December 12th, 2017
Pest infestation is a major problem in urban, low-income housing and may contribute to elevated asthma prevalence andexacerbation rates in such communities. However, there is poor understanding of the effectiveness of integrated pestmanagement (IPM) efforts in controlling pediatric asthma, or of the interactions among various interventions and riskfactors in these settings.As part of the Boston-based Healthy Public Housing Initiative, we conducted a longitudinal,single-cohort community-based participatory research intervention study. Fifty asthmatic children aged 4–17 from threepublic housing developments in Boston, Massachusetts, USA successfully completed interventions and detailedenvironmental, medical, social, and health outcome data collection. Interventions primarily consisted of IPM and relatedcleaning and educational efforts, but also included limited case management and support from trained community healthadvocates. In pre-post analyses, we found significant reductions in a 2-week recall respiratory symptom score (from 2.6 to1.5 on an 8-point scale, p _ 0:0002) and in the frequency of wheeze/cough, slowing down or stopping play, and waking atnight. Longitudinal analyses of asthma-related quality of life similarly document significant improvements, with asuggestion of some improvements prior to environmental interventions with an increased rate of improvement subsequentto pest management activities.Analyses of potential explanatory factors demonstrated significant between-development differences in symptom improvements and suggested some potential contributions of allergen reductions, increased peakflow meter usage, and improved social support, but not medication changes. In spite of limitations with pre-postcomparisons, our results are consistent with aggressive pest management and other allergen reduction efforts having apositive impact on clinical health outcomes associated with asthma. Our findings reinforce the multifactorial nature ofurban asthma and suggest a need for further study of the relative contributions of and possible synergies betweenenvironmental and social factors in asthma intervention programs.