A Community-Based Participatory Study of Housing Conditions, Asthma Triggers, and Unmet Service Needs Among Children In Subsidized Housing In Washington, D.C.

Background: Asthma is one of the most common chronic illnesses among children in the United States and is disproportionately concentrated among children living in low-income, urban, and minority communities (Simoneau & Gaffin, 2023). African American children have the highest pediatric asthma hospitalization rates nationally, more than double the odds of hospitalization and ER visits among Medicaid-enrolled children, and double the odds of asthma diagnosis compared with White peers. The burden is especially concentrated in subsidized housing, where families face compounded risks from aging infrastructure, systemic disinvestment, and barriers to timely maintenance (Howard et al., 2023). Housing conditions are a major determinant of pediatric asthma morbidity, with exposures such as mold, pests, dust, and secondhand smoke exacerbating symptoms (Freund et al., 2023; Patti et al., 2024).

Objective: This study examines housing conditions, asthma triggers, and household management practices among caregivers of children with asthma in subsidized housing in Washington, D.C. Guided by a community-based participatory research framework, the study centers resident and stakeholder voices to generate actionable insights into environmental and systemic health challenges.

Methods: The study was conducted in Washington, D.C., where the pediatric asthma rate (9.7%) exceeds the national average (7.0%). An interdisciplinary team — including a historically Black college and a predominantly White institution — partnered with community co-researchers across all phases of design, implementation, and interpretation. Survey were collected from 137 caregivers of children with asthma residing in subsidized housing, recruited through convenience and snowball sampling at community health events, churches, public schools, and via referrals from resident leaders and local programs. The survey was informed by semi-structured interview themes and adapted healthy homes and pediatric asthma instruments.

Results: The findings reveal persistent gaps in essential housing services and preventive practices that leave in-home asthma triggers largely unaddressed and risk worsening children's asthma outcomes. All 137 respondents reported at least one in-home asthma trigger. The most commonly reported triggers were dust (68%), other insects such as ants or flies (52%), rats or mice (50%), cockroaches (45%), and mold or mildew (35%). The most commonly reported needs were pest control (n = 97, 71%), furnace filter replacement (n = 63, 46%), repair of cracks in walls or bathrooms (n = 59, 43%), and AC filter replacement (n = 57, 42%).

Implications: Findings highlight the urgent need for integrated, cross-sector solutions targeting both environmental and structural determinants of health. Housing authorities could strengthen preventive maintenance programs and ensure consistent enforcement. Healthcare providers could complement these efforts by reinforcing the importance of environmental control strategies and providing families with practical resources. Social workers are uniquely positioned to bridge healthcare, housing, and public health systems — advocating for equitable enforcement of housing standards and expanding programs such as the Healthy Housing Program. Stronger coordination among housing policy, healthcare, and public health interventions is essential to improve asthma outcomes for vulnerable children in subsidized housing. By centering community knowledge, this research demonstrates how community-engaged research and practice can amplify resident voices in housing governance and advance health equity for underserved communities.