Subsidized Housing and Pediatric Asthma

Subsidized Housing and Pediatric Asthma | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Subsidized Housing and Pediatric Asthma Jae Eun Chung, Janet Currie, Meirong Liu, Irene Park, Dharmil Bhavsar, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8016222/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Asthma is among the most common chronic illnesses in U.S. children, with disproportionately high rates in low-income, urban areas, particularly subsidized housing. These environments often contain conditions that worsen asthma, including mold, pests, poor ventilation, and secondhand smoke. This study investigates housing conditions, asthma triggers, and household management practices among families with children who have asthma living in subsidized housing in Washington, D.C. Guided by a community-based participatory research (CBPR) approach, the study prioritizes the voices of residents and local stakeholders to generate actionable insights into environmental and systemic health challenges. Data were collected through a survey of 137 caregivers of children with asthma residing in D.C. subsidized housing. Findings reveal a high prevalence of in-home asthma triggers, most notably pests and mold, alongside unmet needs for critical housing services such as pest control and ventilation repairs. While many families practice basic asthma management strategies, specialized interventions—including allergen-proof bedding and carpet removal—remain underutilized. These results highlight the urgent need for integrated solutions that address both environmental and structural determinants of health. Stronger coordination among housing policy, healthcare, and public health interventions is essential to improve asthma outcomes for vulnerable children in public housing communities. Asthma Children’s health Community-based participatory research Environmental health Subsidized housing Washington D.C INTRODUCTION Asthma is one of the most common chronic illnesses among children in the United States and is disproportionately concentrated among children living in low-income, urban communities. 1,2 Housing conditions have long been recognized as a major determinant of pediatric asthma morbidity, with exposures such as mold, cockroaches, rodents, dust, and secondhand smoke exacerbating symptoms. 3 Families residing in subsidized housing are particularly vulnerable, as older and poorly maintained housing stock often contains multiple environmental triggers. 4 These unfavorable conditions are compounded by systemic disinvestment in public housing infrastructure and barriers to timely maintenance services, which leave many families unable to mitigate known asthma triggers. 5 , 6 Several intervention studies suggest that environmental conditions in subsidized housing are modifiable. 7 For example, the Healthy Neighborhoods Program in New York State demonstrated that low-cost home-based environmental interventions addressing health and safety hazards - including common asthma triggers - effectively improved asthma self-management and mobility outcomes for both adults and children. 8 Similarly, the Collaboration to Lessen Environmental Asthma Risks initiative confirmed that comprehensive, multi-trigger interventions provide effective support for low-income families with children with asthma. 9 While such initiatives highlight the potential for asthma health gains, their scalability and sustained implementation remain challenging in subsidized housing settings due to resource constraints and inconsistent enforcement of housing standards. 10 Overall, the literature indicates that children in subsidized housing remain disproportionately exposed to environmental asthma triggers. These findings suggest that subsidized housing is not only a marker of social disadvantage but also a critical site for structural health interventions. The present study builds on prior studies by examining housing conditions, asthma triggers, and household management practices among families living in subsidized housing in Washington, D.C. By documenting both service provision and unmet needs, this study aims to inform strategies that bridge the gap between clinical care, housing policy, and environmental health interventions for children with asthma. LITERATURE REVIEW Subsidized Housing and Pediatric Asthma in Washington, D.C. Asthma disproportionately burdens children living in low-income urban neighborhoods, with the condition particularly acute in subsidized housing communities. Children in neighborhoods with higher proportions of African American residents have higher asthma prevalence than those in other neighborhoods. 11 In Washington, D.C., about 88% residents in Wards 7 and 8 are African American, with poverty rates of 25.6% and 30.2%, respectively. 12 These wards report the highest rates of asthma-related emergency visits and hospitalization among both adults and children. 13 Children living in these areas are nearly 20 times more likely to visit the emergency department for asthma than peers in wealthier Ward 3. 14 This disparity highlights how neighborhood inequities—driven in part by housing quality—play a pivotal role in pediatric respiratory health. 1 Decades of research have shown that subsidized housing often contains structural and environmental conditions that foster asthma triggers, including mold, cockroach and rodent infestations, poor ventilation, and water leaks. 6 These conditions are disproportionately concentrated in rental housing, including publicly managed units, compared to owner-occupied housing. 15 In D.C., families in subsidized housing frequently report environmental concerns that exacerbate asthma, linking respiratory health outcomes directly to housing quality. 16 Subsidized housing environments, often poorly maintained due to underfunding and systemic management challenges, compound risk exposures for children, perpetuating health inequities. 15 , 17 Housing Conditions and Asthma Outcomes Poor housing conditions are recognized as both direct and indirect drivers of asthma morbidity in children. 6 , 18 Allergens common in public housing—such as mouse and cockroach proteins, mold spores, and secondhand smoke—are strongly associated with increased asthma symptoms, more frequent attacks, and higher rates of hospitalization. 19 A recent report noted that nearly one-quarter of pediatric asthma patients in Washington, D.C. lived in homes with unhealthy conditions, including mold growth, pest infestations, or poor air ventilation. 16 These environmental hazards disproportionately impact children in subsidized housing not only because of chronic exposure but also because families often face limited agency in addressing them—maintenance delays and cost barriers make remediation difficult. As such, children in these households experience multiple and overlapping risk factors, reinforcing structural inequities in health outcomes. 17 Interventions and Policy Initiatives in Public Housing Washington, D.C. has piloted innovative interventions to address asthma triggers in housing, though many remain limited in scale. The IMPACT DC program, in collaboration with the D.C. Department of Health, has implemented home visits—both in-person and virtual—to identify asthma triggers and provide resources to families. Evaluations show that participating children experienced fewer emergency visits and hospitalizations following intervention. 16 Similarly, the Healthy Housing Program targets asthma-related environmental hazards such as mold remediation and pest control in subsidized housing. 20 These initiatives acknowledge that improving public housing conditions is inseparable from improving child health outcomes. However, comprehensive research on how well these interventions address long-term housing quality and reduce disparities remains limited. Despite these interventions, limited research has systematically examined the specific housing conditions, maintenance practices, and household behaviors of families with asthmatic children living in public housing in Washington, D.C. This study aims to fill this gap by assessing the prevalence of in-home asthma triggers, the receipt and need for housing-related services, and household hygiene practices among families in subsidized housing in D.C. Findings from this research will inform targeted interventions to improve housing conditions and asthma outcomes for this high-risk population. METHODS Approach This study applied principles of community-based participatory research (CBPR) to ensure that research questions were informed by community knowledge and oriented toward actionable change. 21 We partnered with (a) a community health organization focused on lung health and (b) a national organization supporting resident service employees and public housing residents. These partnerships were critical for accessing subsidized housing communities and contextualizing the research. Study Design The interdisciplinary team included researchers from a historically Black college and a predominantly White institution. Equitable collaboration was emphasized through shared power and decision-making across all phases of the research. 22 , 23 Community partners served as co-researchers, contributing to study design, implementation, and interpretation. We employed an exploratory sequential design, beginning with qualitative data collection via semi-structured interviews to explore phenomena and generate themes, which then informed the construction of quantitative survey measures. 24 Community stakeholders—including caregivers of children with asthma, health care workers, and public housing resident council leaders—reviewed the survey to ensure content appropriateness and relevance. Participants and Survey Survey participants were caregivers of children (under 21 years) with asthma residing in subsidized housing in Washington, DC. Caregivers were recruited through convenience and snowball sampling at community health events, churches, public schools, and referrals from resident leaders and local programs. Recruitment primarily focused on Wards 7 and 8, where asthma-related morbidity is highest. These two wards also have the largest proportions of children under 18, at 24.6% and 26.4%, respectively. 