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: 9229021
• 负责人: Elizabeth C. Matsui
• 金额: $ 67.74万
• 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/9229021
• 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 Tobacco Smoke; Exhalation; Exposure to; Family; Family Study; Financial Support; Health; Health Care Costs; Home environment; Hospitalization; Housing; IgE; Indoor pollutant; Inflammatory; Intervention; Knowledge; Low income; Measures; Mediating; Modification; Morbidity - disease rate; Mus; 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; Socioeconomic Status; Source; Statistical Methods; Stratification; Symptoms; Visit; cockroach allergen; environmental intervention; high efficiency particulate air filter; high risk population; improved; indoor allergen; minority children; mouse allergen; next generation; pollutant; programs; prospective; 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）：哮喘发病率仍然是一个主要的公共卫生问题，低收入的少数民族儿童生活在城市社区，尽管可用的高效控制药物。该人群中哮喘发病率偏高的主要原因是暴露于害虫过敏原（小鼠和蟑螂）和室内污染物（二手烟引起的颗粒物（PM）和邻居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只有适度的影响，并且对减少急性护理访问或改善肺功能几乎没有影响，这是高医疗保健成本和不良长期结局的关键标志。在这种高风险人群中，EI的疗效有限，可能是由于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，具有很大的潜力，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。我们建议在全国最大的流动性计划巴尔的摩流动性计划（BMP）的背景下进行这样的研究。我们与BMP合作，共同发现，在BMP的家庭谁已经搬离巴尔的摩市，害虫过敏原和PM暴露远远低于家庭中的类似儿童生活在巴尔的摩市。迄今为止，我们的初步数据和研究结果为以下假设提供了强有力的支持：通过住房流动性计划，在更好的社区搬到高质量的住房将导致哮喘结局的改善，并且这些改善将通过减少接触有害生物过敏原和室内PM来介导。通过前瞻性招聘和以下家庭，因为他们进入巴尔的摩流动计划，我们寻求解决以下具体目标：（1）通过比较5-17岁患有持续性哮喘的儿童从低收入城市社区搬到更好社区的高质量住房对哮喘相关结果的影响，确定从低收入城市社区搬到更好社区的高质量住房的影响。和（2）使用环境研究中因果推断的统计方法--主分层法，估计通过搬到更好的住房来减少室内害虫过敏原和PM对哮喘结果的因果影响。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。