By Kat Stafford, Associated Press
Wednesday, May 24, 2023 | 10:06 a.m.
HARTFORD, Conn. — Amid the balloons, cake and games at his best friend’s birthday party on a farm, 5-year-old Carter Manson clutched his small chest.
“He just kept saying ‘I can’t breathe, I can’t breathe,’’’ his mother, Catherine, recalled tearfully. “I picked him up and told him it was OK and to just breathe. Just breathe.”
It was the first time Carter had an asthma attack in public, and the inhaler he sorely needed was in the family car. Catherine calmed her terrified son and ran to get the inhaler; only then was Carter able to breathe easily.
“You say in your head as a parent that I’m going to be prepared next time,” Catherine, 39, said.
“But anything can trigger them,” she said.
Black children are more likely to have asthma than kids of any other race in America. They're more likely to live near polluting plants, and in rental housing with mold and other triggers, because of racist housing laws in the nation's past. Their asthma often is more severe and less likely to be controlled, because of poor medical care and mistrust of doctors.
About 4 million kids in the U.S. have asthma. The percentage of Black children with asthma is far higher than white kids; more than 12% of Black kids nationwide suffer from the disease, compared with 5.5% of white children. They also die at a much higher rate.
Across America, nearly 4 in 10 Black children live in areas with poor environmental and health conditions compared to 1 in 10 white children. Factories spew nitrogen oxide and particulate matter. Idling trucks and freeway traffic kick up noxious fumes and dust.
The disparities are built into a housing system shaped by the longstanding effects of slavery and Jim Crow-era laws. Many of the communities that have substandard housing today or are located near toxic sites are the same as those that were segregated and redlined decades ago.
“The majority of what drives disparities in asthma, it’s actually social and structural,” said Sanaz Eftekhari, vice president of corporate affairs and research of the Asthma and Allergy Foundation of America. “You can tie a lot of the asthma disparities back to things that have happened, years and years and decades ago.”
Asthma is treatable. It can be managed with medicine, routine appointments and inhalers. But Black children often struggle to get treatment, and are more likely than white kids to end up in the emergency room with asthma symptoms.
Kamora Herrington, a community organizer in Hartford, Connecticut, doesn't need to study the statistics to know that the children of her city are suffering.
“We know that our emergency rooms in the middle of the night during the summer are filled with children who can’t breathe,” Herrington said.
The prime cause, she said, is just as apparent.
“People need to demand change for real and people need to not be reasonable. At what point do you say, this is bull —--? White supremacy and racism have everything to do with it.”
___ EDITOR'S NOTE: This story is part of an AP series examining the health disparities experienced by Black Americans across a lifetime. ___
The stubborn mold spores reappeared, no matter how hard Catherine Manson scrubbed the walls of her apartment, outside of Connecticut’s capital of Hartford.
As the mold began to spread further throughout the home, it dotted the walls of the bathroom and even on the bottom of one of the family’s sofas. Catherine became increasingly worried about her family’s health, noticing both she and the kids were coughing more. Their nebulizer treatments became more frequent while they lived there, and Catherine herself was prescribed an albuterol inhaler and diagnosed with asthma.
The property was owned by two different landlords during the four years the family lived there. The first didn’t attempt to fix the mold; the second tried, but failed, Catherine said.
The family thought the apartment would be a good place to raise their children. After all, it was in a relatively quiet neighborhood and affordable.
But as the mold worsened, the family increasingly felt stuck and unable to leave. It was at the height of the COVID-19 pandemic and funds were tight. Catherine suspects the mold began to form because the owners failed to address a leaky roof. The family noticed water and moisture on the walls, whenever it snowed or rained.
“I was so angry,” she recalled. “Everybody was lacking funds. There was nothing we could have done different.”
The family finally moved in 2021.
It’s a common problem for Black families.
The nation’s discriminatory housing policies make Black Americans more likely to live in rental housing. Throughout the 20th century, federal housing policies promoted homeownership and wealth generation — but those benefits were largely inaccessible to Black families.
