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: 10296756
• 负责人: Corinne Keet
• 金额: $ 67.6万
• 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 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10296756
• 关键词: Address; Adult; Allergens; Asthma; Baltimore; Birth; Caregiver Burden; Child; Childhood Asthma; Communities; Data; Discrimination; Enrollment; Environmental Exposure; Exposure to; Follow-Up Studies; Growth; Health; Home; Housing; Intervention; Life Expectancy; Long-Term Effects; Low income; Lung; Measures; Mediating; Medicaid; Morbidity - disease rate; Natural History; Neighborhoods; Outcome; Parents; Participant; Plant Roots; Policies; Pollution; Positioning Attribute; Poverty; Prospective cohort study; Psychosocial Stress; Public Health; Role; Stress; Symptoms; Time; Urban Population; Ursidae Family; base; burden of illness; cohort; development policy; ethnic minority population; family support; follow-up; improved; indoor exposure; inner city; minority children; mouse allergen; poor communities; programs; pulmonary function; stressor; therapy design; tool; urban children; urban setting

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.

生活在贫困城市社区的儿童哮喘发病率很高， 有证据表明，与住房有关的环境暴露，如害虫过敏原，是这一问题的主要驱动因素 哮喘发病率过高。历史上的居住歧视以及对住房的系统性撤资 社区导致了贫困的社区和住房条件，这使得成功的 减少与住房有关的暴露是困难的，在许多情况下是不可能的。相比之下，住房流动性 支持家庭迁往隔离程度较低的社区的方案，可以解决根源问题， 导致哮喘差异的暴露原因，同时也作为一种工具，我们可以分析 不同的房屋和社区暴露的作用，并了解其对哮喘的长期影响。在我们 活动性哮喘项目（MAP，R 01 ES 026170 -05），对哮喘儿童在活动前后进行随访 从高度贫困的隔离社区到低贫困社区。到目前为止，我们发现， 移动，过敏原水平和哮喘的结果显着降低。这表明，住房政策可能是 减少哮喘差异的工具。然而，虽然这些初步调查结果强烈支持住房的好处， 流动性计划对短期哮喘的结果，其他问题已经出现，这只能是 通过对这一独特队列的随访来回答。我们的目的是（1）比较长期（4-7年）哮喘 低收入、少数民族哮喘儿童搬到低贫困地区后的发病率和家庭暴露 社区与类似的儿童生活在高贫困社区，（2）为了确定是否从一个 从高到低的贫困社区与原始MAP中肺功能的改善有关。 参与者通过反复评估肺功能长达4-7年后移动和比较他们的肺功能 轨迹与来自URECA队列的类似人群和（3）为了检查压力的作用，测量 通过：a）暴露于邻居的压力源，B）父母/照顾者的压力，和c）关系中的儿童压力 室内暴露、移动与哮喘发病率和肺功能之间的关系。拟议的MAP后续行动 这项研究准备推进我们对生活在高质量住房中的长期影响的理解， 贫困社区的哮喘和肺功能的增长，并直接告知政策的发展- 定向干预措施，如扩大住房流动方案，这些方案显示出很大的希望， 减少少数哮喘儿童的哮喘负担。