AIRWAY DISEASE AND COCKROACH EXPOSURE IN PUBLIC HOUSING

贫困城市人口的哮喘发病率和死亡率仍然高得令人无法接受。健康科学家还不知道这一现象背后的原因。最近，我们和其他人提出，对蟑螂的过敏性是低收入患者哮喘发病率的重要预测因素。如果这是真的，那么针对蟑螂侵扰的措施应该成为城市住房环境政策规划的中心。这个项目的主要目的是提供额外的证据来支持蟑螂过敏与哮喘和哮喘严重程度有因果关系的概念，并开始研究积极主动的方法来解决这个问题。我们的多学科团队涵盖了临床调查、医学人类学、呼吸流行病学和医学昆虫学等领域，并与巴尔的摩市房屋管理局建立了合作关系，在此基础上，我们建议对现有的公共住房居民进行一项研究，这些居民将被搬迁到新住宅，作为用新社区取代破旧建筑群的广泛计划的一部分。在对公共住宅小区的全部人口进行调查后，我们将确定患有哮喘的居民，并将根据他们的特应性状况和哮喘严重程度对他们进行全面描述。此外，我们将对他们原来的住所进行广泛的蟑螂侵扰和抗原水平评估。采用病例对照方法，我们将评估蟑螂暴露是否是哮喘的危险因素。在所有哮喘患者迁入新居期间，将对他们的哮喘发病率和蟑螂接触情况进行纵向监测。我们的假设是，对蟑螂过敏的个体将被转移到没有蟑螂的环境中，他们的呼吸道疾病将得到显着改善。对蟑螂不敏感的哮喘患者作为阴性对照。在第二组公共住房人口中，我们将测试一项积极的早期教育/行为改变计划的有效性，该计划结合了精确定向的早期缓解措施，以避免新的无蟑螂房屋的侵扰。结合上述项目，我们建议开发和验证一种新的方法来监测蟑螂暴露，使用多站点粉尘采样和空间分析技术。这个项目可以提供关于蟑螂暴露在哮喘中的作用的关键问题的答案，并可以影响美国城市人口的健康，他们不成比例地遭受这种疾病的发病率和死亡率。

Asthma morbidity and mortality in poor, urban populations continues to be unacceptably high. Health scientists have no understanding of the reasons behind this phenomenon. Recently, we and others have suggested that allergic sensitization to cockroaches constitutes an important predictor of asthma morbidity in low income patients. If this is true, measures against cockroach infestation should become central in environmental policy planning with respect to urban housing. The main purpose of this project is to provide additional evidence supporting the concept that cockroach allergy has a causal relationship to asthma and to asthma severity and to begin examining proactive methods to combat this problem. Our multi- disciplinary team which covers the fields of clinical investigation, medical anthropology, respiratory epidemiology and medical entomology, has built a collaboration with the Housing Authority of Baltimore City, based on which we propose to perform a study involving the current residents of public housing that are to be relocated to new dwellings as part of an extensive plan to replace distressed complexes with new communities. After surveying entire populations of public housing complexes, we will identify residents with asthma and will fully characterize them with respect to atopic status and asthma severity. In addition, we will perform extensive evaluation of their original dwellings with respect to cockroach infestation and antigen levels. Using a case-control approach, we will assess whether cockroach exposure is a risk factor for asthma. Asthma morbidity and cockroach exposure will be then monitored longitudinally, in all asthmatics, while they are relocated into new homes. It is our hypothesis that the individuals with cockroach allergy who will be relocated to cockroach-free environments will experience significant improvement in their airway disease. Asthmatics without cockroach sensitivity will serve as negative controls. In a second cohort from the public housing population, we will test the effectiveness of a pro-active, early educational/behavioral modification program, combined with precision-targeted early mitigation, to avoid infestation of the new, cockroach-free homes. In conjunction with the above projects, we propose to develop and validate a new methodology for monitoring cockroach exposure, using multiple site dust sampling and spatial analysis techniques. This project can provide answers to crucial questions regarding the role of cockroach exposure in asthma and can impact the health of urban US populations who have disproportionally suffered from the morbidity and mortality of this disease.