Abstract
Although racial/ethnic, socioeconomic, and neighborhood factors have been linked to asthma, and the association between indoor allergens and asthma is well documented, few studies have examined the relationship between these factors and indoor allergens. We examined the frequency of reported indoor allergens and differences by racial/ethnic, socioeconomic, and neighborhood characteristics among a diverse sample of Los Angeles households. Multilevel logistic regression models were used to analyze the data from 723 households from wave 2 of the Los Angeles Family and Neighborhood Survey. The reported presence of rats, mice, cockroaches, mold, pets, and tobacco smoke were the primary outcomes of interest. Hispanic and Asian households had a nearly threefold increase in the odds of reporting cockroaches compared to non-Hispanic Whites (OR, 2.85; 95 % CI 1.38–5.88 and OR, 2.62; 95 % CI 1.02–6.73, respectively) even after adjusting for socioeconomic factors. Primary caregivers who had obtained a high school degree were significantly less likely to report the presence of mice and cockroaches compared to primary caregivers with less than a high school degree (OR, 0.19; 95 % CI 0.08–0.46 and OR, 0.39; 95 % CI 0.23–0.68, respectively). Primary caregivers with more than a high school degree were also less likely to report the presence of rats, mice, and cockroaches within their households, compared to those with less than a high school degree. Compared to renters, home owners were less likely to report the presence of mice, cockroaches, and mold within their households. At the neighborhood level, households located within neighborhoods of high concentrated poverty (where the average poverty rate is at least 50 %) were more likely to report the presence of mice and cockroaches compared to households in low concentrated poverty neighborhoods (average poverty rate is 10 % or less), after adjusting for individual race/ethnicity and socioeconomic characteristics. Our study found evidence in support of neighborhood-level racial/ethnic and socioeconomic influences on indoor allergen exposure, above and beyond individual factors. Future studies should continue to explore individual and neighborhood-level racial/ethnic and socioeconomic differences in household allergen exposures across diverse contexts.
Keywords: Neighborhood characteristics, Indoor allergens, Multilevel models, Children, Asthma, Los Angeles
Introduction
In the US, asthma is one of the most prevalent chronic conditions affecting millions of children, resulting in frequent emergency room visits, hospitalizations, and even disability and death.1,2 However, the burden of asthma is not born evenly; significant disparities exist along racial/ethnic, socioeconomic, and geographic lines.3–8 Compared with white children, non-Hispanic black children and Puerto Rican children are more likely to have current asthma. Within the US, the higher prevalence rates of asthma and asthma morbidity have been well-documented among children living in low-income neighborhoods within urban cities. These disparities have led to an increase in research focusing on the impact of neighborhood characteristics on childhood asthma.9–19 An extensive body of research has examined the characteristics and quality of the housing environment.20–31 Exposure and sensitization to household allergens such as environmental tobacco smoke,32–34 cockroaches,35–40 mold,41–43 dust mites,40,41,44–46 mice,37,40,47–50 and pets40,51,52 have been linked to airway hyperresponsiveness, wheezing, and increased likelihood in developing asthma.53–58 Among asthmatic children, exposure to allergens have been associated with increased asthma attacks and hospitalizations, as well as increased medication use.41,46,59,60
While researchers have found low-income neighborhoods to have a higher prevalence of suboptimal housing conditions, only one study to our knowledge has explicitly examined the link between neighborhood-level characteristics and household allergens.61 Although several features of neighborhoods have been linked to asthma and the association between indoor allergens and asthma is well documented, factors such as neighborhood poverty and racial/ethnic composition may influence asthma outcomes through the quality of housing conditions, which can impact allergen levels. While research examining disparities in asthma outcomes in Los Angeles have focused extensively on the outdoor environment and exposure to traffic-related pollutants, very little attention has been given to the indoor home environment and exposure to indoor allergens. Our study objectives were to determine whether there were differences in the presence of indoor allergen exposures by race/ethnicity and socioeconomic measures as well as to determine whether any relationship existed between neighborhood social characteristics and presence of indoor allergens among a diverse sample of households within Los Angeles.
