Subject(s)
Asthma/chemically induced , Environmental Exposure/adverse effects , Environmental Pollutants/toxicity , Lead/toxicity , Asthma/blood , Child , Child, Preschool , Cohort Studies , Environmental Exposure/analysis , Environmental Pollutants/blood , Female , Humans , Infant , Lead/blood , Logistic Models , Male , Retrospective Studies , Risk FactorsABSTRACT
BACKGROUND: Childhood asthma morbidity and mortality in New Orleans, Louisiana, is among the highest in the nation. In August 2005, Hurricane Katrina created an environmental disaster that led to high levels of mold and other allergens and disrupted health care for children with asthma. OBJECTIVES: We implemented a unique hybrid asthma counselor and environmental intervention based on successful National Institutes of Health asthma interventions from the National Cooperative Inner City Asthma (NCICAS) and Inner-City Asthma (ICAS) Studies with the goal of reducing asthma symptoms in New Orleans children after Hurricane Katrina. METHODS: Children (4-12 years old) with moderate-to-severe asthma (n = 182) received asthma counseling and environmental intervention for approximately 1 year. HEAL was evaluated employing several analytical approaches including a pre-post evaluation of symptom changes over the entire year, an analysis of symptoms according to the timing of asthma counselor contact, and a comparison to previous evidence-based interventions. RESULTS: Asthma symptoms during the previous 2 weeks decreased from 6.5 days at enrollment to 3.6 days at the 12-month symptom assessment (a 45% reduction, p < 0.001), consistent with changes observed after NCICAS and ICAS interventions (35% and 62% reductions in symptom days, respectively). Children whose families had contact with a HEAL asthma counselor by 6 months showed a 4.09-day decrease [95% confidence interval (CI): 3.25 to 4.94-day decrease] in symptom days, compared with a 1.79-day decrease (95% CI: 0.90, 2.67) among those who had not yet seen an asthma counselor (p < 0.001). CONCLUSIONS: The novel combination of evidence-based asthma interventions was associated with improved asthma symptoms among children in post-Katrina New Orleans. Post-intervention changes in symptoms were consistent with previous randomized trials of NCICAS and ICAS interventions.
Subject(s)
Allergens/toxicity , Asthma/epidemiology , Asthma/prevention & control , Asthma/etiology , Child , Child, Preschool , Cyclonic Storms , Disasters , Environmental Exposure , Female , Humans , Male , Morbidity , New Orleans/epidemiologyABSTRACT
The extensive flooding in the aftermath of Hurricanes Katrina and Rita created conditions ideal for indoor mold growth, raising concerns about the possible adverse health effects associated with indoor mold exposure. Studies evaluating the levels of indoor and outdoor molds in the months following the hurricanes found high levels of mold growth. Homes with greater flood damage, especially those with >3 feet of indoor flooding, demonstrated higher levels of mold growth compared with homes with little or no flooding. Water intrusion due to roof damage was also associated with mold growth. However, no increase in the occurrence of adverse health outcomes has been observed in published reports to date. This article considers reasons why studies of mold exposure after the hurricane do not show a greater health impact.
Subject(s)
Air Pollutants/adverse effects , Cyclonic Storms , Environmental Exposure/adverse effects , Fungi/growth & development , Critical Illness , Floods , Humans , New Orleans , Respiratory System/immunologyABSTRACT
Public policy can be an effective method of promoting public health and preventing disease in a population. The proposing and passing of a municipal ordinance regulating power-sanding of leaded paint in New Orleans is a policy-level intervention that implements a primary prevention measure to address a community-wide risk. The process of achieving policy change involves defining the problem and the proposed intervention, integrating the resources of the individuals and groups with a stake in the situation, and disseminating information to the general public and to legislators. The implementation of the ordinance regulating power-sanding in New Orleans is a community-level lead poisoning prevention strategy.
Subject(s)
Health Policy , Lead Poisoning/prevention & control , Child , Community Health Services/legislation & jurisprudence , Community Health Services/organization & administration , Health Services Research , Humans , Information Services , Lead Poisoning/epidemiology , Louisiana/epidemiologyABSTRACT
BACKGROUND: Exposure to lead hazards is a serious health concern for inner-city children. In the United States, the greatest contributor to an elevated lead level is lead exposure in the home. There are federal regulations to protect children in public housing developments from exposure to lead paint. The efficacy of these regulations has not been examined. METHODS: We assessed the association between residence in a public housing development and the risk of an elevated blood lead level among high-risk children in New Orleans. We did so by conducting a case-control study among 7121 children age 6 to 71 months who received a screening blood lead test from New Orleans public health clinics in 1998. RESULTS: We found elevated blood lead levels for 29% of children who were screened. Children residing in New Orleans housing developments had lead levels no different from those residing in nondevelopment housing when controlling for housing age, and child's sex and age (odds ratio = 0.93; 95% confidence interval = 0.77-1.1). CONCLUSIONS: Despite legislative efforts, public housing does not appear to protect children from elevated lead levels, calling into question the efficacy of existing regulations.
