilation, crowding, residence in multiunit dwellings, deteriorated carpeting, and structural defects can contribute to high levels of indoor asthma triggers. In its Guide to Community Preventive Services, 26 the US Centers for Disease Control and Prevention (CDC) summarized studies 27–35 showing that home visits, in particular those performed by community health workers (CHWs) and addressing multiple asthma triggers, improve self-management behaviors, reduce exposure to triggers, decrease symptoms and urgent health care use, and increase quality of life. The US Department of Housing and Urban Development (HUD), 36 US Environmental Protection Agency, 37 and CDC 26 recommend home visits, and the National Asthma Education and Prevention Program 38 recommends that home visits be considered, but notes that this area needs more research. The historical Seattle–King County Healthy Homes II (HH-II) project studied the effectiveness of CHW home visits for controlling asthma. 39 CHWs provided in-home education and helped participants implement action plans that addressed multiple triggers. The study found that the CHW home education program was relatively inexpensive, significantly reduced asthma morbidity and trigger exposure, and improved caregivers’ quality of life. The HH-II study also found that adding CHW home visits to clinic-based asthma education yielded a clinically important increase in asthma-symptom-free days and modestly improved caretakers’ quality of life. 39 However, the homes of many low-income asthmatic children needed structural interventions beyond the scope of the home visit program. In this Highline Communities Healthy Homes Project, we used a quasi-experimental design to determine whether adding weatherization-plus-health structural interventions to an existing home CHW home visit program resulted in greater reductions in asthma morbidity and exposure to home asthma triggers than reductions achieved for the historical HH-II comparison group receiving CHW home education visits alone. Over 100 000 homes are weatherized each year, 40 yet we found no studies that examined the impact of weatherization work on resident asthma outcomes.
