Implementation of Evidence-based Asthma Interventions in Post-Katrina New Orleans: The Head-off Environmental Asthma in Louisiana (HEAL) Study

Herman Mitchell,¹ Richard D. Cohn,² Jeremy Wildfire,¹ Eleanor Thornton,³ Suzanne Kennedy,¹ Jane M. El-Dahr,⁴ Patricia C. Chulada,⁵ Mosanda M. Mvula,⁶ L. Faye Grimsley,⁷ Maureen Y. Lichtveld,⁷ LuAnn E. White,⁷ Yvonne M. Sterling,⁸ Kevin U. Stephens Sr.,⁶ and William J. Martin II⁹

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


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


Environ Health Perspect 120:1607–1612 (2012). http://dx.doi.org/10.1289/ehp.1104242 [Online 15 August 2012]


Address correspondence to H. Mitchell, Rho Federal Systems Division, Inc, 6330 Quadrangle Dr., Chapel Hill, NC 27517 USA. Telephone (919) 408-8000, ext. 6223. E-mail: herman_mitchell@rhoworld.com


Supplemental Material is available online (http://dx.doi.org/10.1289/ehp.1104242).


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., 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. 


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


Received 20 July 2011; Accepted 9 August 2012; Online 15 August 2012.