Parental reports of indoor environmental exposures in underserved populations: Validity and predictive utility

Identifying asthmatic children exposed to indoor home allergens may help target patients who would benefit from environmental interventions. However, the clinical utility of information collected from parents about home environment risk factors depends on a) how much parent reports reflect actual home conditions (i.e., validity); and b) whether information obtained from parents predicts which children are likely to experience increased morbidity in the future (i.e. predictive utility). This study examines the validity and predictive utility of parental reports about cockroaches and dust mites among pediatric asthma patients. 220 families of low-income asthmatic children participated in this study. During a health care center visit, parents provided information about recent ER visits and adverse asthma events and information about home environment risk factors. During a subsequent home visit, trained observers assessed the home environment. Follow-up information about ER visits and adverse asthma events was collected one year later. Significant concordance was found between parental reports and home observations, particularly for cockroach risk ( χ 2=9.90, Rho=.27, kappa=.67). In hierarchical logistic regression, parents' reports of cockroach risk incrementally predicted the likelihood of subsequent ER visits (adjusted OR=1.76, 95% CI=1.10-2.81) and adverse asthma events (adjusted OR=2.66, 95% CI=1.22-5.79), above and beyond baseline levels of these events. Parents are able to provide valid information about cockroach presence in the home, and this information appears to have predictive utility for identifying pediatric asthma patients at increased risk for subsequent asthma morbidity and ER use.