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负担很高，而且有很强的 有证据表明，与住房相关的环境暴露，如虫害过敏原，是导致这一现象的主要原因 哮喘发病率过高。历史上的居住歧视以及系统性的撤资 社区造成了糟糕的社区和住房条件，这使得 减少与住房相关的风险敞口很困难，而且在许多情况下是不可能的。相比之下，住房流动性 支持家庭搬到种族隔离程度较低的社区的方案可能会解决根本问题-- 暴露导致哮喘差异的原因，同时也是一个工具，通过它我们可以解析 不同的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 活动哮喘项目(MAP，R01 ES026170-05)，对哮喘儿童活动前后进行跟踪观察 从高贫困隔离社区向低贫困社区转变。到目前为止，我们已经发现， 随着时间的推移，过敏原水平和哮喘结果显著降低。这表明住房政策可能是 一种减少哮喘差异的工具。然而，尽管这些初步调查结果有力地支持了住房的好处 关于短期哮喘结果的流动性计划，出现了其他问题，这些问题只能是 答案是对这一独特群体的后续行动。我们在这里的目标是(1)比较长期(4-7年)哮喘 低收入、少数民族哮喘儿童移居低贫困家庭的发病率和家庭暴露情况 有类似孩子的社区生活在高度贫困的社区，(2)确定是否从 在原始地图中，高贫困到低贫困社区与肺功能增长改善相关 参与者在搬家后4-7年内反复评估肺功能，并比较他们的肺功能 与来自URECA队列的相似人群的轨迹和(3)检查压力的作用，测量 通过：a)暴露在邻居的压力下，b)父母/照顾者的压力，以及c)孩子在关系中的压力 室内暴露、运动、哮喘发病率和肺功能之间的关系。拟议的地图后续行动 这项研究将促进我们对居住在高质量住房的长期影响的理解 关于哮喘和肺功能增长的贫困社区，并直接为政策的制定提供信息- 有针对性的干预措施，如扩大住房流动计划，这显示出很有希望 减少患有哮喘的少数族裔儿童中不成比例的哮喘负担。

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.