asthma triggers and avoidance behaviors among indiana children with current asthma
DESCRIPTION
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. - PowerPoint PPT PresentationTRANSCRIPT
A healthier and safer Indiana
ASTHMA TRIGGERS AND AVOIDANCE BEHAVIORS AMONG INDIANA CHILDREN WITH CURRENT ASTHMA
Amy Brandt, MPH — Chronic Respiratory Disease EpidemiologistLinda Stemnock — BRFSS Coordinator
CHRONIC RESPIRATORY DISEASE SECTIONMAY 14, 2013
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 presentationIndiana 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
1. Describe Indiana's child population with current asthma.
2. Examine asthma triggers and avoidance behaviors in Indiana children.
3. Translate data findings into areas of need and practice throughout the state.
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
1. 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.
2. 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
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
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
1. Environmental Protection Agency. (2009). Buildings and their Impact on the Environment: A statistical summary.2. 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
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
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
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 risksShare data with state and local agencies
Behavioral Risk Factor Surveillance System
Questionnaire consists of Core questions
• Rotating core questions Optional modules State-added Questions
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%
Number of Completed Surveys per Year Indiana 2002-2013
0
2000
4000
6000
8000
10000
12000
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Landline Cell
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
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
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*
*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.
9.5
0
2
4
6
8
10
12
2005 2006 2007 2008 2009 2010 2011
Perc
ent
Year
Indiana United States
Child Current Asthma Prevalence for Sex and Race, Indiana, 2011
Source: CDC and ISDH DAT. (2012). Behavioral Risk Factor Surveillance System Prevalence Data, 2011.
9.56.1
11.27.4
22.7
9.7
0
5
10
15
20
25
30
35
Overall Male Female White Black Hispanic
Perc
ent
Results
Impact of asthma on Indiana’s children*, 2006–2010
*Children with current asthmaSource: Centers for Disease Control and Prevention and ISDH Data Analysis Team. (2013). Behavioral Risk Factor
Surveillance System Asthma Call-back Survey, 2006-2010.
61.2
41.4
45.7
0 20 40 60 80
had activity limitations due to asthma?
had a flu shot?
seen a health professional for urgent treatment of worsening
asthma symptoms or for an asthma attack?
Percent
In the past 12 months, has the child with current asthma . . .
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.
81.7
53.1
44.3
0 20 40 60 80 100
Never taken a course to manage asthma
Never given an asthma action plan
Health professional advised changes in home/school to improve child's asthma
Percent
Definition: Triggers• Cigarettes smoked in home• Saw/smelled mold• Saw cockroaches• Saw rodents• Inside pets• Pets allowed in child’s bedroom
High-Level Triggers
• Kitchen/bath fans not used• Carpeting in child’s bedroom• No mattress cover• No pillow cover• Hot water not used for cleaning sheets• Unvented gas logs/fireplace• Air cleaner not used• Dehumidifier not used• Wood burning stove/fireplace• Gas used for cooking
Low-Level Triggers
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.
0.01.0 1.4
4.6
7.0
12.6
16.2 16.8
13.0 13.4 14.0
0
2
4
6
8
10
12
14
16
18
None One Two Three Four Five Six Seven Eight Nine Ten or More
Perc
ent
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.
Low-level triggers/behaviors Percent
Carpeting or rugs in child's bedroom 81.4
Dehumidifier not used 71.9
Pillow cover not used 68.2
Aircleaner not used 62.2
Mattress cover not used 61.5
Hot water not used for child's sheets/pillowcases 61.2Gas used for cooking 41.8
Kitchen exhaust fan not used 40.8
Exhaust fan not used in child's bathroom 34.8
Wood-burning fireplace or wood stove used 16.5
Unvented gas logs/fireplace used in child's home 7.6
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.
0
10
20
30
40
50
60
1 2 3 4 5 6 7 8 9 10
Num
ber o
f Hou
seho
lds
Number of triggers
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.
High-level triggers/behaviors PercentInside pets 59.8
Pets allowed in child's bedroom 58.2
Saw mice or rats 10.5
Cigarettes smoked inside the home 9.0
Seen or smelled mold 5.6
Saw cockroaches 2.6
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.
0
20
40
60
80
100
120
140
0 1 2 3 4
Num
ber o
f Hou
seho
lds
Number of triggers in 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.
0.0%6.6%
29.0%
64.4%
28.4%
62.4%
9.1%0.0%
0%
20%
40%
60%
80%
100%
None 1-2 triggers 3-4 triggers 5+ triggers
Perc
ent
Low Level High Level
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.
0.0%
17.8%
39.1%43.1%
31.5%
57.6%
10.8%
0.0%0%
10%
20%
30%
40%
50%
60%
70%
None 1-2 triggers 3-4 triggers 5-10 triggers
Perc
ent
Low Level High Level
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.
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 familyIncrease family’s self-efficacy
The belief in one’s ability to exercise influence over one’s own life
Engaging Families
Ask open-ended questionsUse a conversational approach, rather than interviewingEffective 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
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?
http://epa.gov/asthma/pdfs/home_environment_checklist.pdf
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
Source: www.healthyhomespartnership.net
Questions?
Contact InformationLinda StemnockBRFSS Coordinator
Indiana State Department of [email protected]
(317) 233-7536
Amy BrandtChronic Respiratory Disease Epidemiologist
Indiana State Department of [email protected]
(317) 233-7793