My daughter Carrie has asthma. Life is a lot easier since we put together an asthma action plan with her doctor. She's a lot less sick now. Coming up with a plan that works and making sure medicines were taken on time and the right way really cut down on her sick days. Going through the house to get rid of the 'triggers' - those things that brought on Carrie's asthma - made a huge difference too.
-Rita, mom of 7-year-old Carrie Lynn
Asthma Home Remediation programs are structured to improve the health of children with asthma by removing triggers from their home environment. The effect of these programs is that children spend more time in the classroom and less in hospitals and the emergency room. The program consists of two main components:
1) a behavioral education program assisting families in maintaining a healthier environment for their children with asthma, and;
2) remediation of the home environment.
In selected cases, a weatherization component exists, but we chose not to include this in our analysis because the evidence of this component is not well documented in the literature.
We modeled this program for low-income (less than 200% of the Federal Poverty Level) families with at least one child, age 0 to 17, who has been diagnosed with asthma.
These programs have been implemented in a wide variety of places, including Philadelphia, Los Angeles, San Diego, the Harlem neighborhood in New York, Multnomah County in Oregon, and others.
In order to be most effective, we advocate for multiple components in an asthma home remediation intervention, which is what we have modeled here. Typically these programs consist of the what we described above: a behavioral education program for families and the actual remediation of the home environment. The example we have modeled does not include the most significant form of home remediation, which includes weatherization.
To estimate the impact of a program or policy, we use systematic literature reviews to determine causal pathways and effect sizes. Well-researched interventions that have robust, high-quality evaluations allow us to model the impact of an intervention with greater certainty. However, sometimes interventions have limited evidence and not all of the outcomes that are likely to be associated with the intervention have been studied. In those cases, we can only model what is available in the evidence base. We urge future research to take the following gaps into consideration.
Academic Performance - We model the effect of an asthma home remediation program on school attendance, however, there was not enough evidence in our literature review to examine longer term academic measures like test scores and graduation rates.
Health Measures - Similar to academic performance, we do model the impact of this program on a short term measure (symptom free days) but did not have the evidence to look at longer term outcomes like morbidity and mortality.