After studying “Asthma Alley” in the Bronx last month, this month the focus is on Red Hook, specifically whether it has higher asthma rates than the rest of the city, and if so why?
NYU Langone’s Dr. Lorna Thorpe is a professor in the Department of Population Health who conducts research on health equity and the impacts of policies. For the last five years, she has studied New York City’s smoke-free housing policy. The rule went into effect on July 30, 2018, and required that all public housing authorities be smoke-free on their premises. This meant people could no longer smoke inside their own apartments or in hallways.
Mold and vermin are known to exacerbate asthma and of course smoking is another big factor that leads to respiratory illnesses.
“We measured nicotine concentration in the air and also air particles” said Thorpe. “We monitored the health impacts and we monitored how well the policy rolled out. We selected 10 high-rise public housing buildings and 11 comparison buildings which were similar but privately managed.”
“We did a survey before the policy went into effect and learned that about 15 percent of people smoked in both types of buildings. We made sure they were similar demographically in terms of how many people were Black and Hispanic, and also that they were similar in terms of how many children were living there. One thing we learned before the policy went into effect is more NYCHA residents reported smelling smoke coming into their apartments from outside.”
The team conducting the study then put air filters in the apartments every six months to measure the air quality using 200 apartments in the NYCHA buildings and 200 apartments in the comparison buildings as well as hallways.
“The data showed higher levels of nicotine in the NYCHA buildings before the policy went into effect,” Thorpe said. “We know it took a long time for the policies to be enforced given there wasn’t federal funding for NYCHA to enforce it. However, over time we did start to see more enforcement and there are programs helping smokers to quit.
“In the first year after the policy went into effect, there was no change in the air quality in the NYCHA buildings. We kept monitoring though and we have now seen a sustained reduction in secondhand smoke and nicotine levels, especially in the hallways.”
The next aspect of the study was examining health outcomes. To do so, they needed a bigger sample size so they looked at all of NYCHA as well as Census Block Groups that have no NYCHA buildings, but are similar in terms of building footprints and demographics.
Though there weren’t any big differences between the two groups in the early stages, Thorpe “doesn’t believe that tells the full story, because it takes time. Part of the challenge is that a lot of the databases have long data lives so we’re still waiting for 2021 data even though it’s 2023.”
Based on the 2020 data, the study did find that children in NYCHA developments experienced an average of 2.8 additional asthma-associated outpatient visits and 1.7 additional asthma-associated emergency department visits per 1,000 children each month, relative to children in the comparison group.”
Could be anything
There are a variety of factors that contribute to respiratory illnesses (many of which are common in the Red Hook Houses) but it can be difficult to determine which factors play the biggest roles.
“We know indoor air quality includes a lot of factors such as mold and vermin,” Thorpe said. “Then we also know outdoor pollution plays a role as well. I don’t think there’s been a study on what is contributing more between indoor vs outdoor in NYCHA specifically but we do know that some neighborhoods persistently have worse air quality than others.”
Dr. Miriam Vega of the Joseph P. Addabbo Family Health Center also spoke about outdoor pollution.
“It’s tough to tell how much of a factor that truck pollution plays but I live in the area and at times walking down Van Brunt St., it’s backed up with trucks,” Vega said. We definitely feel that the quality of air is getting worse here.
“We do believe that kids from the Red Hook Houses have higher rates of asthma than kids in other areas. We know that housing projects always have high rates of asthma and the Red Hook Houses are the largest in Brooklyn. You combine that with all of the trucks and traffic and you know it’s not going to be good.”
According to Vega, asthma diagnoses make up 54 percent of all respiratory illness diagnoses at the Addabbo Center in Red Hook, while bronchitis and pharyngitis make up another 30 percent. There has been an increase in the total number of all three respiratory ailments.
Vega also said that there aren’t many other medical offices in the area, and talked about what it was like at the Addabbo Center during the worst of the pandemic.
“It was very tough because asthma is one of the pre-existing conditions that makes it more likely for someone to get very sick from COVID,” Vega said. “There were a lot of patients in Red Hook coming in with COVID who also had asthma. Unfortunately, there were a lot of very sick patients. One of the things I’m happy about is the vaccination rate in Red Hook is very good compared to some of our other locations.”
NYU Langone’s Dr. Paolo Pina is embarking on a new asthma initiative with the goal of helping control children’s asthma. Though the initiative isn’t only for Red Hook, a lot of the patients are from the neighborhood.
“We’ve partnered with the American Lung Association and the New York State Department of Health to implement this program called ‘Project Breathe,’” Pina said. “We’re in the initial phases of it right now so our project coordinators are going to each of our sites to train staff on the basics of asthma management. We’re going to be providing education and we’ll also be tracking how many times children have to go to the emergency room and keeping track of how often they’re using medication, and then working to make sure their asthma is under control. We’re also looking at mold, stress, vermin, and working on dealing with those factors as well so it’s very comprehensive.”
A 2018 Red Hook Community Health Needs and Assets Assessment (CHNAA) was conducted with more than 600 participants. It found that 45 percent of survey participants rated asthma as one of the most important health issues in Red Hook. Additionally, 23 percent of residents in the Red Hook Houses surveyed by the Red Hook Initiative in 2016 had at least one family member with asthma.
The environment is key
“One of the frustrating things is medication alone isn’t enough to treat asthma if someone is going to continue to get exposed to these factors that can exacerbate their asthma,” Pina said. “We have to address their living environment in order to make a big dent in asthma care for children, like so many living in the Red Hook Houses.
“I also had one family who was coming in regularly with a cough and we were doing medications but it wasn’t controlled. One of the things we do often is partner with community organizations to do a home visit. We did that and in this case, one of the issues was mold in the bathroom. I wrote a letter to the landlord for the mother highlighting how important it was to get the repairs done and they got the work done. I now haven’t seen them in three months so I think it made a big difference.”
Columbia University did an asthma study on more than 700 pregnant women and babies in Northern Manhattan and the South Bronx 10 years ago and came up with a few important takeaways.
“Exposure shortly after birth to ambient metals (like nickel, vanadium, and carbon) is associated with wheezing and coughing in children aged two and younger…High cockroach and mouse allergen levels are significantly associated with asthma prevalence among children and adults…Exposure to secondhand smoke, combined with levels of air pollution found in Northern Manhattan and the South Bronx, increases children’s risk of developing asthma.”
The New York State Department of Health also published statistics on asthma (after collecting data from 2017-2019) including looking at emergency department visits by ZIP Code for children 17 years of age and under. For 11231, which includes Red Hook, the rate of emergency visits was 148.3 per 10,000 which is significantly higher than in any of the four other ZIP Codes that surround 11231. Directly next to 11231 is 11215, which includes Park Slope, and the rate of emergency visits there was just 50.2 per 10,000. The results were similar for those aged 18-64 and those aged 65 and older.
Studies do show that Red Hook has higher asthma rates than most other neighborhoods In New York City, although there are even higher asthma rates in some neighborhoods in the South Bronx. Data also shows that there are higher asthma rates in the Red Hook houses than in the rest of the neighborhood. However, it is unclear which of the factors that trigger asthma (smoking, mold, vermin, truck pollution, stress) plays the biggest role in the high rates.
The biggest takeaway from the doctors who have treated patients with asthma here is they want to eliminate as many of those factors as they can when treating their patients, rather than just providing medication.
