Emily Croce, MSN, APRN, CPNP-PC
The University of Texas at Austin School of Nursing
Moise Levy, MD
Dell Medical School at The University of Texas at Austin
The purpose of this study is to understand the effects of living in a poor neighborhood on AD prevalence and severity. We will examine these relationships using data from a sample of children with persistent asthma, among whom an estimated 50% are expected to have AD. We will use data from TexHALE (P.I. Elizabeth Matsui), a cross-sectional study of 350 children, ages 5-17 years with persistent asthma in Travis County (Austin, Texas). Participants are recruited from high poverty/high minority, low poverty/high minority, high poverty/low minority, and low poverty/low minority census tracts. Therefore, we will have an ethnically diverse study population and be strongly positioned to explore associations between race/ethnicity and AD prevalence/severity, and whether/to what extent these are explained by neighborhood poverty. The specific aims (SA) of this study are:
1. To compare the prevalence and severity of AD between children with persistent asthma living in high poverty neighborhoods with those living in low poverty neighborhoods, adjusting for individual-level socioeconomic status.
2. To examine associations between poverty-associated factors (indoor and outdoor air pollution, indoor allergen exposure, and psychosocial stress) and AD prevalence and severity, adjusting for individual-level socioeconomic status.
By examining these aims within a sample with robust demographic, neighborhood, and indoor/outdoor environmental exposure data, we may begin to understand how neighborhood poverty contributes to AD prevalence and severity and will have a rich source for secondary analyses. Should neighborhood poverty be implicated in excess burden of AD (independent of individual factors such as income), this would be among the first evidence that discriminatory forces that have led to environmental injustices may be responsible, at least in part, for racial and ethnic disparities in AD prevalence and/or severity. Reducing these forces would shrink AD disparities and potential interventions include expansion of housing mobility programs coupled with policies to directly address neighborhood poverty. For example, if housing related exposures seem to be the most important contributors, then housing regulation that increases housing quality would be an important intervention. If differences are found across neighborhoods, we will also determine whether indoor and outdoor air pollution, indoor allergen exposure, and/or psychosocial stress, mediate the effect of poverty on AD prevalence and severity.
This project was funded through a 2021 PeDRA Research Fellowship Grant.