UC Merced

Asthma is the most disparate common disease by race/ethnicity (Oh et al., 2016). To lessen the racial/ethnic gap in asthma, one must understand the mediating pathways in which a social construct such as race/ethnicity is linked to asthma. The aim of this dissertation is to investigate variations in asthma in association with individual- and neighborhood-level discrimination that this closely linked with racial/ethnic composition across three studies. Study 1 is an ecological design and investigates housing quality in association with asthma emergency department (ED) visits among a Hispanic/Latinx population. This study illustrates that housing quality moderates the effect of poverty on asthma ED visits where communities of affluence tend to attenuate the effects of poverty on asthma. More specifically, the effect of poverty on asthma tends to increase as expected in older housing communities where affluent communities have very low rates and poor communities have very high rates. However, the effect of poverty on asthma tends to be different in newer housing developments where affluent communities tend to have higher rates than expected and poor communities have even higher rates of asthma. Study 2 is an ecological analysis and builds on Study 1 by adding air pollution (i.e., ozone and particulate matter 2.5) and environmental degradation sites (e.g., hazardous waste sites) to the model. This study shows that air pollution is positively associated with asthma ED visits (RR = 1.2, 95% CI 1.16 – 1.25). Environmental degradation sites are positively associated with asthma ED visits (RR = 1.09, 95% CI 1.04 – 1.13). Study 3 investigates major life experiences of discrimination and ever being diagnosed with asthma. The study shows that having two or more major life experiences of discrimination, such as being denied a housing loan due to race/ethnicity, is associated with 1.2 times odds increase in ever being diagnosed with asthma in comparison to those who reported one or fewer major life experiences of discrimination. In Conclusion, structural determinants of asthma manifest in different ways at differing levels. This dissertation shows that historical policies of housing and mortgage loan discrimination are linked to present-day asthma ED visits through housing quality. Moreover, concentrations of air pollution and environmental degradation sites increase the risk for asthma ED visits across census tracts. Finally, through self-reported data, the systematic denial of mortgage loans, job promotions, and living in specific neighborhoods is associated with increased risk for ever being diagnosed with asthma. Together, these three studies suggest that racial/ethnic disparities in asthma are at least in part due to the places where people live. Future research should focus on developing a deeper understanding of how community shapes racial/ethnic disparities in asthma to understand the commodities that promote health. Policy implications range from improvement of housing conditions, air pollution, and environmental degradation sites to opportunities of implicit bias training.