Rental units are much more likely to havedeficiencies or inadequaciesand fewer means to address problems that increase exposure to asthma triggers.
In Connecticut, more than half of Black households rent, compared with a quarter of white households. In Hartford, almost 7 in 10 Black households rent.
An Asthma Allergy Foundation of Americareportexamining asthma disparities found that Black renters were more likely to report the presence of mice, cockroaches or mold in their homes. Black people also live in older housing at higher rates, exposing them to triggers like dust and mold. In Hartford, 63% of Black households live in structures built before 1960, according to DataHaven, a nonprofit community organization.
“So many of our children are living in these just utterly disrepair homes with mold, open cracks, leaking, and vermin,” said Dr. Jessica Hollenbach, co-director of the Asthma Center of Connecticut Children’s. ___
Pollution is also a major factor in asthma rates.
In Connecticut, poor neighborhoods in the state’s five largest cities — Bridgeport, Hartford, New Haven, Stamford, and Waterbury — have high concentrations of kids with asthma.
Those same communities are at a higher risk for chemical and environmental exposures that are known asthma triggers.
A recent Environmental Protection Agency National EmissionsInventoryshows Fairfield, Harford, New Haven and New London counties produced more than 10% of the state’s total nitrogen oxide emissions. All four of the counties include census tracts with the highest combined asthma rates.
Nitrogen oxide gases are typically emitted from vehicle exhaust, coal, oil, diesel and natural gas burning and can cause health issues such as eye irritation and asthma aggravation.
Dr. Mark Mitchell, a former director of Hartford’s health department and a founder of the Connecticut Coalition for Environmental Justice, has tried to sound the alarm on Hartford’s asthma rates.
The coalition began investigating and advocating for environmental justice after concerns arose about a regional landfill expansion and possible links to high rates of asthma, cancer and other diseases in communities neighboring them. Mitchell recalled how, in the mid ’90s, he examined about 30 kids and found that a third of them had asthma. He urged the state to look into what he believed was a clear pattern of disparities.
“They told me … we don’t really know who has asthma and doesn’t have asthma, and besides, it’s not unusual for a third of inner-city kids to have asthma,” said Mitchell, who is now associate professor of climate change at George Mason University.
The state’s health department did not respond to multiple requests for comment on its efforts to combat its asthma rates.
Mitchell said his research and work have led him to believe that the state’s asthma rates are heavily tied to traffic-related air pollution, as well as other air pollutants.
Black people suffer the brunt of it. Exposure to pollutants — specifically, fine particulate matter — is oftendisproportionately experiencedby Black and Hispanic populations, while the emissions are disproportionately caused by white populations.
Between 2018 and 2021, more than 21% of children in East Hartford had asthma — compared to 13% statewide, according toDataHaven.
Kamora Herrington has lived in Hartford for much of her life. She launched a gathering space, Kamora’s Cultural Corner, for residents in a north-end neighborhood in Hartford — a mostly Black area of the city facing many socioeconomic challenges and the rippling effects of racism that have led to high poverty rates, poor health outcomes and shortened life expectancies.
Herrington remembers that for decades, where a garden now sits, rows of milk delivery trucks would idle daily, pouring black smoke into the air and clouds of dust. Toxins seeped into the ground as trucks were also repaired on the lot. Across the street sat low-income apartments and multifamily houses; children played nearby. They’re still there today.
The ground is too toxic to plant in, so they use raised flower beds. They’re raising funds to do an environmental cleanup of the lot.
But she wonders about the health impact on generations of Black children who have traversed the neighborhood and the city’s north end. While people may prefer to blame Black parents, saying they should make better choices for their families, she points to the years of inequities that have led people to live where they can.
“As a Black woman who is also a Black mother, I have experienced ridiculous amounts of blame and abuse from a larger system that understands they’re culpable but understands that the issues are so big, that it’s a whole lot easier to say, ‘Black mommy, you’re the problem,’” she said.
Since much of the city’s rental housing stock predates the 1960s, Herrington noted, it often lacks air conditioning or proper ventilation — a burden on asthmatic children during hot summers.
