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

摘要 真菌污染在城市家庭中很常见，对低收入家庭的影响不成比例。 对导致霉菌生长的条件控制较少。世界卫生组织医学研究所 组织和几个荟萃分析已经确定，真菌和室内潮湿与 哮喘症状。这些发现和一些成功的干预研究的结果导致了 结论有足够的证据建议用湿法和霉菌疗法来减少哮喘。 症状。然而，霉菌生长的根本原因，特别是在低收入城市家庭中，往往代价高昂。 修复，因此，不去解决。纽约市住房管理局(NYCHA)拥有302套公共住房 拥有2252栋建筑物和超过365,000名居民的开发项目。居住在NYCHA的儿童和成年人 住房有很高的哮喘发病率负担，NYCHA家庭的霉菌和水损坏的投诉 已经很常见了。2019年，NYCHA实施了一个创新的新计划--Mold Buster，以有效地 使用更好的评估工具、增强的员工培训、新的 质量保证的问责程序和精简的优先顺序反应系统。这个 预计这将大大减少霉菌暴露，并减少哮喘的恶化 NYCHA居民，特别是对霉菌过敏的人。表现出哮喘结果的改善 这一政策干预将对公共卫生产生重大影响。这个项目将把 NYCHA，纽约市健康和精神卫生部门(DOHMH)，一个社区组织， 在低收入住房和学术研究人员中提供哮喘干预措施，以证明改善 与这一大规模干预相关的居民健康通过链接NYCHA关于模具工作订单的数据(这 居民投诉的结果)，纽约市DOHMH关于纽约市急诊科(ED)哮喘就诊的数据， 公立学校关于哮喘患病率的数据，以及学术和社区收集的其他数据 研究人员对居住在NYCHA住房中的儿童子集进行了研究。它还将解决以前的 缺乏对家庭中生长的真菌的充分测量和当前真菌指标的研究 生长/活动，这两者现在都可以用当代的基因测序方法进行评估，这些方法可能 为哮喘儿童和成人暴露于真菌生物气雾剂的光谱提供新的见解 在室内。这一提议将检验这样一种假设，即这种大规模干预将导致 NYCHA家庭儿童和成人哮喘发病率和过敏性真菌种类的减少 使用有关儿童和成人哮喘急诊和NYCHA家庭和模具工作单的管理数据 通过评估哮喘儿童样本中的真菌暴露、过敏反应和哮喘发病率 住在NYCHA的住房里。如果成功，这个项目将展示大规模公共卫生的效用 干预低收入纽约市居民的哮喘发病率，这是一个哮喘负担很高的社区。

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.