Skip to main content
PMC home page
Environmental Health Perspectives logoLink to Environmental Health Perspectives
. 2002 Apr;110(Suppl 2):311–322. doi: 10.1289/ehp.02110s2311

The Seattle-King County healthy homes project: implementation of a comprehensive approach to improving indoor environmental quality for low-income children with asthma.

James K Krieger 1, Tim K Takaro 1, Carol Allen 1, Lin Song 1, Marcia Weaver 1, Sanders Chai 1, Phillip Dickey 1
PMCID: PMC1241178  PMID: 11929743

Abstract

Pediatric asthma is a growing public health issue, disproportionately affecting low-income people and people of color. Exposure to indoor asthma triggers plays an important role in the development and exacerbation of asthma. We describe the implementation of the Seattle-King County Healthy Homes Project, a randomized, controlled trial of an outreach/education intervention to improve asthma-related health status by reducing exposure to allergens and irritants in the home. We randomly assigned 274 low-income children with asthma ages 4-12 to either a high- or a low-intensity group. In the high-intensity group, community health workers called Community Home Environmental Specialists (CHES) conducted initial home environmental assessments, provided individualized action plans, and made additional visits over a 12-month period to provide education and social support, encouragement of participant actions, provision of materials to reduce exposures (including bedding encasements), assistance with roach and rodent eradication, and advocacy for improved housing conditions. Members of the low-intensity group received the initial assessment, home action plan, limited education during the assessment visit, and bedding encasements. We describe the recruitment and training of CHES and challenges they faced and explain the assessment and exposure reduction protocols addressing dust mites, mold, tobacco smoke, pets, cockroaches, rodents, dust, moisture, and toxic or hazardous chemicals. We also discuss the gap between the practices recommended in the literature and what is feasible in the home. We accomplished home interventions and participants found the project very useful. The project was limited in resolving structural housing quality issues that contributed to exposure to indoor triggers.

Full Text

The Full Text of this article is available as a PDF (1,001.5 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Adilah N., Fitzharris P., Crane J., Siebers R. W. The effect of frequent vacuum cleaning on the house dust mite allergen, Der p 1 in carpets: a pilot study. N Z Med J. 1997 Nov 28;110(1056):438–439. [PubMed] [Google Scholar]
  2. Aligne C. A., Auinger P., Byrd R. S., Weitzman M. Risk factors for pediatric asthma. Contributions of poverty, race, and urban residence. Am J Respir Crit Care Med. 2000 Sep;162(3 Pt 1):873–877. doi: 10.1164/ajrccm.162.3.9908085. [DOI] [PubMed] [Google Scholar]
  3. Andriessen J. W., Brunekreef B., Roemer W. Home dampness and respiratory health status in european children. Clin Exp Allergy. 1998 Oct;28(10):1191–1200. doi: 10.1046/j.1365-2222.1998.00322.x. [DOI] [PubMed] [Google Scholar]
  4. Arlian L. G., Neal J. S., Morgan M. S., Vyszenski-Moher D. L., Rapp C. M., Alexander A. K. Reducing relative humidity is a practical way to control dust mites and their allergens in homes in temperate climates. J Allergy Clin Immunol. 2001 Jan;107(1):99–104. doi: 10.1067/mai.2001.112119. [DOI] [PubMed] [Google Scholar]
  5. Arlian L. G., Platts-Mills T. A. The biology of dust mites and the remediation of mite allergens in allergic disease. J Allergy Clin Immunol. 2001 Mar;107(3 Suppl):S406–S413. doi: 10.1067/mai.2001.113670. [DOI] [PubMed] [Google Scholar]
