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，身体(例如，暴露在各种过敏原、毒素和其他因素，如湿度、霉菌和污染)和社会因素(例如，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。这项拟议的研究基于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防治哮喘联盟示范项目首席调查员的经验。这个社区是美国和加勒比海地区最大的低成本住房项目，其高风险的社会人口结构可能会影响哮喘：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和现有的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，包括社会环境(例如，医疗保健机会、犯罪暴露)和物理环境(例如，家庭吸烟、户外污染)的个人和邻里层面的特征；(2)确定研究社区是否出现哮喘发病率和发病率较高的地理聚集性，如果是，社会和自然社区特征是否与这种聚集效应有关；以及(3)确定不同社区社会和自然环境特征的研究人群亚群之间，抗哮喘干预联盟的有效性是否存在差异。据估计，波多黎各岛上40%至50%的儿童患有儿童哮喘--报告的哮喘患病率是所有美国儿童中最高的。拟议的研究提供了一个独特的机会，可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的居住地和就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。这项研究结果也可能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，波多黎各岛上40%至50%的儿童患有儿童哮喘--报告的哮喘患病率是所有美国儿童中最高的。这项拟议的研究提供了一个独特的机会，可以更好地理解环境因素和社区特征是如何导致这一人群经历的不成比例的哮喘负担的。

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.