The color of your skin, poverty and mold: A look into America's - CBS46 News

The color of your skin, poverty and mold: A look into America's childhood asthma epidemic

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Exhibit A: Janice is an 18 year old high school graduate headed to college this fall. She's suffered from respiratory problems since the day she was born. Born premature at two pounds and four ounces, Janice experienced a variety of illnesses throughout childhood. Her asthma was diagnosed at 6 years of age, leading her to the hospital once a year. While she hasn't been hospitalized for asthma in the past five years, she still has wheezing spells that cause her to miss quite a few days of school. She fears that without better control of her wheezing, she won't be able to study hard or even catch her next class in a different building.

Exhibit B: Bill is 15 year old high school sophomore on the varsity football team. Football practice and games have led to ER visits twice a year due to wheezing. While Bill says he takes his medication regularly, his drugstore records suggest otherwise. He does however admit to trying to hide his asthma from his friends and teammates even though he's been suffering with asthma since he was 3 years old.

Exhibit C: Summer is 14 years old entering high school this year. She is currently in the hospital due to an exacerbated episode of asthma. She believes it worsened after spending a weekend with her father and his friends who frequently smoke. While in the ER, her doctor pointed out that her relief inhaler ran out of medicine and did very little to relieve latest episode of asthma. Though her doctor recommends getting it refilled, she says she and her mother have trouble keeping track of when she is supposed to refill her prescription.

The take-home message:

While these three asthmatic teenagers seem like they couldn't be any more different, it's their similarities that may surprise you – all three are African American and reside in rural Georgia counties. Still not too surprised? Well, it was certainly news to scientists, who for the past 50 years have associated urban living, not rural living, with higher rates of asthma in children.

In attempt to drive home the point even further, a new study at the Medical College of Georgia (MCG) compared the percentage of youth with asthma in a rural setting versus in an urban setting. The investigators analyzed data from approximately 2,500 students at four schools in rural Georgia and nearly 7,300 students at six public high schools in Detroit. More than 90 percent of the children in Detroit and about 60 percent of the children in rural Georgia are African American.

The results: Approximately, 15 percent of the students in Detroit were already diagnosed with asthma, while 8 percent were not diagnosed with asthma at the start of the study. The rural Georgia rates were similar at 14 percent with diagnosed asthma and 7.5 percent undiagnosed. “Our answer is that living in a city doesn't seem by itself to be a risk factor. This is hopefully one more piece in a large puzzle that will help us understand asthma better,” says Dr. Dennis Ownby, corresponding study author and an allergist-immunologist at the Medical College of Georgia.

If it's not just the big city life that comes with pollution, allergies and exposure to outdoor smoke, then what is it? “This suggests to me that it is not the inner or central city environment that leads to asthma but something else. I suspect that the something else is poorer living conditions, but race may also be a cause,” says Dr. Dennis Ownby.

There are a lot reasons why these findings are very important. For one, running a high risk of asthma is no longer unique to just urban living, opening new possibilities for asthma research. Currently, the funding initiatives at the National Institutes of Allergy and Infectious Diseases dedicated to urban asthma range from $18.7 million to $70 million. While these studies are stratified by socioeconomic status, there's been very little research of the same nature for rural asthma. This makes it very difficult to make an “apples to apples” - comparison especially when trying to understand why the prevalence of asthma is higher in low-income residents, regardless of their rural or urban environments. The MCG study suggests that this urban-centric funding model is “minimal” in helping understand the large racial, ethnic and socioeconomic asthma disparities in the U.S.

In an earlier study published in January of this year, Johns Hopkins researchers used CDC data from the National Health Interview Survey to try to solve this huge gap. The researchers looked at data from 23,065 children between ages 6 to 17. The study revealed that taking into account the child's race, ethnicity, gender, age and region of the country where he/she lived, there's a very small gap between urban and rural asthma rates – a gap too small to be even statistically significant. However, the study did find that a child's race, ethnic and socioeconomic factors were much better indicators of a child's asthma risk than what neighborhood he/she came from.

Looking back at CDC's data, this makes sense. The CDC even backs the serious racial disparities in childhood asthma with numbers: Hispanic males of Puerto Rican descent top the charts with almost a 24 percent prevalence of asthma among children. African Americans boys, follow right behind at 16.5 percent. The lowest prevalence of asthma was seen in Asian American children at 8.1 percent and white children at 9.6 percent.

Now it sounds like we are making some progress. In addition to being Puerto Rican or African American, children from incomes levels lower than the national poverty threshold were more likely to have asthma and require emergency treatment than children of families with higher incomes. Although the study did not look at the cause of these differing asthma rates, other studies point to genetic and biological reasons that could potentially justify these racial and ethnic differences.

There are many possible reasons why low income may lead to worse control over asthma. “I suspect that eating healthier food and exercising more, along with living in a home that is not damp or infested with cockroaches, mice and rats would all be helpful,” says Dr. Ownby. Other possibilities could be exposure to second-hand smoke, inability to fix/modify living conditions (e.g. replacing the carpet, cleaning a moldy basement or fixing a leaking water pipe). Health care is often harder to access for the poor. Physicians may not be easily available in rural, making a doctor's visit much harder than normal.

The verdict is out. “Most medical schools, where research is done, are located in large cities. It's easier to study asthma in your local area than to travel to rural areas to study asthma.” While we still have mountains to move in asthma research, we at least know where to start.

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