  6. Avner D. B., Perzanowski M. S., Platts-Mills T. A., Woodfolk J. A. Evaluation of different techniques for washing cats: quantitation of allergen removed from the cat and the effect on airborne Fel d 1. J Allergy Clin Immunol. 1997 Sep;100(3):307–312. doi: 10.1016/s0091-6749(97)70242-2. [DOI] [PubMed] [Google Scholar]
  7. Benson V., Marano M. A. Current estimates from the National Health Interview Survey, 1995. Vital Health Stat 10. 1998 Oct;(199):1–428. [PubMed] [Google Scholar]
  8. Brunekreef B., Dockery D. W., Speizer F. E., Ware J. H., Spengler J. D., Ferris B. G. Home dampness and respiratory morbidity in children. Am Rev Respir Dis. 1989 Nov;140(5):1363–1367. doi: 10.1164/ajrccm/140.5.1363. [DOI] [PubMed] [Google Scholar]
  9. Burge H. A., Solomon W. R., Muilenberg M. L. Evaluation of indoor plantings as allergen exposure sources. J Allergy Clin Immunol. 1982 Aug;70(2):101–108. doi: 10.1016/0091-6749(82)90236-6. [DOI] [PubMed] [Google Scholar]
  10. Bush R. K., Portnoy J. M. The role and abatement of fungal allergens in allergic diseases. J Allergy Clin Immunol. 2001 Mar;107(3 Suppl):S430–S440. doi: 10.1067/mai.2001.113669. [DOI] [PubMed] [Google Scholar]
  11. Cabrera P., Julià-Serdà G., Rodríguez de Castro F., Caminero J., Barber D., Carrillo T. Reduction of house dust mite allergens after dehumidifier use. J Allergy Clin Immunol. 1995 Feb;95(2):635–636. doi: 10.1016/s0091-6749(95)70328-4. [DOI] [PubMed] [Google Scholar]
  12. Call R. S., Smith T. F., Morris E., Chapman M. D., Platts-Mills T. A. Risk factors for asthma in inner city children. J Pediatr. 1992 Dec;121(6):862–866. doi: 10.1016/s0022-3476(05)80329-4. [DOI] [PubMed] [Google Scholar]
  13. Carr W., Zeitel L., Weiss K. Variations in asthma hospitalizations and deaths in New York City. Am J Public Health. 1992 Jan;82(1):59–65. doi: 10.2105/ajph.82.1.59. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Chapman M. D., Wood R. A. The role and remediation of animal allergens in allergic diseases. J Allergy Clin Immunol. 2001 Mar;107(3 Suppl):S414–S421. doi: 10.1067/mai.2001.113672. [DOI] [PubMed] [Google Scholar]
  15. Chilmonczyk B. A., Salmun L. M., Megathlin K. N., Neveux L. M., Palomaki G. E., Knight G. J., Pulkkinen A. J., Haddow J. E. Association between exposure to environmental tobacco smoke and exacerbations of asthma in children. N Engl J Med. 1993 Jun 10;328(23):1665–1669. doi: 10.1056/NEJM199306103282303. [DOI] [PubMed] [Google Scholar]
  16. Christiansen S. C., Martin S. B., Schleicher N. C., Koziol J. A., Hamilton R. G., Zuraw B. L. Exposure and sensitization to environmental allergen of predominantly Hispanic children with asthma in San Diego's inner city. J Allergy Clin Immunol. 1996 Aug;98(2):288–294. doi: 10.1016/s0091-6749(96)70152-5. [DOI] [PubMed] [Google Scholar]
  17. Clark N. M., Nothwehr F., Gong M., Evans D., Maiman L. A., Hurwitz M. E., Roloff D., Mellins R. B. Physician-patient partnership in managing chronic illness. Acad Med. 1995 Nov;70(11):957–959. doi: 10.1097/00001888-199511000-00008. [DOI] [PubMed] [Google Scholar]
  18. Crain E. F., Weiss K. B., Bijur P. E., Hersh M., Westbrook L., Stein R. E. An estimate of the prevalence of asthma and wheezing among inner-city children. Pediatrics. 1994 Sep;94(3):356–362. [PubMed] [Google Scholar]
  19. Crater S. E., Platts-Mills T. A. Searching for the cause of the increase in asthma. Curr Opin Pediatr. 1998 Dec;10(6):594–599. doi: 10.1097/00008480-199810060-00010. [DOI] [PubMed] [Google Scholar]
