Shani Zalika, Scott Richard G, Schofield Lynne Steuerle, Johnson John H, Williams Ellen R, Hampton Janiene, Ramprasad Vatsala
Crozer-Keystone Health System, Chester, PA, USA.
Swarthmore College, Swarthmore, PA, USA.
Health Promot Pract. 2015 Mar;16(2):291-8. doi: 10.1177/1524839914529593. Epub 2014 Apr 14.
Asthma prevalence rates are at an all-time high in the United States with over 25 million persons diagnosed with asthma. African Americans and other minorities have higher asthma prevalence and higher exposure to environmental factors that worsen asthma as compared to Caucasians. This article describes the evaluation of an inner-city home-based asthma education and environmental remediation program that addressed both indoor and outdoor triggers through collaboration between a health system and local environmental justice organization. The program enrolled 132 children older than 2.5 years and centers on a 4- to 6-week intervention with peer counselors using the U.S. Environmental Protection Agency Asthma Home Environment Checklist and the You Can Control Asthma curriculum. Families receive asthma-friendly environmental home kits. Peer counselors reinforce key asthma management messages and facilitate the completion of Asthma Action Plans. The environmental justice community partner organized block cleanups to reduce outdoor triggers. The evaluation used a pretest-posttest design to assess changes in client behavior and asthma symptoms. Data were collected at baseline and during a 6-month postintervention period. Participants saw enhanced conditions on asthma severity and control. The improvement was greatest for children whose asthma was considered "severe" based on the validated Asthma Control Test. Other positive results include the following: greater completion of Asthma Action Plans, significant reduction in the number of emergency room visits (p = .006), and substantial decreases in school absenteeism (p = .008) and use of rescue medications (p = .049). The evaluation suggests that the program was effective in improving asthma self-management in a high-risk population living within an environmental justice community.
在美国，哮喘患病率达到历史最高水平，超过2500万人被诊断患有哮喘。与白种人相比，非裔美国人和其他少数族裔的哮喘患病率更高，且更多地暴露于会加重哮喘的环境因素中。本文介绍了一项基于市中心家庭的哮喘教育与环境整治项目的评估情况，该项目通过一个卫生系统与当地环境正义组织的合作，解决了室内和室外的诱发因素。该项目招募了132名2.5岁以上的儿童，以4至6周的干预为核心，由同伴辅导员使用美国环境保护局的哮喘家庭环境检查表和“你能控制哮喘”课程。家庭会收到对哮喘友好的家庭环境套装。同伴辅导员强化关键的哮喘管理信息，并协助完成哮喘行动计划。环境正义社区合作伙伴组织了街区清理活动，以减少室外诱发因素。该评估采用前后测试设计，以评估客户行为和哮喘症状的变化。在基线期和干预后6个月期间收集数据。参与者的哮喘严重程度和控制情况有所改善。对于那些根据经过验证的哮喘控制测试被认为“严重”哮喘的儿童，改善最为明显。其他积极结果包括：哮喘行动计划的完成率更高、急诊室就诊次数显著减少（p = .006）、学校缺勤率大幅下降（p = .008）以及急救药物的使用量大幅减少（p = .049）。该评估表明，该项目在改善生活在环境正义社区的高危人群的哮喘自我管理方面是有效的。