Methods
Study Sample
We examined the relationships between individual racial/ethnic and socioeconomic characteristics, neighborhood-level concentrated poverty and racial/ethnic composition, and indoor household allergens using data from the second wave of the Los Angeles Family and Neighborhood Survey (L.A.FANS). L.A.FANS is a longitudinal study designed to examine how neighborhoods impact the development and health of children, teens, and adults within Los Angeles County.62,63 For our analyses, we utilized the data from participants that were initially selected into the first wave of L.A.FANS that were reinterviewed during the second wave. A total of 723 households which provided data on the current socioeconomic measures and indoor allergens during the second wave were included in the analyses.
Outcome Variables
Six measures of reported presence of indoor household allergens were examined in relation to individual- and neighborhood-level racial/ethnic and socioeconomic characteristics as our primary outcomes of interest. Our selection of each indoor household allergen was based on the strength of the evidence within the literature and included the reported presence of rats, mice, cockroaches, mold, pets, and smoking within the household.
For reported presence of rats, mice, and cockroaches, the primary caregiver was asked the following question during the primary caregiver module of the wave 2 interview: In the last 12 months, have you had any of the following pests in your home? 1. Rats; 2. Mice; 3. Cockroaches; 4. Ants; 5. Spiders; 6. Termites; 8. No problems with pests. The response to this question was further coded for each pest as a binary response of 1 if the respondent answered yes to reporting the presence of the pest and 0 if the respondent answered no to reporting the presence of the pest.
The presence of mold was categorized on the primary caregiver’s response (1 = yes, 0 = no) to the following two questions: In the last 12 months, has there been any mold or mildew on the walls, ceilings, or floors of your home? and In the last 12 months, has there been a moldy or musty smell on your home? The presence of pets was based on the primary caregiver’s response to the following two questions: Do you have any pets that come inside the house or apartment at least part of the time? and What kind of pets do you have? 1. Dog(s); 2. Cat(s); 3. Bird(s); 4. Rabbit(s); 5. Guinea pig(s), gerbil(s), hamster(s); 6. Other (specify). The presence of environmental tobacco smoke was based on the primary caregiver’s response (1 = yes, 0 = no) to the following question: Does anyone live here with you smoke cigarettes, cigars, or a pipe?
Explanatory Variables
Individual-Level Characteristics
Primary caregiver’s race/ethnicity was provided by the primary caregiver within the roster module of L.A.FANS-2, based on the response to the following question: What race or races would you say best describe you (please mark all that apply)? 1. Latino; 2. White; 3. African-American, Black; 4. Asian; 5. Pacific Islander; 6. Native American/American Indian. The primary caregiver’s response to this question was recoded into the following categories: (1) Non-Hispanic White, (2) Hispanic/Latino, (3) Non-Hispanic Black, and (4) Asian/Other.
Primary caregiver’s level of educational attainment was based on the primary caregiver’s response to the following question: How much school have you completed? which included the following response options: 0. None; 1. to 11. Grade 1 through 11; 12. High school graduate or completed GED; 13. Some vocational school; 14. Completed vocational school; 15. Some college; 16. Associates’ degree (AA); 17. Bachelors’ degree (BA, BS); 18. Some graduate or professional school (after completing college); 19. Completed graduate/professional degree. Responses 0–11, 13, and 14 were recoded as (1) less than high school degree, response 12 was retained as (2) high school degree or equivalent, and responses 15–18 were recoded as (3) more than a high school degree.
For receipt of public assistance, primary caregivers were read a list of the types of income that many households receive and were asked to report (1 = yes, 0 = no) whether anyone in the household received any income from public assistance payments or foster care payments, including CalWORKS, county assistance, cash assistance, TANF, AFDC, general relief, or other government payments for foster care, or other government welfare payments.
We assessed housing tenure based on the primary caregiver’s response to the following question: Is this [house/apartment]: 1. Rented by someone in this household; 2. Owned or being bought by someone living in the household; or 3. Neither. Primary caregivers that responded neither were asked to provide a written response which was then recoded based on their response as to who owns or rents the property.