  20. Dales R. E., Zwanenburg H., Burnett R., Franklin C. A. Respiratory health effects of home dampness and molds among Canadian children. Am J Epidemiol. 1991 Jul 15;134(2):196–203. doi: 10.1093/oxfordjournals.aje.a116072. [DOI] [PubMed] [Google Scholar]
  21. Davies D. J., Thornton I., Watt J. M., Culbard E. B., Harvey P. G., Delves H. T., Sherlock J. C., Smart G. A., Thomas J. F., Quinn M. J. Lead intake and blood lead in two-year-old U.K. urban children. Sci Total Environ. 1990 Jan;90:13–29. doi: 10.1016/0048-9697(90)90182-t. [DOI] [PubMed] [Google Scholar]
  22. Dharmage S., Bailey M., Raven J., Mitakakis T., Guest D., Cheng A., Rolland J., Thien F., Abramson M., Walters E. H. A reliable and valid home visit report for studies of asthma in young adults. Indoor Air. 1999 Sep;9(3):188–192. doi: 10.1111/j.1600-0668.1999.t01-1-00005.x. [DOI] [PubMed] [Google Scholar]
  23. Eggleston P. A., Arruda L. K. Ecology and elimination of cockroaches and allergens in the home. J Allergy Clin Immunol. 2001 Mar;107(3 Suppl):S422–S429. doi: 10.1067/mai.2001.113671. [DOI] [PubMed] [Google Scholar]
  24. Eggleston P. A., Bush R. K., American Academy of Asthma, Allergy and Immunology Environmental allergen avoidance: an overview. J Allergy Clin Immunol. 2001 Mar;107(3 Suppl):S403–S405. doi: 10.1067/mai.2001.113673. [DOI] [PubMed] [Google Scholar]
  25. Eggleston P. A. Environmental causes of asthma in inner city children. The National Cooperative Inner City Asthma Study. Clin Rev Allergy Immunol. 2000 Jun;18(3):311–324. doi: 10.1385/CRIAI:18:3:311. [DOI] [PubMed] [Google Scholar]
  26. Ehnert B., Lau-Schadendorf S., Weber A., Buettner P., Schou C., Wahn U. Reducing domestic exposure to dust mite allergen reduces bronchial hyperreactivity in sensitive children with asthma. J Allergy Clin Immunol. 1992 Jul;90(1):135–138. doi: 10.1016/s0091-6749(06)80024-2. [DOI] [PubMed] [Google Scholar]
  27. Ehnert B., Lau-Schadendorf S., Weber A., Buettner P., Schou C., Wahn U. Reducing domestic exposure to dust mite allergen reduces bronchial hyperreactivity in sensitive children with asthma. J Allergy Clin Immunol. 1992 Jul;90(1):135–138. doi: 10.1016/s0091-6749(06)80024-2. [DOI] [PubMed] [Google Scholar]
  28. Eisinger A., Senturia K. Doing community-driven research: a description of Seattle Partners for Healthy Communities. J Urban Health. 2001 Sep;78(3):519–534. doi: 10.1093/jurban/78.3.519. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Etzel R. A. Indoor air pollution and childhood asthma: effective environmental interventions. Environ Health Perspect. 1995 Sep;103 (Suppl 6):55–58. doi: 10.1289/ehp.95103s655. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Evans D. To help patients control asthma the clinician must be a good listener and teacher. Thorax. 1993 Jul;48(7):685–687. doi: 10.1136/thx.48.7.685. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Fletcher A. M., Pickering C. A., Custovic A., Simpson J., Kennaugh J., Woodcock A. Reduction in humidity as a method of controlling mites and mite allergens: the use of mechanical ventilation in British domestic dwellings. Clin Exp Allergy. 1996 Sep;26(9):1051–1056. doi: 10.1111/j.1365-2222.1996.tb00643.x. [DOI] [PubMed] [Google Scholar]
  32. Gelber L. E., Seltzer L. H., Bouzoukis J. K., Pollart S. M., Chapman M. D., Platts-Mills T. A. Sensitization and exposure to indoor allergens as risk factors for asthma among patients presenting to hospital. Am Rev Respir Dis. 1993 Mar;147(3):573–578. doi: 10.1164/ajrccm/147.3.573. [DOI] [PubMed] [Google Scholar]
  33. Gergen P. J., Turkeltaub P. C., Kovar M. G. The prevalence of allergic skin test reactivity to eight common aeroallergens in the U.S. population: results from the second National Health and Nutrition Examination Survey. J Allergy Clin Immunol. 1987 Nov;80(5):669–679. doi: 10.1016/0091-6749(87)90286-7. [DOI] [PubMed] [Google Scholar]