Abimbola Ortade, an activist and board member of Hartford’s Black Lives Matter 860 chapter, recently lost his sister to COVID. Like many Hartford residents, she had asthma for most of her life, and diabetes, a combination that proved deadly. Ortade also has asthma, along with two of his children. He worries frequently about their future — and his.
Asthma, Ortade said, is merely one example of how structural racism fuels health disparities that are likely to worsen as Black children go through life — including the toll of toxic stress on their mental health.
“In my neighborhood, you’ve got to worry about the police killing you, stress killing you, heart failure or asthma killing you,” he said.
Ortade is critical of elected officials and what he believes is a reluctance to truly address the disparities and root causes.
Asthma, he said, “is like a ticking time bomb.” ___ Black kids have other things working against them when it comes to asthma risks.
Low birth weight, which is highest among Black babies, is one risk factor.
The confluence of toxic stress, racism and discrimination that many Black people endure, heightens the risk ofpreterm birthsand low birth weights — and the disorders, like asthma, that may follow. These factors are present regardless of socioeconomic level.
Segregated or low-income communities are less likely to have easy access to health care facilities or specialty medical clinics, which are predominantly in or next to white or higher-income communities.
Advocates say increasing representation of Black doctors — including pulmonologists, allergists, immunologists and researchers — is key to better care, eliminating bias and disrupting valid mistrust in doctors.
Catherine Manson said it’s been challenging to find the right health care professionals to help control her kids’ asthma.
“I feel like the pediatricians are not as knowledgeable as they should be,” Manson said. “As a parent, you have to make those decisions on your own. I’m the advocate for my kids.”
Asthma can be particularly disruptive for Black children and their families beyond its health implications, creating a trickle down effect in other facets of their lives.
Carter, and his 9-year-old sister Caydence who also has asthma, have missed weeks of school, leaving them behind in schoolwork. And in turn, their parents were forced to miss work to care for them – putting a strain on the family’s finances.
“I’m the parent, the teacher, the nurse,” Catherine said, of the toll. “It feels like you’re kind of failing them.”
___ There have been efforts to bring asthma under control.
Dr. Melanie Sue Collins, director of the Pediatric Pulmonary Fellowship and Cardiopulmonary Lab at Connecticut Children's, pointed to the hospital’s Easy Breathing program, which involves more than 330 pediatricians in more than 90 practices in Connecticut and has been adapted for use in schools.
More than 150,000 children have been screened and more than 41,000 have been diagnosed with asthma. The program focuses on improving diagnosis rates and creating a standardized approach to help keep asthma under control.
“I think the biggest issue is that asthma is a chronic disease that requires care every single day,” she said. “And what I see many of my patients and families struggling with is the basic needs of life.”
HUSKY Health, which includes the state’s Medicaid and the Children’s Health Insurance Program, covers about 22% of the state population.
On a federal level, resources have been put toward various housing and health grant programs. An Asthma Disparities Subcommittee was formed by the National Institutes of Health in 2010 and published a federal action plan in 2012. And the Affordable Care Act broadened coverage access for millions.
But advocates say more asthma-specific legislation and funding is needed. Overall asthma rates have trended downward in recent years but rates among Black children remain outsized and disparate.
In Connecticut, the prevalence of asthma in the state’s public school system has slightly decreased over time but about 1 in 8 students have asthma. The incidence among Black students is about 50% higher.
That often means absenteeism — and in the near and long term, failure.
“If you miss school, you can’t succeed in school,” Collins said of a fraught cycle many kids encounter. “And if you don’t succeed in school, you have a really difficult time having a life where you can do things comfortably, whether it’s eating, having shelter or a successful job.”
___ After seemingly endless years of stress, things are improving for the Manson children. Catherine has done well adhering to the children’s asthma control plan. The hard work appears to be paying off.
Carter is playing flag football, something that would have been unheard of just a year ago, and Caydence is running track.
Carter hasn’t used his inhaler since last November. They haven’t missed a day of school this year. It’s a win his mother is proud of.
