Michigan Center for the Environment and Children’s Health: Community Action Against Asthma - A
Community-Based Participatory Research Approach to Understanding and Addressing Environmental Triggers
to Childhood Asthma In Detroit, Michigan * *
Barbara A. Israel*, Dr. P.H., M.P.H.
Professor, University of Michigan
Department of Health Behavior & Health Education
School of Public Health
Lecture presented in Political Science 327: The Politics of the Metropolis
November 14, 2002
*With acknowledgement to all of the partners involved in Community Action Against Asthma
Background: Childhood Asthma Prevalence
Asthma is most common chronic disease of childhood in developed world (~5 million in U.S.)
Prevalence rate of pediatric asthma increased 61% in U.S. (1982-1994)
Mortality rate of pediatric asthma increased by 78% in U.S. (1980-1993)
Childhood asthma particularly prevalent within low income communities, urban areas and communities of color
National trends in increase in childhood asthma are similar in Detroit, Michigan
Risk Factors/Stressors Associated with Childhood Asthma
Causation and aggravation of pediatric asthma complex and multifactorial
Risk factors/stressors associated with childhood asthma include:Genetic disposition;Demographic factors (e.g., socioeconomic status)Indoor environmental exposures (e.g., dust mite and
cockroach allergens, tobacco smoke)Outdoor environmental exposures (e.g., particulate matter,
ozone)Psychosocial stressors (e.g., violence, crime, lack of
community resources)
Implications for Research and Practice
Addressing complex set of factors associated with childhood asthma a major challenge for researchers, practitioners and the affected communities.
Historically research has rarely directly benefited and sometimes actually harmed the communities involved, and has excluded them from influence over the research process.
Implications for Research and Practice (Continued)
Interventions have often not been as effective as could be because:not tailored to concerns and cultures of
participants;not included participants in all aspects of
intervention design, implementation and evaluation.
Increasing calls for more participatory and comprehensive approaches to public health research and practice
DEFINITION OF COMMUNITY-BASED PARTICIPATORY RESEARCH
Community-based participatory research in public health is a partnership approach to research that equitably involves, for example, community members, organizational representatives, and researchers in all aspects of the research process; with all partners contributing their expertise and sharing responsibility and ownership to enhance understanding of a given phenomenon, and to integrate the knowledge gained with action to improve the health and well-being of community members.
Key Principles of Community-Based Participatory Research
1. Recognizes community as unit of identity.
2. Builds on strength and resources within the community.
3. Facilitates collaborative, equitable partnership in all phases of the research, involving an empowering process.
Key Principles of Community-Based Participatory Research
4. Promotes co-learning and capacity building among all partners involved.
5. Integrates knowledge and change for mutual benefit of all partners.
6. Emphasis on local relevance of public health problems and the multiple determinants of health and disease (e.g., biomedical, social, economic, physical environmental).
Key Principles of Community-Based Participatory Research (Continued)
7. Involves cyclical, iterative process.
8. Disseminates findings and knowledge gained to all partners and involves all partners in the dissemination process.
9. Involves a long-term process and commitment.
Michigan Center for the Environment and Children’s Health (MCECH)
Detroit Community-Academic Urban Research Center (URC) as original partnership
URC identified diseases related to environmental concerns (including asthma) as priority area
URC applied for and received funding from National Institute of Environmental Health Sciences and U.S. Environmental Protection Agency: Centers of Excellence
MCECH governed by community-based participatory research principles
Michigan Center for the Environment and Children’s Health - Partners
UM School of Public Health UM School of Medicine Detroit Health Department Butzel Family Center Community Health & Social
Services Center Detroit Hispanic Development
Corporation Detroiters Working for
Environmental Justice
Friends of Parkside Kettering Butzel Health
Initiative Latino Family Services United Housing Coalition Warren/Conner Development
Coalition Henry Ford Health System Michigan Department of
Agriculture, Plant and Pest Management Division
Michigan Center for the Environment and Children’s Health (MCECH)
Overall Goal
To investigate the environmental, patho- physiological and clinical mechanisms of childhood asthma, and to implement and evaluate comprehensive community and household-level interventions aimed at reducing asthma-related environmental threats to children, families and neighborhoods.