12 Data collection took place between January 2024 and January 2025 and involved 137 caregivers, who were interviewed either in person, by phone, or via Zoom, depending on their preference. Written informed consent was obtained prior to participation. Caregivers received a $ 50 gift card. The study was approved by the university’s Institutional Review Board. Surveys required approximately 20 minutes to complete. Measures and Analysis Themes identified from semi-structured interviews guided the development of survey. Survey instruments from prior studies on healthy homes and pediatric asthma 8 , 25 – 27 were also adapted to inform questionnaire design. The survey measured participants’ sociodemographic and housing characteristics, children’s health status, caregiver-reported at-home asthma triggers, current housing conditions, receipt of and need for maintenance or repair services, and household hygiene practices. The questionnaire was pilot tested to refine wording and ensure clarity and accessibility. Data were analyzed using SPSS, with descriptive statistics conducted to summarize responses. Appendix I show the questions in the survey. RESULTS Caregiver Characteristics The study sample consisted of caregivers of children with asthma residing in public housing in Washington, DC. Caregivers had a mean age of 38.6 years (SD = 10.0; range = 22–72). The majority of participants were female caregivers ( n = 123), and the majority of them were single parents ( n = 124, 91%). Regarding the caregiving role, most respondents identified themselves as the child’s mother ( n = 111, 78%), followed by grandmothers ( n = 14, 10%), and fathers ( n = 9, 6%). Over ninety percent identified as Black or African American ( n = 128). For education, the majority reported having a high school diploma or GED equivalent ( n = 80, 51%), followed by some college or vocational training ( n = 45, 30%). A smaller proportion had some high school or less ( n = 19, 12%), while 11 participants (7%) had attained a bachelor’s degree or higher. Almost nine in ten participants (87%) lived in households with incomes below $ 40,000 per year. Specifically, nearly half ( n = 62, 45%) reported an annual household income of less than $ 10,000, about one-fifth ( n = 30, 22%) were between $ 10,001 and $ 25,000, and another one-fifth ( n = 27, 20%) were between $ 25,001 and $ 40,000. In addition, one in ten (n = 13, 10%) reported incomes between $ 40,001– $ 55,000. The majority of participants (n = 98, 72%) reported receiving governmental support through the Supplemental Nutrition Assistance Program (SNAP, formerly known as Food Stamps)or the Supplemental Nutrition Program for Women, Infants, and Children (WIC) program. Nearly half received Temporary Assistance for Needy Families (TANF) ( n = 64, 47%). Child Characteristics Caregivers from 137 households reported a total of 207 children with asthma, ranging from 1 to 5 asthmatic children per household. Seven out of ten households ( n = 94, 69%) had one child with asthma, and a quarter ( n = 34, 25%) had two children. Children’s mean age was 9.1 years ( SD = 3.6). Slightly more than half of the children were male ( n = 115, 56%). Caregivers were asked to report the number of days their child experienced asthma episodes or worsening symptoms over the past six months. On average, children experienced 7.4 days ( SD = 20.7; median = 2), indicating a highly skewed distribution, likely due to variation in caregivers' interpretations of “episodes or worsening symptoms” and recall over a six-month period. Specifically, 106 children (51%) experienced 1–5 days of asthma episodes or worsening symptoms, 21 (10%) experienced 6–10 days, 12 (6%) reported 11–15 days, 4 (2%) reported 15–20 days, and 11 (5%) reported more than 20 days during this period. In the past 12 months, children had an average of 1.4 emergency room (ER) visits due to asthma ( SD = 2.2). More than half (56%) had at least one ER visit (range = 1–20). School absenteeism was also common. Six out of ten children missed at least one day of school due to asthma in the past twelve months. 91 (44%) missed 1–5 days, 25 (12%) missed 6–15 days, and 4 (2%) missed more than 15 days. Taken together, these findings indicate that the majority experienced at least one episode in the past 6 months, with more than half requiring ER care and over 60% missing school as a result of their asthma. Housing Characteristics The majority of participants reported living in public housing ( n = 75, 44%) or utilizing Section 8 rental certificates ( n = 60, 36%). Smaller proportions lived in Section 202 housing ( n = 6, 4%), rapid rehousing programs ( n = 4, 2%), or HUD-subsidized units ( n = 1, 0.6%). Participants reported living at their current address for a wide range of durations, with the majority ( n = 84) residing there for less than 10 years (mean = 8.6 years; median = 5–6 years; mode = 2 years). Median duration was approximately 5–6 years. For building type, seven out of ten ( n = 99, 72%) reported living in an apartment. Smaller proportions resided in a row or duplex ( n = 25, 18%) or a single detached house ( n = 10, 7%). Only a few participants reported living in a house ( n = 2, 1%), a project house ( n = 1, 0.7%), or an attached house ( n = 1, 0.7%). At-Home Asthma Triggers All respondents reported having at least one asthma trigger present in their home. On average, participants identified approximately three types of at-home triggers (M = 2.8, SD = 1.43) from the provided list. The most frequently reported trigger was dust ( n = 93, 68%), followed by other insects such as ants or flies ( n = 71, 52%), rats or mice ( n = 68, 50%), cockroaches ( n = 62, 45%), and mold or mildew ( n = 48, 35%). Less commonly reported triggers included indoor smoke exposure ( n = 4, 3%), carpet ( n = 5, 4%), and water leaks ( n = 2, 2%). Housing Conditions and Services Received The majority of respondents reported having functional ventilation in their kitchen ( n = 94, 69%) and bathroom ( n = 98, 72%), as well as a functional heating system ( n = 103, 75%). However, approximately one in ten ( n = 16, 12%) indicated that their home lacked any functional ventilation or functional heating system. About two-thirds ( n = 92, 67%) reported that smoke-free housing policies were in place, while one-quarter ( n = 35, 26%) indicated otherwise, and 7% ( n = 10) were unsure. Among housing services received, the most frequently reported was pest control ( n = 87, 64%), followed by repair of cracks in the walls or bathroom ( n = 54, 39%), plumbing repairs ( n = 52, 38%), and leak repair ( n = 50, 37%). Fewer respondents received services related to fixing roofs, basement leaks, flooding, or other water damage ( n = 38, 28%), mold removal ( n = 25, 18%), or carpet cleaning or removal ( n = 23, 17%). Housing Service Needs Respondents identified ongoing needs in multiple areas, averaging four service needs per household. The most commonly reported needs were pest control ( n = 97, 71%), furnace filter replacement ( n = 63, 46%), repair of cracks in walls or bathrooms ( n = 59, 43%), and AC filter replacement ( n = 57, 42%). With respect to AC filter maintenance, only about four out of ten residents ( n = 57, 42%) reported that their filter had been changed within the last six months, as is recommended. Eighteen percent ( n = 25) reported a change between 7 and 12 months ago, 8% ( n = 11) indicated 12 to 23 months, 12% ( n = 16) reported never having a filter change, and 20% ( n = 28) were unsure. These findings suggest that even in public housing with managed systems, maintenance may not consistently occur at recommended intervals, with implications for air quality and asthma management. Household Hygiene Practices Many respondents reported engaging in hygienic practices to manage their child’s asthma. The majority reported washing their child’s bed sheets weekly using hot water ( n = 113, 87%), not allowing smoking inside the home ( n = 111, 85%), and dusting the child’s bedroom at least once per week ( n = 97, 75%). Over half of respondents also avoided burning wood, incense, or scented candles ( n = 76, 58%). In contrast, fewer respondents reported implementing additional preventive measures. Less than half reported avoiding bleach and other strong-smelling products, such as perfumes, hairspray, paints, and cleaning agents ( n = 64, 49%), removing indoor plants that could exacerbate allergies or asthma ( n = 63, 48%), or using allergy control covers on mattresses and pillows ( n = 55, 42%). Only about a quarter of respondents ( n = 36, 28%) reported removing carpets from areas where the asthmatic child sleeps or plays. Three out of five respondents reported having pets in their home. Among these households, approximately six out of ten ( n = 49, 61%) allowed pets in the child’s bedroom. About four-fifths ( n = 110, 80%) reported that their children had stuffed toys. Among these households, only about half ( n = 56, 51%) restricted the toys from the child’s bedroom, whereas the other half ( n = 54, 49%) allowed them. DISCUSSION Summary of findings Taken together, the findings highlight a consistent gap between the prevalence of in-home asthma triggers and the extent of housing services or preventive practices implemented. While most households reported receiving some support, such as pest control and basic repairs, service needs—particularly for filter replacements and structural repairs—remain high. Similarly, although many families engage in routine hygienic behaviors such as frequent sheet washing and smoke avoidance, fewer adopt more specialized environmental controls, such as carpet removal, plant elimination, or allergy-proof bedding. These discrepancies underscore the importance of coordinated interventions at both the household and policy levels. Housing authorities could strengthen preventive maintenance programs—particularly for AC and furnace filters—and ensure consistent enforcement of smoke-free housing policies. Healthcare providers and asthma educators could complement these efforts by reinforcing the importance of environmental control strategies and providing families with practical guidance and resources. Together, such measures have the potential to reduce asthma triggers in public housing and improve respiratory health outcomes for vulnerable children. The study further illuminates the complexity of housing-related asthma risks by revealing gaps in essential housing services and maintenance—such as irregular filter changes in ventilation systems and ongoing pest control needs—which can exacerbate asthma outcomes. These findings align with the study of Levy et al. 18 underscoring the importance of combining environmental interventions with remediation education and sustained structural maintenance to achieve meaningful health improvements. This nuanced understanding confirms that, even in managed public housing, exposure risks persist due to systemic challenges such as underfunding and maintenance delays. 