Implementation of evidence-based asthma interventions in post-Katrina New Orleans: the Head-off Environmental Asthma in Louisiana (HEAL) study

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.

Figure 1

MSDs during the previous 2 weeks at baseline (blue) and 12 months (gray) for HEAL (all participants), ICAS, and NCICAS participants who received the study intervention. Changes in MSDs are shown with 95% CIs and p-values comparing symptoms at baseline and 12 months.

Figure 2

The timings of the participants’ first contacts with an asthma counselor in HEAL are shown. Although all HEAL participants were eligible for the intervention, some did not see an asthma counselor until later in the study. Values exclude participants who missed the given assessment (month 6: 29/182; month 12: 23/182). Shaded gray bars represent the interquartile range for the timing of the 6- and 12-month symptom assessment excluding participants who missed the visits.

Figure 3

Change in MSDs between baseline and the 6-month assessment (A) and between baseline and the 12-month assessment (B) in HEAL, ICAS, and NCICAS. ICAS and NCICAS participants are grouped by their treatment intervention (Int) or control (Ctl) randomization assignment, and HEAL participants are grouped by whether they had contact with an asthma counselor before the given assessment (Ctl: no intervention before assessment; Int: received intervention before assessment). Values are effect sizes (95% CIs) and p-values. ICAS and NCICAS estimates are adjusted for site.