The effect of a housing mobility program on environmental exposures and asthma morbidity among low-income minority children

 描述(申请人提供)：哮喘发病率仍然是居住在城市社区的低收入少数族裔儿童中的一个主要公共卫生问题，尽管有高效的控制药物可用。导致这一人群哮喘发病率高得不成比例的主要因素是接触害虫过敏原(老鼠和蟑螂)和室内污染物(二手烟和邻里PM造成的颗粒物(PM))。使用家庭环境干预措施(EIS)减少这些暴露的努力对哮喘症状的衡量只产生了轻微的影响，在减少急性护理就诊或改善肺功能方面几乎没有效果，而肺功能是医疗保健成本高和长期结果差的关键标志。EIS在这一高危人群中的效果有限，可能是因为EIS只适度减少了室内过敏原和污染物。住房流动计划提供了一种替代干预措施，具有实现大幅减少过敏原和污染物的强大潜力，从而在包括急性就诊和肺功能在内的一系列指标上改善哮喘健康。我们建议在巴尔的摩移动性计划(BMP)的背景下进行这样的研究，这是美国最大的移动性计划。我们与BMP合作，共同发现，在BMP中，从巴尔的摩市搬出去的家庭中，虫害过敏原和PM暴露比巴尔的摩市类似儿童的家庭低得多。到目前为止，我们的初步数据和发现有力地支持了这样一种假设，即通过住房流动计划搬到更好的社区的高质量住房将导致哮喘结果的改善，并且这些改善将通过减少接触害虫过敏原和室内PM来实现通过前瞻性地招募和跟踪加入巴尔的摩流动计划的家庭，我们寻求解决以下具体目标：(1)通过比较5-17岁患有持续性哮喘的儿童搬到类似不搬家的儿童的结果，确定从低收入城市社区搬到更好社区的优质住房对哮喘相关结果的影响，以及(2)通过使用主要分层来评估通过搬到更好的住房来减少室内害虫过敏原和PM的因果影响，这是环境研究中因果推断的统计方法。拟议的研究有可能对住房政策作为解决哮喘差距的工具的作用产生重大影响。

 DESCRIPTION (provided by applicant):Asthma morbidity continues to be a major public health problem among low-income minority children living in urban neighborhoods despite the availability of highly effective controller medications. Major contributors to the disproportionatey high asthma morbidity in this population are exposure to pest allergens (mouse and cockroach) and indoor pollutants (particulate matter (PM) due to second hand smoke and neighborhood PM). Efforts to reduce these exposures using home environmental interventions (EIs) have had only modest effects on measures of asthma symptoms and they have had little effect on reducing acute care visits or on improving lung function which are critical markers of high health care costs and poor long-term outcomes. The limited efficacy of EIs in this high-risk population is likely due to only modest reductions of indoor allergens and pollutants achieved by EIs. Housing mobility programs offer an alternative intervention with the strong potential to achieve large reductions in allergens and pollutants and thereby improve asthma health across a broad range of indicators including acute visits and lung function. We propose to conduct such a study in the context of the Baltimore Mobility Program (BMP), the nation's largest mobility program. We have partnered with BMP, and together have found that among families in BMP who have moved away from Baltimore City, pest allergen and PM exposures are much lower than in the homes of similar children living in Baltimore City. Our preliminary data and findings to date provide strong support for the hypothesis that moving to good quality housing in a better neighborhood through a housing mobility program will result in improvements in asthma outcomes, and that these improvements will be mediated by reductions in exposure to pest allergens and indoor PM. Through prospectively recruiting and following families as they enter into the Baltimore Mobility Program, we seek to address the following specific aims: (1) To determine the effect of moving from a low-income urban neighborhood to good quality housing in a better neighborhood on asthma-related outcomes by comparing outcomes among 5-17 year old children with persistent asthma who move to similar children who do not move, and (2) To estimate the causal effects of reducing indoor pest allergens and PM by moving to better housing on asthma outcomes using principal stratification, a statistical method for causal inference in environmental studies. The proposed study has the potential to have significant implications for the role of housing policy as a tool to address asthma disparities.