16 , 17 Implications Practically, this research underscores the urgency for public health programs to integrate comprehensive housing quality assessments and timely maintenance services into asthma intervention strategies. Programs such as IMPACT DC and the Healthy Housing Program have shown promising but limited-scale results, indicating a need for expansion and long-term evaluation. 16 , 20 Additionally, the study’s insights into household hygiene practices suggest opportunities to enhance asthma management education by focusing more on preventive measures that remain underutilized, such as allergen-proof bedding and carpet removal. Theoretically, these findings contribute to the social determinants of health framework by illustrating how structural inequities embedded in housing policies and management perpetuate asthma disparities. The overlapping environmental and social risk factors identified reinforce the need to approach asthma not only as a medical issue but also as an outcome of systemic housing inequality. 6 , 15 Future models of asthma care must therefore incorporate cross-sector collaboration between health, housing, and social services to address this multifaceted problem effectively. Limitations Several limitations should be considered. The reliance on self-reported data may introduce recall bias or social desirability bias, potentially underestimating or overestimating the presence of asthma triggers or hygiene practices. The sample, while intentionally focused on neighborhoods most affected by pediatric asthma, may not be generalizable to all residents in subsidized housing in Washington DC, or to other urban settings with differing housing characteristics or management structures. Finally, the study did not include direct environmental assessments or clinical asthma severity measures, which could provide more objective indicators of risk and symptom burden. References Grant TL, Wood RA. The influence of urban exposures and residence on childhood asthma. Pediatr Allergy Immunol. 2022;33(5):e13784. 10.1111/pai.13784 . Simoneau T, Gaffin JM. Socioeconomic determinants of asthma health. Curr Opin Pediatr. 2023;35(3):337–43. 10.1097/MOP.0000000000001235 . 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Tables Table 1 Caregivers’ Characteristics ( N = 137) Caregiver characteristic n % Age (years) M (SD) 38.6 (10.0) Gender Female 123 90 Male 11 10 Marital status Single and never been married 109 80 Married or living as married 13 9 Divorced 9 7 Widowed 3 2 Separated 3 2 Relationship with child Mother 111 78 Grandmother 14 10 Father 9 6 Others 6 4 Race/Ethnicity Non-Hispanic Black/African American 125 91 Hispanic Black 3 2 Non-Hispanic White 1 0.7 Hispanic White 1 0.7 Other 7 5.1 Education Some high school or less 19 12 High school diploma/GED 80 51 Some college/vocational training 45 30 Bachelor’s degree or higher 11 7 Household income < $ 10,000 62 45 $ 10,001–25,000 30 22 $ 25,001–40,000 27 20 $ 40,001–55,000 13 10 Public assistance Food Stamps/EBT/SNAP/WIC 98 72 Temporary Assistance for Needy Family (TANF) 64 47 Social Security Disability Insurance (SSDI) & Supplemental Security Income (SSI) 8 6 Unemployment Insurance 4 3 Table 2 Child’s Characteristics ( N = 207 children from 137 households) Characteristic n % M (SD) Range Number of children with asthma per household One child 94 69 Two children 34 25 Three or more children 9 7 Age (years) 9.1 (3.6) 1–18 Sex Male 115 56 Female 92 44 Asthma episodes (past 6 months) 7.4 (20.7) 1–180 None 53 26 1–5 episodes 105 51 6–10 episodes 21 10 11–15 episodes 12 6 15–20 episodes 4 2 > 20 episodes 11 5 ER visits due to asthma (past 12 months) 1.4 (2.2) 1–20 None 90 44 1 visit 47 23 2–3 visit 50 24 ≥ 4 visits 20 10 School absenteeism due to asthma (past 12 months) None 79 38 1–5 days 91 44 6–15 days 25 12 > 15 days 4 2 Table 3 At-home Triggers Reported in Households ( N = 137) Triggers n % Dust 93 68 Other insects (e.g., ants, flies) 71 52 Rats or mice 68 50 Cockroaches 62 45 Mold or mildew 48 35 Carpet 5 4 Smoke exposure 4 3 Water leaks 2 2 Table 4 Services Received vs. Services Needed Service Received ( n , %) Needed ( n , %) Difference (Needed − Received) ( n , %) Pest control 87, 64% 97, 71% + 10, + 7% Repair of cracks in walls/bathroom 54, 39% 59, 43% + 5, + 4% Plumbing 52, 38% 28, 20% −24, − 18% Leak repair services 50, 37% 33, 24% –17, − 13% Roof/basement/water damage repair 38, 28% 26, 19% −12, − 9% Mold removal 25, 18% 38, 28% + 13, + 10% Carpet cleaning/removal 23, 17% 44, 32% + 21, + 15% Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8016222","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":539394472,"identity":"15867d13-9226-4fff-9da3-fb828b6649e0","order_by":0,"name":"Jae Eun 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Economics","correspondingAuthor":false,"prefix":"","firstName":"Janet","middleName":"","lastName":"Currie","suffix":""},{"id":539394474,"identity":"ee1955a1-8e09-4945-a9ac-d09825557aeb","order_by":2,"name":"Meirong Liu","email":"","orcid":"","institution":"Howard University School of Social Work","correspondingAuthor":false,"prefix":"","firstName":"Meirong","middleName":"","lastName":"Liu","suffix":""},{"id":539394475,"identity":"2594cb65-9c1f-40e6-a67f-c4f4d015fc11","order_by":3,"name":"Irene Park","email":"","orcid":"","institution":"Princeton University Department of Molecular Biology","correspondingAuthor":false,"prefix":"","firstName":"Irene","middleName":"","lastName":"Park","suffix":""},{"id":539394476,"identity":"6341688e-4683-497a-b526-d003ee512096","order_by":4,"name":"Dharmil Bhavsar","email":"","orcid":"","institution":"Princeton University Department of Molecular Biology","correspondingAuthor":false,"prefix":"","firstName":"Dharmil","middleName":"","lastName":"Bhavsar","suffix":""},{"id":539394477,"identity":"29be8ad3-6cbf-4f2b-a42f-dc2c10efe2d2","order_by":5,"name":"KyAus Washington","email":"","orcid":"","institution":"Howard University School of Social Work","correspondingAuthor":false,"prefix":"","firstName":"KyAus","middleName":"","lastName":"Washington","suffix":""},{"id":539394478,"identity":"408c86c1-ad33-4631-9aa5-3bae3507d59a","order_by":6,"name":"Willem Maniago","email":"","orcid":"","institution":"Princeton University School of Public and International Affairs","correspondingAuthor":false,"prefix":"","firstName":"Willem","middleName":"","lastName":"Maniago","suffix":""},{"id":539394479,"identity":"72328719-5aeb-483e-ba94-96b95e4fc85a","order_by":7,"name":"Minna Abdella","email":"","orcid":"","institution":"Princeton University Department of Politics","correspondingAuthor":false,"prefix":"","firstName":"Minna","middleName":"","lastName":"Abdella","suffix":""}],"badges":[],"createdAt":"2025-11-03 07:45:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8016222/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8016222/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":95834465,"identity":"67e8e4d7-7f6e-40b2-9c1d-283b77276de5","added_by":"auto","created_at":"2025-11-13 13:05:14","extension":"xml","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":10091,"visible":true,"origin":"","legend":"","description":"","filename":"jurhJURHD2500635.xml","url":"https://assets-eu.researchsquare.com/files/rs-8016222/v1/616876206a41358c15769a80.xml"},{"id":95834463,"identity":"906216cb-f655-4c73-84f6-138abcc55f97","added_by":"auto","created_at":"2025-11-13 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13:05:13","extension":"xml","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":101367,"visible":true,"origin":"","legend":"","description":"","filename":"JURHD25006350enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-8016222/v1/c1dc549f8d0ded19ca9c4e89.xml"},{"id":96240698,"identity":"7f7bacdb-5183-48c5-8867-4bf9c21eb95a","added_by":"auto","created_at":"2025-11-19 07:09:24","extension":"xml","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":98599,"visible":true,"origin":"","legend":"","description":"","filename":"JURHD25006350structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-8016222/v1/14f4d008f908aca1a716d062.xml"},{"id":95834467,"identity":"8744b58a-7e8a-410f-ab47-ebb13cb3f62d","added_by":"auto","created_at":"2025-11-13 13:05:14","extension":"html","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":108929,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8016222/v1/75e12f99e1d992c6093f675d.html"},{"id":96365016,"identity":"a970d0fb-e324-4604-88ac-cceb5b3db9a6","added_by":"auto","created_at":"2025-11-20 10:09:55","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":808767,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8016222/v1/ba7f2aa9-eb99-4755-ab9d-42fc5a2c856e.pdf"}],"financialInterests":"","formattedTitle":"Subsidized Housing and Pediatric Asthma","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eAsthma is one of the most common chronic illnesses among children in the United States and is disproportionately concentrated among children living in low-income, urban communities. \u003csup\u003e1,2\u003c/sup\u003e Housing conditions have long been recognized as a major determinant of pediatric asthma morbidity, with exposures such as mold, cockroaches, rodents, dust, and secondhand smoke exacerbating symptoms.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e Families residing in subsidized housing are particularly vulnerable, as older and poorly maintained housing stock often contains multiple environmental triggers.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e These unfavorable conditions are compounded by systemic disinvestment in public housing infrastructure and barriers to timely maintenance services, which leave many families unable to mitigate known asthma triggers.