Abstract
Asthma is the most common chronic condition of childhood, affecting 9.1% of all American children. The prevalence and morbidity of asthma among children in the United States have increased dramatically over the past 3 decades. More than 6 million children currently have asthma, leading to 205,000 pediatric hospitalizations and 697,000 emergency department visits each year (Akinbami et al., Pediatrics 123(Suppl 3):S131–45, 2009). Asthma develops through the interaction of genetic factors with environmental exposures. Strong evidence has linked exposure to dust mites, cockroaches, rodents, mold, and pet dander to the development of sensitization to allergens and subsequent asthma incidence and morbidity (Institute of Medicine, Clearing the air: asthma and indoor air exposures. Washington, DC: National Academy Press, 2000; Institute of Medicine, Damp indoor spaces and health. Washington, DC: National Academy Press, 2004; Platts-Mills et al., J Allergy Clin Immunol 96(4):435–40, 1995; Sporik et al., Thorax 54(8):675–80, 1999; Dales, Am J Epidemiol 134(2):196–203, 1991; Rosenstreich et al., N Engl J Med 336(19):1356–63, 1997; Zock et al., J Allergy Clin Immunol 110(2):285–92, 2002). Exposure to indoor allergens is widespread (Salo et al., Environ Health Perspect 117(3):387–91, 2009). In the United States, disadvantaged and minority populations are disproportionately affected by asthma (Gold and Wright, Annu Rev Public Health 26:89–113, 2005; Asthma and Allergy Foundation of America and National Pharmaceutical Council, Ethnic disparities in the burden and treatment of asthma. Washington, DC, 2005). Relative to wealthier and white populations, they have higher asthma prevalence and experience more serious impacts such as severe attacks leading to emergency department visits and hospitalizations (Aligne et al., Am J Respir Crit Care Med 162: 873–7, 2000; Litonjua et al., Pediatr Pulmonol 28(6):394–401, 1999; Weiss and Gergen, Chest 101(June suppl):362S–7S, 1992; Call et al., J Pediatr 121:862–6, 1992; Lang and Polansky, N Engl J Med 331:1542–6, 1994; Grant et al., Curr Opin Pulm Med 5(1):27–34, 1999; Eggleston, Immunol Allergy Clin North Am 18:75–84, 1998). The current asthma prevalence among blacks is 25% higher than non-Hispanic whites. The emergency department visit rate among blacks is 4.6 times higher than that among whites, the hospitalization rate 3.4 times higher, and the mortality rate 3 times higher (Akinbami, Asthma prevalence, health care use and mortality: United States, 2003–05. http://cdc.gov/nchs/data/hestat/asthma03-05/asthma03-05.htm. Accessed 21 May 2010). Many factors interact to produce these inequities (Eggleston, Immunol Allergy Clin North Am 18:75–84, 1998; Grant et al., Curr Opin Pulm Med 5(1):27–34, 1999). As much as 40% of the excess asthma risk in minority children may be attributable to exposure to residential allergens (Lanphear et al., Pediatrics 107(3):505–11, 2001). Being poor or a person of color is associated with increased rates of sensitization to several asthma-associated allergens found in homes (Christiansen et al., J Allergy Clin Immunol 98(2):288–94, 1996; Willies-Jacobo et al., J Allergy Clin Immunol 92(4):630–2, 1993; Gelber et al., Am Rev Respir Dis 147(3):573–8, 1993; Sarpong et al., J Allergy Clin Immunol 97(6):1393–401, 1996; Lewis et al., J Allergy Clin Immunol 107:615–22, 2001; Strachan, Toxicol Lett 86:199–203, 1996; Huss et al. Ann Allergy 72(2):173–7, 1994; Eggleston, Clin Rev Allergy Immunol 18(3):311–24, 2000). Low-income children and children of color are more likely to live in substandard housing. Living in substandard housing leads to exposure to allergens and higher rates of allergen sensitization (Eggleston, Immunol Allergy Clin North Am 18:75–84, 1998; Huss et al., Ann Allergy 72(2):173–7, 1994; Kitch et al., Environ Health Perspect 108(4):301–7, 2000). Features of substandard housing such as excessive moisture and dampness, poor ventilation, crowding, pest infestations, deteriorated carpeting, and structural deficits are associated with high levels of indoor asthma triggers (Hyndman, Making connections between housing and health. Putting health into place. Syracuse, NY: Syracuse University Press, pp. 191–207, 1998). Exposure to combustion products from unvented stoves can induce asthma symptoms (Eisner et al., Thorax 57:973–8, 2002). A strong parallel thus exists between exposure to asthma triggers and the differential exposure of disadvantaged populations to hazards in the outdoor environment (e.g., toxic waste dumps or freeways) – a hallmark of environmental racism (Northridge and Shepard, Am J Public Health 87(5):730–2, 1997).
