The Utility of Virtual Home Visits to Reduce Asthma Burden in Low-Income Black Communities in Louisiana During the COVID-19 Pandemic.

OBJECTIVES: The Louisiana Department of Health identified a need for greater outreach in low-income Black communities that addressed environmental asthma triggers. We piloted an asthma virtual home visit (VHV) program and evaluated its reach and ability to promote asthma self-management strategies in communities with a high prevalence of poorly controlled asthma. METHODS: Participants from Louisiana were continuously recruited into the VHV program starting in March 2021 and provided with asthma education materials. Participants reporting poorly controlled asthma and environmental triggers were also offered 3 VHVs with a respiratory therapist. All participants were asked to complete a preintervention and postintervention knowledge test, an Asthma Control Test (ACT) (maximum score = 25; scores ≤19 indicate poorly controlled asthma), and a final survey that assessed perceptions about asthma management and reduction of environmental triggers. RESULTS: As of October 2022, 147 participants were enrolled in the program, and 52 had consented to and received ≥1 VHV. Forty VHV recipients (77%) were aged <18 years, 40 (77%) were Black people, and 46 (88%) were from families with extremely low or low incomes. Asthma symptoms improved across all participants, with a median increase of 2.4 points on the ACT. Knowledge tests revealed that 86% of participants learned about ≥1 new asthma trigger; a larger percentage of VHV recipients than nonrecipients (68% vs 36%) had an improved knowledge test score postintervention. Compared with preintervention, about three-quarters of participants reported feeling more empowered to self-manage their asthma and a significant improvement in their quality of life postintervention. CONCLUSIONS: The program provided virtual asthma education to communities with a high burden of asthma and improved asthma outcomes for participants. Similar virtual models can be used to promote health equity, especially in areas with limited access to health care.

Identifying Louisiana communities at the crossroads of environmental and social vulnerability, COVID-19, and asthma.

The COVID-19 pandemic has disproportionately affected the socially and environmentally vulnerable, including through indirect effects on other health conditions. Asthma is one such condition, which may be exacerbated by both prolonged adverse in-home exposures if quarantining in unhealthy homes and prolonged outdoor exposures if the ambient air quality is unhealthy or hazardous. As both are often the case in Environmental Justice (EJ) communities, here we have analyzed data at the census tract (CT) level for Louisiana to assess any correlation between social and environmental vulnerability, and health issues like COVID-19 and asthma. Higher Social Vulnerability Index (SVI), Particulate Matter less than 2.5 µm in diameter (PM2.5) and Ozone levels were associated with higher rates of cumulative COVID-19 incidence at various time points during the pandemic, as well as higher average annual asthma hospitalization rates and estimated asthma prevalence. Further, cumulative COVID-19 incidence during the first three months of the pandemic was moderately correlated with both asthma hospitalizations and estimated prevalence, suggesting similar underlying factors may be affecting both conditions. Additionally, 137 CTs were identified where social and environmental vulnerabilities co-existed, of which 75 (55%) had high estimated prevalence of asthma. These areas are likely to benefit from asthma outreach that considers both social and environmental risk factors. Fifteen out of the 137 CTs (11%) not only had higher estimated prevalence of asthma but also a high burden of COVID-19. Further research in these areas may help to elucidate any common social determinants of health that underlie both asthma and COVID-19 burdens, as well as better clarify the possible role of the environment as related to the COVID-19 burden in Louisiana.

A review of adult asthma hospitalizations in Louisiana, 2006-2011.

This paper examines asthma inpatient hospitalizations for Louisiana residents ages 15 years and older from 2006 to 2011. There were 21,398 asthma hospitalizations, with 14,401 unique cases. Approximately 22 percent of cases had more than one asthma hospitalization. The case rate of adults hospitalized for asthma decreased significantly during the six-year period. However, the rate of all adult hospitalizations for asthma did not significantly change. Black women had the highest age-adjusted case rate, followed by white women. Days hospitalized averaged from 2.8 to 4.9 among the youngest to the oldest age groups, respectively. Differences between black and white patients were observed in type of payment and admit source. Parish rates varied significantly: Caldwell, Jefferson Davis, and LaSalle had rates that were at least twice the mean state rate. Rural parishes had a significantly higher rate than non-rural parishes. The information in this review can be used to target outreach and prevention activities.

