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Assessing Impact of an Asthma Intervention for Children

  • By: NYSHealth
  • Date: July 2017
  • Priority Area: Special Projects Fund
  • Type: Grant Outcome Reports
  • Category: Grant Outcome Report
  • Grantee Name: Fund for Public Health in New York, Inc.

Overview

In the Bronx, the number of children hospitalized for asthma-related reasons is 38% higher than the City average. This disparity is largely associated with indoor allergens from pests, such as mice and cockroaches, which can trigger and exacerbate asthma symptoms. More than 50% of Bronx households report seeing cockroaches and mice in their homes or buildings daily. In contrast, children living in pest-free homes experience fewer asthma-related complications, from school absences to emergency room visits and hospitalizations. The Fund for Public Health New York (FPHNY) designed an Integrated Pest Management (IPM) intervention to address the burden of asthma faced by children in the Bronx. Rather than employing pesticides, IPM eliminates pests by addressing housing conditions conducive to infestation. NYSHealth supported FPHNY, in collaboration with the New York State Department of Health and Montefiore Medical Center, to rigorously evaluate its IPM intervention.

Grantee: Fund for Public Health in New York, Inc. / FPHNY

Dates: March 2014 - July 2016

Grant Amount: $ 300,000

Grantee Website: http://www.fphnyc.org/

Grant ID: 13-02575


FPHNY’s goal was to demonstrate the feasibility of implementing an IPM intervention; evaluate changes in asthma outcomes and asthma-related health system utilization; assess the costs and return on investment for the IPM intervention; and report findings and support policies to adopt insurance reimbursement for IPM interventions.

Outcomes and Lessons Learned:

  • Recruited 393 children for the IPM intervention from the Bronx, northern Manhattan, and Harlem. Participating children were randomized into a control group or intervention group.
  • Conducted a randomized control trial to evaluate the IPM intervention for children between the ages of 5 to 12 years old with persistent asthma living in homes with pests.
  • Followed participants for one year and conducted assessments at baseline, six months, and at completion.

FPHNY initially encountered recruitment challenges for the study. To address this challenge, the recruitment period was extended for six months, and the trial was expanded to include participants from northern Manhattan and Harlem. FPHNY also expanded its engagement with community-based organizations in the Bronx during the extension period.

Although analysis of the data from 6 and 12 months continues, findings from the baseline assessment demonstrated the need for an intervention:

  • In a 2-week period, participants experienced asthma symptoms for an average of 5.8 days;
  • In a 2-week period, caregivers missed an average of 1.2 days of work as a result of their child’s asthma;
  • 59% of respondents lived with both mice and cockroaches in their homes;
  • 70% reported seeing mice in the past 3 months; and
  • 89% reported seeing cockroaches each week, on average noticing 14 per day.

Preliminary results revealed that a one-time, in-home IPM intervention decreased the number of severe self-reported asthma symptoms and the average number of symptom days. Future analyses will evaluate the intervention effects on health care utilization, cost-effectiveness, and return on investment to ultimately support policies for insurance reimbursement for IPM. In the meantime, members of the control group have been offered the intervention.

Co-Funding and Additional Funds Leveraged: FPHNY received a grant of $600,000 from the Robin Hood Foundation to support this project.