Assessing Indoor Environmental Control Practices by Race/Ethnicity Among Children With Asthma in 14 US States and Puerto Rico, 2013–2014

Faye M. Rozwadowski, MD; Ginger L. Chew, ScD; Hatice S. Zahran, MD, MPH; Melissa L. Santorelli, PhD, MPH


Prev Chronic Dis. 2019;16(12):E166 

In This Article


We performed a cross-sectional analysis using publicly available data from the 2013 and 2014 National BRFSS ACBS Child Questionnaire.

Data Source. ACBS is an extension of BRFSS, a key surveillance system designed by the Centers for Disease Control and Prevention (CDC) to monitor modifiable health behaviors and conditions in all US states and territories using telephone surveys. Respondents to the BRFSS include noninstitutionalized, US civilian residents aged ≥18 years. The BRFSS ACBS is an ongoing, state-based and US territory landline and cellular telephone survey administered by BRFSS and developed and funded by the CDC National Asthma Control Program, Asthma and Community Health Branch, in the CDC National Center for Environmental Health. States and US territories included in this assessment met CDC data quality standards (at least 6 months of data collection and at least 75 records) and participated in the landline and cellular phone child ACBS for either one or both years (ie, 2013 and 2014). For 2013, Connecticut, Indiana, Michigan, Mississippi, Montana, Nebraska, New Jersey, Texas, Utah, and Washington were included. For 2014, Georgia, Indiana, Kentucky, Maryland, Michigan, Nebraska, New Jersey, Pennsylvania, Texas, Utah, and Puerto Rico were included. Annual sample weights published by CDC were rescaled to account for the number of years and varying sample sizes per year per state and US territory.[7] ACBS is conducted approximately 2 weeks after the initial BRFSS is completed. If the respondent from a randomly selected household on the BRFSS answers that they have a child (aged <18 years) who has received an asthma diagnosis, then that household is eligible for the in-depth child ACBS. The response rate for households that completed the ACBS Child Questionnaire for 2013 was 44.6%[8] and for 2014 was 46.3%.[9] Annual survey data published by CDC include survey design variables that were used for the analysis. Additional details about survey methods and the recommended use of these design variables are available.[7]

Study Population. Our study population included households with children identified on BRFSS by the adult respondents as having a diagnosis of asthma and answering questions on the ACBS (N = 1,478).

Outcome. The outcome of interest was the use of IEC practices in households of children with asthma. The BRFSS ACBS asks adult respondents multiple IEC questions. These questions include whether an air cleaner/purifier or a dehumidifier is regularly used inside the child's home, whether an exhaust fan venting to the outside is used regularly when cooking in the kitchen, use of an exhaust fan in a child's bathroom that vents to the outside or a pillow [or mattress] cover that is made especially for controlling dust mites, whether the child's sheets and pillowcases are washed in hot water, whether a pet is allowed in the child's bedroom, and whether anyone has smoked inside the child's home in the past week.

Race/Ethnicity and Other Variables. Race/ethnicity of the child was imputed from answers provided by adults about their respective child on the originating BRFSS. Children from the 14 states included were classified as non-Hispanic white; non-Hispanic black; Puerto Rican; other Hispanic; and non-Hispanic other race. Children of households in Puerto Rico were categorized as Puerto Rico Island residents. Other study variables included adult respondent's education level (ie, did not graduate high school, graduated high school, attended college or technical school, or graduated from college or technical school), child's age (0–4 years, 5–9 years, 10–14 years, and 15–17 years), and child's sex.

Statistical Analyses. We analyzed the data using SAS version 9.4 (SAS Institute, Inc) procedures that accounted for the complex survey design. We examined the percentage of households of children with asthma that implement IEC practices by race/ethnicity. We used the Rao-Scott χ 2 test to measure the unadjusted bivariate association between race/ethnicity and IEC practices. We used logistic regression to assess the association between race/ethnicity and use of IEC practices among children with asthma, adjusted for age, household income, and parental education level. We used separate models to 1) compare children from the continental states by race/ethnicity, and 2) compare children from Puerto Rico to children of the 14 US mainland states aggregated. Significance was set at P < .05.