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Homeless Children and Asthma

Sarah Baez, a homeless mother of two, was waiting for the city to find a shelter for her family at the notorious Emergency Assistance Unit in the South Bronx earlier this month, but even when the temperature dipped into the 40s, she preferred standing on the sidewalk across the street from the crowded, noisy intake facility.

“The place is too dirty for my son, and the security guards are always yelling at people,” she said. “My son starts crying as soon as we go in there. I have to calm him down or he can have an attack.”

She is talking about an asthma attack. Her two-year-old, Nathaniel, has been hospitalized with asthma and needs frequent treatments with albuterol, a medication that dilates constricted bronchial tubes.

Nathaniel has plenty of company. Fully half of the homeless children entering New York City family shelters show some symptoms of asthma, according to the authors of a study published this month. Four in ten reported serious, persistent asthma attacks; and a third of those children have never been diagnosed with the disease by a physician. By contrast, about one in 18 children have asthma in the United States as a whole, according to the Centers for Disease Control.

This was not the only alarming report about asthma in New York. Another new study, published in the Journal of Allergy and Clinical Immunology, of 205 children with asthma who lived near the World Trade Center, according to Newsday, "says their condition was worsened by the 9/11 attack, seeing the doctor more often and taking more medication the year after the attack than the year before."

Medical experts have known for a long time that New York City has the worst asthma rate in the country, and that asthma is the childhood disease of the poor. The chronic lung ailment is triggered by environmental agents that occur most often in the poorest neighborhoods, such as dust, industrial pollutants and roach droppings. Once poor children get asthma, their condition suffers from such aggravating factors as persistent psychological stress, and limited access to health care. And the poor children who suffer the most, the new study found, are those who are homeless.

“We knew there were very high asthma rates in some of the city’s poorest neighborhoods,” said Dr. Irwin Redlener, one of the eight authors affiliated with Columbia University and Montefiore Medical Center in the Bronx. “But we were taken aback by the high rates we found.”

The 15-month study, which spent years wending its way through the peer review process before finally appearing in Archives of Pediatrics and Adolescent Medicine this month, began in 1998. Researchers struck an agreement with the city to screen children entering three family shelters, one each in Brooklyn, Queens and the Bronx. The city allowed the scientists to add a questionnaire to the standard medical intake interview, if the researchers would agree not to identify the homeless shelters used in the study.

Parents of 740 children were interviewed; for nearly 13 percent of the children, parents described symptoms in their children consistent with serious persistent asthma, but said that their children had never been diagnosed with the disease

“The study confirms what we know,” said James Anderson, from the Department of Homeless Services. “Homeless children come from communities with the highest risks of asthma, and most come from the most vulnerable families in those communities.”

The researchers have continued collecting data since the formal study ended in 1999. Redlener, who also heads the Children's Health Project, said that a few children may be getting better treatment. But he also points out that the number of children in the shelter system has nearly doubled to about 16,000.

For many such children, the very process of entering the homeless system can trigger asthma attacks. Sarah Baez, her boyfriend, and their two children spent two weeks shuttling between the emergency unit and a variety of shelters and motels for one-night stays. Often, she says, they return too early to get a full night’s sleep or too late to get her daughter to school on time.

“If they wanted to help cut down on asthma attacks, one thing that the city could do immediately is to cease the practice of overnight shelter placements,” said Patrick Markee of the Coalition for the Homeless. The coalition filed suit against the city four years ago, asking for increased services for asthmatic children, the same year that WE ACT, the West Harlem advocacy group, filed a federal complaint against the city for locating diesel bus garages in poor neighborhoods.

The city introduced a policy last fall of trying to place homeless families in shelters near the neighborhood where they once lived, in part to help them stay connected with familiar schools and medical providers. In these shelters, health care educators, such as Shelly Moore of Care for the Homeless, help them learn to manage the triggers in their home environment, and help connect them to medical providers.

“Community placement sounds good,” Moore says. “But the families are telling us a different story. They say the city is pressuring them to take the first apartment that becomes available, even if it has roach infestation or carpeting, which is very inappropriate for children with asthma.”

Ron Feemster has written for The New York Times, City Limits, and National Public Radio.

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