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

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 各种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。

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.