Neighborhood-Level Characteristics
Neighborhood-concentrated poverty was assessed at the census tract level and was developed by Los Angeles County’s Urban Research Division using state and county administrative data. For L.A.FANS tracts in the “very poor” poverty category, the average household poverty rate is 50 %; for those in the “poor” category, it is 30 %; and for those in the “non poor” category, it is 10 %.63 Neighborhood racial/ethnic composition was based on a cluster analysis of the percent of the population in five race/ethnic groups for all census tracts. Census tracts were grouped into five categories based on their composition as follows: (1) high Asian/Pacific Islander, (2) predominantly White, (3) Latino and Black, (4) predominantly Latino, and (5) White and Other.
Statistical Methods
To examine associations between indoor allergen measures and individual and neighborhood sociodemographic characteristics, we conducted a series of two-level multilevel logistic regression models of 723 households at level 1 nested within 65 census tracts at level 2. The use of multilevel modeling allows us to account for natural and sampling-induced nesting within L.A.FANS, as well as model contextual heterogeneity.64 As research has found that allergen levels within homes are influenced but not only individual but also neighborhood characteristics, single-level regression models would be inappropriate.65 We first modeled the effects of individual race/ethnicity and socioeconomic status on the log odds of reporting various allergen measures and subsequently modeled the effects of neighborhood poverty and racial/ethnic composition independently, after controlling for individual factors for each outcome. Data manipulation and descriptive analyses were conducted using STATA 11; multilevel models were implemented using MLwiN. The research was approved by the Harvard School of Public Health Institutional Review Board (approval number P21104-102).
Results
Respondent Characteristics
Table 1 presents the household allergen, demographic, and neighborhood characteristics of the analytic sample. The majority of households within the sample were Hispanic (66.1 %), followed by non-Hispanic Whites (17.6 %), and lastly non-Hispanic blacks and Asian/Pacific Islanders (8.3 and 8.0 %, respectively). The majority of primary caregivers had at least a high school degree or equivalent and one third of the sample were homeowners; approximately 9 % reported currently receiving public assistance. Among reported household allergens, the presence of cockroaches was most commonly reported. The presence of mold was reported among 20 % of respondents; the presence of mice was more frequently reported than rats. Nearly 39 % of respondents reported having a pet living in their household at least part time; the presence of a smoker within the household was reported among 11 % of respondents.
TABLE 1.
Household allergen, sociodemographic, and neighborhood characteristics for L.A.FANS wave 2 participants (n = 723)
| Sociodemographic and neighborhood | |||
|---|---|---|---|
| Presence of household allergens | Number (%) | characteristics | Number (%) |
| Presence of rats in home | Primary caregiver’s race | ||
| Yes | 76 (10.5) | Non-Hispanic White | 127 (17.6) |
| No | 646 (89.4) | Hispanic/Latino | 478 (66.1) |
| Presence of mice in home | Non-Hispanic Black | 60 (8.3) | |
| Yes | 99 (13.7) | Asian/Other | 58 (8.0) |
| No | 624 (86.3) | Primary caregiver’s education | |
| Presence of cockroaches in home | Less than high school | 286 (39.6) | |
| Yes | 194 (26.8) | High school or equivalent | 119 (19.5) |
| No | 529 (73.2) | More than high school | 316 (43.7) |
| Presence of mold or mildew in home | Receive public assistance | ||
| Yes | 144 (19.9) | Yes | 64 (8.9) |
| No | 577 (79.8) | No | 658 (91.0) |
| Presence of pets in home | Home ownership | ||
| Yes | 278 (38.5) | Rented | 448 (64.4) |
| No | 444 (61.4) | Owned | 243 (34.9) |
| Presence of dogs in house (of those with pets) | Poverty Strata | ||
| Yes | 193 (69.4) | Very poor | 237 (32.8) |
| No | 85 (30.6) | Poor | 228 (31.5) |
| Presence of cats in house (of those with pets) | Not poor | 258 (35.7) | |
| Yes | 91 (32.7) | Racial/ethnic composition | |
| No | 187 (62.3) | High Asian/Pacific Islander | 64 (8.9) |
| Current smoker | Predominantly White | 101 (14.0) | |
| Yes | 76 (11.1) | Latino and Black | 88 (12.1) |
| No | 611 (88.9) | Predominantly Latino | 353 (48.8) |
| White and Other | 117 (16.2) |
Table 2 displays the frequency of household allergens by individual race/ethnicity, socioeconomic measures, and neighborhood poverty and racial/ethnic composition. Hispanics households or households currently receiving public assistance most frequently reported the presence of cockroaches. Households where the primary caregiver had less than a high school degree reported higher percentages of mice, rats, and cockroaches. Higher percentages of mold and cockroaches were reported among renters compared to home owners. Households in very poor neighborhoods also reported the presence of mice, rats, and cockroaches more frequently than households in non-poor neighborhoods. Households within Latino and Black neighborhoods also reported the highest percentages of mice and cockroaches compared to homes categorized in other racial/ethnic composition groups.
