Air Filter and Air Conditioner Intervention Study

Michigan Nightlight: Tell us briefly about your research study in terms of its purpose and who it serves.
CAAA Principal Investigator Toby Lewis and CAAA Steering Committee Member Kinnus Paul: The goal of the Air Filter and Air Conditioner Intervention Study is to learn what can be done to help kids with asthma experience fewer symptoms and stay healthy. We know that there are very small microscopic particles called particulate matter in the indoor air that can exacerbate asthma. Indoor particulate matter can come from allergens, cigarette smoke, and air pollution that gets in from outside. It is hard to remove particulate matter from indoor air with simple cleaning activities, so in this project we are testing if air filters can help. In addition, we are looking to see if air conditioners aid in keeping indoor air clean. The idea is that air conditioners would allow families to keep their windows closed in the summer, and that this would reduce the amount of pollution from outdoor air that comes inside through open windows during hotter months. Our goal is to see if using an air filter by itself or with an air conditioner would make any difference in children’s asthma symptoms and in their overall health.
 
What really differentiates this research study?
On a scientific level, this study is unique because we are one of the first to look rigorously at how air filters, in combination

With a lot of research that gets done, the people who participate in the study never get to see the results. CAAA, on the other hand, is committed to sharing its results and using those results to make Detroit a healthier place.

with air conditioners, impact indoor air quality. We measure how air moves through the house to better understand how characteristics of housing influence air quality. We also track how air quality changes throughout the seasons and in different types of weather conditions. Learning how these factors impact asthma will enable us to give better advice on how to care for children’s health.
 
What also sets this research study apart is our direct involvement and interaction with the community. With a lot of research that gets done, the people who participate in the study never get to see the results. CAAA, on the other hand, is committed to sharing its results and using those results to make Detroit a healthier place. As part of the study, we have hosted a community health exposition where residents came out to get information and items to take home with them and had opportunities to discuss what we were learning. We also gave participants in the study direct feedback about the levels of air pollution in their homes and information about their child’s health so that they were able to make informed decisions going forward. Participants also had opportunities to become involved at a community level and speak up about air quality and the environment in community planning efforts.
 
What are the keys to success for your study?
The whole idea for this study and the concern for children’s asthma started with the community. Our community partners wanted to know what kinds of tools existed for families that could help children with asthma stay healthier. The idea of using air filters got a lot of support as something that was simple and easy to implement. So part of the reason families were interested in joining the air filter intervention study was because it felt like a good idea to them too.
 
Another key to success was hiring community members to do the work. Staff basically lived in the same neighborhoods as the families that were asked to participate. Historically in Detroit you don’t get many people who will open their doors to a stranger and let them put air filters in their children’s bedrooms; however, CAAA staffers could explain and relate the research study to people’s concerns in such a way that people were comfortable working with the staff and wanted them to install the study equipment. It took a lot of trust and training for the interviewers to be able to build those types of relationships with families and ultimately led to the success of the study.
 
What existing challenges remain with this study and how do you plan to overcome them?
Our biggest challenge is that, even though people are interested in having air filters, they do not always turn them on. We talked to participants to try to understand why and learned that some people thought the air filters were noisy or generated a breeze or, depending on the financial situation, the electricity to run the air filters cost too much money. So the next step will be to sit down with people and brainstorm what we can do together to design a plan that will meet the families’ needs while also having the benefit of filtering indoor air.
 
How do you find and engage families to participate in the study?
We engage people through a variety of ways. We used our connections with community leaders, principals at schools, and at community centers. We also meet people at community events, advertised, and spread information by word of mouth. There is a lot of uncertainty in the community about being involved in a research project, so when we reached out to people, we helped them understand what good research looked like, what their rights were, and what they could and should ask about before entering a study. Even if people did not sign up for our study, they felt more confident that they are able to make good

There is a lot of uncertainty in the community about being involved in a research project, so when we reached out to people, we helped them understand what good research looked like, what their rights were, and what they could and should ask about before entering a study.

decisions about participating in studies after talking with us, and this enables them to be more knowledgeable and engaged in the future.
 
It is also important that people from the community who are part of the research team are reaching out and engaging families. When people walk up and down the street who don’t look like they live here, it is weird to see them going around asking questions. When people from the community are the ones doing the work, participants feel a little more comfortable. They know the person talking to them has experienced some of their same challenges. When someone who lives around the corner from you comes and says, “Yeah, my house is doing this same thing,” it doesn’t feel like a top down approach. Since our study is implemented in partnership with the community, participants are more comfortable participating and often refer their friends or family to get involved as well.
 
How does your study take a collective, collaborative approach to changing health outcomes for children?
This is an extremely collaborative project that folds in expertise from many different arenas.  Our steering committee is comprised of medical professionals, scientific researchers, Detroit community leaders, health and human services professionals, and experts in housing and health. For example, Detroiters Working for Environmental Justice, one of our partner organizations, runs a “green jobs” training program. CAAA hired people with technical skills who went through that program to help conduct this research study. Another one of our partners, the Detroit Department of Health and Wellness Promotion, which is now the Institute for Population Health, really understands how to improve the health of a whole community.  Other community partners understand the types of projects that would be of interest to residents and know how to relate our research to residents’ everyday lives.
 
We draw on all of this expertise from the very start, from generating research ideas, to designing the intervention, to creating outreach materials. For example, all our materials are translated into Spanish to make them accessible to Spanish speaking residents in Detroit. When we start to have results from the study, the entire steering committee assists in trying to understand what they mean and how they fit into the context of what is happening in Detroit right now. Each partner comes to the table with a different perspective or challenge depending on the part of town they are from. We work to solve those issues together. This inclusive process and having different points of view around the table has made our study much stronger.
 
Our work is about more than research, it is about the people we serve, so much so that the focus on educating participants is equally as important as collecting information. Even after we finish this study, we will continue to work with the community on identifying next steps and how to make our interventions more effective so that children with asthma will ultimately benefit from our efforts.