Still, worry lingers in the background as the seasons change and potential triggers loom.
“I’ve missed work, their dad has missed work,” said Catherine, who now works in the medical field as a patient service representative, after leaving a beloved career in part to focus on her family’s health.
“But you have to pay the bills. Then you miss work and you miss money and that comes out of your budget. It affects everything.”
Kat Stafford, based in Detroit, is a national investigative race writer for the AP’s Race and Ethnicity team. She was a 2022 Knight-Wallace Reporting Fellow at the University of Michigan.
Why are black children more likely to have asthma? ›
Physical Environmental Factors The physical environment plays a major role in the higher prevalence of asthma in urban African American children. The environmental factors that contribute to higher rates of asthma and poorer health outcomes are indoor allergens due to poor building structures and pollution.Why do blacks have a higher rate of asthma? ›
Causes of higher asthma rates in African Americans
The results suggested that the African American participants had greater eosinophilic airway inflammation than white participants, even when taking the same dosage of asthma medication. Eosinophilic airway inflammation is one of the primary causes of asthma symptoms.
The burden of asthma in the United States falls disproportionately on Black, Hispanic and American Indian/Alaska Native people. These groups have the highest asthma rates, deaths and hospitalizations.How many black kids have asthma? ›
|Current asthma prevalence percentage, children under 18 years, 2021|
|Non-Hispanic Black||Non-Hispanic White|
Burden of Asthma on Black Populations
Black people are also at risk of worse asthma outcomes. They are: Two times as likely to have a hospital stay due to asthma. Three times as likely to die from asthma.
Researchers believe several factors may be leading to more and more children developing asthma. These factors include: Exposure to more allergens such as dust, air pollution and secondhand smoke. Not enough exposure to childhood illnesses that build up their immune systems.What are the racial disparities in childhood asthma? ›
The seven-year observational study conducted across 18 states using electronic health record data of 41,276 children with asthma found 54% of black children had fewer than two visits annually, while for white and Spanish-preferring Latino children, it was 49.2% and 30.1%, respectively.Why do some communities have higher rates of asthma? ›
The researchers suggested that structural factors including racism, discrimination, discriminatory policies, education, the physical environment, and access to health care may be playing a role in the disparities.Where are the highest rates of asthma in America? ›
- Poughkeepsie, New York. ...
- Harrisburg, Pennsylvania. ...
- Charleston, South Carolina. ...
- Fresno, California. ...
- Lakeland, Florida. ...
- Allentown, Pennsylvania. ...
- Cleveland, Ohio. ...
- Detroit, Michigan.
Exposure to tobacco smoke, including before birth. Previous allergic reactions, including skin reactions, food allergies or hay fever, also called allergic rhinitis. A family history of asthma or allergies. Living in an area with high pollution.
Is asthma more genetic or environmental? ›
Some researchers describe it as a “highly heritable disease.” According to a 2014 review study , genetic factors account for around 70% of a person's risk for developing asthma, meaning that genes play a large role in whether a person develops the condition. However, genetics are not the only cause of asthma.Is asthma genetic or environmental? ›
Rather, asthma is a polygenic, multifactorial disorder, which means that many factors contribute to its development. These factors are both genetic and environmental; accordingly, the combined action of several genes interacting with one another and with environmental factors causes the condition (1).What percentage of kids get asthma? ›
1 in 12. About 6 million children in the US ages 0-17 years have asthma. 50%.How many children are likely to have asthma in a class? ›
It is also one of the leading causes of school absenteeism. On average, in a classroom of 30 children, about 3 are likely to have asthma.What age has the most asthma? ›
Presentation of Asthma: Early Childhood (0–6 Years) Studies of asthma's natural history have shown that almost 80% of cases begin during the first 6 years of life (31). The symptoms of pediatric asthma in this age group are varied and not specific to asthma making the diagnosis challenging.Is asthma caused by poor lifestyle? ›
However, a person's lifestyle choices and habits can reduce their exposure to asthma triggers . Until recently, asthma symptoms were thought to be solely linked to environmental factors such as air quality, smoke, scented products, and mold . Research now reveals a strong correlation between asthma and genetics .How does the environment affect asthma? ›
A wide range of indoor and outdoor allergens, irritants, as well as cold temperatures, can exacerbate asthma. Household exposures to dust mites and cockroach allergens, and the irritant effects of environmental tobacco smoke, contribute significantly to asthma morbidity.Is asthma caused by poor air quality? ›
Air pollution exposure is thought to potentially cause asthma in children by impacting the developing lung and immune system. Air pollution, especially traffic-related pollution, can increase the chances of developing asthma in adults as well.Is asthma most common in children? ›
Asthma often starts during childhood, usually before age 5. Many children have asthma - it is the most common chronic disease of childhood.What is the most common type of asthma in children? ›
Allergic asthma in children is the most common type of asthma in children. Allergic asthma affects more that 24 million people in the U.S., according to the Asthma and Allergy Foundation of America. Allergic asthma is the most common type, with 60% of people with asthma experiencing this type.
