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Asthma Triggers and Avoidance Behaviors Among Indiana Children with Current Asthma. Amy Brandt, MPH — Chronic Respiratory Disease Epidemiologist Linda Stemnock — BRFSS Coordinator. Chronic Respiratory Disease Section. May 14, 2013. Overview.

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asthma triggers and avoidance behaviors among indiana children with current asthma

Asthma Triggers and Avoidance Behaviors Among Indiana Children with Current Asthma

Amy Brandt, MPH — Chronic Respiratory Disease Epidemiologist

Linda Stemnock — BRFSS Coordinator

Chronic Respiratory Disease Section

May 14, 2013

overview
Overview

This slide set was presented at the Indiana Statewide Asthma Conference on May 14, 2013. These slides are intended to be a resource for our partners.

Suggested citation for the presentation

Indiana State Department of Health Chronic Respiratory Disease Section and Epidemiology Resource Center Data Analysis Team. (2013). Asthma Triggers and Avoidance Behaviors Among Indiana Children with Current Asthma [PowerPoint slides]. Retrieved from http://www.in.gov/isdh/17279.htm

Citations for individual graphs are on the slides.

session learning objectives
Session Learning Objectives
  • Describe Indiana's child population with current asthma.
  • Examine asthma triggers and avoidance behaviors in Indiana children.
  • Translate data findings into areas of need and practice throughout the state.
background
Background
  • Home visits are effective, evidence-based interventions that decrease asthma symptoms and exacerbations
  • A randomized clinical trial in Baltimore found that home visits reduced indoor air pollutants and allergen exposures, which in turn, reduced asthma symptoms1
  • Intensive home visits that use a multifaceted individualized approach of education, exposure reduction and resources are highly effective in improving health outcomes and changing behaviors2

Eggleston, P.A., Butz, A., Rand, C., et al. (2005). Home environmental intervention in inner-city asthma: A randomized controlled clinical trial. Annals of Allergy, Asthma & Immunology; 95:518-524.

Krieger, J.W., Takaro, T.K., Song, L., & Weaver, M. (2005). 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, 95, 652-659.

background asthma triggers
Background: Asthma Triggers
  • Allergens: Substances that cause no problem for a majority of people but which trigger an allergic reaction in some people.
    • Examples: Mites, cockroaches, mold, animal dander
  • Irritants: Substances that trigger asthma symptoms by stimulating irritant receptors in the airways.
    • Examples: Cigarette smoke, perfumes, added fragrances, gasoline fumes
asthma and the home environment
Asthma and the Home Environment
  • Why should we care?
    • Americans spend about 90 percent or more of their time indoors1
    • Indoor pollutant levels may be two to five times higher than outdoor levels1
    • People have a greater ability to modify indoor environments
    • The epithelium is more susceptible to damage in children with asthma
    • Exposure to air pollution alters the normal process of lung development2

Environmental Protection Agency. (2009). Buildings and their Impact on the Environment: A statistical summary.

Gauderman WJ, Avol E, Gilliland F, Vora H, Thomas D, Berhane K, McConnell R, Kuenzli N, Lurmann F, Rappaport E, Margolis H, Bates D,

and Peters J. The effect of air pollution on lung development from 10 to 18 years of age. N Engl J Med, 351 (11): 1-11.