J.W. Krieger
Chief, Chronic Disease and Injury Prevention Section, Public Health—Seattle and King County, Clinical Associate Professor of Medicine and Health Services, University of Washington, Seattle, Washington, USA
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References
Harrison BD. Psychosocial aspects of asthma in adults. Thorax. 1998;53(6):519–25.
Wright RJ, Steinbach SF. Violence: an unrecognized environmental exposure that may contribute to greater asthma morbidity in high risk inner-city populations. Environ Health Perspect. 2001;109(10):1085–9.
Wright RJ, Cohen RT, Cohen S. The impact of stress on the development and expression of atopy. Curr Opin Allergy Clin Immunol. 2005;5(1):23–9.
Lang DM, Polansky M. Patterns of asthma mortality in Philadelphia from 1969 to 1991. N Engl J Med. 1994;331:1542–6.
Stingone JA, Claudio L. Disparities in allergy testing and health outcomes among urban children with asthma. J Allergy Clin Immunol. 2008;122(4):748–53.
Shields AE, Comstock C, Weiss KB. Variations in asthma care by race/ethnicity among children enrolled in a state Medicaid program. Pediatrics. 2004;113(3 Pt 1):496–504.
Crain EF, Kercsmar C, Weiss KB, Mitchell H, Lynn H. Reported difficulties in access to quality care for children with asthma in the inner city. Arch Pediatr Adolesc Med. 1998;152(4):333–9.
Apter AJ, Reisine ST, Affleck G, Barrows E, ZuWallack RL. Adherence to twice-daily dosing of inhaled steroids. Socioeconomic and health-belief differences. Am J Respir Crit Care Med. 1998;157:1810–17.
Institute of Medicine. Clearing the air: asthma and indoor air exposures. Washington, DC: National Academy Press; 2000.
Krieger J, Jacobs DE, Ashley PJ, Baeder A, Chew G, Dearborn D, et al. Housing interventions and control of indoor biologic agents: a review of the evidence. J Public Health Manage Pract. 2010;16(5 Suppl):S11–20.
Eggleston PA. Improving indoor environments: reducing allergen exposures. J Allergy Clin Immunol. 2005;116(1):122–6.
Custovic A, Woodcock A. On allergens and asthma (again): does exposure to allergens in homes exacerbate asthma? Clin Exp Allergy. 2001;31:670–3.
Platts-Mills TAE. Allergen avoidance. J Allergy Clin Immunol. 2004;113:388–91.
Carswell F, Birmingham K, Oliver J, Crewes A, Weeks J. The respiratory effects of reduction of mite allergen in the bedrooms of asthmatic children – a double-blind controlled trial. Clin Exp Allergy. 1996;26:386–96.
De Blay F, Chapman MD, Platts-Mills TA. Airborne cat allergen (Fel d I). Environmental control with the cat in situ. Am Rev Respir Dis. 1991;143(6):1334–9.
Ostro BD, Lipsett MJ, Mann JK, Wiener MB, Selner J. Indoor air pollution and asthma. Results from a panel study. Am J Respir Crit Care Med. 1994;149(6):1400–6.
