1. 2018-19 NC J. Bradley Wilson Schweitzer Fellow
Helping to Improve the Health of Low-Income, Eastern North Carolina Families with Children with Asthma through Environmental Assessments
NC J. Bradley Wilson Schweitzer Fellow
Gabriel Beattie-Sergio, MPH/MSEH(c) ECU Brody School of Medicine, Department of Public Health
Background
Results
For children with asthma, living in poor quality, indoor housing environments can play a major role in having an asthma attack. Poor housing conditions can create environments for allergy triggers including exposure to furry pets, dust mites, ETS, mold, cockroaches and mice. Other factors such as access to healthcare, and having enough food to eat can create social stress that can add additional burdens to a family with limited resources.
Hurricane Matthew exacerbated poor housing conditions and disrupted families lives, particularly those in financial need. Identifying and addressing those needs of underserved populations are essential components of environmental public health.
Environmental:
Of the 35 families screened by the team, 29 requested environmental assessments to be done in their home. Of the 29 homes, 76.1% of them had identifiable indoor environmental asthma triggers present. The two most common environmental triggers found during the assessments have included water/dampness and issues with pests, including bed bugs and cockroaches.
Asthma Triggers
Social Determinants of Health
Environmental Assessment Tool
Social Determinants of Health: Screening Tool
Fig. 4
Fig. 5
Social Determinants of Health:
Evaluating families with the SDOH screening tool helps to identify non-medical needs. The two biggest issues families are facing are food insecurity and problems with pests in the home. More than 20% of the families screened reported having to care for someone in the home with a disability or long-term health condition, other than the child with asthma.
Objectives:
Using a collaborative approach among Legal Aid of NC, Vidant-Medical Center and ECU, the objectives for this project are to;
Identify asthma triggers in the homes of low income families that have children with asthma,; and
2) Evaluate the Social Determinants of Health (SDOH) by identifying non-medical needs of low-income families that have children with asthma, living in rural eastern North Carolina.
Fig. 6
Discussion
Children with asthma living in poverty often face increased environmental exposures due to substandard housing conditions. Many common asthma triggers can be found in poor-quality indoor environments, including dust mites, molds, cockroaches and other pests, chemical irritants and secondhand smoke. In 2016 hurricane Mathew devastated ENC, leaving record breaking flooding in parts of the region.
As public health professionals look to continue to help families recover from Matthew and more recently Florence, there should be emphasis on SDOH. Poor housing conditions from flood and water damage, among other determinants further increase the uneven distribution of poor health outcomes for the eastern part of the state.
Intervention Strategies
In our project, we used two intervention strategies;
Home-based asthma intervention approach that includes a combination of tools, including an environmental visual assessment checklist to identify asthma triggers present in the indoor environment. Through home assessments and interviews with families, it is possible to determine asthma triggers related to asthma symptoms and attacks. Each home is evaluated for the presence of cockroaches, rodents, mold and moisture, dust, signs of smoking indoors, roof leaks/ water damage, fragrances, stuffed toys and furry pets. Environmental measurements in the home are collected using 1) an Amprobe THWD-3 temperature and relative humidity device; and 2) Extech meter to measure moisture in home building materials.
2) SDOH screening tool. A SDOH screening tool is used to evaluate the socio-economic and well-being of family needs (i.e., food insecurity, housing insecurity, safety, stress and transportation issues.
Acknowledgments
Fig. 2. Eastern North Carolina Region
Special thanks to the following; Theresa Blount and Vidant Peds Asthma Program; Madlyn Morreale and Legal Aid of NC for support and contributions to this project. The Albert Schweitzer Fellowship and BlueCross BlueShield of NC Foundation for guidance and funding for this project.
Fig. 1.Environmental Assessment
Fig. 3. Social Determinants Evaluations