TABLE 2.
Presence of allergens in home by household sociodemographic and neighborhood characteristics
| Total (%) | Presence of allergens within home | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| Household characteristics | Mice | Rats | Cockroaches | Mold | Pets | Dogs | Cats | Smoker | |
| Primary caregiver’s race | |||||||||
| Non-Hispanic White | 127 (17.6) | 10 (7.9) | 14 (11.0) | 11 (8.7) | 23 (18.1) | 84 (66.1) | 61 (72.6) | 35 (41.7) | 28 (22.0) |
| Hispanic/Latino | 478 (66.1) | 71 (14.9) | 59 (12.3) | 164 (34.3) | 99 (20.7) | 149 (31.2) | 106 (71.1) | 31 (20.8) | 93 (19.5) |
| Non-Hispanic Black | 60 (8.3) | 12 (20.0) | 1 (1.7) | 9 (15.0) | 13 (21.7) | 21 (35.0) | 12 (57.1) | 10 (47.6) | 17 (28.3) |
| Asian/Other | 58 (8.0) | 6 (10.3) | 2 (3.4) | 10 (16.7) | 9 (15.5) | 24 (41.4) | 14 (58.3) | 15 (62.5) | 9 (15.5) |
| Primary caregiver’s education | |||||||||
| Less than high school | 286 (39.6) | 61 (21.3) | 45 (15.7) | 117 (40.9) | 61 (21.3) | 86 (30.1) | 55 (64.0) | 16 (18.6) | 55 (19.2) |
| High school or equivalent | 119 (19.5) | 7 (5.9) | 9 (7.6) | 21 (17.6) | 27 (22.7) | 51 (42.9) | 38 (74.5) | 15 (29.4) | 34 (28.6) |
| More than high school | 316 (43.7) | 30 (9.5) | 22 (7.0) | 55 (17.4) | 55 (17.4) | 140 (44.3) | 100 (71.4) | 60 (42.9) | 57 (18.0) |
| Receive public assistance | |||||||||
| Yes | 64 (8.9) | 15 (23.4) | 8 (12.5) | 29 (45.3) | 16 (25.0) | 22 (34.4) | 14 (63.6) | 3 (13.6) | 14 (21.9) |
| No | 658 (91.0) | 84 (12.8) | 68 (10.3) | 165 (25.1) | 128 (19.5) | 255 (38.8) | 179 (70.2) | 87 (34.1) | 133 (20.2) |
| Home ownership | |||||||||
| Rented | 448 (64.4) | 68 (15.2) | 45 (10.0) | 149 (33.3) | 107 (23.9) | 119 (26.6) | 66 (55.5) | 30 (25.2) | 88 (19.6) |
| Owned | 243 ( 34.9) | 31 (12.8) | 31 (12.8) | 43 (17.7) | 37 (15.2) | 159 (65.4) | 127 (79.9) | 61 (38.4) | 59 (24.3) |
| Neighborhood characteristics | |||||||||
| Poverty strata | |||||||||
| Very poor | 237 (32.8) | 60 (25.3) | 36 (15.2) | 89 (37.6) | 48 (20.3) | 58 (24.5) | 33 (56.9) | 13 (22.4) | 42 (17.7) |
| Poor | 228 (31.5) | 22 (9.6) | 20 (8.8) | 74 (32.5) | 51 (22.4) | 85 (37.3) | 62 (72.9) | 21 (24.7) | 47 (20.6) |
| Not poor | 258 (35.7) | 17 (6.6) | 20 (7.8) | 31 (12.0) | 45 (17.4) | 135 (52.3) | 98 (72.6) | 57 (42.2) | 58 (22.5) |
