As part of a university research study focusing on high rates of asthma and chronic obstructive pulmonary disease (COPD) in Letcher and Harlan counties, interviewers and project staff are randomly knocking on doors and asking people to participate in a confidential health survey.
“It’s a way to understand our health around here and to ultimately improve it,” said Beverly May, project manager of the Mountain Air Project. “It’s just like any other good deed you do for a neighbor.”
The Mountain Air Project will examine risk factors leading to serious respiratory diseases in eastern Kentucky. May, a retired nurse practitioner, said risk factors include allergens, genetic disposition, pollen, chemical exposures, and outdoor and indoor air quality.
Smoking rates are high in eastern Kentucky, but May said it doesn’t entirely answer why the COPD rate is three times higher than the national average.
Nineteen percent of Harlan County adults and 14 percent of Letcher County adults have asthma, compared with the national average of seven percent.
The Mountain Air Project is a five-year study being conducted by the University of Kentucky with $2.5 million in funding from the National Institutes of Health (NIH). The project calls for 1,200 participants in the two eastern Kentucky counties to answer a health questionnaire and have a pulmonary function test conducted. Since November, five interviewers have completed health surveys of 170 people in Little Cowan, Big Cowan and some of Whitco in Letcher County and Little Creek and Teetersville in Harlan County.
“ The most gratifying thing about this kind of work is that when you knock on a door and you invite someone to participate in the study and tell them it is about asthma and COPD, they immediately say ‘yes I want to help,’” said May. “In other places it is very hard to get people to participate in research. They shut the door immediately. Here, people are really nice. Ultimately, the reason why folks want to participate in research is to help their community. It’s really gratifying to see that. I really appreciate how people have been so receptive.”
The interviewers have had experience gathering research for previous projects through Faith Moves Mountains, a UK community based participatory research office based in Whitesburg.
Participants in the study are randomly selected.
“We have a geographer who is on the team and he was able to divide the counties into these units of hollows and then he gave us 30 hollows to work on,” said May.
May and Nell Fields, community engagement specialist with The Mountain Air Project, drive up and down the selected hollows assigning each house a number. Homes are randomly selected for interviewers and staff to knock on doors and ask homeowners if they would be willing to participate in the study.
Fields and May have driven all over nearly seven of the 30 selected hollows.
“We have Partridge to Cumberland halfway done,” said May. “It is very time consuming. As labor intensive as getting out and numerating all of the hollows is, it is going to give us a really good, accurate sample frame. I think we’re going to end up with some good statistical validity with a lot of legwork that made it happen.”
Fields said she and the interviewers do not go inside the homes during introductions.
“The whole invitation process can take place on the porch or outside and they have the option to choose whether or not to have someone come inside their home to do the interview or meet them someplace else,” said Fields. “They do not have to have people come inside their home if they choose not to.”
If a homeowner agrees to participate, the interviewer schedules a time and place to gather health information and conduct the pulmonary function test on one adult member in the household. Undiagnosed pulmonary problems will most likely be detected during some of the health screenings, May said.
Each assessment takes about 30 minutes to complete and the interviewer records the participant’s answers directly into a database on an online research platform.
“The data we get can’t be traced back to any individuals,” said May.
Participants receive a pulmonary function testing report and a $40 check from UK for participating in the study.
Part of the study is to see how factors in different seasons affect hospitalization rates and people with those respiratory illnesses.
A subsample of about 80 households will be randomly selected to receive home testing for dust, mold, humidity and radon.
The interviewing process is expected to be completed by the end of December.
In 2017, data will be analyzed with two community advisory boards and risk factors will be identified. In the third year of the project, community advisory board members, community members and scientists will assist in determining recommendations for decreasing risk factors and implementing a community wide intervention. Home remediation strategies will also be recommended to participants of The Mountain Air Project. The study’s last year will be spent testing the intervention to see if it made things better, May said.
The objective of The Mountain Air Project is to decrease the amount of visits to emergency rooms, decrease hospitalization for asthma attacks, decrease the number of adults who develop lung disease and provide a higher quality of life for those with respiratory diseases.
The UK research team is lead by Dr. Steven Browning, associate professor of epidemiology, and Dr. Nancy Schoenberg, associate dean for research in the College of Public Health. Other members of the university-based team include Dr. David Mannino, chair of the department of preventive medicine and environmental health; Dr. Wayne Sanderson, interim dean of the College of Public Health and professor of epidemiology; Dr. Jay Christian, assistant professor of epidemiology; and Dr. Heather Bush, associate professor of biostatistics.