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Parent-Reported Environmental Exposures and Environmental Control Measures for Children With Asthma
Jonathan A. Finkelstein, MD, MPH;
Anne Fuhlbrigge, MD, MS;
Paula Lozano, MD, MPH;
Evalyn N. Grant, MD;
Reeva Shulruff, MD;
Kelly E. Arduino, MA;
Kevin B. Weiss, MD, MPH
Arch Pediatr Adolesc Med. 2002;156:258-264.
Background Mounting evidence suggests that indoor allergens and irritants contribute
to childhood asthma. National asthma guidelines highlight the importance of
their reduction as part of comprehensive asthma treatment.
Objectives To assess the prevalence of potential environmental triggers, to identify
risk factors for such exposures, and to determine whether prior parental education
about trigger avoidance is associated with fewer such exposures.
Setting and Patients Children with asthma in practices affiliated with 3 managed care organizations.
Interventions Parents of 638 children, aged 3 to 15 years, were interviewed on enrollment
in a randomized trial of asthma care improvement strategies. Parents reported
recent asthma symptoms and exposures to potential environmental triggers.
Multivariate models were used to identify specific demographic risk factors
for environmental exposures and to determine if prior education was associated
with fewer such exposures.
Results Exposures to environmental triggers were frequent: 30% of households
had a smoker, 18% had household pests, and 59% had furry pets. Other exposures
included bedroom carpeting (78%) and forced-air heat (58%). Most children
did not have mattress (65%) or pillow (84%) covers. Of the parents, 45% reported
ever receiving written instructions regarding trigger avoidance and 11% reported
them given in the past year. However, 42% reported discussing triggers in
the home environment with a clinician in the past 6 months. In multivariate
models, predictors of smoking at home included low annual family income and
lower parental educational attainment. Dog ownership was associated with low
educational attainment, and dog and cat ownership were less likely with black
race. Reports of pests were increased for black children compared with white
children. Black race was associated with lower rates of other exposures, including
bedroom carpeting. After controlling for potential confounders, there was
no association of reduced exposures with prior receipt of environmental control
instructions.
Conclusions Exposure to potential environmental triggers is common, and recommended
trigger avoidance measures are infrequently adopted. While specific exposures
may vary with demographic and socioeconomic variables, all children are at
risk. New methods for educating parents to reduce such exposures should be
tested.
From the Department of Ambulatory Care and Prevention, Harvard Medical
School and Harvard Pilgrim Health Care, and the Department of Pediatrics,
Harvard Medical School, Boston, Mass (Dr Finkelstein); the Channing Laboratory,
Brigham and Women's Hospital, Boston (Dr Fuhlbrigge); the Center for Health
Studies, Group Health Cooperative, Seattle, Wash (Dr Lozano); Departments
of Immunology/Microbiology and Pediatrics, Rush-Presbyterian-St Luke's Medical
Center (Dr Grant), the Rush Prudential Health Plan (Dr Shulruff), and the
Center for Healthcare Studies and Division of General Medicine, Department
of Medicine, Northwestern University Medical School (Dr Weiss), Chicago, Ill;
and the Midwest Center for Health Services and Policy Research, Hines VA Hospital,
Hines, Ill (Ms Arduino and Dr Weiss).
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