The Head-off Environmental Asthma in Louisiana (HEAL) study--methods and study population

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.

Figure 1

Timeline for HEAL study activities. Children were prescreened for eligibility by phone. During the call, caretakers were asked about the children’s asthma symptoms and post-Katrina living conditions. Eligible children were invited to have a baseline clinical evaluation, where they received a complete asthma workup to confirm their asthma status, blood work for basic clinical and immunological parameters, and skin sensitivity testing. Children who were enrolled in HEAL received three home evaluations and the hybrid asthma counseling intervention over a 1-year period. During each home evaluation, the children’s homes were examined visually, and air and dust samples were collected. The intervention included two in-person visits with an asthma counselor, with one of these conducted in the children’s homes, and additional asthma counseling sessions as needed. The asthma counselor called the caretaker 2 weeks after each in-person session to provide follow-up. To assess changes in the children’s asthma morbidity, caretakers were called every 3 months and surveyed about their children’s asthma outcomes. At the end of the 1-year study period, the children received a final clinical evaluation.

Figure 2

Geospatial mapping of the children’s homes at the time of study enrollment (n = 182 participants). Red dots ­represent children’s homes in Orleans Parish, and blue dots represent homes in Jefferson and other parishes (St. Bernard and St. Tammany). Flooding overlays were only available for Orleans and St. Bernard Parishes. Although areas of Jefferson Parish also flooded, they are not shown on this map. Numbers ­represent the children’s ZIP codes.