A.
Specific Aims 1) To better understand childhood asthma within a special population of children living in a homeless shelter in a major city. a) To what extent do homeless shelters contribute to parental perceptions about the child's asthma (controlled/uncontrolled;severity) b) To what extent do homeless shelters increase or reduce episodes of asthma in children living in homeless shelters c) To assess the prevalence of asthma episodes of children living in homeless shelters 2) To better understand the association of social support systems (e.g. case managers, on-site medical clinic, educational programs) in homeless shelters and asthma hospital admission rates, asthma emergency room (ER) visits. a) To what extent do homeless shelters that are able to engage families in social support systems (case management, educational activities, and medical encounters) have better asthma outcomes (less episodes, less ER visits, less hospital admissions) in children diagnosed with asthma? b) To quantify the link between social support systems in homeless shelters and asthma episodes, ER visits, hospital admission rates, and parental perception of asthma severity. 3) To better understand how the physical environments in homeless shelters contribute to asthma triggers (e.g. mold, cigarette smoke, cockroaches) a) To what extent do physical environments in homeless shelters reduce or increase asthma triggers (mold, overcrowding, and cockroaches)? b) To quantify the link between the physical environment in homeless shelters and asthma triggers that precipitate asthma episodes, ER visits, and hospital admissions. 4) To better understand the role of social capital as measured by activities in the homeless shelter that encourage social engagement, civic responsibility, and trust and asthma episodes, ER visits, hospital admissions, parental perception of asthma severity in their child. a) To what extent do social capital structures (social engagement, civic responsibility, and trust) in homeless shelters reduce asthma episodes in children diagnosed with asthma? b) To help clarify the extent to which social capital acts a protective factor for childhood asthma The theoretical frameworks guiding this study are drawn from Bronfenbrenner's ecological model and Putnam's theory of social capital. Bronfenbrenner's ecological model examines the """"""""complex layers of environment"""""""" and the association with the development of asthma in children (Earls &Carlson, 2001). Social capital involves those features of social relationships (interpersonal trust, norms of reciprocity, and civic responsibilities) within communities that act as resources for the individual and facilitate collective action for mutual benefit (Putnam, 1995). The study's main assumptions are that (a) living in a homeless shelter is a major risk factor of childhood asthma, (b) the physical environment in homeless shelters (pest-control programs, overcrowding, room conditions) are risk factors for childhood asthma triggers, (c) the social environments in homeless shelters (medical clinic, case managers, daycare facilities, educational programs) influence childhood asthma rates, and (d) social capital features (civic participation, trust, social engagement) in homeless shelters are protective mechanisms for childhood asthma.
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