Burr ML, Matthews IP, Arthur RA, et al. Effects on patients with asthma of eradicating visible indoor mould: a randomised controlled trial. Thorax. 2007;62(9):766–71.
Arlian L, Neal J, Morgan M, et al. Reducing relative humidity is a practical way to control dust mites and their allergens in homes in temperate climates. J Allergy Clin Immunol. 2001;107(1):99–104.
Storey E, Dangman KH, Schenck P, Yang C, et al. Guidance for clinicians on the recognition and management of health effects related to mold exposure and moisture indoors. Farmington: University of Connecticut Health Center, Center for Environments and Health; 2004.
Vojta PJ, Randels SP, Stout J, et al. Effects of physical interventions on house dust mite allergen levels in carpet, bed, and upholstery dust in low-income, urban homes. Environ Health Perspect. 2001;109(8):815–9.
Howden-Chapman P, Pierse N, Nicholls S, et al. Effects of improved home heating on asthma in community dwelling children: randomised controlled trial. BMJ. 2008;337:a1411.
Eggleston PA, Butz A, Rand C, et al. Home environmental intervention in inner-city asthma: a randomized controlled clinical trial. Ann Allergy Asthma Immunol. 2005;95(6):518–24.
Wright GR, Howieson S, McSharry C, et al. Effect of improved home ventilation on asthma control and house dust mite allergen levels. Allergy. 2009;64:1671–80.
Kercsmar CM, Dearborn DG, Schluchter M, et al. Reduction in asthma morbidity in children as a result of home remediation aimed at moisture sources. Environ Health Perspect. 2006;114:1574–80.
Simpson A, Custovic A. Prevention of allergic sensitization by environmental control. Curr Allergy Asthma Rep. 2009;9(5):363–9.
Woodcock A, Forster L, Matthews E, Martin J, Letley L, Vickers M, et al. Control of exposure to mite allergen and allergen-impermeable bed covers for adults with asthma. N Engl J Med. 2003;349:225–36.
Crocker DD, Hopkins D, Kinyota S, et al. A systematic review of home-based multi-trigger multi-component environmental interventions to reduce asthma morbidity. J Allergy Clin Immunol. 2009;123:S20.
Morgan WJ, Crain EF, Gruchalla RS, O’Connor GT, Kattan M, Evans III R, et al. Results of a home-based environmental intervention among urban children with asthma. N Engl J Med. 2004;351:1068–80.
Williams SG, Brown CM, Falter KH, Alverson CJ, Gotway-Crawford C, Homa D, et al. Does a multifaceted environmental intervention alter the impact of asthma on inner-city children? J Natl Med Assoc. 2006;98(2):249–60.
Brown JV, Demi AS, Wilson SR. Home-based asthma education of young low-income children and their families. J Pediatric Psychol. 2002;27:667–88.
Carter MC, Perzanowski MS, Raymond A, et al. Home intervention in the treatment of asthma among inner-city children. J Allergy Clin Immunol. 2001;108:732–7.
Eggleston PA, Butz A, Rand C, Curtin-Brosnan J, Kanchanaraksa S, Swartz L, et al. Home environmental intervention in inner-city asthma: a randomized controlled clinical trial. Ann Allergy Asthma Immunol. 2005;95(6):518–24.
Krieger JW, Song L, Takaro T. The Seattle-King County Healthy Homes Project: a randomized, controlled trial of a community health worker intervention to decrease exposure to indoor asthma triggers among low-income children. Am J Public Health. 2005;95:652–9.
Krieger J, Takaro TK, Song L, et al. The Seattle-King County Healthy Homes II Project: a randomized controlled trial of asthma self-management support comparing clinic-based nurses and in-home community health workers. Arch Pediatr Adolesc Med. 2009;163:141–9.
Krieger J. Home visits for asthma: we cannot afford to wait any longer. Arch Pediatr Adolesc Med. 2009;163:279–91.
