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在儿童哮喘健康结局中的重要性。目前的知识表明，无论是物理（例如，暴露于各种过敏原、毒素和其它因素，例如湿气、霉菌和污染）和社会成分（例如，压力、家庭结构和其他与贫困有关的因素）促成了疾病的病因和表现。拟议的研究建立在劳拉博士作为波多黎各示范项目中的Luis Llorens托雷斯住宅项目的波多黎各联盟抗哮喘主要研究者的经验基础上。这个社区--美国和加勒比地区最大的低成本住房项目--具有影响哮喘的高风险社会人口特征：近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很高。我们建议对这项波多黎各研究中独特丰富的现有地理编码数据集进行二次分析，以满足以下特定目标：（1）探索与哮喘患病率相关的风险因素，以及该人群中症状控制和生活质量较差，包括社会环境的个人和社区水平特征（例如，卫生保健的获得，犯罪风险）和物理环境（例如，（2）确定在所研究的社区中是否发生了哮喘高患病率和发病率的地理集群，如果是，社区的社会和物理特征是否与这种集群效应相关;并且，在本发明中，（三）确定在不同社区的研究人群亚群中，哮喘防治联盟干预的有效性是否存在差异社会和自然环境特征。据估计，波多黎各岛40%至50%的儿童患有儿童哮喘-这是所有美国儿童中哮喘患病率最高的。这项拟议的研究提供了一个独特的机会，以更好地了解导致该人群哮喘负担不成比例的因素。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邻里物理和社会环境背景因素。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，波多黎各岛40%至50%的儿童患有儿童哮喘-这是所有美国儿童中哮喘患病率最高的。这项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该人群经历的哮喘负担不成比例。

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.