The effect of a housing mobility program on environmental exposures and asthma morbidity among low-income minority children

住房流动计划对低收入少数族裔儿童的环境暴露和哮喘发病率的影响

• 批准号: 9006550
• 负责人: Elizabeth C. Matsui
• 金额: $ 67.57万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-03-01 至 2021-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9006550
• 关键词: 17 year old; Acute; Address; Affect; Allergens; Area; Asthma; Baltimore; Caring; Child; Cities; Clinical; Communities; Counseling; County; Data; Dictyoptera; Emergency department visit; Environmental Exposure; Environmental Risk Factor; Environmental Tobacco Smoke; Exhalation; Exposure to; Family; Financial Support; Health; Health Care Costs; Home environment; Hospitalization; Housing; IgE; Indoor pollutant; Inflammatory; Intervention; Knowledge; Life; Low income; Measures; Mediating; Modification; Morbidity - disease rate; Neighborhoods; Nitric Oxide; Outcome; Particulate Matter; Pharmaceutical Preparations; Physiological; Pilot Projects; Policies; Pollution; Population; Poverty; Public Health; Pulmonary Inflammation; Recruitment Activity; Respiratory physiology; Role; Section 8; Severities; Source; Statistical Methods; Stratification; Symptoms; Visit; cockroach allergen; environmental intervention; high efficiency particulate air filter; high risk; improved; indoor allergen; low socioeconomic status; minority children; mouse allergen; next generation; pollutant; programs; public health relevance; segregation; tool; voucher

 DESCRIPTION (provided by applicant):Asthma morbidity continues to be a major public health problem among low-income minority children living in urban neighborhoods despite the availability of highly effective controller medications. Major contributors to the disproportionatey high asthma morbidity in this population are exposure to pest allergens (mouse and cockroach) and indoor pollutants (particulate matter (PM) due to second hand smoke and neighborhood PM). Efforts to reduce these exposures using home environmental interventions (EIs) have had only modest effects on measures of asthma symptoms and they have had little effect on reducing acute care visits or on improving lung function which are critical markers of high health care costs and poor long-term outcomes. The limited efficacy of EIs in this high-risk population is likely due to only modest reductions of indoor allergens and pollutants achieved by EIs. Housing mobility programs offer an alternative intervention with the strong potential to achieve large reductions in allergens and pollutants and thereby improve asthma health across a broad range of indicators including acute visits and lung function. We propose to conduct such a study in the context of the Baltimore Mobility Program (BMP), the nation's largest mobility program. We have partnered with BMP, and together have found that among families in BMP who have moved away from Baltimore City, pest allergen and PM exposures are much lower than in the homes of similar children living in Baltimore City. Our preliminary data and findings to date provide strong support for the hypothesis that moving to good quality housing in a better neighborhood through a housing mobility program will result in improvements in asthma outcomes, and that these improvements will be mediated by reductions in exposure to pest allergens and indoor PM. Through prospectively recruiting and following families as they enter into the Baltimore Mobility Program, we seek to address the following specific aims: (1) To determine the effect of moving from a low-income urban neighborhood to good quality housing in a better neighborhood on asthma-related outcomes by comparing outcomes among 5-17 year old children with persistent asthma who move to similar children who do not move, and (2) To estimate the causal effects of reducing indoor pest allergens and PM by moving to better housing on asthma outcomes using principal stratification, a statistical method for causal inference in environmental studies. The proposed study has the potential to have significant implications for the role of housing policy as a tool to address asthma disparities.

 描述（由申请人提供）：尽管有高效的控制药物，但哮喘发病率仍然是城市社区低收入少数族裔儿童的一个主要公共卫生问题。该人群哮喘发病率过高的主要原因是接触害虫过敏原（老鼠和蟑螂）和室内污染物（二手烟和邻居 PM 引起的颗粒物 (PM)）。使用家庭环境干预措施（EI）来减少这些暴露的努力对哮喘症状的测量效果有限，并且对减少急诊就诊或改善肺功能几乎没有影响，而肺功能是高医疗保健成本和不良长期结果的关键标志。 EI 对这一高危人群的功效有限，可能是因为 EI 只能适度减少室内过敏原和污染物。住房流动计划提供了一种替代干预措施，具有巨大的潜力，可以大幅减少过敏原和污染物，从而改善哮喘健康状况，包括急性就诊和肺功能等一系列指标。我们建议在全国最大的流动计划巴尔的摩流动计划 (BMP) 的背景下进行此类研究。我们与 BMP 合作，共同发现，在 BMP 中搬离巴尔的摩市的家庭中，害虫过敏原和 PM 暴露量远低于居住在巴尔的摩市的类似儿童的家庭。我们迄今为止的初步数据和研究结果为以下假设提供了强有力的支持：通过住房流动计划搬到更好社区的优质住房将改善哮喘结果，而这些改善将通过减少接触害虫过敏原和室内颗粒物来介导。通过前瞻性地招募和跟踪加入巴尔的摩流动计划的家庭，我们力求实现以下具体目标：(1) 通过比较 5-17 岁患有持续性哮喘的儿童搬到不搬家的类似儿童的结果，确定从低收入城市社区搬到更好社区的优质住房对哮喘相关结果的影响；(2) 估计减少室内活动的因果影响 通过使用主分层（一种环境研究中因果推断的统计方法）转向更好的住房来减少害虫过敏原和 PM 的哮喘结果。拟议的研究有可能对住房政策作为解决哮喘差异的工具的作用产生重大影响。