Steve Mellon, Post-Gazette Tonya Wright learns about keeping her North Side home a safe and healthy environment for daughter Tashae, 6, right, who suffers from asthma. Healthy Home Resources, an organization that addresses the home environment of children with asthma, assessed the Wrights' home and offered advice on how to make it healthier for Tashae. Miss Wright's son Ramere, 3, is at left. Click photo for larger image.

Tonya Wright, mother of 6-year-old Tashae Wright, may have to give up her scented candles and aerosol sprays, but she says she's willing to do that to make her North Side home a healthy place for her children.

The AT HOME (Asthma Trigger Home Evaluation) Program is helping Miss Wright with making her century-old house as allergen-free as possible for Tashae, who has asthma. It's run by Healthy Home Resources with money from the U.S. Department of Housing and Urban Development and Heinz and various other charitable foundations.

Miss Wright signed up her daughter and recently received a visit from Melissa Satler, education coordinator, and other HHR staff members. She led Miss Wright, who works in child care, through the steps of making and keeping her home healthy and safe.

Staff member Jane Trout unpacked a HEPA vacuum cleaner, two air cleaners, allergen-control mops, cloths and cleaning equipment, as well as mattress and pillow covers for Tashae's bed. A doormat to stop outdoor allergens from getting tracked indoors was provided -- leaving shoes on the mat helps even more.

In general, wiping horizontal surfaces in the kitchen (with vinegar and water to kill germs and baking soda to scrub) is a recommended daily chore, along with washing dishes and dumping trash. Weekly cleaning of floors and washing sheets and throw rugs in hot water keep them clear of allergens.

Miss Wright said a carpet cleaning service had done its job, using a recommended method that doesn't aggravate asthma. "They were very good. They took their time," she reported. The pest control service will also be essential to keeping insect and rodent allergens from triggering Tashae's symptoms.

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Miss Wright, who also has her 3-year-old son, Ramere, to look after, said she's happy with the program.

"I'm getting skilled at keeping a healthy and more safe house," she said. The inspection revealed also high levels of lead in the unused basement. Lead is not an asthma trigger, but it can be deadly, so the Wrights plan to avoid that area of the rented house.

After the visit offering cleaning tips, Miss Wright said, AT HOME staff dropped by again, bringing an antibacterial bath mat; fire extinguisher; carbon monoxide detector, flashlight, smoke alarm, $25 Giant Eagle gift certificate and -- for the children -- a $15 Toys R Us gift card.

John Gallo, HHR executive director, said the cost of the program is about $5,800 per family, which includes about $2,500 in supplies and services. He said the program is also dedicated to helping families find whatever other social services they might need to address the family's health issues. Working with landlords is a primary role, getting them to agree to lead testing and pest control, for example.

Program grows

The AT HOME program is two years into its three-year run.

Originally created to promote healthy indoor environments for low-income families, Healthy Home Resources has taken efforts to eliminate lead hazards in the home and expanded to address other in-home threats to health, such as asthma triggers, household chemicals and radon.

AT HOME reached its maximum of 150 families within 1¹/₂ years, and had a waiting list. Last year, it was expanded from the North Side to include Community Development Block Grant-eligible areas of Allegheny County. Most recently, with $500,000 from the Pittsburgh Foundation, 100 children will be added.

"Clearly there's a demand for this kind of program," said Mr. Gallo.

There are four parts to the program:

First, AT HOME visits participants to provide education and assess the conditions in the home.

Second, doctors assess a child's condition, including determining what triggers the child's breathing difficulties.

Third, HHR staff shows the family how to clean up the triggers and provides ongoing education and support.

The fourth step is a follow-up to see if the program has helped, by measuring asthma triggers in the home and checking the child's symptoms.

Does it work?

Results of the program are being evaluated by the University of Pittsburgh Graduate School of Public Health. Conrad Dan Volz, principal investigator, said outcomes are positive so far.

"It's a very good intervention, a very good program," Dr. Volz said. Of the first 150 families, he said, 63 percent have finished the intervention. Among the successes, he said, are a lower number of lost school days, a lower number of times using rescue medication, and fewer days when a child experiences asthma symptoms over a 14-day period.

In a report for the quarter ending April 1, out of 87 children finishing the program, 65 reported using their rescue medication less and 80 had fewer lost school days. In addition, 69 had fewer symptom days and all had fewer emergency room visits. Mr. Gallo said data are still being compiled for the 152 children who have completed AT HOME so far.

Another sign that the program may benefit families, Dr. Volz said, is positive assessments of how much children's caretakers remember of what they've learned about controlling asthma.

After the program was completed, the adults took a second try at a test to gauge their asthma knowledge, attitudes and beliefs. Their higher scores predict that the adults may change their behavior and keep a healthier home for their child with asthma. In the quarterly report, scores improved for caretakers of 75 out of the 87 children ending the program.

"That means they have much more knowledge that the disease has environmental links. Knowledge is power," Dr. Volz said.

In addition, he said, "We've seen that, as the program progresses, as HHR goes into the home [after housekeeping help] to see if it's cleaner, we find that it is.

"We've seen there is an improvement over the course of the program to date, but we haven't done the six-month follow-up yet ... We have seen improvement in the three months of the project," Dr. Volz said. "It would be good to follow them for several years."

One factor in improving indoor air has been hard to address: In the quarterly report, 30 percent of the child caretakers were smokers.

"We can do all these things, but secondhand smoke is the big gorilla in the room. ... It's one of the hardest things to change. ... It's hard to get people to quit," Dr. Volz said, adding that there's been some success getting adults into smoking-cessation programs.

Dr. David Nash, clinical director of allergy/immunology at Children's Hospital, struck a cautionary note. "It's very labor intensive," he said, adding that cockroaches are hard to control and it's hard to get people to quit smoking.

"I'm pessimistic. When you do these things there's so many factors you cannot control." Also, he says it can be difficult to measure the impact of intervention programs or even an individual child's exposure to environmental allergens.

To improve a child's outcomes, Dr. Nash said he would prefer a system that ensures that children can take their medicine as prescribed.

AT HOME experts want families to follow through on what they've learned about the importance of regular medical checkups and asthma-controlling medications.

Its focus is a little different, Mr. Gallo said: "In the clinic, they treat the health of the child. We treat the house and the family."

For another Health & Science story about children with asthma, see Close watch helps the growing number of children with asthma