Asthma Triggers and Avoidance Behaviors Among Indiana Children with Current Asthma - PowerPoint Presentation

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Asthma Triggers and Avoidance Behaviors Among Indiana Children with Current Asthma

Amy Brandt, MPH — Chronic Respiratory Disease EpidemiologistLinda Stemnock — BRFSS Coordinator

Chronic Respiratory Disease Section

May 14, 2013

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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.htmCitations for individual graphs are on the slides.

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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.

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Background

Home visits are effective, evidence-based interventions that decrease asthma symptoms and exacerbationsA randomized clinical trial in Baltimore found that home visits reduced indoor air pollutants and allergen exposures, which in turn, reduced asthma symptoms1Intensive home visits that use a multifaceted individualized approach of education, exposure reduction and resources are highly effective in improving health outcomes and changing behaviors

2

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.

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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

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Asthma and the Home Environment

Why should we care?Americans spend about 90 percent or more of their time indoors1Indoor pollutant levels may be two to five times higher than outdoor levels

1People have a greater ability to modify indoor environmentsThe epithelium is more susceptible to damage in children with asthma

Exposure to air pollution alters the normal process of lung development

2

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.

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Methods

Study Population (N=350)All children (0-17) who were ever diagnosed with asthma and still have asthmaParents/caregivers gave responses for childrenData Source

Indiana Behavioral Risk Factor Surveillance System and Asthma Call Back SurveyCombined data source for years 2006 to 2010

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Behavioral Risk Factor Surveillance System

Started by CDC in 1984Provides state- and national-level prevalence for risk factors, behaviors and select chronic conditionsRandom-digit dial telephone surveyLargest continuously-conducted health survey in the world

Survey conducted for an entire calendar year

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Goals and Objectives of BRFSS

Determine prevalence of behaviors associated with leading causes of premature deathIncrease

public awareness of lifestyle changes that can improve healthMonitor 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

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Behavioral Risk Factor Surveillance System

Questionnaire consists ofCore questionsRotating core questionsOptional modulesState-added Questions

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Cross Tabulations

Adults reporting fair or poor healthWith current asthma = 37.5%; no current asthma =

16.8%Adults who are current smokersWith current asthma =

32.1%

; no current asthma =

24.7%Adults ever told they had a depressive disorderWith current asthma = 38.9%; no current asthma = 18.7%

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Number of Completed Surveys per Year Indiana 2002-2013

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Random Child Selection and Child Asthma Modules

Use of random child selection and child asthma modules provides child asthma prevalenceRandom child selection module:Month/year of birthGender

Race/ethnicityRelationship to childChild Asthma Module

Health professional ever said child has asthma

Does child still have asthma?

Yes to both of these questions = current child asthmaIndiana included these modules from 2006-2010

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Asthma Call Back Survey

Piloted in 2005 with three states – Indiana started in 2006Funded 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 weeksSeparate survey from BRFSS, but links to responses in BRFSSParent/guardian most familiar with selected child is proxy

For this presentation, using data from the Child ACBS

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Asthma Call Back Survey contents

Questions cover:Age and time since diagnosisTime since they talked to a doctor, took asthma medicationFrequency/duration of symptomsFrequency of asthma episodes/attacks

InsuranceActivity limitationsMD/urgent/ER/hospital visits for asthma

Action plan/course to manage asthma

Triggers in home

Detailed information on prescription medication

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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.

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Child Current Asthma Prevalence for Sex and Race, Indiana, 2011

Source: CDC and

ISDH DAT. (2012).

Behavioral Risk Factor Surveillance System Prevalence Data, 2011.

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Results

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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

.

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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

.

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Definition: Triggers

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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.

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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.

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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.

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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.

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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.

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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

.

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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

.

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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.

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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

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How Do Home Visits Help?

Secondary preventionEducate family on the pertinent health conditionObserve 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

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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 listenerEffective Nonverbal MessagesFacial 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

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Examples of triggers to look for in the home

Secondhand smokeHome or car where smoking is allowedCan be found in clothing

Dust MitesMattresses, bedding, carpets, etc.

Pests (cockroaches, rodents)

Areas with food and standing water

Cluttered areas with paper and cardboardMoldAreas with excess moistureNitrogen DioxideGas cooking appliances, fireplaces, woodstovesPets

Does the pet sleep with the patient?

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http://epa.gov/asthma/pdfs/home_environment_checklist.pdf

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Resources

211: information hotline (English and Spanish speakers)Local health department sanitarianExamples of agencies in Indiana currently doing home visitsMarion County Public Health DepartmentParkview Hospital in Fort Wayne

St. Mary’s Health System in Evansville

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Source:

www.healthyhomespartnership.net

Questions?

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Contact Information

Linda Stemnock

BRFSS

Coordinator

Indiana State Department of Health

lstemnoc@isdh.in.gov(317) 233-7536

Amy Brandt

Chronic Respiratory Disease Epidemiologist

Indiana State Department of Health

abrandt@isdh.in.gov

(317) 233-7793