Environmental Asthma Triggers and Active Asthma by Socioeconomic Status Among Children in Texas, 2006-2010

BACKGROUND: Assessment of environmental triggers is important to describe patterns related to childhood asthma and to inform asthma self-management. The study objective was to examine the relationship between active asthma status and exposure to asthma triggers in the home by socioeconomic status (SES) among children in Texas. 

METHODS: Data from the 2006-2010 combined Texas Behavioral Risk Factor Surveillance System Child Asthma Call-Back Survey were analyzed using logistic regression. Asthma status was the outcome variable, categorized as “active” or “inactive”. Children had active asthma if, in the last 12 months any of the following occurred: adult talked to a doctor or other health care provider about the child’s asthma, child took any asthma medication, or child had any symptoms of asthma without having a cold or respiratory infection. Responses to nine questions about the presence of environmental triggers within the home were categorized into four types of indoor exposures: cigarette smoke, mold, animals, and use of wood burning/gas. The primary exposure variable was categorized as exposure to 0, 1, 2, or 3-4 environmental trigger groups. SES was categorized by household income: <$25,000 (low), $25,000-$75,000 (middle), and ≥$75,000 (high). Full models were adjusted for child’s age, child’s sex, current flu vaccine, and adult’s race/ethnicity. 

RESULTS: Among 780 children who had ever been told by a health professional they have asthma, 73.8% had active asthma (n = 576). Children with active asthma were significantly more likely to be younger, and to have a non-White adult respondent, lower household income, current flu vaccine, public health insurance, and to not have furry or feathered pets in the home or in the child’s bedroom (p < 0.05). Among low SES children, those exposed to two asthma trigger groups were significantly less likely to have active asthma compared to those exposed to no asthma trigger groups (OR = 0.18, 95% Confidence Interval (CI): 0.04-0.90), in the fully adjusted model. Among middle and high SES children, asthma trigger groups were not significantly associated with active asthma.   

CONCLUSIONS: Low SES children exposed to more asthma triggers were less likely to have active asthma in Texas.  A better understanding of the association between environmental triggers, asthma, and SES may help improve asthma management and focus interventions among youth. Future analysis should incorporate exposure to asthma triggers in other settings such as school or daycare.