An equity-focused evaluation of a system-wide intervention to reduce mold in NYC public housing and its impact on asthma burden

PROJECT SUMMARY/ABSTRACT Asthma is one of the most prevalent chronic conditions in the United States (US); it is also one of the most disparate. Both in the US and in New York City (NYC), differences exist in asthma prevalence, morbidity, and mortality by racial/ethnic and socioeconomic groups. Substandard conditions faced by lower-income families living in rented or public housing partially drive these asthma disparities by increasing exposure to indoor asthma triggers such as mold. Mold can release spores, fragments, and toxins into the air which can lead to respiratory responses; mold has been causally implicated in both the development and exacerbation of asthma. Despite the known adverse health impacts of mold, proprietors have little incentive to perform remediations. Mold remediations, especially those targeting the root causes of water damage and mold growth, may be costly, often requiring pipe, roof, or ventilation system replacement. Thus, mold issues, especially in renter-occupied homes, often go unaddressed. There are critical knowledge gaps surrounding (a) how, in the context of climate change, mold growth exacerbates asthma disparities and (b) if mold interventions have the largest health benefits for those needing it the most. Residents of the NYC Housing Authority (NYCHA) – the largest public housing authority in North America, housing over 380,000 NYC residents – have long endured disproportionate exposures to dampness and mold in their homes, likely contributing to consistently high rates of asthma morbidity. However, in 2019, NYCHA implemented ‘Mold Busters’—a comprehensive program aimed to remove mold in NYCHA developments. ‘Mold Busters’ presents a natural experiment and a wealth of data that could be leveraged for our objectives: to understand (a) the dual burdens of mold growth and climate change faced by NYCHA residents (b) neighborhood and building characteristics conducive to mold growth and (c) changes in asthma morbidity resulting from ‘Mold Busters’—all of which could inform housing agencies’ approaches for mold problems. We will combine building-level, longitudinal mold reports collected by NYCHA with longitudinal meteorological and asthma-related emergency department visit data. First, we will conduct time series analyses to quantify the relationship between extreme weather events, expected to increase with climate change, and reports of mold, both overall and considering neighborhood and building characteristics that may modify this relationship (Aim 1). Next, we will use pre-‘Mold Busters’ data to understand the neighborhood and building characteristics that contribute to mold growth and asthma morbidity (Aim 2). Finally, we will conduct building- level difference-in-difference (DiD) analyses comparing pre/post-‘Mold Busters’ asthma-related emergency department visits in NYCHA buildings to non-NYCHA, control buildings, while considering neighborhood, building, and individual characteristics (Aim 3). If we are successful, together these analyses will inform future interventions by identifying vulnerable neighborhoods, buildings, and subgroups where further action targeting mold and/or asthma morbidity is necessary, and that climate change will disproportionately affect.