Postma J, Karr C, Kieckhefer G. Community health workers and environmental interventions for children with asthma: a systematic review. J Asthma. 2009;46(6):564–76.
Bryant-Stephens T, Kurian C, Guo R, Zhao H. Impact of a household environmental intervention delivered by lay health workers on asthma symptom control in urban, disadvantaged children with asthma. Am J Public Health. 2009;99(S3):S657–65.
National Center for Healthy Housing. Comparing green building guidelines and healthy homes principles: a preliminary investigation. 2006. http://www.centerforhealthyhousing.org/Green_Analysis.pdf. Accessed 30 Apr 2010.
National Center for Healthy Housing. Seven principles of a healthy home. 2010. http://www.nchh.org/What-We-Do/Healthy-Homes-Principles.aspx. Accessed 29 Apr 2010.
U.S. Green Building Council’s LEED for Homes. 2010. http://www.usgbc.org/DisplayPage.aspx?CMSPageID=147&. Accessed 30 Apr 2010.
National Association of Home Builders’ NAHB Green Home Building Guidelines. 2010. http://www.nahb.org/generic.aspx?sectionID=222&genericContentID=56077. Accessed 30 Apr 2010.
Enterprise Community Partner’s Green Communities Criteria. 2010. http://www.greencommunitiesonline.org/tools/criteria. Accessed 30 Apr 2010.
U.S. Environmental Protection Agency’s (EPA) Energy Star with Indoor Air Package. 2010. http://www.energystar.gov/ia/partners/bldrs_lenders_raters/downloads/IAPBuild508.pdf. Accessed 30 Apr 2010.
American Lung Association’s Health House Builder Guidelines. 2010. http://www.alaw.org/air_quality/healthy_house_programs. Accessed 30 Apr 2010.
Takaro TK, Krieger JW, Song L. Effect of environmental interventions to reduce exposure to asthma triggers in homes of low-income children in Seattle. J Expo Anal Environ Epidemiol. 2004;14(S1):S133–43.
Krieger JK, Takaro TK, Allen C, Song L, Weaver M, Chai S, et al. The Seattle-King County healthy homes project: implementation of a comprehensive approach to improving indoor environmental quality for low-income children with asthma. Environ Health Perspect. 2002;110 Suppl 2:311–22.
Berkman LF, Glass T. Social integration, social networks, social support, and health. In: Berkman LF, Kawachi I, editors. Social epidemiology. New York: Oxford University Press; 2000. p. 137–73.
Juniper EF, Svensson K, Mork AC, Stahl E. Measurement properties and interpretation of three shortened versions of the asthma control questionnaire. Respir Med. 2005;99(5):553–8. Epub 2004 Nov 26.
American Academy of Allergy, Asthma and Immunology. Pediatric asthma: promoting best practice. Milwaukee: AAAI; 1999.
Roter DL, Hall JA, Merisca R, Nordstrom B, Cretin D, Svarstad B. Effectiveness of interventions to improve patient compliance: a meta-analysis. Med Care. 1998;36(8):1138–61.
Clark NM, Nothwehr F, Gong M, et al. Physician–patient partnership in managing chronic illness. Acad Med. 1995;70(11):957–9.
Meichenbaum D, Turk D. Facilitating treatment adherence: a practitioners guidebook. New York: Plenum Press; 1987.
Rollnick S, MIller W, Butler C. Motivational interviewing in health care: helping patients change behavior. New York: Guilford Press; 2008.
Ehnert B, Lau-Schadendorf S, Weber A, Buettner P, Schou C, Wahn U. Reducing domestic exposure to dust mite allergen reduces bronchial hyperreactivity in sensitive children with asthma. J Allergy Clin Immunol. 1992;1:135–8.
Platts-Mills TA. Allergen avoidance in the treatment of asthma and rhinitis. N Engl J Med. 2003;349(3):207–8.
Popplewell EJ, Innes VA, Lloyd-Hughes S, et al. The effect of high-efficiency and standard vacuum-cleaners on mite, cat and dog allergen levels and clinical progress. Pediatr Allergy Immunol. 2000;11(3):142–8.
