Clinical Trial: Asthma and Pest Control Study: Demonstrating Return-on-Investment for In-Home Pest Control for Children With Persistent Asthma

Study Status: Active, not recruiting
Recruit Status: Active, not recruiting
Study Type: Interventional

Official Title: Asthma and Pest Control Study: Demonstrating Return-on-Investment for In-Home Pest Control for Children With Persistent Asthma

Brief Summary:

The New York City Department of Health and Mental Hygiene and Montefiore Medical Center, with the Fund for Public Health of New York (FPHNY), DOHMH's fiscal agent, are partnering on a study to evaluate the feasibility, health outcomes and return-on-investment of a single, integrated pest management (IPM) intervention for Bronx, Harlem, and Northern Manhattan children aged 5 to 12 with persistent asthma who are living in homes with pests. By demonstrating cost effectiveness, this study could provide the basis for health insurance coverage of an IPM visit embedded in clinical treatment plans for high-risk asthma patients living with pests.

Asthma is the most common childhood disease in New York City, and both prevalence and hospitalization rates are highest in high-poverty neighborhoods. The greatest individual and community-level factor associated with asthma disparities is varying exposure to triggers in the home, most notably cockroaches and mice. Asthma health care costs are significant, and prevention efforts to reduce triggers could result in improved outcomes and significant cost savings. Unlike traditional pest control, which relies on pesticides, IPM eliminates pests and prevents re-infestation by addressing housing conditions conducive to pests and with safe, targeted use of pesticides. This project targets low-income children with the potential to significantly improve their health and well-being. A total of 400 families - 400+ children which includes screened and recruited siblings - will be recruited on to the study.

The study is designed to evaluate an inexpensive and scalable environmental intervention for asthma that can be replicated in other New York City neighborhoods and incorporated into any urban healthcare setting in New York State and nationwide.


Detailed Summary:

The New York City Department of Health and Mental Hygiene (DOHMH) and Montefiore Medical Center, with the Fund for Public Health of New York, DOHMH's fiscal agent, have partnered on a study to evaluate the feasibility, health outcomes and return-on-investment of a single integrated pest management (IPM) intervention for Bronx, Harlem and Northern Manhattan children aged 5 to 12 with persistent asthma who are living in homes with pests. Principal Investigator (PI) Daniel Kass, MSPH, Deputy Commissioner of the DOHMH Division of Environmental Health, has extensive experience overseeing evaluation of program and policy initiatives, and co-PI Marina Reznik, MD, MS, Associate Professor of Pediatrics at Montefiore, has conducted research on evaluating the impact of a home-based asthma intervention on asthma-related outcomes in children with persistent asthma recruited from Montefiore clinics.

Asthma is the most common childhood disease in New York City, and both prevalence and hospitalization rates are highest in high-poverty neighborhoods. The greatest individual and community-level factor associated with asthma disparities is varying exposure to triggers in the home, most notably cockroaches and mice. Asthma health care costs are significant, and prevention efforts to reduce triggers could result in improved outcomes and significant cost savings. Unlike traditional pest control, which relies solely on pesticides, IPM eliminates pests and prevents re-infestation by addressing housing conditions conducive to pests and with safe, targeted use of pesticides.

The specific goals of the project are to:

  • Demonstrate the feasibility of implementing a basic IPM intervention in the homes of children aged 5-12 years with persistent asthma or current prescripti
    Sponsor: New York City Department of Health and Mental Hygiene

    Current Primary Outcome:

    • Change from baseline in counts of urgent care (unscheduled ambulatory) visits at 6 months [ Time Frame: Baseline to 6-months ]
    • Change from baseline in costs of urgent care (unscheduled ambulatory) visits at 6 months [ Time Frame: Baseline to 6-Months ]
    • Change from 6-months in counts of urgent care (unscheduled ambulatory) visits at 12 months [ Time Frame: 6 months and 12 months ]
    • Change from 6-months in costs of urgent care (unscheduled ambulatory) visits at 12 months [ Time Frame: 6 months and 12 months ]
    • Change from baseline in counts of urgent care (unscheduled ambulatory) visits at 12 months [ Time Frame: Baseline and 12 months ]
    • Change from baseline in costs urgent care (unscheduled ambulatory) visits at 12 months [ Time Frame: Baseline and 12 months ]
    • Change from baseline in counts of Emergency Department visits at 6 months [ Time Frame: Baseline to 6 months ]
    • Change from baseline in costs of Emergency Department visits at 6 months [ Time Frame: Baseline to 6 months ]
    • Change from 6-months in counts of Emergency Department visits at 12 months [ Time Frame: 6 month to 12 month ]
    • Change from 6-months in costs of Emergency Department visits at 12 months [ Time Frame: 6 month to 12 month ]
    • Change from baseline in counts of Emergency Department visits at 12 months [ Time Frame: Baseline to 12 months ]
    • Change fr

      Original Primary Outcome: Same as current

      Current Secondary Outcome:

      • Change from baseline in number of symptom days per 2-weeks (Participant Reported Outcome) at 6 months [ Time Frame: Baseline to 6 months ]

        Mean number of caregiver-reported asthma symptom days in the past 2 weeks (as per National Cooperative Inner-City Asthma Study), calculated as the maximum of 3 measures:

        i. Number of days when the child had wheezing, tightness in the chest, or cough; ii. Number of nights when the child lost sleep because of asthma iii. Number of days the child slowed down or stopped regular play or activities because of asthma.

      • Change from 6 months in number of symptom days per 2-weeks (participant Reported Outcome) at 12 months [ Time Frame: 6 months to 12 months ]

        Mean number of caregiver-reported asthma symptom days in the past 2 weeks (as per National Cooperative Inner-City Asthma Study), calculated as the maximum of 3 measures:

        i. Number of days when the child had wheezing, tightness in the chest, or cough; ii. Number of nights when the child lost sleep because of asthma iii. Number of days the child slowed down or stopped regular play or activities because of asthma.

      • Change from baseline in number of symptom days per 2-weeks (participant reported outcome) at 12 months [ Time Frame: Baseline to 12 months ]

        Mean number of caregiver-reported asthma symptom days in the past 2 weeks (as per National Cooperative Inner-City Asthma Study), calculated as the maximum of 3 measures:

        i. Number of days when the child had wheezing, tightness in the chest, or cough; ii. Number of nights when the child lost sleep because of asthma iii. Number of days the child slowed down or stopped regular play or activities because of asthma.

      • Change from Baseline in the Number of Days Child Missed School (Participant Reported Outcome) at 6 months [ Time Frame: Baseline to 6 months ]
      • Change from 6 Months in the Number of Days Child Missed School (Participant Reported Outcome) at 12 months [ Time Frame: 6 months to 12 months ]
      • Change from Baseline in the Number of Days Child Missed School (Participant Reported Outcome) at 12 months [ Time Frame: Baseline to 12 months ]
      • Change from Baseline in the Number of Days Parent Missed Work (Participant Reported Outcome) at 6 Months [ Time Frame: Baseline to 6 Months ]
      • Change from 6 Months in the Number of Days Parent Missed Work (Participant Reported Outcome) at 12Months [ Time Frame: 6 Months to 12 Months ]
      • Change from Baseline in the Number of Days Parent Missed Work (Participant Reported Outcome) at 12Months [ Time Frame: Baseline to 12 Months ]


      Original Secondary Outcome: Same as current

      Information By: New York City Department of Health and Mental Hygiene

      Dates:
      Date Received: March 31, 2015
      Date Started: December 2013
      Date Completion: August 2017
      Last Updated: April 3, 2017
      Last Verified: April 2017