  34. Gergen P. J., Weiss K. B. The increasing problem of asthma in the United States. Am Rev Respir Dis. 1992 Oct;146(4):823–824. doi: 10.1164/ajrccm/146.4.823. [DOI] [PubMed] [Google Scholar]
  35. Gold D. R. Environmental tobacco smoke, indoor allergens, and childhood asthma. Environ Health Perspect. 2000 Aug;108 (Suppl 4):643–651. doi: 10.1289/ehp.00108s4643. [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Grant E. N., Alp H., Weiss K. B. The challenge of inner-city asthma. Curr Opin Pulm Med. 1999 Jan;5(1):27–34. doi: 10.1097/00063198-199901000-00005. [DOI] [PubMed] [Google Scholar]
  37. Graves E. J., Kozak L. J. Detailed diagnoses and procedures, National Hospital Discharge Survey, 1996. Vital Health Stat 13. 1998 Sep;(138):i-iii, 1-151. [PubMed] [Google Scholar]
  38. Hill D. J., Thompson P. J., Stewart G. A., Carlin J. B., Nolan T. M., Kemp A. S., Hosking C. S. The Melbourne house dust mite study: eliminating house dust mites in the domestic environment. J Allergy Clin Immunol. 1997 Mar;99(3):323–329. doi: 10.1016/s0091-6749(97)70049-6. [DOI] [PubMed] [Google Scholar]
  39. Huss K., Rand C. S., Butz A. M., Eggleston P. A., Murigande C., Thompson L. C., Schneider S., Weeks K., Malveaux F. J. Home environmental risk factors in urban minority asthmatic children. Ann Allergy. 1994 Feb;72(2):173–177. [PubMed] [Google Scholar]
  40. Infante-Rivard C. Childhood asthma and indoor environmental risk factors. Am J Epidemiol. 1993 Apr 15;137(8):834–844. doi: 10.1093/oxfordjournals.aje.a116745. [DOI] [PubMed] [Google Scholar]
  41. Israel B. A. Social networks and social support: implications for natural helper and community level interventions. Health Educ Q. 1985 Spring;12(1):65–80. doi: 10.1177/109019818501200106. [DOI] [PubMed] [Google Scholar]
  42. Jackson E. J., Parks C. P. Recruitment and training issues from selected lay health advisor programs among African Americans: a 20-year perspective. Health Educ Behav. 1997 Aug;24(4):418–431. doi: 10.1177/109019819702400403. [DOI] [PubMed] [Google Scholar]
  43. Johnston S. L., Pattemore P. K., Sanderson G., Smith S., Lampe F., Josephs L., Symington P., O'Toole S., Myint S. H., Tyrrell D. A. Community study of role of viral infections in exacerbations of asthma in 9-11 year old children. BMJ. 1995 May 13;310(6989):1225–1229. doi: 10.1136/bmj.310.6989.1225. [DOI] [PMC free article] [PubMed] [Google Scholar]
  44. Juniper E. F., Guyatt G. H., Feeny D. H., Ferrie P. J., Griffith L. E., Townsend M. Measuring quality of life in children with asthma. Qual Life Res. 1996 Feb;5(1):35–46. doi: 10.1007/BF00435967. [DOI] [PubMed] [Google Scholar]
  45. Kane M. P., Jaén C. R., Tumiel L. M., Bearman G. M., O'Shea R. M. Unlimited opportunities for environmental interventions with inner-city asthmatics. J Asthma. 1999 Jun;36(4):371–379. doi: 10.3109/02770909909068230. [DOI] [PubMed] [Google Scholar]
  46. Kimpen J. L. Viral infections and childhood asthma. Am J Respir Crit Care Med. 2000 Sep;162(3 Pt 2):S108–S112. doi: 10.1164/ajrccm.162.supplement_2.ras-11. [DOI] [PubMed] [Google Scholar]
  47. Kitch B. T., Chew G., Burge H. A., Muilenberg M. L., Weiss S. T., Platts-Mills T. A., O'Connor G., Gold D. R. Socioeconomic predictors of high allergen levels in homes in the greater Boston area. Environ Health Perspect. 2000 Apr;108(4):301–307. doi: 10.1289/ehp.00108301. [DOI] [PMC free article] [PubMed] [Google Scholar]
