NEIGHBORHOOD & HEALTH CARE EFFECTS IN CHILDHOOD ASTHMA

邻里

• 批准号: 7472284
• 负责人: Marielena Lara
• 金额: $ 9.41万
• 依托单位: RAND CORPORATION
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-07-18 至 2010-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7472284
• 关键词: Affect; Allergens; Ally; Asthma; Caribbean natives; Caribbean region; Characteristics; Child; Childhood Asthma; Code; Communities; Crime; Data; Data Set; Disease; Educational Activities; Effectiveness; Environmental Risk Factor; Epidemiologic Studies; Etiology; Exposure to; Foundations; Funding; Health; Health Services Accessibility; Health Status; Healthcare; Hispanics; Household; Household Heads; Housing; Income; Individual; Intervention; Island; Knowledge; Learning; Molds; Morbidity - disease rate; Mothers; National Health Interview Survey; Neighborhoods; Not Hispanic or Latino; Outcome; Participant; Persons; Physical environment; Pollution; Population; Population Study; Poverty; Prevalence; Principal Investigator; Public Health; Puerto Rican; Puerto Rico; Quality of life; Reporting; Research; Risk; Risk Factors; Schools; Site; Smoking; Social Characteristics; Social Environment; Stress; Surveys; Symptoms; Toxin; Unemployment; United States; Wood material; base; contextual factors; cost; experience; family structure; health care service utilization; programs; residence; social

DESCRIPTION (provided by applicant): Epidemiological studies have shown the importance of environmental risk factors and access to health care in childhood asthma health outcomes. Current knowledge suggests that both physical (e.g., exposure to a variety of allergens, toxins, and other factors, such as moisture, mold, and pollution) and social components (e.g., stress, family structure, and other poverty-related factors) contribute to disease etiology and expression. The proposed research builds on Dr. Lara's experience as Principal Investigator of the Allies Against Asthma in Puerto Rico demonstration project in the Luis Llorens Torres Residential Project in San Juan, Puerto Rico. This community - the largest low-cost housing project in the United States and the Caribbean - has a high- risk socio-demographic profile that can affect asthma: almost one-third of households are headed by unwed mothers; over half of residents have monthly incomes under $500; and unemployment and apathy toward educational activities is high. We propose to perform secondary analyses of a uniquely rich and existing geo-coded dataset for this Puerto Rico study, to meet the following specific aims: (1) to explore the risk factors associated with asthma prevalence, and poor symptom control and quality of life in this population, including individual- and neighborhood-level characteristics of the social environment (e.g., health care access, crime exposure) and physical environment (e.g., smoking in the household, outdoor pollution); (2) to determine whether geographic clusters of high asthma prevalence and morbidity occur in the neighborhoods studied and, if so, whether social and physical neighborhood characteristics are associated with this clustering effect; and, (3) to determine if differences exist in the effectiveness of the Allies Against Asthma intervention across subsets of the studied population with different neighborhood social and physical environment characteristics. Forty to fifty percent of Island Puerto Rican children are estimated to have childhood asthma - the highest reported prevalence of asthma of all U.S. children. The proposed study provides a unique opportunity to better understand the factors contributing to the disproportionate burden of asthma this population experiences. Our dataset contains geo-coded information on site of residence and schooling of all study participants, as well as possible neighborhood physical and social environmental contextual factors that can contribute to this asthma disparity among Puerto Ricans. The study findings can also be highly relevant to interventions to reduce asthma disparities in other Hispanic and non-Hispanic high-risk children. Forty to fifty percent of Island Puerto Rican children are estimated to have childhood asthma - the highest reported prevalence of asthma of all U.S. children. The proposed study provides a unique opportunity to better understand how environmental factors and neighborhood characteristics contribute to the disproportionate burden of asthma this population experiences.

描述（由申请人提供）：流行病学研究表明环境风险因素和获得医疗保健对儿童哮喘健康结果的重要性。目前的知识表明，身体因素（例如，接触各种过敏原、毒素和其他因素，如潮湿、霉菌和污染）和社会因素（例如，压力、家庭结构和其他与贫困相关的因素）都会导致疾病的病因和表现。拟议的研究以 Lara 博士作为波多黎各抗哮喘联盟示范项目首席研究员的经验为基础，该项目位于波多黎各圣胡安的 Luis Llorens Torres 住宅项目中。该社区是美国和加勒比海地区最大的低成本住房项目，其社会人口特征可能会影响哮喘：几乎三分之一的家庭以未婚母亲为户主；超过一半的居民月收入低于500美元；失业率和对教育活动的冷漠程度很高。我们建议对这项波多黎各研究的独特丰富的现有地理编码数据集进行二次分析，以满足以下具体目标：（1）探索与该人群哮喘患病率、症状控制不良和生活质量相关的风险因素，包括个人和社区层面的社会环境特征（例如，医疗保健获取、犯罪暴露）和物理环境（例如，家庭吸烟、 室外污染）； (2) 确定所研究的社区中是否存在哮喘高患病率和发病率的地理集群，如果是，则社会和物理社区特征是否与该集群效应相关； (3) 确定具有不同邻里社会和物理环境特征的研究人群子集的“哮喘联盟”干预措施的有效性是否存在差异。据估计，百分之四十到五十的波多黎各岛儿童患有儿童哮喘——这是美国所有儿童中哮喘患病率最高的报告。拟议的研究提供了一个独特的机会，可以更好地了解导致该人群经历的哮喘负担过大的因素。我们的数据集包含所有研究参与者的居住地和学校的地理编码信息，以及可能导致波多黎各人哮喘差异的社区物理和社会环境背景因素。该研究结果也与减少其他西班牙裔和非西班牙裔高危儿童哮喘差异的干预措施高度相关。据估计，百分之四十到五十的波多黎各岛儿童患有儿童哮喘——这是美国所有儿童中哮喘患病率最高的报告。拟议的研究提供了一个独特的机会，可以更好地了解环境因素和社区特征如何导致该人群遭受不成比例的哮喘负担。