ALLERGENS IN INNER-CITY SCHOOLS AND CHILDHOOD ASTHMA

描述(申请人提供)：过敏性哮喘是美国最常见的儿童慢性病。在美国，哮喘也是导致旷课的头号原因。室内过敏原暴露在家庭中的作用以及哮喘的发生和发病率已经得到了广泛的研究。由于孩子们在学校的时间很长，学校教室环境可能与家里的过敏原接触一样，是过敏原暴露和随后的哮喘发病率的重要来源。然而，关于过敏原暴露在学校和哮喘发病率中的作用，人们知之甚少。我们假设，即使在控制了家庭过敏原暴露之后，在教室里暴露于常见的室内过敏原也会增加市中心哮喘儿童哮喘发病率的风险。在一项对来自波士顿市中心25所学校多个教室的600名患有哮喘的小学生的纵向研究中，我们将检查以下具体目标：1)测试教室中过敏原水平的升高是否会增加哮喘发病的风险，即使在控制了家庭中的过敏原暴露之后；以及2)测试特定过敏原的课堂水平升高是否会使对该过敏原特别敏感的人的哮喘发病率增加的风险最高。了解学校教室特有的暴露风险因素至关重要，因为学校教室环境可能被视为通过以学校为基础的干预措施减少对许多有症状儿童的暴露而预防市内哮喘发病率的有效目标。虽然课堂环境对哮喘儿童健康的潜在重要性已经在全国范围内得到认可，但对这一领域的研究还很缺乏。这一独特的应用将建立在布里格姆妇女医院钱宁实验室、波士顿儿童医院、哈佛公共卫生学院、马萨诸塞大学阿默斯特分校和波士顿公立学校系统之间的重要合作基础上。我们的多学科研究小组在哮喘流行病学和环境流行病学(Phipatanakul博士和Gold博士)、环境评估(Phipatanakul博士、Gold博士、Muilenberg博士和Rogers博士)以及统计学(Ryan、Hoffman博士和Sankaranarayanan博士[Subramanian])方面拥有丰富的专业知识。除了与公共卫生相关之外，这项提案还将招募一个独特的学校儿科队列，这将有助于未来的假设检验。与公共卫生相关：哮喘是一种疾病，每年有超过1400万天的旷课，影响着超过12%的18岁以下美国人，是美国旷课的头号原因。小学生每天在学校的时间是6到10个小时，其中大部分时间是在一个教室里度过的。本项目的目标是提供对特定于课堂的暴露风险因素的了解。这一点至关重要，因为教室环境可能被认为是预防市内哮喘发病率的有效目标，方法是通过在学校教室进行干预，减少与许多有症状儿童的接触。

DESCRIPTION (provided by applicant): Allergic asthma is the most common chronic disease of childhood in the United States. Asthma is also the number one cause of school absences in America. The role of indoor allergen exposure in homes and asthma development and morbidity has been extensively studied. Because children spend a significant amount of time in school, the school classroom environment may be as significant a source of allergen exposure and consequent asthma morbidity as allergen exposure in the home. However, little is known about the role of allergen exposure in schools and asthma morbidity. We hypothesize that exposure to common indoor allergens in the classroom will increase the risk of asthma morbidity in inner-city children with asthma, even after controlling for home allergen exposures. In a longitudinal study of 600 elementary school-aged children with asthma from multiple classrooms in 25 Boston inner-city schools, we will examine the following specific aims: 1) to test whether elevated levels of allergens in the classroom increase the risk of asthma morbidity, even after controlling for allergen exposure in the home; and 2) to test whether the risk of increased asthma morbidity in relation to elevated classroom levels of a specific allergen will be highest for those specifically sensitized to that allergen. An understanding of exposure risk factors specific to the school classroom is critical, because the school classroom environment could potentially be considered as an effective target for prevention of inner-city asthma morbidity by reducing exposures to many symptomatic children through school- based interventions. While the potential importance of the classroom environment to the health of asthmatic children has been recognized nationally, study of this area has lacking. This unique application will build on significant collaborations between the Channing Laboratory at the Brigham and Women's Hospital, Children's Hospital Boston, the Harvard School of Public Health, the University of Massachusetts Amherst, and the Boston Public School System. Our multidisciplinary research group has significant expertise in asthma epidemiology and environmental epidemiology (Drs. Phipatanakul and Gold), environmental assessment (Drs. Phipatanakul, Gold, Muilenberg, and Rogers), and statistics (Drs. Ryan, Hoffman, and Sankaranarayanan [Subramanian]). In addition to its public health relevance, this proposal will recruit a unique school pediatric cohort that will facilitate future hypothesis testing. PUBLIC HEALTH RELEVANCE: Asthma is a disease that affects more than 12% of Americans under the age of 18 for over 14 million missed school days per year, and is the number one cause of school absences in America. Elementary school children spend 6 to 10 hours a day in school, and most of that time is spent in one classroom. The goals of this project are to provide an understanding of exposure risk factors specific to the classroom. This is critical, because the classroom environment could potentially be considered as an effective target for prevention of inner-city asthma morbidity by reducing exposures to many symptomatic children through an intervention in the school classrooms.