Which child is more likely to develop asthma psychology? ›
Children of lower socioeconomic status are more frequently diagnosed with asthma, and their asthma tends to be more severe and persistent.What is the black box of racial disparities in asthma? ›
In the United States, racial disparities in asthma have been well documented. African American children have higher rates of asthma and disproportionately worse asthma outcomes than white children including higher rates of hospitalizations and deaths.Are children living in poverty at a higher risk of developing asthma? ›
Children of all races who live in poverty have higher rates of asthma than children who live in higher income neighborhoods. But Black and Hispanic children continue to have a higher risk of asthma, no matter their family's income level.What causes asthma? ›
Outdoor allergens, such as pollens from grass, trees and weeds. Indoor allergens, such as pet dander, dust mites, cockroaches and mold. Irritants in the air, such as smoke, chemical fumes and strong odors. Exercise (although people with well-controlled asthma can exercise)
- Pollen from trees, grasses, hay, ragweed. ...
- Mold. ...
- Animals such as cats, dogs, rabbits, hamsters, gerbils, birds, rats, mice, etc. ...
- Dust mites. ...
- Insects such as cockroaches. ...
- Sensitivity to sulfites, food preservatives, aspirin, or food dyes.
Poor housing conditions, including home disrepair and exposure to pests, mold, and pollution, have been associated with increased risk of childhood asthma and asthma morbidity.Why asthma is a social justice issue? ›
A shortage of healthy housing in poor neighborhoods means that people experience a range of housing conditions like mold, pests, and leaks that trigger asthma and make it worse. A lack of access to high-quality health care means that people with asthma may not be on the right medicine to prevent attacks.What state is best for asthma? ›
|Ranking||Metropolitan area||Asthma prevalence|
|1||Provo, UT||better than average|
|2||Winston-Salem, NC||better than average|
|3||Colorado Springs, CO||better than average|
|4||Raleigh, NC||better than average|
- #5: Louisville, Kentucky.
- #4: Philadelphia, Pennsylvania.
- #3: Dayton, Ohio.
- #2: Richmond, Virginia.
- #1: Springfield, Massachusetts.
A small study suggests that the best room temperature for people with asthma is between 68 and 71°F (20 and 21.6°C). This air temperature is mild, so it won't irritate the airways. Additionally, an indoor humidity level between 30 and 50 percent is ideal.
Is asthma inherited from mother or father? ›
If both parents have asthma, a child has a 70% chance of developing it. Like other diseases, asthma likely results from both a tendency present in the genes and exposure to environmental factors.Does asthma transfer from one person to another? ›
Asthma is a non-communicable disease and is not transmitted from one person to another. It is a chronic non-communicable disease. However, respiratory viral infections (such as colds and influenza) may cause complications for an asthmatic patient and should be avoided.Can asthma be prevented? ›
While there's no way to prevent asthma, you and your doctor can design a step-by-step plan for living with your condition and preventing asthma attacks. Follow your asthma action plan. With your doctor and health care team, write a detailed plan for taking medications and managing an asthma attack.Does asthma always run in families? ›
Asthma can run in families
There's slightly more chance of asthma being passed on by the mother than the father. But having someone with asthma in your close family doesn't mean you or your child will definitely get it. And people can get asthma without anyone in their family having it.
