Seven years ago when Marisol Alcantaro moved with her family from Puerto Rico to Lowell, Mass., her youngest daughter, Alondra, then a toddler, began exhibiting signs of asthma. Over the years, the little girl’s condition worsened and began adversely affecting every aspect of her life.
“She had trouble sleeping at night — she would wake up wheezing,” Alcantaro recalls. “It was hard for her to breathe when she ran or when she walked up the stairs. She began to miss school a lot, and that was hard for her because she loves school. She was just so unhappy.”
When Alondra did attend school, she was often unable to participate in gym class and she couldn’t keep up with her friends on the playground or during playtime after school. Although her doctor prescribed medication, her asthma attacks continued to increase in frequency.
Alcantaro, who speaks little English and had had difficulty navigating the health system in America, was at a loss for how to help her daughter.
An Angel at the Door
Then, last year, an outreach worker at the Lowell-based CDC Coalition for a Better Acre (CBA) — an “angel,” Alondra says — came to her door to tell her about the Lowell Healthy Homes Program. Alcantaro and her daughter live in the North Canal Apartments, a 267-unit development that is owned by CBA.
The Healthy Homes Program is a HUD-funded initiative run through the Center for Family, Work, and Community at the University of Massachusetts at Lowell with the goal of improving the health of asthmatic children in low-income families living in Lowell. The program provides free health and home environment assessments, education about healthy home practices, home remediation services such as pest management and industrial cleaning, and items that improve health and safety such as allergen-blocking mattresses and pillow covers, HEPA vacuum cleaners, smoke and carbon monoxide alarms, and pest control items.
When the CBA outreach worker discovered that Alcantaro’s daughter had asthma, he arranged for a community health worker from the Lowell Community Health Center to come to their home for an assessment.
Alcantaro said that following the assessment, the community health worker provided her with extensive education about what can aggravate asthma and trigger attacks, and resources to help her mitigate those triggers. The worker explained that dust mites and other allergens could be problematic even in a well-kept house, and that special practices were required to keep them under control. The worker also said that household chemicals, plug-in air fresheners, perfumes, and other fragrances could aggravate asthma.
“She taught me so much. She cleared up a lot of questions and doubts I had about how I could help Alondra get better,” Alcantaro says. “I didn’t know all of those things were making her asthma worse.”
As part of the program, Alcantaro received a new vacuum cleaner with a HEPA air filter (required to pull very fine allergens out of the air), as well as a new anti-allergen mattress cover and pillow cover.
Putting these new resources into effect, she immediately saw results. “There has been a huge difference. Alondra has improved significantly to the point that she has had no major allergy problems in the past six months,” Alcantaro says. Today, Alondra rarely requires asthma medication and its use is limited to days of very poor air quality. She is much more active and she rarely misses school. Her trips to the doctor have decreased dramatically.
“Now I can play with my friends and it’s not so hard to breathe,” says Alondra. “And I don’t have to miss school.” She proudly shows off a big gold sticker she received for paying attention in class and being a good safety role model for her classmates.
Since most health professionals are trained to treat symptoms and are not well versed in prevention when it comes to environmental hazards, the causes of Alondra’s asthma attacks had been, up to this point, never properly addressed. This is changing as more nurses and physicians are receiving training on strategies to minimize environmental health risks facing children.
Mice and cockroach infestation was one of the most common problems exacerbating asthma conditions among the children in the Healthy Homes program. Other hazards included mold, dust mites, pet dander, damp indoor spaces, and tobacco smoke, which often migrates through buildings with multifamily units.
While tenant education greatly increases awareness about how to address asthma triggers, landlords and property managers also play a large role in mitigation of environmental hazards. To this end, the Lowell Healthy Homes Program provided healthy homes training to property management and maintenance staff from local housing providers. Residents were also encouraged to seek code enforcement assistance from the city and, in some cases, to advocate collectively for better quality housing conditions in their apartments. In some cases, when landlords were intransigent, tenants moved to secure healthier housing conditions.
The Lowell Healthy Homes Program conducted 160 home interventions with 236 asthmatic children from September 2009 to August 2011. University of Massachusetts at Lowell staff gathered final health outcome data on 172 of those children (Table 1) through follow-ups approximately one year later in 116 homes. They collected data using an American Academy of Pediatrics questionnaire, the Children’s Health Survey for Asthma, and some additional questions added by the Coalition for a Better Acre.
Between the initial assessment and the follow up, the number of doctor visits and the number of episodes of wheezing in the preceding four weeks each showed a three-fold decrease. Asthma attacks showed a four-fold decrease, and emergency room visits a five-fold decrease. Nearly 85 percent of the children used asthma medication at the outset, but at the one-year follow-up, that percentage had dropped to just shy of 60 percent.
Savings and Beyond
The change in Alondra’s health was dramatic, resulting in significant decreases in medication and healthcare visits, and equally dramatic increases in physical activity level and emotional health. Improvements like these can often produce noticeable cost savings for families, health providers, and society at large. Comparing the four weeks before the initial assessment and the four weeks before the one-year assessment, the decrease in hospitalizations and doctor and emergency room visits lowered the total medical costs incurred by those 116 households by an estimated $71,164 per year.
But those numbers are secondary for Alcantaro, who says the greatest reward is seeing her daughter laugh and run around playing with her friends like all the other children: “She is just so much happier now. That is the greatest result of all.”
With Alondra’s asthma under control, both she and her mother are breathing much easier these days.