methods
Methods
  • Study Population (N=350)
    • All children (0-17) who were ever diagnosed with asthma and still have asthma
    • Parents/caregivers gave responses for children
  • Data Source
    • Indiana Behavioral Risk Factor Surveillance System and Asthma Call Back Survey
    • Combined data source for years 2006 to 2010
behavioral risk factor surveillance system
Behavioral Risk Factor Surveillance System
  • Started by CDC in 1984
  • Provides state- and national-level prevalence for risk factors, behaviors and select chronic conditions
  • Random-digit dial telephone survey
  • Largest continuously-conducted health survey in the world
  • Survey conducted for an entire calendar year
goals and objectives of brfss
Goals and Objectives of BRFSS
  • Determine prevalence of behaviors associated with leading causes of premature death
  • Increase public awareness of lifestyle changes that can improve health
  • Monitor risk factors for trend data, focus on factors that are not improving
  • Assess progress in meeting national health objectives for health promotion and disease prevention
  • Assess the impact of state legislation on behavioral risks
  • Share data with state and local agencies
behavioral risk factor surveillance system1
Behavioral Risk Factor Surveillance System
  • Questionnaire consists of
    • Core questions
      • Rotating core questions
    • Optional modules
    • State-added Questions
cross tabulations
Cross Tabulations
  • Adults reporting fair or poor health
    • With current asthma = 37.5%; no current asthma = 16.8%
  • Adults who are current smokers
    • With current asthma = 32.1%; no current asthma = 24.7%
  • Adults ever told they had a depressive disorder
    • With current asthma = 38.9%; no current asthma = 18.7%
random child selection and child asthma modules
Random Child Selection and Child Asthma Modules
  • Use of random child selection and child asthma modules provides child asthma prevalence
    • Random child selection module:
      • Month/year of birth
      • Gender
      • Race/ethnicity
      • Relationship to child
    • Child Asthma Module
      • Health professional ever said child has asthma
      • Does child still have asthma?
      • Yes to both of these questions = current child asthma
  • Indiana included these modules from 2006-2010
asthma call back survey
Asthma Call Back Survey
  • Piloted in 2005 with three states – Indiana started in 2006
  • Funded by the National Asthma Control Program (NACP) in the Air Pollution and Respiratory Health Branch of the National Center for Environmental Health (NCEH).
  • If adult or randomly selected child has ever had asthma, they are asked to participate in the ACBS
  • Contacted within two weeks
  • Separate survey from BRFSS, but links to responses in BRFSS
  • Parent/guardian most familiar with selected child is proxy
  • For this presentation, using data from the Child ACBS
asthma call back survey contents
Asthma Call Back Survey contents
  • Questions cover:
    • Age and time since diagnosis
    • Time since they talked to a doctor, took asthma medication
    • Frequency/duration of symptoms
    • Frequency of asthma episodes/attacks
    • Insurance
    • Activity limitations
    • MD/urgent/ER/hospital visits for asthma
    • Action plan/course to manage asthma
    • Triggers in home
    • Detailed information on prescription medication
prevalence of current asthma among children indiana and the united states 2005 2010 2011
Prevalence of current asthma among children, Indiana and the United States, 2005–2010, 2011*

*The 2011 prevalence estimate was determined using a new, more precise methodology, including the addition of cell phone respondents and new weighting techniques; therefore, the 2011 estimate should not be compared to earlier prevalence estimates.

Source: CDC and ISDH DAT. (2012). Behavioral Risk Factor Surveillance System Prevalence Data, 2005-2011.

child current asthma prevalence for sex and race indiana 2011
Child Current Asthma Prevalence for Sex and Race, Indiana, 2011

Source: CDC and ISDH DAT. (2012). Behavioral Risk Factor Surveillance System Prevalence Data, 2011.

impact of asthma on indiana s children 2006 2010
Impact of asthma on Indiana’s children*, 2006–2010

*Children with current asthma

Source: Centers for Disease Control and Prevention and ISDH Data Analysis Team. (2013). Behavioral Risk Factor Surveillance System Asthma Call-back Survey, 2006-2010.

medical management of asthma children with current asthma indiana 2006 2010
Medical management of asthma, children with current asthma, Indiana, 2006–2010

Source: Centers for Disease Control and Prevention and ISDH Data Analysis Team. (2013). Behavioral Risk Factor Surveillance System Asthma Call-back Survey, 2006-2010.

distribution of asthma triggers present in child s home 2006 2010
Distribution of asthma triggers present in child’s* home, 2006–2010

*Children who currently have asthma.