Munir AK, Einarsson R, Dreborg SK. Vacuum cleaning decreases the levels of mite allergens in house dust. Pediatr Allergy Immunol. 1993;4(3):136–43.
Roberts JW, Clifford WS, Glass G, Hummer PG. Reducing dust, lead, dust mites, bacteria, and fungi in carpets by vacuuming. Arch Environ Contam Toxicol. 1999;36(4):477–84.
Vaughan JW, Woodfolk JA, Platts-Mills TA. Assessment of vacuum cleaners and vacuum cleaner bags recommended for allergic subjects. J Allergy Clin Immunol. 1999;104(5):1079–83.
Gibson PG, Powell H. Written action plans for asthma: an evidence-based review of the key components. Thorax. 2004;59(2):94–9.
Zielenback S. Catalyzing community development: HOPE VI and neighborhood revitalization. J Affordable Hous. 2003;13(2):40–3.
The Urban Institute. Housing choice for hope VI relocatees. Washington, DC; 2001.
Takaro TT, Krieger J, Song L, Sharify D, Beaudet N. The Breathe Easy Home: Impact of asthma-friendly home design and construction on asthma clinical outcomes and trigger exposure. Submitted for publication, 2010.
Krieger J, Higgins DL. Housing and health: time again for public health action. Am J Public Health. 2002;92:758–68.
Sandel M, Phelan K, Wright R, Hynes HP, Lanphear BP. The effects of housing interventions on child health. Pediatr Ann. 2004;33:474–81.
National Center for Healthy Housing. An evaluation of green housing rehabilitation in Minnesota. 2010. http://www.nchh.org/Research/Minnesota-Green-Housing-Rehabilitation.aspx. Accessed 22 Apr 2010.
Akinbami LJ, Moorman JE, Garbe PL, Sondik EJ. Status of childhood asthma in the United States, 1980–2007. Pediatrics. 2009;123 Suppl 3:S131–45.
Institute of Medicine. Damp indoor spaces and health. Washington, DC: National Academy Press; 2004.
Platts-Mills TA, Sporik RB, Wheatley LM, Heymann PW. Is there a dose-response relationship between exposure to indoor allergens and symptoms of asthma? J Allergy Clin Immunol. 1995;96(4):435–40.
Sporik R, Squillace SP, Ingram JM, Rakes G, Honsinger RW, Platts-Mills TA. Mite, cat, and cockroach exposure, allergen sensitisation, and asthma in children: a case-control study of three schools. Thorax. 1999;54(8):675–80.
Dales RE. Respiratory health effects of home dampness and molds among Canadian children. Am J Epidemiol. 1991;134(2):196–203.
Rosenstreich DL, Eggleston P, Kattan M, et al. The role of cockroach allergy and exposure to cockroach allergen in causing morbidity among inner-city children with asthma. N Engl J Med. 1997;336(19):1356–63.
Zock JP, Jarvis D, Luczynska C, Sunyer J, Burney P. European Community Respiratory Health Survey. Housing characteristics, reported mold exposure, and asthma in the European Community Respiratory Health Survey. J Allergy Clin Immunol. 2002;110(2):285–92.
Salo PM, Jaramillo R, Cohn RD, London SJ, Zeldin DC. Exposure to mouse allergen in U.S. homes associated with asthma symptoms. Environ Health Perspect. 2009;117(3):387–91.
Gold DR, Wright R. Population disparities in asthma. Annu Rev Public Health. 2005;26:89–113.
Asthma and Allergy Foundation of America and National Pharmaceutical Council. Ethnic disparities in the burden and treatment of asthma. Washington, DC; 2005.
Aligne CA, Auinger P, Byrd RS, Weitzman M. Risk factors for pediatric asthma: contributions of poverty, race, and urban residence. Am J Respir Crit Care Med. 2000;162:873–7.