| Racial/ethnic composition | |||||||||
| High Asian/Pacific Islander | 64 (8.9) | 3 (4.7) | 3 (4.7) | 13 (20.3) | 13 (20.3) | 24 (37.5) | 11 (45.8) | 10 (41.7) | 17 (26.6) |
| Predominantly White | 101 (14.0) | 8 (7.9) | 12 (11.9) | 9 (8.9) | 22 (21.8) | 69 (68.3) | 49 (71.0) | 29 (42.0) | 17 (16.8) |
| Latino and Black | 88 (12.1) | 27 (30.7) | 10 (11.4) | 32 (36.4) | 18 (20.5) | 20 (22.7) | 15 (75.0) | 6 (30.0) | 19 (21.6) |
| Predominantly Latino | 353 (48.8) | 56 (15.9) | 42 (11.9) | 124 (35.1) | 72 (20.4) | 115 (32.6) | 74 (64.3) | 26 (22.6) | 68 (19.3) |
| White and Other | 117 (16.2) | 5 (4.3) | 9 (7.7) | 16 (13.7) | 19 (16.2) | 50 (42.7) | 44 (88.0) | 20 (40.0) | 26 (22.2) |
Multi-Level Logistic Regression Results
Individual-Level Racial/Ethnic and Socioeconomic Differences
Within Table 3, adjusted odds ratios of reporting a presence of household allergens by race/ethnicity and individual socioeconomic measures are depicted. Hispanic households had a significantly higher odds of reporting cockroaches compared to non-Hispanic Whites (OR, 2.85; 95 % CI 1.38–5.88) even after adjusting for socioeconomic measures. Odds of reporting the presence of cockroaches was also higher among households of Asian, Pacific Islander, or Native American origin compared to non-Hispanic Whites (OR, 2.62; 95 % CI 1.02–6.73). Compared to non-Hispanic Whites, lower odds of reported presence of pets within the household were observed for Hispanics, non-Hispanic Blacks, and Asian households. After adjustment for socioeconomic measures, no racial/ethnic differences were observed in the odds of reporting mice, rats, mold, or smoking within the household. As displayed in Table 3, primary caregivers who had a high school degree reported an 80 % lower odds on the presence of mice and a 60 % lower odds on the presence of cockroaches compared to primary caregivers with less than a high school degree (OR, 0.19; 95 % CI 0.08–0.46 and OR, 0.39; 95 % CI 0.23–0.68, respectively). In addition to reporting lower odds of mice and cockroaches, primary caregivers with more than a high school degree also reported lower odds of rats within their households (OR, 0.43; 95 % CI 0.23–0.84) compared to those with less than a high school degree.
TABLE 3.