Source: Centers for Disease Control and Prevention and ISDH Data Analysis Team. (2013). Behavioral Risk Factor Surveillance System Asthma Call-back Survey, 2006-2010.

household management of asthma prevalence of environmental triggers and avoidance behaviors
Household Management of Asthma: Prevalence of environmental triggers and avoidance behaviors

Source: Centers for Disease Control and Prevention and ISDH Data Analysis Team. (2013). Behavioral Risk Factor Surveillance System Asthma Call-back Survey, 2006-2010.

distribution of the number of low level triggers present in the home
Distribution of the number of low-level triggers present in the home

Source: Centers for Disease Control and Prevention and ISDH Data Analysis Team. (2013). Behavioral Risk Factor Surveillance System Asthma Call-back Survey, 2006-2010.

household management of asthma prevalence of environmental triggers and avoidance behaviors1
Household Management of Asthma: Prevalence of environmental triggers and avoidance behaviors

Source: Centers for Disease Control and Prevention and ISDH Data Analysis Team. (2013). Behavioral Risk Factor Surveillance System Asthma Call-back Survey, 2006-2010.

distribution of the number of high level triggers present in the home
Distribution of the number of high-level triggers present in the home

Source: Centers for Disease Control and Prevention and ISDH Data Analysis Team. (2013). Behavioral Risk Factor Surveillance System Asthma Call-back Survey, 2006-2010.

had asthma attack episode in past year by number and type of triggers in the child s home
Had asthma attack/episode in past year by number and type of triggers in the child’s* home

*Children who currently have asthma.

Source: Centers for Disease Control and Prevention and ISDH Data Analysis Team. (2013). Behavioral Risk Factor Surveillance System Asthma Call-back Survey, 2006-2010.

ever taken a course to manage asthma by number and type of triggers in the child s home
Ever taken a course to manage asthma by number and type of triggers in the child’s* home

*Children who currently have asthma.

Source: Centers for Disease Control and Prevention and ISDH Data Analysis Team. (2013). Behavioral Risk Factor Surveillance System Asthma Call-back Survey, 2006-2010.

association between triggers and health outcomes
Association between triggers and health outcomes
  • Having at least one high level trigger present in the child’s home increases the odds of an asthma attack/episode by 14% compared to children who do not have a high level trigger.
  • A lower percentage of children with 4+ low level triggers (58.5%) in their household were told by a health professional to modify their environment compared to children with 3 or less triggers.
slide30

Why Do Home Visits?

“We should not expect to change lives dramatically, particularly by visiting people sometimes once or twice a month. But we should expect to make a dent, to make their lives and the lives of their children at least a little better, taking small steps towards change.”

--Matthew Melmed

how do home visits help

Secondary prevention

    • Educate family on the pertinent health condition
    • Observe possible causes of health condition in the home
  • Identify other health needs within the family
  • Increase family’s self-efficacy
    • The belief in one’s ability to exercise influence over one’s own life
How Do Home Visits Help?
engaging families

Ask open-ended questions

  • Use a conversational approach, rather than interviewing
  • Effective Verbal Messages
    • Keep important messages succinct and free of jargon
    • Be mindful of the possibility for resistance in the listener
  • Effective Nonverbal Messages
    • Facial expressions
    • Posture and gestures
  • Effective Listening
    • Requires the listener to put aside their thoughts and agenda
    • Conveying an attitude of respect and acceptance
      • A desire to understand the speaker
Engaging Families
examples of triggers to look for in the home
Examples of triggers to look for in the home
  • Secondhand smoke
    • Home or car where smoking is allowed
    • Can be found in clothing
  • Dust Mites
    • Mattresses, bedding, carpets, etc.
  • Pests (cockroaches, rodents)
    • Areas with food and standing water
    • Cluttered areas with paper and cardboard
  • Mold
    • Areas with excess moisture
  • Nitrogen Dioxide
    • Gas cooking appliances, fireplaces, woodstoves
  • Pets
    • Does the pet sleep with the patient?
resources
Resources
  • 211: information hotline (English and Spanish speakers)
  • Local health department sanitarian
  • Examples of agencies in Indiana currently doing home visits
    • Marion County Public Health Department
    • Parkview Hospital in Fort Wayne
    • St. Mary’s Health System in Evansville
questions
Questions?
  • Source: www.healthyhomespartnership.net