Litonjua AA, Carey VJ, Weiss ST, Gold DR. Race, socioeconomic factors, and area of residence are associated with asthma prevalence. Pediatr Pulmonol. 1999;28(6):394–401.
Weiss KB, Gergen PJ. Inner-city asthma: the epidemology of an emerging US public health concern. Chest. 1992;101(June suppl):362S–7.
Call RS, Smith TF, Morris E, Chapman MD, Platts-Mills TAE. Risk factors for asthma in inner city children. J Pediatr. 1992;121:862–6.
Grant EN, Alp H, Weiss KB. The challenge of inner-city asthma. Curr Opin Pulm Med. 1999;5(1):27–34. hhii 24.
Eggleston PA. Urban children and asthma. Immunol Allergy Clin North Am. 1998;18:75–84.
Akinbami L. Asthma prevalence, health care use and mortality: United States, 2003–05. CDC. 2010. http://cdc.gov/nchs/data/hestat/asthma03-05/asthma03-05.htm. Accessed 21 Apr 2010.
Lanphear BP, Aligne CA, Auinger P, Weitzman M, Byrd RS. Residential exposures associated with asthma in US children. Pediatrics. 2001;107(3):505–11.
Christiansen SC, Martin SB, Schleicher NC, Koziol JA, Hamilton RG, Zuraw BL. Exposure and sensitization to environmental allergen of predominantly Hispanic children with asthma in San Diego’s inner city. J Allergy Clin Immunol. 1996;98(2):288–94.
Willies-Jacobo LJ, Denson-Lino JM, Rosas A, O’Connor RD, Wilson NW. Socioeconomic status and allergy in children with asthma. J Allergy Clin Immunol. 1993;92(4):630–2.
Gelber LE, Seltzer LH, Bouzoukis JK, Pollart SM, Chapman MD, Platts-Mills TA. Sensitization and exposure to indoor allergens as risk factors for asthma among patients presenting to hospital. Am Rev Respir Dis. 1993;147(3):573–8.
Sarpong SB, Hamilton RG, Eggleston PA, Adkinson NF. Socioeconomic status and race as risk factors for cockroach allergen exposure and sensitization in children with asthma. J Allergy Clin Immunol. 1996;97(6):1393–401.
Lewis SA, Weiss ST, Platts-Mills TAE, Syring M, Gold DR. Association of specific allergen sensitization with socioeconomic factors and allergic disease in a population of Boston women. J Allergy Clin Immunol. 2001;107:615–22.
Strachan D. Socioeconomic factors and the development of allergy. Toxol Lett. 1996;86:199–203.
Huss K, Rand CS, Butz AM, et al. Home environmental risk factors in urban minority asthmatic children. Ann Allergy. 1994;72(2):173–7.
Eggleston PA. Environmental causes of asthma in inner city children. The National Cooperative Inner City Asthma Study. Clin Rev Allergy Immunol. 2000;18(3):311–24.
Kitch BT, Chew G, Burge HA, Muilenberg ML, Weiss ST, Platts-Mills TA, et al. Socioeconomic predictors of high allergen levels in homes in the greater Boston area. Environ Health Perspect. 2000;108(4):301–7.
Hyndman S. Making connections between housing and health. Putting health into place. Syracuse, NY: Syracuse University Press; 1998. p. 191–207.
Eisner MD, Yelin EH, Katz PP, Earnest G, Blanc PD. Exposure to indoor combustion and adult asthma outcomes: environmental tobacco smoke, gas stoves and wood smoke. Thorax. 2002;57:973–8.
Northridge ME, Shepard PM. Environmental racism and public health. Am J Public Health. 1997;87(5):730–2.
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Krieger, J.W., Takaro, T.K., Rabkin, J.C. (2011). Breathing Easier in Seattle: Addressing Asthma Disparities Through Healthier Housing. In: Williams, R. (eds) Healthcare Disparities at the Crossroads with Healthcare Reform. Springer, Boston, MA. https://doi.org/10.1007/978-1-4419-7136-4_19
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