The results of this study suggest that parental consanguinity does not increase the risk of bronchial asthma in children. It is generally believed that bronchial asthma is caused by the interaction between genetic susceptibility and environmental exposure.What inherited traits cause asthma? ›
Unlike other inherited conditions, there is no single gene for asthma. Neither is there a guarantee that you'll develop it if your parents had it, as it can skip a generation. Genetic research has identified various asthma genes, or gene complexes, that play a strong role. These include DPP10, GRPA and SPINK5.What are the genetic bases of asthma? ›
Novel genes for asthma identified using this approach include ADAM33, VDR, DPP10, PHF11, HLA-G, and GPR154. These genes are thought to be involved in atopy, bronchial hyperresponsiveness, elevated IgE levels, and other asthma-related traits, although the effect of each gene on asthma susceptibility seems to be small.What gender is most likely to get asthma? ›
Asthma is more common in female adults than male adults. Around 9.7% of female adults have asthma, compared to 6.2% of male adults. It is a leading chronic disease in children.What is the life expectancy of a person with asthma? ›
The life expectancy of asthma patients is no less than any other normal human being, up to 80 years on an average.Do any famous singers have asthma? ›
Bono, born Paul David Hewson, is the front man of one of the most popular rock bands of all time and has one of the most influential voices in the music industry. However, most fans are unaware that off stage, he and one of his children manage the symptoms of asthma.
Is asthma more common in children or adults? ›
Asthma prevalence is higher in children (9.4 percent) than in adults (7.7 percent), and higher in females (9.2 percent) than males (7.0 percent).
No. Asthma is a lifelong disease. Some children may have fewer symptoms in their teens but they still have asthma. The pattern of wheezing seen in young children can make this issue confusing.In what year was the percentage of children with asthma the highest? ›
Asthma prevalence among children increased from 8.7% in 2001 to 9.4% in 2010, and then decreased to 8.3% in 2016.What race has the most asthma? ›
The burden of asthma in the United States falls disproportionately on Black, Hispanic and American Indian/Alaska Native people. These groups have the highest asthma rates, deaths and hospitalizations.Why do so many children have asthma? ›
Researchers believe several factors may be leading to more and more children developing asthma. These factors include: Exposure to more allergens such as dust, air pollution and secondhand smoke. Not enough exposure to childhood illnesses that build up their immune systems.How many African Americans have asthma? ›
How Does Asthma Affect African American Populations? From 2018-2020, 4.0 million non-Hispanic blacks (adults and children) reported that they currently have asthma. Non-Hispanic African Americans were 30 percent more likely to have asthma than non-Hispanic whites, in 2019.Which groups of children are more likely to develop asthma? ›
Non-Hispanic Black children are more than two times more likely to have asthma compared to non-Hispanic white children. Asthma is more common in male children than female children. Around 7.3% of male children have asthma, compared to 5.6% of female children.Which child is more likely to develop asthma? ›
Boys are more likely to develop childhood asthma, as compared with girls, at least until the point of puberty. This has been explained by smaller airway size in boys compared with girls under age 10 years, which predisposes to worsened airway reactivity, as compared with girls of the same age, height and weight (21).Which child is at higher risk for developing asthma? ›
Children more likely to have asthma are those who: Had a mother who smoked during pregnancy. Born with a low birth weight or are premature. Born via a Cesarean section.Is there a correlation between poverty and asthma? ›
In 2019, the percentage of children who had an asthma attack in the past 12 months was highest among those living below 100% of the federal poverty level (FPL). SOURCE: National Center for Health Statistics, National Health Interview Survey.
Which state has the highest asthma rate? ›
|State or Territory||Number With Current Asthma||Percent With Current Asthma (SE)|