An equity-focused evaluation of a system-wide intervention to reduce mold in NYC public housing and its impact on asthma burden

对旨在减少纽约市公共住房霉菌及其对哮喘负担影响的全系统干预措施进行以公平为中心的评估

• 批准号: 10751871
• 负责人: Nina Flores
• 金额: $ 3.48万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-15 至 2025-08-14
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10751871
• 关键词: Address; Adult; Affect; Age; Air; American; Asthma; Atmosphere; Authorization documentation; Black race; Censuses; Centers for Disease Control and Prevention (U.S.); Cessation of life; Characteristics; Child; Chronic; Climate; Color; Communities; Construction Materials; Coronavirus; Data; Data Collection; Development; Diagnosis; Disparate; Disparity; Disparity population; Economic Burden; Education; Emergency department visit; Equity; Ethnic Origin; Evaluation; Event; Exposure to; Future; Growth; Health; Health Benefit; Home; Household; Housing; Hurricane; Incentives; Income; Individual; Insurance; Intervention; Knowledge; Legal; Link; Low income; Molds; Morbidity - disease rate; National Institute of Environmental Health Sciences; Natural experiment; Neighborhoods; New York City; North America; Parents; Policies; Prevalence; Public Housing; Race; Reporting; Reproduction spores; Research; Schools; Services; Subgroup; Symptoms; System; Temperature; Testing; Time Series Analysis; Toxin; Training; Underserved Population; United States; United States National Aeronautics and Space Administration; Visit; Water; Weather; Work; asthma exacerbation; authority; burden of illness; climate change; cost; environmental justice; experience; extreme weather; health data; improved; lower income families; mortality; parent grant; programs; remediation; repaired; respiratory; response; sex; social; social determinants; sociodemographics; socioeconomics; tool; underserved community; ventilation

PROJECT SUMMARY/ABSTRACT Asthma is one of the most prevalent chronic conditions in the United States (US); it is also one of the most disparate. Both in the US and in New York City (NYC), differences exist in asthma prevalence, morbidity, and mortality by racial/ethnic and socioeconomic groups. Substandard conditions faced by lower-income families living in rented or public housing partially drive these asthma disparities by increasing exposure to indoor asthma triggers such as mold. Mold can release spores, fragments, and toxins into the air which can lead to respiratory responses; mold has been causally implicated in both the development and exacerbation of asthma. Despite the known adverse health impacts of mold, proprietors have little incentive to perform remediations. Mold remediations, especially those targeting the root causes of water damage and mold growth, may be costly, often requiring pipe, roof, or ventilation system replacement. Thus, mold issues, especially in renter-occupied homes, often go unaddressed. There are critical knowledge gaps surrounding (a) how, in the context of climate change, mold growth exacerbates asthma disparities and (b) if mold interventions have the largest health benefits for those needing it the most. Residents of the NYC Housing Authority (NYCHA) – the largest public housing authority in North America, housing over 380,000 NYC residents – have long endured disproportionate exposures to dampness and mold in their homes, likely contributing to consistently high rates of asthma morbidity. However, in 2019, NYCHA implemented ‘Mold Busters’—a comprehensive program aimed to remove mold in NYCHA developments. ‘Mold Busters’ presents a natural experiment and a wealth of data that could be leveraged for our objectives: to understand (a) the dual burdens of mold growth and climate change faced by NYCHA residents (b) neighborhood and building characteristics conducive to mold growth and (c) changes in asthma morbidity resulting from ‘Mold Busters’—all of which could inform housing agencies’ approaches for mold problems. We will combine building-level, longitudinal mold reports collected by NYCHA with longitudinal meteorological and asthma-related emergency department visit data. First, we will conduct time series analyses to quantify the relationship between extreme weather events, expected to increase with climate change, and reports of mold, both overall and considering neighborhood and building characteristics that may modify this relationship (Aim 1). Next, we will use pre-‘Mold Busters’ data to understand the neighborhood and building characteristics that contribute to mold growth and asthma morbidity (Aim 2). Finally, we will conduct building- level difference-in-difference (DiD) analyses comparing pre/post-‘Mold Busters’ asthma-related emergency department visits in NYCHA buildings to non-NYCHA, control buildings, while considering neighborhood, building, and individual characteristics (Aim 3). If we are successful, together these analyses will inform future interventions by identifying vulnerable neighborhoods, buildings, and subgroups where further action targeting mold and/or asthma morbidity is necessary, and that climate change will disproportionately affect.

项目概要/摘要 哮喘是美国最常见的慢性疾病之一，也是最常见的慢性疾病之一。 在美国和纽约市 (NYC)，哮喘患病率、发病率和发病率均存在差异。 按种族/族裔和社会经济群体划分的死亡率。低收入家庭面临的不合格状况。 居住在出租或公共住房中会增加接触室内哮喘的机会，从而在一定程度上加剧了这些哮喘差异 霉菌等触发因素会将孢子、碎片和毒素释放到空气中，从而导致呼吸道疾病。 尽管霉菌与哮喘的发生和恶化都有因果关系。 由于霉菌已知对健康产生不利影响，业主几乎没有动力进行补救措施。 补救措施，特别是针对水损害和霉菌生长的根本原因的补救措施，通常可能成本高昂 需要更换管道、屋顶或通风系统因此，霉菌问题，尤其是在租房者的房屋中， 围绕（a）如何在气候变化的背景下，存在着关键的知识差距。 霉菌的生长会加剧哮喘的差异；(b) 霉菌干预措施是否对以下人群具有最大的健康益处： 最大的公共住房——纽约市住房管理局 (NYCHA) 的居民。 北美当局，居住着超过 380,000 名纽约市居民 - 长期以来一直忍受着不成比例的情况 在家中暴露在潮湿和霉菌的环境中，可能导致哮喘发病率持续居高不下 然而，2019 年，NYCHA 实施了“霉菌克星”——一项旨在消除发病率的综合计划。 NYCHA 开发项目中的霉菌展示了一个自然的实验和大量的数据。 实现我们的目标：了解 (a) 霉菌生长和气候变化的双重负担 NYCHA 居民 (b) 有利于霉菌生长的社区和建筑特征以及 (c) 环境变化 “霉菌破坏者”导致的哮喘发病率——所有这些都可以为住房机构针对霉菌的方法提供参考 我们将把 NYCHA 收集的建筑级纵向模具报告与纵向结合起来。 首先，我们将进行时间序列分析。 量化预计随着气候变化而增加的极端天气事件之间的关系，以及 霉菌报告，总体而言，并考虑到可能改变这一点的邻里和建筑特征 接下来，我们将使用“霉菌克星”之前的数据来了解社区和建筑物。 导致霉菌生长和哮喘发病的特征（目标 2）。 比较“霉菌克星”前后哮喘相关紧急情况的双重差分 (DiD) 分析 各部门对 NYCHA 建筑物和非 NYCHA 建筑物进行访问，控制建筑物，同时考虑社区， 如果我们成功，这些分析将为未来提供信息。 通过识别脆弱的社区、建筑物和小组来采取干预措施，以进一步采取行动 霉菌和/或哮喘发病率是必然的，而气候变化将产生不成比例的影响。