  48. Kleinman A., Eisenberg L., Good B. Culture, illness, and care: clinical lessons from anthropologic and cross-cultural research. Ann Intern Med. 1978 Feb;88(2):251–258. doi: 10.7326/0003-4819-88-2-251. [DOI] [PubMed] [Google Scholar]
  49. Koné A., Sullivan M., Senturia K. D., Chrisman N. J., Ciske S. J., Krieger J. W. Improving collaboration between researchers and communities. Public Health Rep. 2000 Mar-Jun;115(2-3):243–248. doi: 10.1093/phr/115.2.243. [DOI] [PMC free article] [PubMed] [Google Scholar]
  50. Krieger J. W., Song L., Takaro T. K., Stout J. Asthma and the home environment of low-income urban children: preliminary findings from the Seattle-King County healthy homes project. J Urban Health. 2000 Mar;77(1):50–67. doi: 10.1007/BF02350962. [DOI] [PMC free article] [PubMed] [Google Scholar]
  51. Lang D. M., Polansky M. Patterns of asthma mortality in Philadelphia from 1969 to 1991. N Engl J Med. 1994 Dec 8;331(23):1542–1546. doi: 10.1056/NEJM199412083312302. [DOI] [PubMed] [Google Scholar]
  52. Larson T. V., Koenig J. Q. Wood smoke: emissions and noncancer respiratory effects. Annu Rev Public Health. 1994;15:133–156. doi: 10.1146/annurev.pu.15.050194.001025. [DOI] [PubMed] [Google Scholar]
  53. Leung R., Koenig J. Q., Simcox N., van Belle G., Fenske R., Gilbert S. G. Behavioral changes following participation in a home health promotional program in King County, Washington. Environ Health Perspect. 1997 Oct;105(10):1132–1135. doi: 10.1289/ehp.971051132. [DOI] [PMC free article] [PubMed] [Google Scholar]
  54. Lewis S. A., Weiss S. T., Platts-Mills T. A., Syring M., Gold D. R. Association of specific allergen sensitization with socioeconomic factors and allergic disease in a population of Boston women. J Allergy Clin Immunol. 2001 Apr;107(4):615–622. doi: 10.1067/mai.2001.113523. [DOI] [PubMed] [Google Scholar]
  55. Lioy P. J., Yiin L. M., Adgate J., Weisel C., Rhoads G. G. The effectiveness of a home cleaning intervention strategy in reducing potential dust and lead exposures. J Expo Anal Environ Epidemiol. 1998 Jan-Mar;8(1):17–35. [PubMed] [Google Scholar]
  56. Litonjua A. A., Carey V. J., Weiss S. T., Gold D. R. Race, socioeconomic factors, and area of residence are associated with asthma prevalence. Pediatr Pulmonol. 1999 Dec;28(6):394–401. doi: 10.1002/(sici)1099-0496(199912)28:6<394::aid-ppul2>3.0.co;2-6. [DOI] [PubMed] [Google Scholar]
  57. Love M. B., Gardner K., Legion V. Community health workers: who they are and what they do. Health Educ Behav. 1997 Aug;24(4):510–522. doi: 10.1177/109019819702400409. [DOI] [PubMed] [Google Scholar]
  58. Macey G. P., Her X., Reibling E. T., Ericson J. An investigation of environmental racism claims: testing environmental management approaches with a geographic information system. Environ Manage. 2001 Jun;27(6):893–907. doi: 10.1007/s002670010197. [DOI] [PubMed] [Google Scholar]
  59. Mannino D. M., Homa D. M., Pertowski C. A., Ashizawa A., Nixon L. L., Johnson C. A., Ball L. B., Jack E., Kang D. S. Surveillance for asthma--United States, 1960-1995. MMWR CDC Surveill Summ. 1998 Apr 24;47(1):1–27. [PubMed] [Google Scholar]
  60. Manson A. Language concordance as a determinant of patient compliance and emergency room use in patients with asthma. Med Care. 1988 Dec;26(12):1119–1128. doi: 10.1097/00005650-198812000-00003. [DOI] [PubMed] [Google Scholar]
  61. Mason K., Riley G., Siebers R., Crane J., Fitzharris P. Hot tumble drying and mite survival in duvets. J Allergy Clin Immunol. 1999 Aug;104(2 Pt 1):499–500. doi: 10.1016/s0091-6749(99)70400-8. [DOI] [PubMed] [Google Scholar]
  62. Munir A. K., Einarsson R., Dreborg S. K. Vacuum cleaning decreases the levels of mite allergens in house dust. Pediatr Allergy Immunol. 1993 Aug;4(3):136–143. doi: 10.1111/j.1399-3038.1993.tb00082.x. [DOI] [PubMed] [Google Scholar]
