标题：The Seattle-King County Healthy Homes Project: A Randomized, Controlled Trial of a Community Health Worker Intervention to Decrease Exposure to Indoor Asthma Triggers
摘要：Objectives. We assessed the effectiveness of a community health worker intervention focused on reducing exposure to indoor asthma triggers. Methods. We conducted a randomized controlled trial with 1-year follow-up among 274 low-income households containing a child aged 4–12 years who had asthma. Community health workers provided in-home environmental assessments, education, support for behavior change, and resources. Participants were assigned to either a high-intensity group receiving 7 visits and a full set of resources or a low-intensity group receiving a single visit and limited resources. Results. The high-intensity group improved significantly more than the low-intensity group in its pediatric asthma caregiver quality-of-life score ( P =.005) and asthma-related urgent health services use ( P =.026). Asthma symptom days declined more in the high-intensity group, although the across-group difference did not reach statistical significance (P= .138). Participant actions to reduce triggers generally increased in the high-intensity group. The projected 4-year net savings per participant among the high-intensity group relative to the low-intensity group were $189–$721. Conclusions. Community health workers reduced asthma symptom days and urgent health services use while improving caregiver quality-of-life score. Improvement was greater with a higher-intensity intervention. Asthma prevalence and morbidity among children in the United States have increased dramatically in the past 2 decades and remain high. 1 Exposure and sensitization to allergens and irritants found in the indoor environment are major factors in the development and exacerbation of asthma. 2– 4 Wheezing, asthma, and exposure to asthma triggers are associated with specific home environmental conditions, such as dampness and carpeting. 2, 5 In recent years, the “Healthy Homes” model has emerged as a promising approach for reducing exposure to indoor asthma triggers. 6– 8 The Healthy Homes model involves conducting home environmental audits to assess multiple exposures, motivating participants to take low-cost actions, and offering advice, tools to reduce exposures, and advocacy for improved housing. The National Institute of Environmental Health Sciences, 9 the Department of Housing and Urban Development, 10 and the Environmental Protection Agency 11 have recognized the potential of the Healthy Homes approach and have funded research and demonstration projects. Initial Healthy Homes programs had certain limitations. Evidence from rigorously conducted evaluations regarding their effectiveness was lacking. They did not focus on the urban, low-income, ethnically diverse households that are disproportionately affected by asthma. 12 Community health workers (CHWs) seem well suited to implementing the Healthy Homes approach among these households. 13– 16 However, evidence of CHW effectiveness in improving health outcomes is limited. 14 In particular, the effectiveness of a CHW-based Healthy Homes program for controlling asthma has not been assessed. Therefore, we developed the Seattle–King County Healthy Homes Project. We tested the hypothesis that a high-intensity intervention would be more effective than a low-intensity intervention for changing asthma-related behaviors, reducing trigger exposure, and decreasing asthma morbidity among low-income, ethnically diverse urban households. The high-intensity intervention consisted of 7 home visits by CHWs over a year and a full set of trigger control resources, whereas the low-intensity intervention included a single home visit and limited resources.
