The effect of a housing mobility program on environmental exposures and asthma morbidity among low-income minority children

住房流动计划对低收入少数族裔儿童的环境暴露和哮喘发病率的影响

• 批准号: 9006550
• 负责人: Elizabeth C. Matsui
• 金额: $ 67.57万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-03-01 至 2021-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9006550
• 关键词: 17 year old; Acute; Address; Affect; Allergens; Area; Asthma; Baltimore; Caring; Child; Cities; Clinical; Communities; Counseling; County; Data; Dictyoptera; Emergency department visit; Environmental Exposure; Environmental Risk Factor; Environmental Tobacco Smoke; Exhalation; Exposure to; Family; Financial Support; Health; Health Care Costs; Home environment; Hospitalization; Housing; IgE; Indoor pollutant; Inflammatory; Intervention; Knowledge; Life; Low income; Measures; Mediating; Modification; Morbidity - disease rate; Neighborhoods; Nitric Oxide; Outcome; Particulate Matter; Pharmaceutical Preparations; Physiological; Pilot Projects; Policies; Pollution; Population; Poverty; Public Health; Pulmonary Inflammation; Recruitment Activity; Respiratory physiology; Role; Section 8; Severities; Source; Statistical Methods; Stratification; Symptoms; Visit; cockroach allergen; environmental intervention; high efficiency particulate air filter; high risk; improved; indoor allergen; low socioeconomic status; minority children; mouse allergen; next generation; pollutant; programs; public health relevance; segregation; tool; voucher

 DESCRIPTION (provided by applicant):Asthma morbidity continues to be a major public health problem among low-income minority children living in urban neighborhoods despite the availability of highly effective controller medications. Major contributors to the disproportionatey high asthma morbidity in this population are exposure to pest allergens (mouse and cockroach) and indoor pollutants (particulate matter (PM) due to second hand smoke and neighborhood PM). Efforts to reduce these exposures using home environmental interventions (EIs) have had only modest effects on measures of asthma symptoms and they have had little effect on reducing acute care visits or on improving lung function which are critical markers of high health care costs and poor long-term outcomes. The limited efficacy of EIs in this high-risk population is likely due to only modest reductions of indoor allergens and pollutants achieved by EIs. Housing mobility programs offer an alternative intervention with the strong potential to achieve large reductions in allergens and pollutants and thereby improve asthma health across a broad range of indicators including acute visits and lung function. We propose to conduct such a study in the context of the Baltimore Mobility Program (BMP), the nation's largest mobility program. We have partnered with BMP, and together have found that among families in BMP who have moved away from Baltimore City, pest allergen and PM exposures are much lower than in the homes of similar children living in Baltimore City. Our preliminary data and findings to date provide strong support for the hypothesis that moving to good quality housing in a better neighborhood through a housing mobility program will result in improvements in asthma outcomes, and that these improvements will be mediated by reductions in exposure to pest allergens and indoor PM. Through prospectively recruiting and following families as they enter into the Baltimore Mobility Program, we seek to address the following specific aims: (1) To determine the effect of moving from a low-income urban neighborhood to good quality housing in a better neighborhood on asthma-related outcomes by comparing outcomes among 5-17 year old children with persistent asthma who move to similar children who do not move, and (2) To estimate the causal effects of reducing indoor pest allergens and PM by moving to better housing on asthma outcomes using principal stratification, a statistical method for causal inference in environmental studies. The proposed study has the potential to have significant implications for the role of housing policy as a tool to address asthma disparities.

 描述（由应用程序提供）：尽管有高效的控制器药物可用，但居住在城市社区的低收入少数族裔儿童中，哮喘发病率仍然是一个主要的公共卫生问题。在该人群中，导致高哮喘发病率不成比例的主要因素是暴露于害虫过敏原（小鼠和蟑螂）和室内污染物（由于二手烟雾和邻居PM）引起的室内污染物（颗粒物（PM））。使用家庭环境干预措施减少这些暴露的努力（EIS）对哮喘症状的度量只有适度的影响，它们对减少急性护理访问或改善肺功能的影响很小，这是高医疗保健成本和长期长期结局的关键标志。 EIS在此高风险人群中的有效性可能仅仅是由于EIS所实现的室内过敏原和污染物的适度减少所致。住房流动计划提供了另一种干预措施，具有强大的潜力，可以大大减少过敏原和污染物，从而在包括急性访问和肺功能在内的广泛指标中改善哮喘健康。我们建议在巴尔的摩流动计划（BMP）的背景下进行此类研究，该计划是美国最大的出行计划。我们已经与BMP合作，并共同发现，在从巴尔的摩市搬离的BMP家庭中，害虫过敏原和PM暴露要比在巴尔的摩市居住的类似儿童的家中低得多。我们迄今为止的初步数据和发现为假设提供了强有力的支持：假设通过住房移动计划转移到更好的社区中的高质量住房将导致哮喘结果的改善，并且这些改善将通过减少暴露于害虫过敏原和室内PM的降低来介导。通过前瞻性招募和跟随家庭进入巴尔的摩流动计划，我们试图解决以下特定目标：（1）确定从低收入城市社区转变为在更好的社区中在更好的社区中对哮喘相关结果的高质量住房的影响害虫过敏原和PM通过使用主要分层转移到更好的哮喘结局上，这是环境研究中因果推断的统计方法。拟议的研究有可能对住房政策作为解决哮喘分布的工具具有重大影响。