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Objective: To report implementation strategies and outcomes of an evidence-based asthma counseling intervention. The Head-off Environmental Asthma in Louisiana (HEAL) intervention integrated asthma counseling (AC) capacity and addressed challenges facing children with asthma in post-disaster New Orleans., Methods: The HEAL intervention enrolled 182 children (4-12 years) with moderate-to-severe persistent asthma. Recruitment occurred from schools in the Greater New Orleans area for one year. Participants received home environmental assessments and tailored asthma counseling sessions during the study period based on the National Cooperative Inner City Asthma Study and the Inner City Asthma Study. Primary (i.e., asthma symptoms) and secondary outcomes (i.e., healthcare utilization) were captured. During the study, changes were made to meet the demands of a post-hurricane and resource-poor environment which included changes to staffing, training, AC tools, and AC sessions., Results: After study changes were made, the AC visit rate increased by 92.3%. Significant improvements were observed across several adherence measures (e.g., running out of medications (p = 0.009), financial/insurance problems for appointments (p = 0.006), worried about medication side-effects (p = 0.01), felt medications did not work (p < 0.001)). Additionally, an increasing number of AC visits was modestly associated with a greater reduction in symptoms (test-for-trend p = 0.059)., Conclusion: By adapting to the needs of the study population and setting, investigators successfully implemented a counseling intervention that improved participant behaviors and clinical outcomes. The strategies for implementing the AC intervention may serve as a guide for managing asthma and other chronic conditions in resource-poor settings., Competing Interests: Declaration of Interest Section The authors have no financial and/or personal relationships to disclose that could inappropriately influence (bias) their work. The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Objectives: To review how disasters introduce unique challenges to conducting population-based research and community-based participatory research (CBPR)., Methods: From 2007-2009, we conducted the Head-off Environmental Asthma in Louisiana (HEAL) Study in the aftermath of Hurricane Katrina in a Gulf Coast community facing an unprecedented triple burden: Katrina's and other disasters' impact on the environment and health, historic health disparities, and persistent environmental health threats., Results: The unique triple burden influenced every research component; still, most existing CBPR principles were applicable, even though full adherence was not always feasible and additional tailored principles govern postdisaster settings., Conclusions: Even in the most challenging postdisaster conditions, CBPR can be successfully designed, implemented, and disseminated while adhering to scientific rigor.

Background: Rain and flooding from Hurricane Katrina resulted in widespread growth of mold and bacteria and production of allergens in New Orleans, Louisiana, which may have led to increased exposures and morbidity in children with asthma., Objectives: The goal of the Head-off Environmental Asthma in Louisiana (HEAL) study was to characterize post-Katrina exposures to mold and allergens in children with asthma., Methods: The homes of 182 children with asthma in New Orleans and surrounding parishes were evaluated by visual inspection, temperature and moisture measurements, and air and dust sampling. Air was collected using vacuum-pump spore traps and analyzed for > 30 mold taxa using bright field microscopy. Dust was collected from the children's beds and bedroom floors and analyzed for mouse (Mus m 1), dust mite (Der p 1), cockroach (Bla g 1), and mold (Alternaria mix) allergens using ELISA., Results: More than half (62%) of the children were living in homes that had been damaged by rain, flooding, or both. Geometric mean indoor and outdoor airborne mold levels were 501 and 3,958 spores/m3, respectively. Alternaria antigen was detected in dust from 98% of homes, with 58% having concentrations > 10 µg/g. Mus m 1, Der p 1, and Bla g 1 were detected in 60%, 35%, and 20% of homes, respectively, at low mean concentrations., Conclusions: Except for Alternaria antigen in dust, concentrations of airborne mold (ratio of indoor to outdoor mold) and dust allergens in the homes of HEAL children were lower than measurements found in other studies, possibly because of extensive post-Katrina mold remediation and renovations, or because children moved into cleaner homes upon returning to New Orleans.

Background: Childhood asthma morbidity and mortality in New Orleans, Louisiana, is among the highest in the nation. In August 2005, Hurricane Katrina created an environmental disaster that led to high levels of mold and other allergens and disrupted health care for children with asthma., Objectives: We implemented a unique hybrid asthma counselor and environmental intervention based on successful National Institutes of Health asthma interventions from the National Cooperative Inner City Asthma (NCICAS) and Inner-City Asthma (ICAS) Studies with the goal of reducing asthma symptoms in New Orleans children after Hurricane Katrina., Methods: Children (4-12 years old) with moderate-to-severe asthma (n = 182) received asthma counseling and environmental intervention for approximately 1 year. HEAL was evaluated employing several analytical approaches including a pre-post evaluation of symptom changes over the entire year, an analysis of symptoms according to the timing of asthma counselor contact, and a comparison to previous evidence-based interventions., Results: Asthma symptoms during the previous 2 weeks decreased from 6.5 days at enrollment to 3.6 days at the 12-month symptom assessment (a 45% reduction, p < 0.001), consistent with changes observed after NCICAS and ICAS interventions (35% and 62% reductions in symptom days, respectively). Children whose families had contact with a HEAL asthma counselor by 6 months showed a 4.09-day decrease [95% confidence interval (CI): 3.25 to 4.94-day decrease] in symptom days, compared with a 1.79-day decrease (95% CI: 0.90, 2.67) among those who had not yet seen an asthma counselor (p < 0.001)., Conclusions: The novel combination of evidence-based asthma interventions was associated with improved asthma symptoms among children in post-Katrina New Orleans. Post-intervention changes in symptoms were consistent with previous randomized trials of NCICAS and ICAS interventions.