Adjusted odds ratios (ORs) and 95 % confidence intervals (CI) for reported presence of household allergen among L.A.FANS-2 households by race/ethnicity and individual socioeconomic measures
| Mice | Rats | Cockroaches | Mold | Pets | Smoker | |
|---|---|---|---|---|---|---|
| Race/ethnicitya | ||||||
| Non-Hispanic White | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
| Hispanic | 0.90 (0.39–2.03) | 0.72 (0.34–1.54) | 2.85 (1.38–5.88)* | 0.78 (0.44–1.41) | 0.27 (0.17–0.43)* | 0.70 (0.41–1.22) |
| Non-Hispanic Black | 2.28 (0.87–5.97) | 0.13 (0.02–1.04) | 1.24 (0.46–3.36) | 0.85 (0.38–1.90) | 0.30 (0.16–0.58)* | 1.20 (0.58–2.47) |
| Asian/PI/NA | 1.32 (0.45–3.88) | 0.29 (0.06–1.33) | 2.62 (1.02–6.73)* | 0.90 (0.38–2.14) | 0.36 (0.19–0.68)* | 0.69 (0.30–1.58) |
| Primary caregiver educationb | ||||||
| Less than high school | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
| High school | 0.19 (0.08–0.46)* | 0.47 (0.22–1.02) | 0.39 (0.23–0.68)* | 1.06 (0.63–1.80) | 1.43 (0.90–2.27) | 1.50 (0.90–2.50) |
| More than high school | 0.34 (0.19–0.62)* | 0.43 (0.23–0.84)* | 0.48 (0.31–0.76)* | 0.79 (0.49–1.26) | 1.12 (0.75–1.68) | 0.79 (0.49–1.29) |
| Public assistanceb | ||||||
| No | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
| Yes | 1.72 (0.89–3.34) | 1.24 (0.55–2.78) | 2.05 (1.16–3.62)* | 1.33 (0.72–2.43) | 0.81 (0.47–1.42) | 1.04 (0.56–1.96) |
| Home ownershipb | ||||||
| Renter | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
| Owner | 0.58 (0.36–0.94)* | 0.89 (0.53–1.49) | 0.32 (0.21–0.47)* | 0.31 (0.20–0.48)* | 1.63 (1.18–2.26)* | 0.76 (0.51–1.12) |
aModels adjusted for primary caregiver’s education, receipt of public assistance, and home ownership
bModels adjusted for primary caregiver’s race/ethnicity
*p < 0.05
Primary caregivers currently receiving public assistance had more than twofold increase on the presence of cockroaches within their households, compared to primary caregivers not receiving public assistance (OR, 2.05; 95 % CI 1.16–3.62). Receipt of public assistance was not significantly associated with other indoor allergens. Compared to renters, home owners were more than 40 % less likely to report the presence of mice (OR, 0.58; 95 % CI 0.36–0.94) and nearly 70 % less likely to report the presence of cockroaches and mold within their households (OR, 0.32; 95 % CI 0.21–0.47 and OR, 0.31; 95 % CI 0.20–0.48, respectively). Home owners were also 60 % more likely to report having a pet, compared to renters.
Neighborhood-Level Concentrated Poverty and Racial/Ethnic Composition
At the neighborhood level, neighborhood-concentrated poverty was also associated with increased odds of reporting mice; we observed that households in very poor neighborhoods had more than fourfold odds of reporting mice compared to households in non-poor neighborhoods, even after controlling for race/ethnicity and individual socioeconomic measures (Table 4). Households living in neighborhoods where the average household poverty rate was 50 % or more were nearly twice as likely of reporting cockroaches compared to households in non-poor neighborhoods (average household poverty rate is 10 % or less), which was marginally statistically significant after adjustment for covariates (OR, 1.90; 95 % CI 1.00–3.60).
TABLE 4.