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eSeveral intervention studies suggest that environmental conditions in subsidized housing are modifiable.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e For example, the Healthy Neighborhoods Program in New York State demonstrated that low-cost home-based environmental interventions addressing health and safety hazards - including common asthma triggers - effectively improved asthma self-management and mobility outcomes for both adults and children.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e Similarly, the Collaboration to Lessen Environmental Asthma Risks initiative confirmed that comprehensive, multi-trigger interventions provide effective support for low-income families with children with asthma.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e While such initiatives highlight the potential for asthma health gains, their scalability and sustained implementation remain challenging in subsidized housing settings due to resource constraints and inconsistent enforcement of housing standards.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eOverall, the literature indicates that children in subsidized housing remain disproportionately exposed to environmental asthma triggers. These findings suggest that subsidized housing is not only a marker of social disadvantage but also a critical site for structural health interventions.\u003c/p\u003e\u003cp\u003eThe present study builds on prior studies by examining housing conditions, asthma triggers, and household management practices among families living in subsidized housing in Washington, D.C. By documenting both service provision and unmet needs, this study aims to inform strategies that bridge the gap between clinical care, housing policy, and environmental health interventions for children with asthma.\u003c/p\u003e"},{"header":"LITERATURE REVIEW","content":"\u003cp\u003e\u003cb\u003eSubsidized Housing and Pediatric Asthma in Washington, D.C.\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAsthma disproportionately burdens children living in low-income urban neighborhoods, with the condition particularly acute in subsidized housing communities. Children in neighborhoods with higher proportions of African American residents have higher asthma prevalence than those in other neighborhoods.\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e In Washington, D.C., about 88% residents in Wards 7 and 8 are African American, with poverty rates of 25.6% and 30.2%, respectively.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e These wards report the highest rates of asthma-related emergency visits and hospitalization among both adults and children.\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e Children living in these areas are nearly 20 times more likely to visit the emergency department for asthma than peers in wealthier Ward 3.\u003csup\u003e14\u003c/sup\u003e This disparity highlights how neighborhood inequities\u0026mdash;driven in part by housing quality\u0026mdash;play a pivotal role in pediatric respiratory health.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eDecades of research have shown that subsidized housing often contains structural and environmental conditions that foster asthma triggers, including mold, cockroach and rodent infestations, poor ventilation, and water leaks.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e These conditions are disproportionately concentrated in rental housing, including publicly managed units, compared to owner-occupied housing.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e In D.C., families in subsidized housing frequently report environmental concerns that exacerbate asthma, linking respiratory health outcomes directly to housing quality.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e Subsidized housing environments, often poorly maintained due to underfunding and systemic management challenges, compound risk exposures for children, perpetuating health inequities.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e,\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eHousing Conditions and Asthma Outcomes\u003c/h2\u003e\u003cp\u003ePoor housing conditions are recognized as both direct and indirect drivers of asthma morbidity in children.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e Allergens common in public housing\u0026mdash;such as mouse and cockroach proteins, mold spores, and secondhand smoke\u0026mdash;are strongly associated with increased asthma symptoms, more frequent attacks, and higher rates of hospitalization.\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e A recent report noted that nearly one-quarter of pediatric asthma patients in Washington, D.C. lived in homes with unhealthy conditions, including mold growth, pest infestations, or poor air ventilation.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eThese environmental hazards disproportionately impact children in subsidized housing not only because of chronic exposure but also because families often face limited agency in addressing them\u0026mdash;maintenance delays and cost barriers make remediation difficult. As such, children in these households experience multiple and overlapping risk factors, reinforcing structural inequities in health outcomes.\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eInterventions and Policy Initiatives in Public Housing\u003c/h3\u003e\n\u003cp\u003eWashington, D.C. has piloted innovative interventions to address asthma triggers in housing, though many remain limited in scale. The IMPACT DC program, in collaboration with the D.C. Department of Health, has implemented home visits\u0026mdash;both in-person and virtual\u0026mdash;to identify asthma triggers and provide resources to families. Evaluations show that participating children experienced fewer emergency visits and hospitalizations following intervention.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eSimilarly, the Healthy Housing Program targets asthma-related environmental hazards such as mold remediation and pest control in subsidized housing.\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e These initiatives acknowledge that improving public housing conditions is inseparable from improving child health outcomes. However, comprehensive research on how well these interventions address long-term housing quality and reduce disparities remains limited.\u003c/p\u003e\u003cp\u003eDespite these interventions, limited research has systematically examined the specific housing conditions, maintenance practices, and household behaviors of families with asthmatic children living in public housing in Washington, D.C. This study aims to fill this gap by assessing the prevalence of in-home asthma triggers, the receipt and need for housing-related services, and household hygiene practices among families in subsidized housing in D.C. Findings from this research will inform targeted interventions to improve housing conditions and asthma outcomes for this high-risk population.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003eApproach\u003c/h2\u003e\u003cp\u003eThis study applied principles of community-based participatory research (CBPR) to ensure that research questions were informed by community knowledge and oriented toward actionable change.\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e We partnered with (a) a community health organization focused on lung health and (b) a national organization supporting resident service employees and public housing residents. These partnerships were critical for accessing subsidized housing communities and contextualizing the research.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eStudy Design\u003c/h3\u003e\n\u003cp\u003eThe interdisciplinary team included researchers from a historically Black college and a predominantly White institution. Equitable collaboration was emphasized through shared power and decision-making across all phases of the research.\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e,\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e Community partners served as co-researchers, contributing to study design, implementation, and interpretation. We employed an exploratory sequential design, beginning with qualitative data collection via semi-structured interviews to explore phenomena and generate themes, which then informed the construction of quantitative survey measures.\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e Community stakeholders\u0026mdash;including caregivers of children with asthma, health care workers, and public housing resident council leaders\u0026mdash;reviewed the survey to ensure content appropriateness and relevance.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eParticipants and Survey\u003c/h2\u003e\u003cp\u003eSurvey participants were caregivers of children (under 21 years) with asthma residing in subsidized housing in Washington, DC. Caregivers were recruited through convenience and snowball sampling at community health events, churches, public schools, and referrals from resident leaders and local programs. Recruitment primarily focused on Wards 7 and 8, where asthma-related morbidity is highest. These two wards also have the largest proportions of children under 18, at 24.6% and 26.4%, respectively.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e Data collection took place between January 2024 and January 2025 and involved 137 caregivers, who were interviewed either in person, by phone, or via Zoom, depending on their preference. Written informed consent was obtained prior to participation. Caregivers received a \u003cspan\u003e$\u003c/span\u003e50 gift card. The study was approved by the university\u0026rsquo;s Institutional Review Board. Surveys required approximately 20 minutes to complete.