ALLERGENS IN INNER-CITY SCHOOLS AND CHILDHOOD ASTHMA

描述（由申请人提供）：过敏性哮喘是美国儿童最常见的慢性疾病。哮喘也是美国学生旷课的头号原因。室内过敏原暴露在家庭和哮喘的发展和发病率的作用已被广泛研究。由于儿童在学校花费大量的时间，学校教室环境可能是过敏原暴露和随后的哮喘发病率的重要来源，因为过敏原暴露在家中。然而，很少有人知道过敏原暴露在学校和哮喘发病率的作用。我们假设，即使在控制了家庭过敏原暴露后，教室中常见的室内过敏原暴露也会增加市中心哮喘儿童的哮喘发病率。在波士顿市中心25所学校多个教室的600名小学学龄哮喘儿童的纵向研究中，我们将研究以下具体目标：1）测试教室中过敏原水平升高是否会增加哮喘发病的风险，即使在控制了家中过敏原暴露之后;以及2）测试与特定变应原的升高的教室水平相关的哮喘发病率增加的风险对于那些对该变应原特异性致敏的人是否最高。了解学校教室特有的暴露风险因素是至关重要的，因为学校教室环境可能被认为是预防市中心哮喘发病的有效目标，通过学校干预减少许多有症状的儿童的暴露。虽然教室环境对哮喘儿童健康的潜在重要性已被全国公认，但缺乏这方面的研究。这种独特的应用将建立在布里格姆妇女医院的钱宁实验室、波士顿儿童医院、哈佛公共卫生学院、马萨诸塞州阿默斯特大学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和Gold博士），环境评估（Phipatanakul，Gold，Muilenberg和Rogers博士）和统计学（Ryan，霍夫曼和Sankaranarayanan [Subramanian]博士）方面具有重要的专业知识。除了其公共卫生相关性，该提案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。公共卫生相关性：哮喘是一种疾病，每年影响超过12%的18岁以下的美国人超过1400万个缺课日，并且是美国缺课的头号原因。小学生每天在学校里呆6到10个小时，大部分时间都在一个教室里度过。这个项目的目标是提供一个特定的教室暴露风险因素的理解。这是至关重要的，因为教室环境可能被认为是一个有效的目标，通过减少暴露于许多有症状的儿童，通过干预学校教室，预防内城哮喘发病率。

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.