Assessing indoor asthma triggers in urban homes of children with asthma through a household walk-through.

Abstract

This dissertation examines the frequency of asthma triggers in the homes of a sample of three hundred and eighteen asthmatic children in eastside and southwest Detroit, Michigan using an observational assessment. It also tests the agreement between the observational assessment of the home environment using household walk-through (HWT) data and the assessment using dust sampling. Finally, this dissertation evaluates the impact of allergen and irritant exposure in the home environment on asthma health status and child and caregiver asthma-related quality of life. The data for this dissertation is from the Community Action Against Asthma (CAAA) project of the Michigan Center for the Environment and Children's Health (MCECH). The majority of the data is from a baseline HWT in which trained community members visited the homes of CAAA participants to identify asthma triggers. One central element of this dissertation is the creation of allergen or irritant-specific composite scores. This dissertation found the greatest evidence of exposure to environmental tobacco smoke (ETS), cockroaches, rodents, fungi/mold, and dust mites. A total of 24.5% of CAAA participants were exposed to a combination of five allergens or irritants. Few homes of CAAA participants used allergen or irritant control strategies. This dissertation also found HWT composite scores to be closely associated with asthma classification and asthma-related symptoms. Overall, the direct evidence of exposure composite scores (especially cockroach, fungi/mold and the multiple allergen or irritant composite score) performed best across asthma health outcomes in multivariate analysis. This dissertation validated the use of observational assessment to identify allergen or irritant exposure in the home environment. There are modest positive correlations between the dust sampling results and the HWT composite scores (range 0.20 to 0.51). Finally, this dissertation affirmed the importance of using a comprehensive assessment of the home environment (including the importance of assessing allergen or irritant exposures occurring in combination with one another). By using the HWT results in concert with information about a child's asthma health status and allergen sensitivity, an intervention can be tailored to address the most salient asthma triggers.