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eMeasures and Analysis\u003c/h3\u003e\n\u003cp\u003eThemes identified from semi-structured interviews guided the development of survey. Survey instruments from prior studies on healthy homes and pediatric asthma\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan additionalcitationids=\"CR26\" citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e were also adapted to inform questionnaire design. The survey measured participants\u0026rsquo; sociodemographic and housing characteristics, children\u0026rsquo;s health status, caregiver-reported at-home asthma triggers, current housing conditions, receipt of and need for maintenance or repair services, and household hygiene practices. The questionnaire was pilot tested to refine wording and ensure clarity and accessibility. Data were analyzed using SPSS, with descriptive statistics conducted to summarize responses. Appendix \u003cspan refid=\"Sec22\" class=\"InternalRef\"\u003eI\u003c/span\u003e show the questions in the survey.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eCaregiver Characteristics\u003c/h2\u003e\u003cp\u003eThe study sample consisted of caregivers of children with asthma residing in public housing in Washington, DC. Caregivers had a mean age of 38.6 years (SD\u0026thinsp;=\u0026thinsp;10.0; range\u0026thinsp;=\u0026thinsp;22\u0026ndash;72). The majority of participants were female caregivers (\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;123), and the majority of them were single parents (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;124, 91%). Regarding the caregiving role, most respondents identified themselves as the child\u0026rsquo;s mother (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;111, 78%), followed by grandmothers (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;14, 10%), and fathers (\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;9, 6%). Over ninety percent identified as Black or African American (\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;128).\u003c/p\u003e\u003cp\u003eFor education, the majority reported having a high school diploma or GED equivalent (\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;80, 51%), followed by some college or vocational training (\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;45, 30%). A smaller proportion had some high school or less (\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;19, 12%), while 11 participants (7%) had attained a bachelor\u0026rsquo;s degree or higher.\u003c/p\u003e\u003cp\u003eAlmost nine in ten participants (87%) lived in households with incomes below \u003cspan\u003e$\u003c/span\u003e40,000 per year. Specifically, nearly half (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;62, 45%) reported an annual household income of less than \u003cspan\u003e$\u003c/span\u003e10,000, about one-fifth (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;30, 22%) were between \u003cspan\u003e$\u003c/span\u003e10,001 and \u003cspan\u003e$\u003c/span\u003e25,000, and another one-fifth (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;27, 20%) were between \u003cspan\u003e$\u003c/span\u003e25,001 and \u003cspan\u003e$\u003c/span\u003e40,000. In addition, one in ten (n\u0026thinsp;=\u0026thinsp;13, 10%) reported incomes between \u003cspan\u003e$\u003c/span\u003e40,001\u0026ndash;\u003cspan\u003e$\u003c/span\u003e55,000. The majority of participants (n\u0026thinsp;=\u0026thinsp;98, 72%) reported receiving governmental support through the Supplemental Nutrition Assistance Program (SNAP, formerly known as Food Stamps)or the Supplemental Nutrition Program for Women, Infants, and Children (WIC) program. Nearly half received Temporary Assistance for Needy Families (TANF) (\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;64, 47%).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eChild Characteristics\u003c/h2\u003e\u003cp\u003eCaregivers from 137 households reported a total of 207 children with asthma, ranging from 1 to 5 asthmatic children per household. Seven out of ten households (\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;94, 69%) had one child with asthma, and a quarter (\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;34, 25%) had two children. Children\u0026rsquo;s mean age was 9.1 years (\u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;3.6). Slightly more than half of the children were male (\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;115, 56%).\u003c/p\u003e\u003cp\u003eCaregivers were asked to report the number of days their child experienced asthma episodes or worsening symptoms over the past six months. On average, children experienced 7.4 days (\u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;20.7; median\u0026thinsp;=\u0026thinsp;2), indicating a highly skewed distribution, likely due to variation in caregivers' interpretations of \u0026ldquo;episodes or worsening symptoms\u0026rdquo; and recall over a six-month period. Specifically, 106 children (51%) experienced 1\u0026ndash;5 days of asthma episodes or worsening symptoms, 21 (10%) experienced 6\u0026ndash;10 days, 12 (6%) reported 11\u0026ndash;15 days, 4 (2%) reported 15\u0026ndash;20 days, and 11 (5%) reported more than 20 days during this period.\u003c/p\u003e\u003cp\u003eIn the past 12 months, children had an average of 1.4 emergency room (ER) visits due to asthma (\u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2.2). More than half (56%) had at least one ER visit (range\u0026thinsp;=\u0026thinsp;1\u0026ndash;20). School absenteeism was also common. Six out of ten children missed at least one day of school due to asthma in the past twelve months. 91 (44%) missed 1\u0026ndash;5 days, 25 (12%) missed 6\u0026ndash;15 days, and 4 (2%) missed more than 15 days. Taken together, these findings indicate that the majority experienced at least one episode in the past 6 months, with more than half requiring ER care and over 60% missing school as a result of their asthma.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eHousing Characteristics\u003c/h2\u003e\u003cp\u003eThe majority of participants reported living in public housing (\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;75, 44%) or utilizing Section 8 rental certificates (\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;60, 36%). Smaller proportions lived in Section 202 housing (\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;6, 4%), rapid rehousing programs (\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;4, 2%), or HUD-subsidized units (\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;1, 0.6%). Participants reported living at their current address for a wide range of durations, with the majority (\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;84) residing there for less than 10 years (mean\u0026thinsp;=\u0026thinsp;8.6 years; median\u0026thinsp;=\u0026thinsp;5\u0026ndash;6 years; mode\u0026thinsp;=\u0026thinsp;2 years). Median duration was approximately 5\u0026ndash;6 years. For building type, seven out of ten (\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;99, 72%) reported living in an apartment. Smaller proportions resided in a row or duplex (\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;25, 18%) or a single detached house (\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;10, 7%). Only a few participants reported living in a house (\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;2, 1%), a project house (\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;1, 0.7%), or an attached house (\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;1, 0.7%).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eAt-Home Asthma Triggers\u003c/h2\u003e\u003cp\u003eAll respondents reported having at least one asthma trigger present in their home. On average, participants identified approximately three types of at-home triggers (M\u0026thinsp;=\u0026thinsp;2.8, SD\u0026thinsp;=\u0026thinsp;1.43) from the provided list. The most frequently reported trigger was dust (\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;93, 68%), followed by other insects such as ants or flies (\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;71, 52%), rats or mice (\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;68, 50%), cockroaches (\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;62, 45%), and mold or mildew (\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;48, 35%). Less commonly reported triggers included indoor smoke exposure (\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;4, 3%), carpet (\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;5, 4%), and water leaks (\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;2, 2%).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eHousing Conditions and Services Received\u003c/h2\u003e\u003cp\u003eThe majority of respondents reported having functional ventilation in their kitchen (\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;94, 69%) and bathroom (\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;98, 72%), as well as a functional heating system (\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;103, 75%). However, approximately one in ten (\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;16, 12%) indicated that their home lacked any functional ventilation or functional heating system. About two-thirds (\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;92, 67%) reported that smoke-free housing policies were in place, while one-quarter (\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;35, 26%) indicated otherwise, and 7% (\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;10) were unsure.\u003c/p\u003e\u003cp\u003eAmong housing services received, the most frequently reported was pest control (\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;87, 64%), followed by repair of cracks in the walls or bathroom (\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;54, 39%), plumbing repairs (\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;52, 38%), and leak repair (\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;50, 37%). Fewer respondents received services related to fixing roofs, basement leaks, flooding, or other water damage (\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;38, 28%), mold removal (\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;25, 18%), or carpet cleaning or removal (\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;23, 17%).