Particulate Reduction Education in City Homes

150 children aged 6-12 years who reside in Baltimore and have a smoker in the household are
to be enrolled in this study. All children will be randomized into three groups: HEPA air
cleaners plus ETS/Indoor particulate behavior management, HEPA air cleaners and a standard
asthma education and a standard asthma education group with delayed HEPA filter use. The
HEPA air cleaner plus ETS/Indoor particulate behavior management intervention group will
receive four home visits by a health coach to assess motivation for parental behavior change
and then assist the parent to reduce/eliminate their child's exposure to ETS in the home.
The intervention is based on the social cognitive theory that utilizes behavior modification
techniques (e.g., modeling, reinforcement, self-monitoring, feedback and rehearsal) to
change health behaviors. Families in this group and the HEPA air cleaner only group will
receive two HEPA air cleaners to use over the 6-month follow-up period and three home visits
for standard asthma education. Use of air cleaners will be electronically monitored to
determine level or "dose" of air cleaning used by families. The standard asthma education
group (delayed HEPA Filter group) will receive three home visits to deliver basic asthma
education. All children receive a baseline home inspection, 7-day home PM exposure
monitoring, home dust allergen collection, skin testing, urine cotinine, spirometry, serum
eosinophilia and exhaled NO testing. Caregivers of each child will be interviewed at
baseline and at the 6-month follow-up regarding ETS reduction behaviors in the home, symptom
frequency, asthma control, other environmental exposures and health care utilization
outcomes. The primary outcome for this study is reduction in PM10 and PM2.5 over the 6 month
follow-up. Secondary outcomes include ETS reduction behavior change (i.e. smoker is smoking
outside of home, child not sitting with smoker, reduction in number of household smokers),
symptom free days and health care utilization measures. If successful, this intervention
could have significant clinical and public health applications for pediatric asthma
management in children with persistent asthma and high ETS home exposure.

Inclusion Criteria:

- An eligible child will be defined as:

- Age 6-12 years

- Doctor's diagnosis of asthma

- Currently having persistent asthma, defined as asthma symptoms or use of quick
reliever asthma medication > 2 days/week in the last 2 weeks or use of daily
controller asthma medication in past 2 weeks based on parent report.

- Reside in eligible household at least 5 days per week

Household:

- Located in Baltimore

- Housing an eligible child

- Housing an English speaking family

- Housing at least one smoker, who smokes 5 or more cigarettes per day. Smoking in the
car will be recorded, but if ETS exposure is limited to the car, the household is not
eligible.

- Having working electricity and no major structural damage.

- Having no working air cleaner

Exclusion Criteria:

- Children will be excluded is they have other respiratory morbidity such as cystic
fibrosis or bronchopulmonary dysplasia, if they smoke cigarettes, if they do not have
asthma symptoms or medication use in the month before randomization

- Families living in a shelter or transitional housing will be excluded