Designing and Piloting a Community-Based Intervention to Reduce Wildfire Smoke Exposure in Children with Asthma

Wildfire smoke (WFS) exposure is associated with increased acute respiratory symptoms and healthcare utilization for children with asthma, and is a growing health threat due to increasing frequency and severity of wildfires over time. Despite strong evidence for the acute health risks of WFS exposure, the translation of this evidence to real-world interventions is lacking. Existing public health guidelines for protecting children from WFS are difficult for families of low socioeconomic status to implement due to communication gaps and lack of resources. To bridge these gaps, through our preliminary work we have developed a Wildfire Smoke Intervention (WFS-I), which is based on the highly successful community health worker asthma model. The WFS-I is a community educator-delivered intervention for parents of children with asthma consisting of education, in-home evaluation of sources of poor air quality, a personalized WFS action plan, and delivery of supplies including a HEPA air cleaner. This K23 proposal builds on our early WFS-I plan by taking a community-engaged approach to finalizing and piloting the intervention in an at-risk community in Central Washington. To accomplish these goals, we propose three specific aims, which will be carried out in close collaboration with our community partners. Aim 1: Identify the key drivers of WFS protective behaviors among parents of children with asthma through qualitative interviews and framework-driven analysis, and use these results to refine the draft WFS-I. Aim 2: Test the acceptability of the revised WFS-I to parents of children with asthma and community educators through focus groups, and subsequently finalize the intervention plan. Aim 3: Determine the feasibility and acceptability of the WFS-I by conducting a randomized controlled pilot trial of the intervention in 60 children with asthma and their parents. We will also pilot data collection strategies for determining changes in parents’ WFS protective behaviors, respiratory outcomes in the child with asthma, and particulate matter (PM2.5) exposure through in-home monitoring over the course of a full WFS season. The results of this research will be used to prepare for a larger randomized controlled intervention trial examining both the effectiveness of the WFS-I and optimal implementation strategies. In addition, this proposal describes a career development plan wherein Dr. Crocker, a pediatric pulmonologist with a strong foundation of research addressing environmental exposures for children with asthma, will receive excellent mentorship and training that will launch her toward an independent research career. This plan will focus on developing expertise in conduct of intervention trials to address environmental exposures, air pollution exposure assessment methods, community-engaged research, and qualitative research methods. This training will take place in the rich environments of Seattle Children's Research Institute and the University of Washington. This award will be instrumental for Dr. Crocker to reach her long-term career goal of producing near-term improvements in child respiratory health through the translation of knowledge of environmental exposures to equitable, practical, and scalable interventions. Project Number: 1K23HL179490-01 | Fiscal Year: 2025 | NIH Institute/Center: National Heart Lung and Blood Institute (NHLBI) | Principal Investigator: Mary Crocker | Institution: SEATTLE CHILDREN'S HOSPITAL, SEATTLE, WA | Award Amount: $160,380 | Activity Code: K23 | Study Section: NHLBI Mentored Patient-Oriented Research Study Section[MPOR (JA)] View on NIH RePORTER: https://reporter.nih.gov/project-details/1K23HL17949001