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


The purpose of this study was to evaluate potential differences in IEC practices by race and ethnicity among children of vulnerable populations with asthma using data from the BRFSS ACBS. The study results indicate that these practices vary by race/ethnicity among children with asthma in 14 states and Puerto Rico.

Our findings are mixed in comparison with a previously published study that investigated 4 states and did not include residents of Puerto Rico.[10] The study found that non-Hispanic black children and Hispanic children were less likely to use mattress encasements and dust mite–impermeable pillow covers and were more likely to live in a home without pets compared to non-Hispanic white children.[10] Our findings for pet avoidance by race/ethnicity are consistent with those of that study. In contrast, we did not observe a difference in the use of mattress and pillow covers by race/ethnicity in the 14 states. Furthermore, we observed higher odds for air purifier and dehumidifier use among non-Hispanic black children. National Health Interview Survey data from 2013 indicated that, compared with non-Hispanic white children, non-Hispanic black children also have a higher prevalence of receiving an asthma action plan, another NHLBI guideline recommendation.[11]

A concerted effort is evident among families in Puerto Rico, who disproportionally experience asthma, to curb allergens that induce symptoms by using dust mite–impermeable pillow and mattress encasements, but these homes generally lack use of exhaust fans to clear irritants (mold and smoke) to children with asthma. Anecdotally, public health personnel familiar with Puerto Rico note that many homes do not have exhaust fans.

Our study has limitations. Our analysis was not designed to assess asthma control, which could potentially modify the association between race/ethnicity and implementation of IEC practices. Other limitations were the potential lack of generalizability to other US states/territories and the inability to evaluate the IEC practices in association with the medical management of asthma. The sample size was also limited, as evidenced by wide confidence intervals for the Puerto Rico sample and for Puerto Rican children in the continental states.

Our study also has multiple strengths. Most notably, it used a more comprehensive population-based sample than did previous studies.[6,10] In addition, previous literature has not looked at children in Puerto Rico separately, whereas we separately analyze this vulnerable group. Findings from this study can be used by public health and clinical providers to guide implementation of IEC practices for vulnerable races and ethnicities in platforms, including the Community Preventive Services Task Force Recommendation on Home-Based Multi-Trigger, Multicomponent Environmental Interventions for Children and Adolescents with Asthma,[12] and the NHLBI Guidelines for the Diagnosis and Management of Asthma.[13]

This population-based study indicated greater odds of implementing IEC practices among vulnerable racial/ethnic groups of children with asthma, compared with the less-affected non-Hispanic white population with asthma. Because there are differences in IEC practices among children of different racial/ethnic groups, health care providers and stakeholders developing public health guidelines could consider addressing an individualized intake and management plan for children. This customized approach would account for our study results, indicating where certain vulnerable populations successfully implement IEC practices and where other ethnic and racial groups are deficient. Additional evaluation is needed to assess the role of asthma severity, asthma control, and medical management in the association between race/ethnicity and implementation of IEC practices.