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eHousing Service Needs\u003c/h2\u003e\u003cp\u003eRespondents identified ongoing needs in multiple areas, averaging four service needs per household. The most commonly reported needs were pest control (\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;97, 71%), furnace filter replacement (\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;63, 46%), repair of cracks in walls or bathrooms (\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;59, 43%), and AC filter replacement (\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;57, 42%).\u003c/p\u003e\u003cp\u003eWith respect to AC filter maintenance, only about four out of ten residents (\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;57, 42%) reported that their filter had been changed within the last six months, as is recommended. Eighteen percent (\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;25) reported a change between 7 and 12 months ago, 8% (\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;11) indicated 12 to 23 months, 12% (\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;16) reported never having a filter change, and 20% (\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;28) were unsure. These findings suggest that even in public housing with managed systems, maintenance may not consistently occur at recommended intervals, with implications for air quality and asthma management.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003eHousehold Hygiene Practices\u003c/h2\u003e\u003cp\u003eMany respondents reported engaging in hygienic practices to manage their child\u0026rsquo;s asthma. The majority reported washing their child\u0026rsquo;s bed sheets weekly using hot water (\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;113, 87%), not allowing smoking inside the home (\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;111, 85%), and dusting the child\u0026rsquo;s bedroom at least once per week (\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;97, 75%). Over half of respondents also avoided burning wood, incense, or scented candles (\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;76, 58%).\u003c/p\u003e\u003cp\u003eIn contrast, fewer respondents reported implementing additional preventive measures. Less than half reported avoiding bleach and other strong-smelling products, such as perfumes, hairspray, paints, and cleaning agents (\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;64, 49%), removing indoor plants that could exacerbate allergies or asthma (\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;63, 48%), or using allergy control covers on mattresses and pillows (\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;55, 42%). Only about a quarter of respondents (\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;36, 28%) reported removing carpets from areas where the asthmatic child sleeps or plays.\u003c/p\u003e\u003cp\u003eThree out of five respondents reported having pets in their home. Among these households, approximately six out of ten (\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;49, 61%) allowed pets in the child\u0026rsquo;s bedroom. About four-fifths (\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;110, 80%) reported that their children had stuffed toys. Among these households, only about half (\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;56, 51%) restricted the toys from the child\u0026rsquo;s bedroom, whereas the other half (\u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;54, 49%) allowed them.\u003c/p\u003e\u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003eSummary of findings\u003c/h2\u003e\u003cp\u003eTaken together, the findings highlight a consistent gap between the prevalence of in-home asthma triggers and the extent of housing services or preventive practices implemented. While most households reported receiving some support, such as pest control and basic repairs, service needs\u0026mdash;particularly for filter replacements and structural repairs\u0026mdash;remain high. Similarly, although many families engage in routine hygienic behaviors such as frequent sheet washing and smoke avoidance, fewer adopt more specialized environmental controls, such as carpet removal, plant elimination, or allergy-proof bedding.\u003c/p\u003e\u003cp\u003eThese discrepancies underscore the importance of coordinated interventions at both the household and policy levels. Housing authorities could strengthen preventive maintenance programs\u0026mdash;particularly for AC and furnace filters\u0026mdash;and ensure consistent enforcement of smoke-free housing policies. Healthcare providers and asthma educators could complement these efforts by reinforcing the importance of environmental control strategies and providing families with practical guidance and resources. Together, such measures have the potential to reduce asthma triggers in public housing and improve respiratory health outcomes for vulnerable children.\u003c/p\u003e\u003cp\u003eThe study further illuminates the complexity of housing-related asthma risks by revealing gaps in essential housing services and maintenance\u0026mdash;such as irregular filter changes in ventilation systems and ongoing pest control needs\u0026mdash;which can exacerbate asthma outcomes. These findings align with the study of Levy et al.\u003csup\u003e18\u003c/sup\u003e underscoring the importance of combining environmental interventions with remediation education and sustained structural maintenance to achieve meaningful health improvements. This nuanced understanding confirms that, even in managed public housing, exposure risks persist due to systemic challenges such as underfunding and maintenance delays.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e,\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\u003ch2\u003eImplications\u003c/h2\u003e\u003cp\u003ePractically, this research underscores the urgency for public health programs to integrate comprehensive housing quality assessments and timely maintenance services into asthma intervention strategies. Programs such as IMPACT DC and the Healthy Housing Program have shown promising but limited-scale results, indicating a need for expansion and long-term evaluation.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e,\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e Additionally, the study\u0026rsquo;s insights into household hygiene practices suggest opportunities to enhance asthma management education by focusing more on preventive measures that remain underutilized, such as allergen-proof bedding and carpet removal.\u003c/p\u003e\u003cp\u003eTheoretically, these findings contribute to the social determinants of health framework by illustrating how structural inequities embedded in housing policies and management perpetuate asthma disparities. The overlapping environmental and social risk factors identified reinforce the need to approach asthma not only as a medical issue but also as an outcome of systemic housing inequality.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e Future models of asthma care must therefore incorporate cross-sector collaboration between health, housing, and social services to address this multifaceted problem effectively.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\u003ch2\u003eLimitations\u003c/h2\u003e\u003cp\u003eSeveral limitations should be considered. The reliance on self-reported data may introduce recall bias or social desirability bias, potentially underestimating or overestimating the presence of asthma triggers or hygiene practices. The sample, while intentionally focused on neighborhoods most affected by pediatric asthma, may not be generalizable to all residents in subsidized housing in Washington DC, or to other urban settings with differing housing characteristics or management structures. Finally, the study did not include direct environmental assessments or clinical asthma severity measures, which could provide more objective indicators of risk and symptom burden.\u003c/p\u003e\u003c/div\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eGrant TL, Wood RA. The influence of urban exposures and residence on childhood asthma. Pediatr Allergy Immunol. 2022;33(5):e13784. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/pai.13784\u003c/span\u003e\u003cspan address=\"10.1111/pai.13784\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSimoneau T, Gaffin JM. 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Asthma and Housing Conditions in Washington. Children\u0026rsquo;s National Hospital; 2020.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChildren\u0026rsquo;s Law Center. Fighting for Air: How D.C.\u0026rsquo;s Homes Are Harming Children\u0026rsquo;s Health. Children\u0026rsquo;s Law Center; 2021.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLevy JI, Brugge D, Peters JL, Clougherty JE, Saddler SS. A community-based participatory research study of multifaceted in-home environmental interventions for pediatric asthmatics in public housing. Soc Sci Med. 2006;63(8):2191\u0026ndash;203. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.socscimed.2006.05.006\u003c/span\u003e\u003cspan address=\"10.1016/j.socscimed.2006.05.006\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAmerican Lung Association. Asthma Trends Brief: Asthma Trends and Burden. Accessed November 2. 2025. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.lung.org/research/trends-in-lung-disease/asthma-trends-brief/trends-and-burden\u003c/span\u003e\u003cspan address=\"https://www.lung.org/research/trends-in-lung-disease/asthma-trends-brief/trends-and-burden\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDC government. Healthy Housing Program. Accessed November 2. 2025. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://dchealth.dc.gov/service/healthy-housing-program-0\u003c/span\u003e\u003cspan address=\"https://dchealth.dc.gov/service/healthy-housing-program-0\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDavis LF, Ram\u0026iacute;rez-Andreotta MD. Participatory Research for Environmental Justice: A Critical Interpretive Synthesis. Environ Health Perspect. 2021;129(2):26001. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1289/EHP6274\u003c/span\u003e\u003cspan address=\"10.1289/EHP6274\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMuhammad M, Wallerstein N, Sussman AL, Avila M, Belone L, Duran B. Reflections on Researcher Identity and Power: The Impact of Positionality on Community Based Participatory Research (CBPR) Processes and Outcomes. Crit Sociol. 