Healthy Homes, Healthy Kids: Assessing Built Environment Disparities and Solutions Among Children in Boston

Abstract

The built environment, or the physical spaces where people “play, pray, and go about their day,” profoundly shapes the health and well-being of children. Differences in neighborhood opportunity, socioeconomic conditions, and other structural determinants of health contribute to disparities in pediatric health, particularly in outcomes such as elevated blood lead levels (BLLs) and asthma. Addressing these disparities requires a “healthy homes” approach that considers the cumulative impact of housing-related concerns and emphasizes multisector solutions. The objective of this dissertation is to investigate the impact of built environment disparities on pediatric environmental health. We achieve this by examining three dimensions of pediatric clinical care: primary care, acute care, and intervention. In our first study (Chapter 2), we conduct a cross-sectional multilevel analysis of primary care patients to assess whether census block-group level Child Opportunity Index and 311 tenant-reported housing complaint burden are associated with elevated BLLs. In our second study (Chapter 3), we shift to the acute care space and examine whether short-term increases in 311 housing complaints are associated with pediatric asthma-related emergency department visits. In our third study (Chapter 4), we evaluate participants in the Community Asthma Initiative, a home-based intervention program, to assess whether baseline environmental exposures are associated with subsequent asthma-related acute care utilization and cost. We conduct all three studies in partnership with Boston Children’s Hospital, one of the largest pediatric health centers in Boston, MA. Using methods from spatial analysis, environmental epidemiology, and health services research, this dissertation demonstrates how local administrative data can be leveraged to characterize environmental burden and identify opportunities for intervention. Findings highlight persistent inequities in housing-related exposures across neighborhoods and suggest that integrating clinical and municipal data sources may support more targeted and equitable strategies to reduce pediatric environmental health disparities.