The Head-off Environmental Asthma in Louisiana (HEAL) Study—Methods and Study Population

Patricia C. Chulada,¹ Suzanne Kennedy,² Mosanda M. Mvula,³ Katy Jaffee,² Jeremy Wildfire,² Eleanor Thornton,⁴ Richard D. Cohn,⁵ L. Faye Grimsley,⁶ Herman Mitchell,² Jane El-Dahr,⁷ Yvonne Sterling,⁸ William J. Martin,⁹ LuAnn White,⁶ Kevin U. Stephens,³ and Maureen Lichtveld⁶

¹Clinical Research Program, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, North Carolina, USA; ²Rho Federal Systems Division, Inc., Chapel Hill, North Carolina, USA; ³New Orleans Health Department, New Orleans, Louisiana, USA; ⁴Visionary Consulting Partners, LLC, Fairfax Station, Virginia, USA; ⁵SRA International, Inc., Durham, NC, USA; ⁶School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA; ⁷Department of Pediatrics, Tulane University School of Medicine, New Orleans, Louisiana, USA; ⁸Health Sciences Center School of Nursing, Louisiana State University, New Orleans, Louisiana, USA; ⁹National Institute of Child Health and Development, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, USA


Abstract

Background: In the city of New Orleans, Louisiana, and surrounding parishes (NOLA), children with asthma were perilously impacted by Hurricane Katrina as a result of disrupted health care, high home mold and allergen levels, and high stress.


Objectives: The Head-off Environmental Asthma in Louisiana (HEAL) study was conducted to examine relationships between the post-Katrina environment and childhood asthma in NOLA and assess a novel asthma counselor intervention that provided case management and guidance for reducing home mold and allergen levels.


Methods: Children (4–12 years old) with moderate-to-severe asthma were recruited from NOLA schools. Over 1 year, they received two clinical evaluations, three home environmental evaluations, and the asthma intervention. Quarterly end points included symptom days, medication use, and unscheduled emergency department or clinic visits. A community advisory group was assembled and informed HEAL at all phases.


Results: Of the children (n = 182) enrolled in HEAL, 67% were African American, and 25% came from households with annual incomes < $15,000. HEAL children were symptomatic, averaging 6.6 symptom days in the 2 weeks before baseline, and had frequent unscheduled visits to clinics or emergency departments (76% had at least one unscheduled visit in the preceding 3 months). In this report, we describe study design and baseline characteristics of HEAL children.


Conclusions: Despite numerous challenges faced by investigators, study staff, and participants, including destroyed infrastructure, disrupted lives, and lost jobs, HEAL was successful in terms of recruitment and retention, the high quality of data collected that will provide insight into asthma-allergen relationships, and the asthma intervention. This success was attributable to using an adaptive approach and refining processes as needed.


Key words: asthma, asthma case management, asthma counselor, environmental intervention, Hurricane Katrina, indoor allergens, mold. 


Environ Health Perspect 120:1592–1599 (2012). http://dx.doi.org/10.1289/ehp.1104239 [Online 15 August 2012]


Address correspondence to P.C. Chulada, Westat, Inc., 1009 Slater Rd., Suite 110, Durham, NC 27703 USA. Telephone: (919) 542-0915. E-mail: patriciachulada@westat.com


This project has been funded, in whole or in part, with federal funds from the National Institute of Environmental Health Sciences (NIEHS), National Institutes of Health (NIH), under contract NO1-ES-55553. Additional funding support was provided by the Merck Childhood Asthma Network and the National Center on Minority Health and Health Disparities under the auspices of the Foundation for the NIH, a nonprofit, 501(c)(3) charitable organization that raises private-sector funds for a broad portfolio of unique programs that complement and enhance the NIH priorities and activities. Other organizations that contributed include the National Toxicology Program (NIEHS), the U.S. Environmental Protection Agency (Cincinnati, OH), and the de Laski Family Foundation. The Clinical and Translational Research Center of Tulane and Louisiana State Universities Schools of Medicine was supported in whole or in part by funds provided through the Louisiana Board of Regents RC/EEP. H.M., J.W., K.J., and S.K. are employed by Rho Federal Systems Division, Inc., R.D.C. is employed by SRA International, Inc., E.T. is employed by Visionary Consulting Partners, LLC, Rho Federal Systems Division, Inc.


The authors declare they have no actual or potential competing financial interests.


Received 20 July 2011; Accepted 7 August 2012; Online 15 August 2012.