Emergency department visits for carbon monoxide poisoning in LA.

Carbon monoxide (CO) poisoning is preventable, yet it remains one of the most common causes of poisoning in the United States. This analysis was performed to estimate the number of emergency department (ED) visits in 2010 in Louisiana for all-cause (fire-related, non-fire, and unknown) unintentional CO poisoning. Results demonstrate approximately 1,696,746 total ED visits occurred in 2010. Among these, an estimated 116 individuals were diagnosed with CO poisoning (68 CO cases per million ED visits; 26.2 CO cases per million population). Emergency Department visits for CO poisoning occurred most frequently in the winter months. Caddo, Jefferson, and Orleans parishes had the highest numbers of CO poisonings in 2010. The most common symptoms included headache, hypertension, nausea, and dizziness. The ED database presented more cases of the most common CO poisoning cases (non-fatal) than previously used surveillance databases. This study demonstrated the utility and importance of ED data as a surveillance tool.

Fishing, fish consumption and advisory awareness among Louisiana's recreational fishers.

This paper presents results from the first known population-based survey of recreational fishers in Louisiana (n=1774). The ultimate goal of this study was to obtain data in support of the development of regional advisories for a high exposure population with unique seafood consumption patterns. Between July and August of 2008, a survey was mailed to a random sample of licensed recreational fishers to characterize local fishing habits, sportfish consumption, and advisory awareness. Eighty-eight percent of respondents reported eating sportfish. Respondents ate an estimated mean of four fish meals per month, of which, approximately half were sportfish. Over half of all sportfish meals (54%) were caught in the Gulf of Mexico or bordering brackish areas. Sportfish consumption varied by license and gender; and was highest among Sportsman's Paradise license holders (2.8±0.2 meals per month), and males (2.2±0.1 meals per month). The most frequently consumed sportfish species were red drum, speckled trout, catfish, bass, crappie and bream. Advisory awareness rates varied by gender, ethnicity, geographic area, license type, age and education; and were lowest among women (53%), African-Americans (43%), fishers from the southeast of Louisiana (50%), holders of Senior Hunting and Fishing licenses (51%), individuals between 15 and 19 years of age (41%), and individuals with less than a high school education (43%). Results were used to identify ways to optimize monitoring, advisory development and outreach activities.

Acute illnesses associated with pesticide exposure at schools.

CONTEXT: Pesticides continue to be used on school property, and some schools are at risk of pesticide drift exposure from neighboring farms, which leads to pesticide exposure among students and school employees. However, information on the magnitude of illnesses and risk factors associated with these pesticide exposures is not available. OBJECTIVE: To estimate the magnitude of and associated risk factors for pesticide-related illnesses at schools. DESIGN, SETTING, AND PARTICIPANTS: Analysis of surveillance data from 1998 to 2002 of 2593 persons with acute pesticide-related illnesses associated with exposure at schools. Nationwide information on pesticide-related illnesses is routinely collected by 3 national pesticide surveillance systems: the National Institute for Occupational Safety and Health's Sentinel Event Notification System for Occupational Risks pesticides program, the California Department of Pesticide Regulation, and the Toxic Exposure Surveillance System. MAIN OUTCOME MEASURES: Incidence rates and severity of acute pesticide-related illnesses. RESULTS: Incidence rates for 1998-2002 were 7.4 cases per million children and 27.3 cases per million school employee full-time equivalents. The incidence rates among children increased significantly from 1998 to 2002. Illness of high severity was found in 3 cases (0.1%), moderate severity in 275 cases (11%), and low severity in 2315 cases (89%). Most illnesses were associated with insecticides (n = 895, 35%), disinfectants (n = 830, 32%), repellents (n = 335, 13%), or herbicides (n = 279, 11%). Among 406 cases with detailed information on the source of pesticide exposure, 281 (69%) were associated with pesticides used at schools and 125 (31%) were associated with pesticide drift exposure from farmland. CONCLUSIONS: Pesticide exposure at schools produces acute illnesses among school employees and students. To prevent pesticide-related illnesses at schools, implementation of integrated pest management programs in schools, practices to reduce pesticide drift, and adoption of pesticide spray buffer zones around schools are recommended.