Healthy Homes II Asthma Project

Healthy Homes II was sponsored by the King County Asthma Forum and funded through the National Institutes of Environmental Health Sciences. The project was developed by incorporating lessons learned from Healthy Homes I, the perspectives of community partners, and evidence from the scientific literature.

Healthy Homes II looked at two main approaches to improving asthma control. The first approach utilized a "Community Asthma Nurse" who provided patient education, training in self-management, the development of a patient-specific asthma action plan, and case management/review.

The second approach provided all aspects of the Community Asthma Nurse intervention plus in-home outreach, education and resources (bedding covers, vacuums, cleaning supplies, etc.) to address environmental triggers (like Healthy Homes-I). Support in self-management, medication use, provider-patient communication, etc. were also reinforced. Community Health Workers (based on the "natural helper" model) provided the in-home outreach. They were educated about asthma, asthma self-management, and the control of environmental asthma triggers.

A third approach was funded separately through the office of Housing and Urban Development (HUD). This added structural remediation of housing for conditions that increase exposure to asthma triggers (e.g. poor ventilation, mold-infiltrated surfaces, leaks, holes in walls, carpeting, etc.). An average of $3000 per unit was spent, which was supplemented by funds leveraged from weatherization and other local housing programs.

The three levels of intervention tested the following hypotheses within a randomized controlled trial:

Level 1 Intervention. Clinic-based asthma education emphasizing self-management and linked to case management provided by a Community Asthma Nurse will:

• increase knowledge
• increase self-efficacy
• change behaviors
• improve health status and reduce asthma-related medical care utilization among low-income children age 3-13 with persistent asthma who live in King County

Level 2 Intervention. The addition of in-home self management support, environmental assessment and support for making behavioral changes to improve indoor environmental quality, provided by specially trained, salaried Community Health Workers, will further:

• increase knowledge of home environmental health threats and asthma self-management
• change behaviors to reduce these threats
• lower the risk of exposure to such threats
• improve health status and reductions in asthma-related medical care utilization beyond that seen with asthma education and case management alone.

Level 3 Intervention. Adding remediation of structural problems related to exposure to asthma triggers to the two interventions mentioned above will:

• further lower exposures
• yield additional improvements in health status and reductions in asthma-related medical care utilization beyond those seen with the interventions described in levels 1 and 2.

Addendum to exit questionnaire: Process evaluation (for Group CAN only)
Addendum to exit questionnaire: Process evaluation (for Group CAN + CAS)
Baseline interview
Encounter form
Functional Status II questionnaire
Quarterly telephone interview questionnaire
Telephone screening questions script

• Healthy Homes I Asthma Project
• Allies Against Asthma: Asthma Education Materials Review Toolkit

• James Krieger, MD, MPH; Tim K. Takaro, MD, MPH, MS; Lin Song, PhD; Nancy Beaudet, MS; Kristine Edwards, RN, MN, MPH. A Randomized Controlled Trial of Asthma Self-management Support Comparing Clinic-Based Nurses and In-Home Community Health Workers. Arch Pediatr Adolesc Med/Vol 163 (No. 2), Feb 2009.
  
  
• Krieger JW, Takaro T, Song L, Weaver M. The Seattle-King County Healthy Homes Project: A Randomized, Controlled Trial of a Community Health Worker Intervention to Decrease Exposure to Indoor Asthma Triggers. American Journal of Public Health,2005; 94(4): 652-659.
  
  
• Takaro TK, Krieger JW and Song L. Effect of environmental interventions to reduce exposure to asthma triggers in homes of low-income children in Seattle. Exp. Anal. Env. Epid. 14: Suppl 1:S133-43, 2004.
  
  
• Krieger J, Takaro T, Allen C, Song L, Weaver M, Chai S, Dickey P. The Seattle-King County Healthy Homes Project: Implementation of a Comprehensive Approach to Improving Indoor Environmental Quality for Low-Income Children with Asthma. Env Health Perspec, 2002;110 (suppl 2): 311-322.

For more information about the Healthy Homes-II Asthma Project, please contact:

James Krieger, MD, MPH - Project Director
Public Health - Seattle & King County
Chief, Epidemiology, Planning and Evaluation
James.Krieger@kingcounty.gov