C. S. Mott Children's Hospital
Pulmonology: Research
Toby Crowe Lewis, M.D., M.P.H.
Impact of a lay environmental outreach worker on family behavior change and asthma morbidity reduction among urban African-American and Hispanic children with asthma.
Urban children, particularly children of color, bear a disproportionate burden of the morbidity associated with the asthma epidemic that has been occurring in the US over the last three decades. This phenomenon has been attributed to multiple factors, including reduced access to healthcare and increased environmental exposures associated with poor housing stock and residence in areas with high concentration of air pollution, and is clearly compounded by the social environmental stress of inner-city living.
In collaboration with colleagues at the Michigan Center for the Environment and Children’s Health (MCECH), Dr. Lewis is conducting a randomized trial of a community-based intervention consisting of two years of home visits by a lay environmental outreach worker with the goal of modifying the home indoor environment to reduce an asthmatic child’s exposure to triggering agents. This study takes a comprehensive approach to health; taking into account the interplay between the individual, the physical environment, and the social environment. It is conducted with a community-based participatory research (CBPR) strategy, where community leaders serve as co-investigators and are involved with all aspects of research design, implementation, and assessment.
Interaction between air pollution and allergy on the respiratory health of asthmatic children.
Indoor environmental exposures play a key role in asthma aggravation. Strong associations have been found with indoor allergens, particularly to cockroach and dustmite, to which a child is sensitized, but also with exposure to indoor tobacco smoke, indoor fungi, and other irritants. Increased ambient air pollution levels, particularly respirable particulates (PM2.5 and PM10) and ozone, have been reported to precipitate symptoms of asthma and to increase emergency department visits and hospitalizations for asthma. The role of outdoor ambient pollutants in the potentiation of the inflammatory effects of subsequent exposure to allergens has been examined in animal and human experimental models, but there is limited data on the interaction between these pro-inflammatory stimuli in the “real life” of asthmatics.
As part of her work at the Michigan Center for the Environment and Children’s Health, Dr. Lewis is measuring asthma-related health outcomes over a two-year period among 300 asthmatic children in Detroit, MI. She is analyzing the effect of simultaneous exposure to air pollution, and household cockroach allergen levels among sensitized asthmatics. Preliminary results indicate that there is a significant reduction in pulmonary function with exposure to high levels of ozone among children with allergy to cockroach, but not among those who are not sensitized. This project is also being conducted using a CBPR approach. Future studies will investigate the role of tobacco smoke and other allergens in this enhanced response to air pollution.
Recent publications:
- Cabana MD, and Lewis, TC, “Overcoming barriers to using asthma clinical practice guidelines” Semin Med Pract 3: 19-32, 2000.
- Cabana MD, and Lewis TC, “Improving Physician Adherence to Asthma Guidelines” J Clin Outcomes Management 8: 35-46, 2001.
- Parker EA, Israel BA, Lewis TC, Brakefield-Caldewell W, Keeler G, Ramirez E, Rowe Z, Williams M, “Community Action Against Asthma: Examining the partnership process of a community-based participatory research project.” In press J Gen Intern Med.
