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: 10469499
• 负责人: Corinne Keet
• 金额: $ 64.33万
• 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/10469499
• 关键词: Address; Adult; Allergens; Asthma; Baltimore; Birth; Child; Childhood Asthma; Communities; Data; Discrimination; Enrollment; Environmental Exposure; Exposure to; Follow-Up Studies; Growth; Home; Housing; Intervention; Life Expectancy; Long-Term Effects; Low income; 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; caregiver stress; cohort; development policy; ethnic minority population; family support; follow-up; improved; indoor exposure; inner city; lung health; 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承受着较高的哮喘发病率负担，而且有很强的 有证据表明，与住房相关的环境暴露（例如害虫过敏原）是这一现象的主要驱动因素 哮喘发病率过高。历史性的居住歧视以及系统性的投资减少 社区造成了贫困的社区和住房条件，这使得成功 缓解与住房相关的风险非常困难，而且在许多情况下是不可能的。相比之下，住房流动性 支持家庭搬到隔离程度较低的社区的方案可能会解决以下问题的根本问题： 造成哮喘差异的暴露原因，同时也可以作为我们解析哮喘差异的工具 各种住房和社区暴露的作用，并了解它们对哮喘的长期影响。在我们的 移动哮喘项目（MAP，R01 ES026170-05），对患有哮喘的儿童在移动前后进行跟踪 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，随着 移动、过敏原水平和哮喘结果显着降低。这表明住房政策可能会 减少哮喘差异的工具。然而，虽然这些初步发现强烈支持住房的好处 关于短期哮喘结果的流动计划，出现了更多问题，这些问题只能是 通过对这个独特群体的后续行动来回答。我们的目标是 (1) 比较长期（4-7 年）哮喘 低收入、少数民族哮喘儿童的发病率和家庭暴露情况 居住在高度贫困社区的类似儿童的社区，(2) 确定是否从 从高贫困到低贫困社区与原始 MAP 中肺功能增长的改善相关 通过在搬家后 4-7 年内反复评估参与者的肺功能并比较他们的肺功能 URECA 队列中类似人群的轨迹，以及 (3) 检查压力的作用，测量 通过：a）暴露于邻里压力源，b）父母/照顾者压力，以及c）人际关系中的儿童压力 室内暴露、移动以及哮喘发病率和肺功能之间的关系。拟议的 MAP 后续行动 研究旨在加深我们对居住在高品质低质量住房的长期影响的理解 贫困社区对哮喘和肺功能增长的影响，并直接为政策的制定提供信息 定向干预措施，例如扩大住房流动计划，显示出巨大的希望 减少少数民族哮喘儿童不成比例的哮喘负担。