NEIGHBORHOOD & HEALTH CARE EFFECTS IN CHILDHOOD ASTHMA

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卫生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（如暴露于各种过敏原、毒素和其他因素，如潮湿、霉菌和污染）和社会因素（如压力、家庭结构和其他与贫困有关的因素）都有助于疾病的病因和表现。拟议的研究基于Lara博士在波多黎各圣胡安的Luis Llorens Torres住宅项目中担任波多黎各哮喘联盟示范项目首席研究员的经验。这个社区是美国和加勒比地区最大的低成本住房项目，它具有可能影响哮喘的高风险社会人口特征：几乎三分之一的家庭由未婚母亲担任户主；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也很高。我们建议为这项波多黎各研究对一个独特的丰富的现有地理编码数据集进行二次分析，以实现以下具体目标：(1)探索与该人群中哮喘患病率、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）和物理环境特征（例如，家庭吸烟、室外污染）；(2)确定所研究的社区是否存在高哮喘患病率和发病率的地理聚类，如果存在，社区的社会和物理特征是否与这种聚类效应有关；(3)确定不同邻域社会和自然环境特征的研究人群亚群间哮喘联盟干预的有效性是否存在差异。据估计，波多黎各岛上40%到50%的儿童患有儿童哮喘，这是所有美国儿童中哮喘发病率最高的。拟议的研究提供了一个独特的机会，以更好地了解导致这一人群经历的不成比例的哮喘负担的因素。我们的数据集包含所有研究参与者居住和上学地点的地理编码信息，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。研究结果也可以与干预措施高度相关，以减少其他西班牙裔和非西班牙裔高危儿童的哮喘差异。据估计，波多黎各岛上40%到50%的儿童患有儿童哮喘，这是所有美国儿童中哮喘发病率最高的。拟议的研究提供了一个独特的机会，以更好地了解环境因素和社区特征如何导致这一人群所经历的不成比例的哮喘负担。

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.