Then she got a visit from Hopkins researchers doing another study - and learned she was doing a lot of things wrong. She was kicking up dust that made her sons wheeze every time she swept. The air fresheners were triggering symptoms in 9-year-old Da'Shawn. She even made him sick when she tried to bake a treat of snickerdoodles because of her kitchen's poor ventilation. The indoor air, Spears was learning, could be worse than the pollution and pollen outdoors.
"I thought, 'The house is clean. You've got wood floors. It smells fresh.' But no," she said.
Not every parent listens. Last spring, outreach workers from the Coalition to End Childhood Lead Poisoning began visiting the homes of 250 Baltimore children as part of a program aimed at keeping asthma in check. Kevin Gummer and Gia Wilkerson come armed with special particle-removing vacuums and pest management advice and new windows - whatever a home needs. The idea is that a $100 HEPA vacuum might save $1,500 in doctor or emergency room visits avoided.
The workers say that showing a family how they can make changes is far more effective than just handing out pamphlets about how to make a home healthier.
"We'll go in and ask people, 'Do you smoke?' and they say, 'No,' " Wilkerson said. "But the child sleeps in the same bedroom as they do and the ashtray is right there."
Sometimes, families trying to make things better only make them worse. For example, in trying to get rid of mice and cockroaches - which, among other ills, can trigger asthma attacks - families often use foggers or other chemical sprays. Gummer says those don't solve the problem, and they can aggravate asthma symptoms.
The childhood lead coalition moved into the realm of asthma as a complement to its successful efforts to reduce lead paint in city homes. "When we were leaving homes in the late '90s, cleaning up the lead, our guys were replacing windows ... [but] the kids were still getting sick - not necessarily from lead but asthma and injuries," said Executive Director Ruth Ann Norton. "In those families, about 50 percent of their kids had asthma."
The problem of poor indoor air quality appears to be most serious in low-income city households. Reasons for that aren't fully understood, but researchers point out that city homes tend to be smaller than those in the suburbs, so bad air has less chance to be diffused. And in older houses, there is more likely to be dust from old plaster and wood. City children also tend to spend lots of time indoors, often because their parents fear the potential for violence outside.