Adjusted odds ratios (ORS) and 95 % confidence intervals (CI) for reported presence of household allergen among L.A.FANS households by neighborhood measures
| Mice | Rats | Cockroaches | Mold | Pets | Smoker | |
|---|---|---|---|---|---|---|
| Neighborhood poverty | ||||||
| Non-poor | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
| Poor | 1.53 (0.72-3.28) | 0.89 (0.42-1.90) | 1.81 (0.98-3.35) | 0.98 (0.58-1.65) | 0.75 (0.49-1.15) | 0.76 (0.46-1.26) |
| Very poor | 4.23 (1.98-9.03)* | 1.57 (0.71-3.46) | 1.90 (1.00-3.60)* | 0.79 (0.44-1.41) | 0.46 (0.28-0.74) | 0.57 (0.33-1.00) |
| Neighborhood racial/ethnic composition | ||||||
| Predominantly White | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
| High Asian/PI | 0.50 (0.11-2.24) | 0.30 (0.07-1.36) | 1.10 (0.34-3.55) | 0.46 (0.18-1.16) | 0.48 (0.23-1.01) | 2.01 (0.84-4.82) |
| Latino and Black | 4.54 (1.38-14.93)* | 0.53 (0.15-1.91) | 1.85 (0.59-5.79) | 0.34 (0.13-0.88)* | 0.27 (0.12-0.60)* | 1.26 (0.50-3.20) |
| Predominantly Latino | 2.01 (0.64-6.29) | 0.48 (0.15-1.49) | 1.54 (0.55-4.34) | 0.33 (0.14-0.76)* | 0.48 (0.24-0.92)* | 1.20 (0.53-2.72) |
| White and Other | 0.49 (0.14-1.76) | 0.55 (0.19-1.63) | 0.76 (0.26-2.23) | 0.35 (0.16-0.80)* | 0.52 (0.28-0.98)* | 1.35 (0.62-2.90) |
Models adjusted for primary caregiver’s race/ethnicity, education, receipt of public assistance, home ownership status, and mutually adjusted for each neighborhood-level characteristic
*p < 0.05
Compared to households located in predominantly White neighborhoods, households located in Hispanic and Black neighborhoods had more than 4.5-fold increase in the odds of reporting mice, after adjustment of individual-level racial/ethnic and socioeconomic characteristics, and neighborhood concentrated poverty. Interestingly, statistically significant differences were observed by neighborhood racial/ethnic composition in the odds of reporting mold. Compared to households in predominantly White neighborhoods, households located in neighborhoods that were predominantly Latino, Latino and Black, or White and other all reported nearly 70 % lower odds of mold within their households. This difference was not observed among households located in neighborhoods of high Asian or Pacific Islander racial/ethnic composition compared to predominantly White households. Significantly lower odds of pet ownership were found among households located in neighborhoods that were predominantly Latino, Latino and Black, or White and other compared to households located in predominantly White neighborhoods. No statistically significant differences in the reported presence of rats, cockroaches, or smokers were observed by neighborhood racial/ethnic composition, after adjustment for individual-level racial/ethnic and socioeconomic characteristics, and neighborhood-concentrated poverty.
Discussion
Our primary objectives were to examine whether differences in indoor allergen exposures existed by race/ethnicity, socioeconomic measures, and neighborhood-level characteristics. As these associations have been previously understudied, our study is an important contribution to the literature. While the majority of the literature has focused on cities in the Northeast and Midwest, studies have also shown that there is geographic variability in the frequency of certain indoor allergens, such as cockroach and dust mites.43,66,67Consistent with the literature, our study demonstrated a statistically significant difference in the reported presence of cockroach allergen among Hispanics compared to non-Hispanic Whites. Hispanics were no more likely than non-Hispanic Whites to report the presence of other allergens including mice, rats, or mold, contrary to prior studies. This may be due to geographic differences in allergen distributions in Los Angeles compared to other major cities, or there may be other factors, such as language or immigration status, which may influence reporting of allergens among Hispanics. Results from a recent study of housing affordability among L.A.FANS participants suggest that unauthorized Latino immigrants have the highest housing burden compared to non-Hispanic Whites, non-Hispanic Blacks, US-born Latinos, and authorized Latino immigrants within the sample.68 As other studies among Latino immigrants have utilized either interviewer household observation or sample collection to assess household allergen exposure, it is possible that our observed patterns may be influenced by immigration or language issues in reporting.38,39,46
No significant differences in the reported presence of cockroaches within households were found between non-Hispanic Blacks and Whites, contrary to prior studies. However, our small sample size of non-Hispanic Blacks within the study (n = 60) may have limited our ability to detect differences between the groups. Measures of socioeconomic status were significantly associated with a range of indoor allergen outcomes. Overall, primary caregiver’s education appeared to have a protective effect on exposure to indoor allergens; receipt of public assistance was also associated with the increased report of cockroach exposure. Furthermore, home owners reported lower odds of mice, cockroaches, and mold compared to renters. These findings suggest that, irrespective of race/ethnicity, individuals with higher educational and socioeconomic levels may have access to healthier homes and resources to be able to prevent and mitigate exposure to allergens, such as integrated pest management or reduction of allergens in the home. As exposure to these allergens have been extensively studied within the asthma literature, reducing exposure to these allergens via programs and interventions targeted at those most at risk may be beneficial in reducing asthma disparities.69–74