  63. Murray A. B., Ferguson A. C. Dust-free bedrooms in the treatment of asthmatic children with house dust or house dust mite allergy: a controlled trial. Pediatrics. 1983 Mar;71(3):418–422. [PubMed] [Google Scholar]
  64. Northridge M. E., Shepard P. M. Environmental racism and public health. Am J Public Health. 1997 May;87(5):730–732. doi: 10.2105/ajph.87.5.730. [DOI] [PMC free article] [PubMed] [Google Scholar]
  65. O'Connor G. T., Gold D. R. Cockroach allergy and asthma in a 30-year-old man. Environ Health Perspect. 1999 Mar;107(3):243–247. doi: 10.1289/ehp.99107243. [DOI] [PMC free article] [PubMed] [Google Scholar]
  66. Ostro B. D., Lipsett M. J., Mann J. K., Wiener M. B., Selner J. Indoor air pollution and asthma. Results from a panel study. Am J Respir Crit Care Med. 1994 Jun;149(6):1400–1406. doi: 10.1164/ajrccm.149.6.8004290. [DOI] [PubMed] [Google Scholar]
  67. Owen S., Morganstern M., Hepworth J., Woodcock A. Control of house dust mite antigen in bedding. Lancet. 1990 Feb 17;335(8686):396–397. doi: 10.1016/0140-6736(90)90219-u. [DOI] [PubMed] [Google Scholar]
  68. Patchett K., Lewis S., Crane J., Fitzharris P. Cat allergen (Fel d 1) levels on school children's clothing and in primary school classrooms in Wellington, New Zealand. J Allergy Clin Immunol. 1997 Dec;100(6 Pt 1):755–759. doi: 10.1016/s0091-6749(97)70269-0. [DOI] [PubMed] [Google Scholar]
  69. Perlin S. A., Wong D., Sexton K. Residential proximity to industrial sources of air pollution: interrelationships among race, poverty, and age. J Air Waste Manag Assoc. 2001 Mar;51(3):406–421. doi: 10.1080/10473289.2001.10464271. [DOI] [PubMed] [Google Scholar]
  70. Platts-Mills T. A., Sporik R. B., Wheatley L. M., Heymann P. W. Is there a dose-response relationship between exposure to indoor allergens and symptoms of asthma? J Allergy Clin Immunol. 1995 Oct;96(4):435–440. doi: 10.1016/s0091-6749(95)70284-9. [DOI] [PubMed] [Google Scholar]
  71. Platts-Mills T. A., Vaughan J. W., Carter M. C., Woodfolk J. A. The role of intervention in established allergy: avoidance of indoor allergens in the treatment of chronic allergic disease. J Allergy Clin Immunol. 2000 Nov;106(5):787–804. doi: 10.1067/mai.2000.110548. [DOI] [PubMed] [Google Scholar]
  72. Poland M. L., Giblin P. T., Waller J. B., Jr, Bayer I. S. Development of a paraprofessional home visiting program for low-income mothers and infants. Am J Prev Med. 1991 Jul-Aug;7(4):204–207. [PubMed] [Google Scholar]
  73. Prochaska J. O., DiClemente C. C. Stages and processes of self-change of smoking: toward an integrative model of change. J Consult Clin Psychol. 1983 Jun;51(3):390–395. doi: 10.1037//0022-006x.51.3.390. [DOI] [PubMed] [Google Scholar]
  74. Rosenstreich D. L., Eggleston P., Kattan M., Baker D., Slavin R. G., Gergen P., Mitchell H., McNiff-Mortimer K., Lynn H., Ownby D. The role of cockroach allergy and exposure to cockroach allergen in causing morbidity among inner-city children with asthma. N Engl J Med. 1997 May 8;336(19):1356–1363. doi: 10.1056/NEJM199705083361904. [DOI] [PubMed] [Google Scholar]
  75. Roter D. L., Hall J. A., Merisca R., Nordstrom B., Cretin D., Svarstad B. Effectiveness of interventions to improve patient compliance: a meta-analysis. Med Care. 1998 Aug;36(8):1138–1161. doi: 10.1097/00005650-199808000-00004. [DOI] [PubMed] [Google Scholar]
  76. Sarpong S. B., Hamilton R. G., Eggleston P. A., Adkinson N. F., Jr Socioeconomic status and race as risk factors for cockroach allergen exposure and sensitization in children with asthma. J Allergy Clin Immunol. 1996 Jun;97(6):1393–1401. doi: 10.1016/s0091-6749(96)70209-9. [DOI] [PubMed] [Google Scholar]