MCECH Core Research Projects
Household and neighborhood level interventions focusing on reduction of environmental triggers for childhood asthma
An exposure assessment to assess the separate and possible interaction effects of outdoor and indoor air quality on exacerbation of asthma in children
A murine model project to determine if the mechanism of chronic pulmonary inflammation due to repeated exposure to allergens is mediated by the excessive local production of chemokines
Community Action Against Asthma (CAAA)Intervention and Exposure Assessment Project
Participants from two geographic areas within city of Detroit, east side (90% African-American) and southwest (50% African-American, 40% Latino and 10% non-Latino white)
300 families with at least one child age 7 to 11 with probable or known asthma enrolled
Recruited through screening questionnaire distributed through mail and at schools
Community Action Against Asthma - Household-Level Intervention Activities
Staggered research design - families randomly assigned to Wave 1 or Wave 2
Two year intervention in intensive and less intensive phases
Community Action Against Asthma - Household-Level Intervention Activities
(continued)
Minimum of nine visits by “Community Environmental Specialists” in intensive phase, and 3 visits in Year 2 less intensive phaseEducation (e.g., dustmite, cockroaches, household
cleaning)Materials distributed (e.g., vacuum cleaners, mattress
covers)Integrated pest managementOther (e.g., housing, obtaining city services, furniture,
translation)
Community Action Against Asthma - Household Level Intervention Objectives
Increase knowledge and perceived self-efficacy of participants about asthma and behaviors to reduce environmental triggers
Increase behaviors to reduce indoor environmental triggers (e.g., vacuuming, damp mopping)
Reduce indoor exposures to environmental triggers (e.g., dust levels, cockroach antigens)
Community Action Against Asthma - Household Level Intervention Objectives
(continued)
Strengthen psychosocial factors associated with asthma-related health status (e.g., social support)
Improve asthma-related health status (e.g.., quality of life, functional status, symptom severity)
Reduce use of medications and asthma-related health services utilization
Community Action Against Asthma - Evaluation Research Methods
Skin test assessment Annual measurements
Questionnaires for parents and children (e.g., psychosocial factors and health)
Household dust sampling and environmental checklistNeighborhood Environmental Checklist
Qualitative evaluation of process of adhering to CBPR principlesIn-depth interviews with members of SC
Community Action Against Asthma - Exposure Assessment
Two weeks in duration (total of 11 assessments over 2 1/2 years)
Assessment of health outcomes (e.g., symptom diary, lung functioning)
Daily ambient measures of particulate matter 2.5, PM10, ozone, meterological variables in each community
Community Action Against Asthma - Exposure Assessment (continued)
Daily indoor measures of PM2.5, PM10, and Vapor Phase Nicotine in homes of 20 children
Daily personal exposure monitoring of PM10 for same 20 children
Community Action Against Asthma - Community-Level Intervention Activities
Neighborhood and policy level organizers in east side and southwest communities
Identifying priority environmental concerns through data already collected and interviews with key groups and organizations
Community Action Against Asthma - Community-Level Intervention Activities
(continued)
Establishing inter-organizational network to address priority concerns
Will work with existing organizations and coalitions on environmental organizing campaigns and facilitate other activities based on priorities selected
CAAACommunity Level Intervention
Objectives Increase knowledge and awareness about
asthma and indoor and outdoor environmental triggers
Increase neighborhood and community social support and cohesion
Increase capacity of neighborhoods to work collectively to reduce environmental triggers associated with asthma
CAAACommunity Level Intervention
Objectives (continued)
Increase knowledge about available resources in the community (e.g., tenants’ rights organizations, environmental groups)
Reduce physical environmental hazards in the neighborhoods involved (e.g., illegal dumping, air pollution)
Advantages of Using a CBPR Approach
Enhances relevance and use of dataData collection: content and quality
Increases quality and validity of research and interventionRecruitmentRetention
Advantages of Using a CBPR Approach (continued)
Improves intervention design and implementationSelection and training of outreach workersExtends beyond asthma directed needs
Advantages of Using a CBPR Approach (continued)
Knowledge gained and actions taken benefit the community
Joins partners with diverse expertise to address complex public health problems
Has potential to translate research findings to guide development of further interventions and policy change
Lessons Learned: Recommendations for Conducting CBPR
Time and support needed up front to establish trust and jointly define priorities
Partnerships need to constantly re-assess to maintain trust and ensure involvement and influence of all members
Different cultures of partner organizations need to be recognized and respected