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

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Children living in poor-urban neighborhoods bear a high burden of asthma morbidity, and there is strong evidence that housing-related environmental exposures such as pest allergens are a major driver of this excess asthma morbidity. Historic residential discrimination together with systemic disinvestment in neighborhoods have contributed to poor neighborhood and housing conditions, which make successful mitigation of housing-related exposures difficult, and in many cases, impossible. In contrast, housing mobility programs, where families are supported in moving to less segregated communities, may address the root- causes of the exposures that drive asthma disparities, while also serving as a tool by which we can parse the role of various housing and neighborhood exposures and understand their long-term effects on asthma. In our Mobility Asthma Project (MAP, R01 ES026170-05), children with asthma are followed before and after moving from high-poverty segregated neighborhoods to low-poverty neighborhoods. We have found, so far, that with moving, allergen levels and asthma outcomes are markedly reduced. This suggests that housing policy may be a tool to reduce asthma disparities. However, while these initial findings strongly support the benefit of housing mobility programs on short-term asthma outcomes, additional questions have emerged which can only be answered by follow-up of this unique cohort. Our aims here are (1) To compare long-term (4-7 years) asthma morbidity and home exposures between low-income, minority children with asthma who move to low-poverty neighborhoods with similar children living in high-poverty neighborhoods, (2) To determine if moving from a high- to a low-poverty neighborhood is associated with improved lung function growth among the original MAP participants by repeatedly assessing lung function up to 4-7 years post-move and comparing their lung function trajectories with a similar population from the URECA cohort and (3) To examine the role of stress, measured by: a) exposure to neighborhood stressors, b) parental/caregiver stress, and c) child stress in the relationships between indoor exposures, moving, and asthma morbidity and lung function. The proposed MAP Follow-Up Study is poised to advance our understanding of the long-term effects of living in poor quality housing in high poverty neighborhoods on asthma and lung function growth and directly inform the development of policy- oriented interventions, such as expansion of housing mobility programs, which show great promise for reducing the disproportionate burden of asthma among minority children with asthma.