Benefits and Challenges of Following a Community Based Participatory Model: Community Action Against Asthma

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Benefits and Challenges of Following a Community
Based Participatory Model Community Action
Against Asthma

• Funded by the National Institute of Environmental
  Health Sciences (R01-ES010688, P01-ES09589 ) and
  the Environmental Protection Agency
  (P-01-ES09589)

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Who Are We and What is Our Experience With CBPR?

• Members of the Urban Research Center (URC)
• Members of the Community Action Against Asthma
  Research Project
• Working Together for 13 years in both of these
  CBPR partnerships

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What is Asthma?

• Chronic condition related to reversible airway
  obstruction
• Affects over 5 million kids in the U.S.
• Disproportionately affects children living in
  poverty and in urban areas, and African-American
  populations.

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Childhood Asthma in Detroit

• Asthma prevalence high
• 14.3 physician diagnosis and wheeze in the last
  12 months
• Additional 14.3 with probable asthma
• High hospitalization rates
• Among children age 1-14 3x Michigan rate
• African-Americans bear higher burden
• Hospitalization among children 1-14 yrs old 4x
  Caucasian rate
• Death among patients ages 1-44 years 6x
  Caucasian rate

Joseph C. et al, 1996 MI Dept of Community
Health, 2003
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What is Community-Based Participatory Research
(CBPR)?

• Collaborative approach that involves community
  members, organizational representatives and other
  parties in all aspects of the planning and
  implementation and evaluation process. (Israel,
  Schulz, Parker and Becker, 1998)

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Why might CBPR improve our research and practice
with asthma in minority populations?

• Historical exclusion of communities from
  influence in research process.
• Questions of direct benefit from and even
  sometimes harm resulting from research endeavors.
  
• Interventions developed that lack community input
  and not tailored to concerns and culture of
  participants.
• CBPR allows for participation which may
• better identify causative factors of asthma
• improve interventions

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Background of Community Action Against Asthma
(CAAA)

• 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 National Institute for
  Environmental Sciences/Environmental Protection
  Agency Center for Excellence.
• Project follows community-based research
  principles.

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Aspects of Community-Based Participatory Research
(CBPR) Principles

• Involve all partners, as appropriate, in all
  major phases of the research process.
• Ensures that findings are produced, interpreted,
  and disseminated to community members in clear
  and respectful language that can be used to
  benefit the community.

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Community Action Against Asthma Partners

• UM School of Public Health
• UM School of Medicine
• Arab CommunityDetroit Health Department
• Community Health Social Services Center
• Detroit Hispanic Development Corporation
• Detroiters Working for Environmental Justice

• Friends of Parkside
• Latino Family Services
• Warren/Conner Development Coalition
• Henry Ford Health System
• Michigan Department of Agriculture, Plant and
  Pest Management Division

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Original CAAA Combined Two Research Projects

• Household Intervention
• To reduce environmental triggers
• For asthma
• Exposure and Health Effects Assessment- To assess
  separate possible interaction effects of
  outdoor and indoor
• air quality on exacerbation of asthma in
  children

Community Action Against Asthma
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CAAA Population

• Eastside (90 African-American) and Southwest
  (50 African-American, 40 Latino and 10
  non-Latino white).
• Population-based recruitment through screening
  questionnaire distributed at schools.
• 298 families with at least one child age 6 to 11
  with probable or known asthma enrolled.
• Project Timeline- Fall 1998 to Summer 2003

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CAAA Detroit Communities
5 km
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CAAA Intervention Hypothesis

• A household-level environmental intervention
  consisting of
• home visits, services, and supplies
• tailored to individual family needs
• provided by lay community outreach workers
• Can
• Improve caregivers knowledge of and behaviors to
  reduce environmental triggers for asthma
• modify the physical environment, and
• improve asthma-related health outcomes

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Household Intervention

• Randomized controlled trial with staggered design
• 1 year intensive intervention
• Minimum of 9 visits
• Household visits by Community Environmental
  Specialists (CESs)
• Core curriculum for all participants
• Individualized plan tailored to child and family
  specific needs

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Community Environmental Specialists
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Household Intervention Activities

• Activities during visits include
• Education on reduction of asthma
• Provision of materials (vacuum cleaner, cleaning
  supplies, mattress covers)
• Provision of Integrated Pest management
• Referrals for medical care, tenant issues,
  smoking cessation, and other issues
• Provision of social support

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Putting Together Vacuum Cleaners
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Photos From Integrated Pest Management
Abell Meets CESs at the House
Roaches in bedroom desk
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Photos From Integrated Pest Management
CESs looking for roaches
Egg casings and markings
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Special Activities - Furniture Delivery
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Exposure and Health Effects Study
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Exposure and Health Effects Study Outdoor PM and
Ozone Sample Collection

• Collected in southwest Detroit at Maybury
  Elementary.
• Collected in east Detroit at Keith Elementary.

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Exposure and Health Effects Study

• Collected health data for 2 weeks each season for
  2 years
• Daily log of symptoms, medications and activity
  level
• Morning and evening measurement of lung function

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Exposure and Health Effects Study

• In subset of the 298 participating households
• Outdoor/indoor sampling at homes
• Personal sampling on children (with a backpack)
• Two-week integrated measure of vapor phase
  nicotine using a passive sample

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Indoor Air Sampling

• PHOTOS HERE

Indoor air sampling machine
Ursula at family feedback forum
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Summary of Findings
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Summary of Findings

• The household intervention
• improved lung function
• reduced depressive symptoms in caregivers and
  reduced doctor visits, emergency room visits,
  hospitalization and ICU stays of children.
• increased the percent of children adequately
  medicated.

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More Findings

• Levels of PM 2.5 outdoors may be above the
  current annual standard, especially in SW
  Detroit.
• Levels of summertime ozone outdoors are above the
  current 8-hour standard.

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More Findings

• Among children with asthma in Detroit who have
  moderate to severe asthma, increases in PM and of
  ozone are significantly associated with worse
  pulmonary functioning on days following their
  exposure.

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Effects of September 11th, 2001
Elemental Carbon (EC) in PM2.5
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Advantages of a CBPR approach
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Advantages of Using a CBPR Approach

• Focuses on Issue of Concern to Community
• Environmental Causes of Asthma
• Use of data by community to advocate for changes
  in proposed transportation programs
• Replication of intervention by Health Department

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Advantages of Using a CBPR Approach

• Improves the Research
• Hiring of Staff
• Data Collection
• Recruitment and Retention
• Dissemination

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Challenges of Doing CBPR

• Constraints and costs of doing CBPR across
  different organizational cultures
• Learning how to conduct research and work
  together in different ways
• Challenge of ensuring community member
  participation in day-to-day research and
  governance decisions
• Challenges Related to Maintaining Trust

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Field Trip at U. of M.
Practicing with the Spirometry Machine
Wearing Clean Lab Suits
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Field Trip at U. of M.
Learning about mice in the lab
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Elemental Carbon (a diesel particulate marker)
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Outdoor PM10 in Detroit (2000-2001)
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Outdoor PM2.5 in Detroit (2000-2001)