Mold Policy Intervention in New York City Public Housing and Asthma Morbidity

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SUMMARY Fungal contamination is common in urban homes and disproportionately affects lower-income families who have less control over conditions that cause mold growth. The Institute of Medicine, the World Health Organization and several meta-analyses have established that fungi and home dampness are associated with asthma symptoms. These findings and those of some successful intervention studies have led to the conclusion that there is sufficient evidence to recommend dampness and mold remediation to reduce asthma symptoms. However, the root causes of mold growth, especially in lower-income urban homes are often costly to fix and, therefore, go unaddressed. New York City Housing Authority (NYCHA) has 302 public housing developments with 2,252 buildings and more than 365,000 residents. Children and adults living in NYCHA housing have a high burden of asthma morbidity, and complaints of mold and water damage in NYCHA homes have been common. In 2019, NYCHA implemented ‘Mold Busters’, an innovative new program to effectively remediate mold in NYC’s public housing using better tools of assessment, enhanced staff training, new accountability procedures for quality assurance and a streamlined prioritization response system. The expectation is that this will substantially reduce mold exposure and decrease asthma exacerbations for NYCHA residents, specifically mold-allergic individuals. Demonstrating improved asthma outcomes resulting from this policy intervention would have a substantial public health impact. This project will bring together NYCHA, the NYC Department of Health and Mental Hygiene (DOHMH), a community organization that provides asthma interventions in low-income housing and academic researchers to demonstrate improved resident health associated with this large-scale intervention by linking NYCHA data on mold work orders (which result from resident complaints), NYC DOHMH data on NYC emergency department (ED) visits for asthma, public school data on asthma prevalence, and additional data collected by academic and community researchers on a subset of children living in NYCHA housing. It will also address limitations of previous studies that lacked adequate measurement of fungi growing in homes and indicators of current fungal growth/activity, both of which can now be assessed with contemporary gene sequencing methods that may provide new insight into the spectrum of fungal bioaerosols that asthmatic children and adults are exposed to indoors. This proposal will test the hypotheses that this large-scale intervention will lead to a decrease in pediatric and adult asthma morbidity for residents and decreases in allergic fungal species in NYCHA homes using administrative data on pediatric and adult asthma ED visits and mold work orders in NYCHA homes and by assessing fungal exposure, allergic sensitization, and asthma morbidity in a sample of asthmatic children living in NYCHA housing. If successful, this project will demonstrate the utility of a large-scale public health intervention on asthma morbidity among low-income NYC residents, a community with a high asthma burden.