Background: In the city of New Orleans, Louisiana, and surrounding parishes (NOLA), children with asthma were perilously impacted by Hurricane Katrina as a result of disrupted health care, high home mold and allergen levels, and high stress., Objectives: The Head-off Environmental Asthma in Louisiana (HEAL) study was conducted to examine relationships between the post-Katrina environment and childhood asthma in NOLA and assess a novel asthma counselor intervention that provided case management and guidance for reducing home mold and allergen levels., Methods: Children (4-12 years old) with moderate-to-severe asthma were recruited from NOLA schools. Over 1 year, they received two clinical evaluations, three home environmental evaluations, and the asthma intervention. Quarterly end points included symptom days, medication use, and unscheduled emergency department or clinic visits. A community advisory group was assembled and informed HEAL at all phases., Results: Of the children (n = 182) enrolled in HEAL, 67% were African American, and 25% came from households with annual incomes < $15,000. HEAL children were symptomatic, averaging 6.6 symptom days in the 2 weeks before baseline, and had frequent unscheduled visits to clinics or emergency departments (76% had at least one unscheduled visit in the preceding 3 months). In this report, we describe study design and baseline characteristics of HEAL children., Conclusions: Despite numerous challenges faced by investigators, study staff, and participants, including destroyed infrastructure, disrupted lives, and lost jobs, HEAL was successful in terms of recruitment and retention, the high quality of data collected that will provide insight into asthma-allergen relationships, and the asthma intervention. This success was attributable to using an adaptive approach and refining processes as needed.

Objective: To analyze the relationship of phencyclidine (PCP) and pregnancy outcome, as judged by low birth weight (< 2,500 g)., Study Design: A retrospective, case-control study of PCP use was conducted among pregnant women who delivered at a large hospital in New Orleans. PCP use was ascertained by urine screening at the time of obstetric admission. Three control patients were selected for each case, matched for age, parity and month of delivery. The study intended to address the prevalence of low birth weight., Results: Between January 1990 and June 1996, 13,653 patients delivered. Of these, 23 were identified as PCP users. PCP users had smaller infants (2,698 vs. 3,011 g, P < .05); that may have been accounted for by a reduction in gestational age (37.3 vs. 38.3 weeks, P = NS). The users were more likely to give histories of using tobacco, alcohol or marijuana but not cocaine. Syphilis and diabetes mellitus were found more often in the study group. Multisubstance use was also common in the study group. The prevalence of low birth weight was not statistically different for the study and control groups., Conclusion: PCP use was not associated with an increase in low birth weight. When identified, patients using PCP require comprehensive evaluation.

Objective: To evaluate the effectiveness of an advanced-practice nurse-obstetrician collaborative prenatal practice., Methods: A group of 194 consecutively enrolled medically low-risk obstetric patients was identified between January 1, 1994 and December 31, 1994 at Neighborhood Pregnancy Care, a collaborative-practice site. An equal number of medically low-risk patients attending the Louisiana State University obstetric clinic at the Medical Center of Louisiana at New Orleans was selected randomly from among those registering the same month. The two groups were compared on the primary outcome variable, low birth weight. Data were analyzed by chi2, Fisher exact test, t test, and regression models., Results: We compared 179 collaborative-care and 181 university patients with retrievable information. By univariate analysis, collaborative-care patients more often were teenagers and black, and less likely to be married or employed. Collaborative-care patients had more prenatal visits and were more likely to participate in Medicaid, but less likely to deliver at the Medical Center of Louisiana at New Orleans. Birth weight and gestational age at delivery were greater. Both delivery before 37 weeks (7.3% versus 17.7%, P < .001) and birth weight less than 2500 g (8.9% versus 19.3%, P < .001) were less common. When differences identified at the initial obstetric visit were considered, multivariate weighted logistic regression confirmed the importance of prenatal care at the collaborative-practice program for low birth weight (odds ratio [OR] 0.37; 95% confidence interval [CI] 0.19, 0.71) and preterm delivery (OR 0.36; 95% CI 0.16, 0.78). When all differences were entered, low birth weight remained a significantly less likely occurrence at the collaborative-practice site (OR 0.46; 95% CI 0.23, 0.92)., Conclusion: An advanced-practice nurse-obstetrician collaborative practice may be implemented successfully and lead to acceptable perinatal outcomes, as judged by low birth weight and prematurity.