2015;41(7\u0026ndash;8):1045\u0026ndash;63. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/0896920513516025\u003c/span\u003e\u003cspan address=\"10.1177/0896920513516025\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSuarez-Balcazar Y. Meaningful Engagement in Research: Community Residents as Co-creators of Knowledge. Am J Community Psychol. 2020;65(3\u0026ndash;4):261\u0026ndash;71. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/ajcp.12414\u003c/span\u003e\u003cspan address=\"10.1002/ajcp.12414\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShiyanbola OO, Rao D, Bolt D, Brown C, Zhang M, Ward E. Using an exploratory sequential mixed methods design to adapt an Illness Perception Questionnaire for African Americans with diabetes: the mixed data integration process. Health Psychol Behav Med. 2021;9(1):796\u0026ndash;817. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1080/21642850.2021.1976650\u003c/span\u003e\u003cspan address=\"10.1080/21642850.2021.1976650\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGomez M, Reddy AL, Dixon SL, Wilson J, Jacobs DE. A Cost-Benefit Analysis of a State-Funded Healthy Homes Program for Residents With Asthma: Findings From the New York State Healthy Neighborhoods Program. J Public Health Manag Pract. 2017;23(2):229\u0026ndash;38. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/PHH.0000000000000528\u003c/span\u003e\u003cspan address=\"10.1097/PHH.0000000000000528\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKrieger JW, Takaro TK, Song L, Weaver M. The Seattle-King County Healthy Homes Project: A Randomized, Controlled Trial of a Community Health Worker Intervention to Decrease Exposure to Indoor Asthma Triggers. Am J Public Health. 2005;95(4):652\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2105/AJPH.2004.042994\u003c/span\u003e\u003cspan address=\"10.2105/AJPH.2004.042994\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eL\u0026oacute;pez R, Chantarat T, Bozack A, Lopez A, Weiss L. Reducing Childhood Asthma Triggers in Public Housing: Implementation and Outcomes from an East Harlem Community Health Worker Program. Environ Justice. 2015;8(5):185\u0026ndash;91. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1089/env.2015.0017\u003c/span\u003e\u003cspan address=\"10.1089/env.2015.0017\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":" Tables","content":"\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eCaregivers\u0026rsquo; Characteristics (\u003cspan type=\"Italic\" class=\"Italic\" name=\"Emphasis\"\u003eN\u003c/span\u003e\u0026thinsp;=\u0026thinsp;137)\u003c/div\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eCaregiver characteristic\u003c/div\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Italic\" class=\"Italic\" name=\"Emphasis\"\u003en\u003c/span\u003e\u003c/div\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e%\u003c/div\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eAge (years)\u003c/span\u003e M (SD)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e38.6 (10.0)\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eGender\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eFemale\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e123\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e90\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eMale\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e11\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e10\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eMarital status\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eSingle and never been married\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e109\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e80\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eMarried or living as married\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e13\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e9\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eDivorced\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e9\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e7\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eWidowed\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e3\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eSeparated\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e3\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eRelationship with child\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eMother\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e111\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e78\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eGrandmother\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e14\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e10\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eFather\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e9\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e6\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eOthers\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e6\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e4\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eRace/Ethnicity\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eNon-Hispanic Black/African American\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e125\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e91\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eHispanic Black\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e3\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eNon-Hispanic White\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.7\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eHispanic White\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.7\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eOther\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e7\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e5.1\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eEducation\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eSome high school or less\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e19\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e12\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eHigh school diploma/GED\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e80\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e51\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eSome college/vocational training\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e45\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e30\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eBachelor\u0026rsquo;s degree or higher\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e11\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e7\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eHousehold income\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u0026lt; \u003cspan\u003e$\u003c/span\u003e10,000\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e62\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e45\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan\u003e$\u003c/span\u003e10,001\u0026ndash;25,000\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e30\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e22\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan\u003e$\u003c/span\u003e25,001\u0026ndash;40,000\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e27\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e20\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan\u003e$\u003c/span\u003e40,001\u0026ndash;55,000\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e13\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e10\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003ePublic assistance\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eFood Stamps/EBT/SNAP/WIC\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e98\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e72\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eTemporary Assistance for Needy Family (TANF)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e64\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e47\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eSocial Security Disability Insurance (SSDI) \u0026amp; Supplemental Security Income\u0026nbsp;(SSI)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e8\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e6\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eUnemployment Insurance\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e4\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e3\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv id=\"19\" class=\"btn-xs-small Annotation tooltipped\" data-position=\"top\" data-tooltip=\"\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eChild\u0026rsquo;s Characteristics (\u003cspan type=\"Italic\" class=\"Italic\" name=\"Emphasis\"\u003eN\u003c/span\u003e\u0026thinsp;=\u0026thinsp;207 children from 137 households)\u003c/div\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eCharacteristic\u003c/div\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Italic\" class=\"Italic\" name=\"Emphasis\"\u003en\u003c/span\u003e\u003c/div\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e%\u003c/div\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eM (SD)\u003c/div\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eRange\u003c/div\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eNumber of children with asthma per household\u003c/div\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eOne child\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e94\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e69\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eTwo children\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e34\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e25\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eThree or more children\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e9\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e7\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eAge (years)\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e9.1 (3.6)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1\u0026ndash;18\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eSex\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eMale\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e115\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e56\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eFemale\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e92\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e44\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eAsthma episodes (past 6 months)\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e7.4 (20.7)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1\u0026ndash;180\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eNone\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e53\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e26\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1\u0026ndash;5 episodes\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e105\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e51\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e6\u0026ndash;10 episodes\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e21\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e10\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e11\u0026ndash;15 episodes\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e12\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e6\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e15\u0026ndash;20 episodes\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e4\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u0026gt;\u0026thinsp;20 episodes\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e11\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e5\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eER visits due to asthma (past 12 months)\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1.4 (2.2)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1\u0026ndash;20\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eNone\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e90\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e44\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1 visit\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e47\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e23\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2\u0026ndash;3 visit\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e50\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e24\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u0026ge;\u0026thinsp;4 visits\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e20\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e10\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"6\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eSchool absenteeism due to asthma (past 12 months)\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eNone\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e79\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e38\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1\u0026ndash;5 days\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e91\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e44\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e6\u0026ndash;15 days\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e25\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e12\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u0026gt;\u0026thinsp;15 days\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e4\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eAt-home Triggers Reported in Households (\u003cspan type=\"Italic\" class=\"Italic\" name=\"Emphasis\"\u003eN\u003c/span\u003e\u0026thinsp;=\u0026thinsp;137)\u003c/div\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eTriggers\u003c/div\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Italic\" class=\"Italic\" name=\"Emphasis\"\u003en\u003c/span\u003e\u003c/div\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e%\u003c/div\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eDust\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e93\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e68\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eOther insects (e.g., ants, flies)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e71\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e52\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eRats or mice\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e68\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e50\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eCockroaches\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e62\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e45\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eMold or mildew\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e48\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e35\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eCarpet\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e5\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e4\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eSmoke exposure\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e4\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e3\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eWater leaks\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv id=\"21\" class=\"btn-xs-small Annotation tooltipped\" data-position=\"top\" data-tooltip=\"\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eServices Received vs. Services Needed\u003c/div\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eService\u003c/div\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eReceived (\u003cspan type=\"Italic\" class=\"Italic\" name=\"Emphasis\"\u003en\u003c/span\u003e, %)\u003c/div\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eNeeded (\u003cspan type=\"Italic\" class=\"Italic\" name=\"Emphasis\"\u003en\u003c/span\u003e, %)\u003c/div\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eDifference (Needed\u0026thinsp;\u0026minus;\u0026thinsp;Received) (\u003cspan type=\"Italic\" class=\"Italic\" name=\"Emphasis\"\u003en\u003c/span\u003e, %)\u003c/div\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003ePest control\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e87, 64%\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e97, 71%\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e+\u0026thinsp;10, +\u0026thinsp;7%\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eRepair of cracks in walls/bathroom\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e54, 39%\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e59, 43%\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e+\u0026thinsp;5, +\u0026thinsp;4%\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003ePlumbing\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e52, 38%\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e28, 20%\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u0026minus;24, \u0026minus;\u0026thinsp;18%\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eLeak repair services\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e50, 37%\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e33, 24%\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u0026ndash;17, \u0026minus;\u0026thinsp;13%\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eRoof/basement/water damage repair\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e38, 28%\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e26, 19%\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u0026minus;12, \u0026minus;\u0026thinsp;9%\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eMold removal\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv 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\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Asthma, Children’s health, Community-based participatory research, Environmental health, Subsidized housing, Washington, D.C","lastPublishedDoi":"10.21203/rs.3.rs-8016222/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8016222/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eAsthma is among the most common chronic illnesses in U.S. children, with disproportionately high rates in low-income, urban areas, particularly subsidized housing. These environments often contain conditions that worsen asthma, including mold, pests, poor ventilation, and secondhand smoke. This study investigates housing conditions, asthma triggers, and household management practices among families with children who have asthma living in subsidized housing in Washington, D.C. Guided by a community-based participatory research (CBPR) approach, the study prioritizes the voices of residents and local stakeholders to generate actionable insights into environmental and systemic health challenges. Data were collected through a survey of 137 caregivers of children with asthma residing in D.C. subsidized housing. Findings reveal a high prevalence of in-home asthma triggers, most notably pests and mold, alongside unmet needs for critical housing services such as pest control and ventilation repairs. While many families practice basic asthma management strategies, specialized interventions\u0026mdash;including allergen-proof bedding and carpet removal\u0026mdash;remain underutilized. These results highlight the urgent need for integrated solutions that address both environmental and structural determinants of health. Stronger coordination among housing policy, healthcare, and public health interventions is essential to improve asthma outcomes for vulnerable children in public housing communities.\u003c/p\u003e","manuscriptTitle":"Subsidized Housing and Pediatric Asthma","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-13 13:05:09","doi":"10.21203/rs.3.rs-8016222/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a616a4f0-ff25-4ef1-a834-64656cf8cf38","owner":[],"postedDate":"November 13th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-11-19T16:16:16+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-13 13:05:09","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8016222","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8016222","identity":"rs-8016222","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}