  77. Schappert S. M. Ambulatory care visits to physician offices, hospital outpatient departments, and emergency departments: United States, 1996. Vital Health Stat 13. 1998 Feb;(134):1–37. [PubMed] [Google Scholar]
  78. Senturia Y. D., McNiff Mortimer K., Baker D., Gergen P., Mitchell H., Joseph C., Wedner H. J. Successful techniques for retention of study participants in an inner-city population. Control Clin Trials. 1998 Dec;19(6):544–554. doi: 10.1016/s0197-2456(98)00032-4. [DOI] [PubMed] [Google Scholar]
  79. Shapiro G. G., Wighton T. G., Chinn T., Zuckrman J., Eliassen A. H., Picciano J. F., Platts-Mills T. A. House dust mite avoidance for children with asthma in homes of low-income families. J Allergy Clin Immunol. 1999 Jun;103(6):1069–1074. doi: 10.1016/s0091-6749(99)70181-8. [DOI] [PubMed] [Google Scholar]
  80. Sporik R., Squillace S. P., Ingram J. M., Rakes G., Honsinger R. W., Platts-Mills T. A. Mite, cat, and cockroach exposure, allergen sensitisation, and asthma in children: a case-control study of three schools. Thorax. 1999 Aug;54(8):675–680. doi: 10.1136/thx.54.8.675. [DOI] [PMC free article] [PubMed] [Google Scholar]
  81. Strachan D. Socioeconomic factors and the development of allergy. Toxicol Lett. 1996 Aug;86(2-3):199–203. doi: 10.1016/0378-4274(96)03691-0. [DOI] [PubMed] [Google Scholar]
  82. Sullivan M., Kone A., Senturia K. D., Chrisman N. J., Ciske S. J., Krieger J. W. Researcher and researched--community perspectives: toward bridging the gap. Health Educ Behav. 2001 Apr;28(2):130–149. doi: 10.1177/109019810102800202. [DOI] [PubMed] [Google Scholar]
  83. Tovey E. R., McDonald L. G. A simple washing procedure with eucalyptus oil for controlling house dust mites and their allergens in clothing and bedding. J Allergy Clin Immunol. 1997 Oct;100(4):464–466. doi: 10.1016/s0091-6749(97)70136-2. [DOI] [PubMed] [Google Scholar]
  84. Tovey E., Marks G. Methods and effectiveness of environmental control. J Allergy Clin Immunol. 1999 Feb;103(2 Pt 1):179–191. doi: 10.1016/s0091-6749(99)70488-4. [DOI] [PubMed] [Google Scholar]
  85. Vaughan J. W., McLaughlin T. E., Perzanowski M. S., Platts-Mills T. A. Evaluation of materials used for bedding encasement: effect of pore size in blocking cat and dust mite allergen. J Allergy Clin Immunol. 1999 Feb;103(2 Pt 1):227–231. doi: 10.1016/s0091-6749(99)70495-1. [DOI] [PubMed] [Google Scholar]
  86. Vaughan J. W., Platts-Mills T. A. New approaches to environmental control. Clin Rev Allergy Immunol. 2000 Jun;18(3):325–339. doi: 10.1385/CRIAI:18:3:325. [DOI] [PubMed] [Google Scholar]
  87. Vaughan J. W., Woodfolk J. A., Platts-Mills T. A. Assessment of vacuum cleaners and vacuum cleaner bags recommended for allergic subjects. J Allergy Clin Immunol. 1999 Nov;104(5):1079–1083. doi: 10.1016/s0091-6749(99)70092-8. [DOI] [PubMed] [Google Scholar]
  88. Verhoeff A. P., van Strien R. T., van Wijnen J. H., Brunekreef B. Damp housing and childhood respiratory symptoms: the role of sensitization to dust mites and molds. Am J Epidemiol. 1995 Jan 15;141(2):103–110. doi: 10.1093/oxfordjournals.aje.a117398. [DOI] [PubMed] [Google Scholar]
  89. Wahlgren D. R., Hovell M. F., Meltzer S. B., Hofstetter C. R., Zakarian J. M. Reduction of environmental tobacco smoke exposure in asthmatic children. A 2-year follow-up. Chest. 1997 Jan;111(1):81–88. doi: 10.1378/chest.111.1.81. [DOI] [PubMed] [Google Scholar]