At the neighborhood level, poverty was associated with higher odds of reporting cockroaches and mice, even after controlling for individual race/ethnicity and socioeconomic measures. Prior studies have found that poorer neighborhoods have increased crowding, poorer housing conditions, and higher rates of housing code violations which may result in increased indoor allergen exposures.35,61,75,76 Previous studies have also found that cockroach and mice are more commonly sighted among lower socioeconomic neighborhoods. As low SES neighborhoods have also been found to have higher asthma prevalence rates, reducing exposure to cockroach and mice allergens may have important implications for reducing the asthma burden within these communities. Our study also found that the racial/ethnic composition of a neighborhood may have an impact on the presence of indoor allergens, irrespective of individual race/ethnicity and socioeconomic status. We found that households living in predominantly Latino, Latino and Black, and White and other neighborhoods reported lower presence of pets and mold compared to predominantly White neighborhoods. Although these findings are intriguing, as we are unaware of any other studies that have explicitly examined the impact of neighborhood racial/ethnic composition and only one other study has examined the association between neighborhood characteristics and indoor household allergens, it is difficult to assess whether our findings are consistent with prior studies.
The study had several limitations which should be considered including the cross-sectional nature of the study design and the use of self-report for allergen presence, rather than the collection of actual samples, which limited our ability to assess levels of exposure to each allergen. Although some studies have found home characteristics reporting a relatively weak predictor in the absence of the allergen, previous studies have found correlations between participant report of presence of indoor allergen and samples collected independently and reported presence of indoor allergens may be a viable alternative when collection of samples is not feasible51,77–79.We also could not assess the presence of dust allergen as it was not included in home environment questionnaire. While dust exposure is an important predictor of asthma, all allergens included in the study have been found to play a role in asthma morbidity independent of presence of dust.
Conclusions
Our findings suggest several directions for additional research. Studies should continue to explore racial/ethnic and socioeconomic differences in household allergen exposures not only within inner city neighborhoods, but within suburban and rural areas, as well as in newer cities in the Southwest and Northwest; these studies could potentially highlight specific features of neighborhoods that commonly impact childhood asthma outcomes. Within diverse populations, greater attention should be paid to characteristics such as nativity, country of origin, and legal status which may help identify subgroups that are particularly vulnerable to poor housing conditions and toxic environmental exposures. Furthermore, additional research is needed examining the association between neighborhood characteristics and indoor household allergen exposures from a more comprehensive approach. While studies have previously linked neighborhood social features such as poverty, crime, and social capital as well as environmental and structural features such as traffic patterns and housing stock, it is likely that these features independently and simultaneously influence asthma outcomes. The examination of reporting and remediation practices related to fair housing law and housing code violations have been understudied with respect to childhood asthma and warrant consideration along with other neighborhood features. As disparities in asthma onset and morbidity continue to persist, multilevel and multifactorial approaches in research, interventions, and policies are needed to reduce the burden of asthma within high-risk neighborhoods and populations.
Acknowledgments
This research is supported by a National Institutes of Health Career Development Award (NHLBI K25 HL081275). National Heart, Lung and Blood Institute had no further role in study design, data collection, analysis, or interpretation in the writing of the report, or in the decision to submit the paper for publication. We would also like to thank RAND Corporation for allowing the use of L.A.FANS data.
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