In the United States, although the families of children who are non-Hispanic black with asthma and children in Puerto Rico with asthma are more likely to use indoor environmental control (IEC) practices than the families of children who are non-Hispanic white with asthma, these populations still experience a higher asthma burden, according to a study published in Preventing Chronic Disease. These findings indicate the need to continue assessing asthma prevention and control measures in these vulnerable populations.

Among US children with asthma, children who are non-Hispanic black children and those in Puerto Rico have a higher asthma burden than children living on the mainland in the United States who are non-Hispanic white. It is already known that indoor environmental control practices reduce the symptoms of asthma in children. The current study analyzed 2013 and 2014 data from the Behavioral Risk Factor Surveillance System Asthma Call-back Survey Child Questionnaire from Puerto Rico and 14 mainland states to determine associations between race/ethnicity and IEC practices. Data were adjusted for sociodemographic covariates, and ethnic/racial groups were compared using aggregated data.

Across all ethnic/racial groups, >80% reported no smoking allowed in the home, and >58% reported not allowing pets in the bedroom. Across the 14 states, the adjusted odds of employing IEC practices were higher for children who were non-Hispanic black, than for children who were non-Hispanic white, with approximately 4 times higher odds of restricting pets from the bedroom (adjusted odds ratio [AOR], 4.45; 95% CI, 2.26-8.75), after adjusting for age, parental education level, and household income. Compared with children with asthma who were non-Hispanic, the families of children with asthma who were Hispanic and living in the mainland states showed higher odds of washing linens in hot water (AOR, 1.81; 95% CI, 1.06-3.09) and using a kitchen exhaust fan (AOR, 1.79; 95% CI, 1.02-3.13).

Compared with children in the 14 mainland states, children in Puerto Rico had lower adjusted odds of using a bathroom exhaust fan (AOR, 0.14; 95% CI, 0.07-0.31), and of using a kitchen exhaust fan (AOR, 0.22; 95% CI, 0.11-0.42). However, children with asthma who are island residents had the highest odds of using mattress encasement (AOR, 2.44; 95% CI, 1.23-4.83) or a dust mite–impermeable pillow cover (AOR, 3.59; 95% CI, 1.82-7.09).

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Although this study was limited by not being designed to assess asthma control, investigators conclude, “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 … 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.”


Rozwadowski FM, Chew GL, Zahran HS, Santorelli ML. Assessing indoor environmental control practices by race/ethnicity among children with asthma in 14 US states and Puerto Rico, 2013-2014. Prev Chronic Dis. 2019;16:E166.