  90. Warner J. A., Frederick J. M., Bryant T. N., Weich C., Raw G. J., Hunter C., Stephen F. R., McIntyre D. A., Warner J. O. Mechanical ventilation and high-efficiency vacuum cleaning: A combined strategy of mite and mite allergen reduction in the control of mite-sensitive asthma. J Allergy Clin Immunol. 2000 Jan;105(1 Pt 1):75–82. doi: 10.1016/s0091-6749(00)90181-7. [DOI] [PubMed] [Google Scholar]
  91. Weiss K. B., Gergen P. J., Crain E. F. Inner-city asthma. The epidemiology of an emerging US public health concern. Chest. 1992 Jun;101(6 Suppl):362S–367S. doi: 10.1378/chest.101.6.362s. [DOI] [PubMed] [Google Scholar]
  92. Weitzman M., Gortmaker S., Walker D. K., Sobol A. Maternal smoking and childhood asthma. Pediatrics. 1990 Apr;85(4):505–511. [PubMed] [Google Scholar]
  93. Willey C. Behavior-changing methods for improving adherence to medication. Curr Hypertens Rep. 1999 Dec;1(6):477–481. doi: 10.1007/s11906-996-0019-6. [DOI] [PubMed] [Google Scholar]
  94. Willies-Jacobo L. J., Denson-Lino J. M., Rosas A., O'Connor R. D., Wilson N. W. Socioeconomic status and allergy in children with asthma. J Allergy Clin Immunol. 1993 Oct;92(4):630–632. [PubMed] [Google Scholar]
  95. Wissow L. S., Gittelsohn A. M., Szklo M., Starfield B., Mussman M. Poverty, race, and hospitalization for childhood asthma. Am J Public Health. 1988 Jul;78(7):777–782. doi: 10.2105/ajph.78.7.777. [DOI] [PMC free article] [PubMed] [Google Scholar]
  96. Witmer A., Seifer S. D., Finocchio L., Leslie J., O'Neil E. H. Community health workers: integral members of the health care work force. Am J Public Health. 1995 Aug;85(8 Pt 1):1055–1058. doi: 10.2105/ajph.85.8_pt_1.1055. [DOI] [PMC free article] [PubMed] [Google Scholar]
  97. Wood R. A. Indoor allergens: thrill of victory or agony of defeat? J Allergy Clin Immunol. 1997 Sep;100(3):290–292. doi: 10.1016/s0091-6749(97)70239-2. [DOI] [PubMed] [Google Scholar]
  98. Wood R. A., Johnson E. F., Van Natta M. L., Chen P. H., Eggleston P. A. A placebo-controlled trial of a HEPA air cleaner in the treatment of cat allergy. Am J Respir Crit Care Med. 1998 Jul;158(1):115–120. doi: 10.1164/ajrccm.158.1.9712110. [DOI] [PubMed] [Google Scholar]
  99. Young S., Le Souëf P. N., Geelhoed G. C., Stick S. M., Turner K. J., Landau L. I. The influence of a family history of asthma and parental smoking on airway responsiveness in early infancy. N Engl J Med. 1991 Apr 25;324(17):1168–1173. doi: 10.1056/NEJM199104253241704. [DOI] [PubMed] [Google Scholar]
  100. de Blay F., Chapman M. D., Platts-Mills T. A. Airborne cat allergen (Fel d I). Environmental control with the cat in situ. Am Rev Respir Dis. 1991 Jun;143(6):1334–1339. doi: 10.1164/ajrccm/143.6.1334. [DOI] [PubMed] [Google Scholar]
  101. van der Heide S., Kauffman H. F., Dubois A. E., de Monchy J. G. Allergen reduction measures in houses of allergic asthmatic patients: effects of air-cleaners and allergen-impermeable mattress covers. Eur Respir J. 1997 Jun;10(6):1217–1223. doi: 10.1183/09031936.97.10061217. [DOI] [PubMed] [Google Scholar]
  102. van der Heide S., de Monchy J. G., de Vries K., Bruggink T. M., Kauffman H. F. Seasonal variation in airway hyperresponsiveness and natural exposure to house dust mite allergens in patients with asthma. J Allergy Clin Immunol. 1994 Feb;93(2):470–475. doi: 10.1016/0091-6749(94)90356-5. [DOI] [PubMed] [Google Scholar]
  103. van der Heide S., van Aalderen W. M., Kauffman H. F., Dubois A. E., de Monchy J. G. Clinical effects of air cleaners in homes of asthmatic children sensitized to pet allergens. J Allergy Clin Immunol. 1999 Aug;104(2 Pt 1):447–451. doi: 10.1016/s0091-6749(99)70391-x. [DOI] [PubMed] [Google Scholar]

Articles from Environmental Health Perspectives are provided here courtesy of National Institute of Environmental Health Sciences

RESOURCES