An equity-focused evaluation of a system-wide intervention to reduce mold in NYC public housing and its impact on asthma burden

对旨在减少纽约市公共住房霉菌及其对哮喘负担影响的全系统干预措施进行以公平为中心的评估

• 批准号: 10751871
• 负责人: Nina Flores
• 金额: $ 3.48万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-15 至 2025-08-14
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10751871
• 关键词: Address; Adult; Affect; Age; Air; American; Asthma; Atmosphere; Authorization documentation; Black race; Censuses; Centers for Disease Control and Prevention (U.S.); Cessation of life; Characteristics; Child; Chronic; Climate; Color; Communities; Construction Materials; Coronavirus; Data; Data Collection; Development; Diagnosis; Disparate; Disparity; Disparity population; Economic Burden; Education; Emergency department visit; Equity; Ethnic Origin; Evaluation; Event; Exposure to; Future; Growth; Health; Health Benefit; Home; Household; Housing; Hurricane; Incentives; Income; Individual; Insurance; Intervention; Knowledge; Legal; Link; Low income; Molds; Morbidity - disease rate; National Institute of Environmental Health Sciences; Natural experiment; Neighborhoods; New York City; North America; Parents; Policies; Prevalence; Public Housing; Race; Reporting; Reproduction spores; Research; Schools; Services; Subgroup; Symptoms; System; Temperature; Testing; Time Series Analysis; Toxin; Training; Underserved Population; United States; United States National Aeronautics and Space Administration; Visit; Water; Weather; Work; asthma exacerbation; authority; burden of illness; climate change; cost; environmental justice; experience; extreme weather; health data; improved; lower income families; mortality; parent grant; programs; remediation; repaired; respiratory; response; sex; social; social determinants; sociodemographics; socioeconomics; tool; underserved community; ventilation

PROJECT SUMMARY/ABSTRACT Asthma is one of the most prevalent chronic conditions in the United States (US); it is also one of the most disparate. Both in the US and in New York City (NYC), differences exist in asthma prevalence, morbidity, and mortality by racial/ethnic and socioeconomic groups. Substandard conditions faced by lower-income families living in rented or public housing partially drive these asthma disparities by increasing exposure to indoor asthma triggers such as mold. Mold can release spores, fragments, and toxins into the air which can lead to respiratory responses; mold has been causally implicated in both the development and exacerbation of asthma. Despite the known adverse health impacts of mold, proprietors have little incentive to perform remediations. Mold remediations, especially those targeting the root causes of water damage and mold growth, may be costly, often requiring pipe, roof, or ventilation system replacement. Thus, mold issues, especially in renter-occupied homes, often go unaddressed. There are critical knowledge gaps surrounding (a) how, in the context of climate change, mold growth exacerbates asthma disparities and (b) if mold interventions have the largest health benefits for those needing it the most. Residents of the NYC Housing Authority (NYCHA) – the largest public housing authority in North America, housing over 380,000 NYC residents – have long endured disproportionate exposures to dampness and mold in their homes, likely contributing to consistently high rates of asthma morbidity. However, in 2019, NYCHA implemented ‘Mold Busters’—a comprehensive program aimed to remove mold in NYCHA developments. ‘Mold Busters’ presents a natural experiment and a wealth of data that could be leveraged for our objectives: to understand (a) the dual burdens of mold growth and climate change faced by NYCHA residents (b) neighborhood and building characteristics conducive to mold growth and (c) changes in asthma morbidity resulting from ‘Mold Busters’—all of which could inform housing agencies’ approaches for mold problems. We will combine building-level, longitudinal mold reports collected by NYCHA with longitudinal meteorological and asthma-related emergency department visit data. First, we will conduct time series analyses to quantify the relationship between extreme weather events, expected to increase with climate change, and reports of mold, both overall and considering neighborhood and building characteristics that may modify this relationship (Aim 1). Next, we will use pre-‘Mold Busters’ data to understand the neighborhood and building characteristics that contribute to mold growth and asthma morbidity (Aim 2). Finally, we will conduct building- level difference-in-difference (DiD) analyses comparing pre/post-‘Mold Busters’ asthma-related emergency department visits in NYCHA buildings to non-NYCHA, control buildings, while considering neighborhood, building, and individual characteristics (Aim 3). If we are successful, together these analyses will inform future interventions by identifying vulnerable neighborhoods, buildings, and subgroups where further action targeting mold and/or asthma morbidity is necessary, and that climate change will disproportionately affect.

项目摘要/摘要 哮喘是美国（US）最普遍的慢性病之一;它也是最常见的慢性病之一。 完全不同在美国和纽约市（NYC），哮喘患病率、发病率和 按种族/族裔和社会经济群体分列的死亡率。低收入家庭面临的不合标准的条件 居住在出租房或公共住房中，通过增加对室内哮喘的暴露，部分地推动了这些哮喘差异 触发器，如模具。霉菌可以释放孢子，碎片和毒素到空气中，这可能导致呼吸道感染。 反应;霉菌在哮喘的发展和恶化中有因果关系。尽管 已知霉菌对健康的不利影响，业主几乎没有动力进行补救。模具 补救措施，特别是那些针对水损害和霉菌生长的根本原因的补救措施，可能是昂贵的，往往 需要更换管道、屋顶或通风系统。因此，霉菌问题，特别是在租客居住的房屋， 往往得不到解决。（a）在气候变化背景下， 霉菌生长加剧哮喘差异和（B）如果霉菌干预具有最大的健康益处， 最需要的人。纽约市住房管理局（NYCHA）的居民-最大的公共住房 在北美的权威，住房超过380，000纽约市居民-长期以来一直忍受不成比例的 暴露在潮湿和霉菌的家中，这可能导致哮喘的发病率一直很高。 发病率然而，在2019年，NYCHA实施了“模具克星”-一项旨在消除 在NYCHA的发展模具。“Mold Busters”提供了一个自然的实验和丰富的数据， 利用我们的目标：了解（a）霉菌生长和气候变化所面临的双重负担， NYCHA居民（B）邻里和建筑特征有利于霉菌生长和（c）变化， 哮喘发病率导致的“模具克星”-所有这些都可以告知住房机构的方法，模具 问题我们将结合联合收割机建筑水平，纵向模具报告收集的NYCHA与纵向 气象和哮喘相关的急诊就诊数据。首先，我们将进行时间序列分析 量化预计随着气候变化而增加的极端天气事件之间的关系， 模具的报告，无论是整体和考虑邻里和建筑特点，可能会修改这一点， 目标（1）。接下来，我们将使用“Mold Busters”前的数据来了解社区和建筑 有助于霉菌生长和哮喘发病率的特征（目标2）。最后，我们将进行建设- 比较“Mold Busters”治疗前后哮喘相关紧急情况的水平差异（DiD）分析 部门访问NYCHA建筑物非NYCHA，控制建筑物，同时考虑邻里， 建筑和个人特征（目标3）。如果我们成功了，这些分析将为未来提供信息。 通过识别脆弱的社区，建筑物和亚组进行干预，进一步采取行动 霉菌和/或哮喘发病率是必要的，气候变化将不成比例地影响。