A Longitudinal Analysis of the Efficacy of Environmental Interventions on Asthma-Related Quality of Life and Symptoms Among Children in Urban Public Housing

Abstract

In an environmental intervention study in public housing, we examined monthly Juniper Paediatric Asthma Quality of Life (QOL) Questionnaires for 51 children. Longitudinal analysis and spline models were used to identify time periods with significant improvements in QOL to inform judgments about causality. We found significant improvements in QOL, with moderate improvements before environmental interventions, increased rates of improvement immediately after, and reduced rates more than 5 months post-intervention. Effect modification analyses identified high-risk subpopulations and emphasized the importance of environmental, social, and economic conditions. Our results demonstrate the value of longitudinal techniques in evaluating the benefits of environmental interventions for asthma.

Keywords:

• childhood asthma
• quality of life
• symptoms
• environmental interventions
• indoor air

ABBREVIATIONS
AIC	=	Akaike's Information Criteria;
Bla g 1, Bla g 2	=	cockroach antigens;
BMI	=	body mass index;
CHAs	=	community health advocates;
Der f 1, Der p 1	=	dust mite antigens;
ED	=	emergency department (emergency room);
ETS	=	environmental tobacco smoke;
FVC	=	forced vital capacity;
HPA	=	hypothalmic pituitary adrenal axis;
HPHI	=	Healthy Public Housing Initiative;
IL-5	=	interleukin-5;
IFN-γ	=	interferon-gamma;
IPM	=	integrated pest management;
NCICAS	=	National Cooperative Inner-City Asthma Study;
NHLBI	=	National Heart, Lung, and Blood Institute;
NICU	=	Neonatal Intensive Care Unit;
NO2	=	nitrogen dioxide;
PAQLQ	=	Juniper Paediatric Asthma Quality of Life Questionnaire;
PPB	=	parts per billion;
PSS	=	Perceived Stress Scale;
SES	=	socioeconomic status;
Th-1, Th-2	=	T-helper lymphocytes;
QOL	=	quality of life

ABBREVIATIONS
AIC	=	Akaike's Information Criteria;
Bla g 1, Bla g 2	=	cockroach antigens;
BMI	=	body mass index;
CHAs	=	community health advocates;
Der f 1, Der p 1	=	dust mite antigens;
ED	=	emergency department (emergency room);
ETS	=	environmental tobacco smoke;
FVC	=	forced vital capacity;
HPA	=	hypothalmic pituitary adrenal axis;
HPHI	=	Healthy Public Housing Initiative;
IL-5	=	interleukin-5;
IFN-γ	=	interferon-gamma;
IPM	=	integrated pest management;
NCICAS	=	National Cooperative Inner-City Asthma Study;
NHLBI	=	National Heart, Lung, and Blood Institute;
NICU	=	Neonatal Intensive Care Unit;
NO2	=	nitrogen dioxide;
PAQLQ	=	Juniper Paediatric Asthma Quality of Life Questionnaire;
PPB	=	parts per billion;
PSS	=	Perceived Stress Scale;
SES	=	socioeconomic status;
Th-1, Th-2	=	T-helper lymphocytes;
QOL	=	quality of life