Black children are more likely to have asthma. A lot comes down to where they live | Chattanooga Times Free Press (2023)

HARTFORD, Conn. (AP) — 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.”

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___ 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.

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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.

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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.

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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.”

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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.

What race is most affected by 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.

What is the prevalence of asthma disparities among African American children? ›

Non-Hispanic African Americans were 30 percent more likely to have asthma than non-Hispanic whites, in 2019. In 2020, non-Hispanic blacks were almost three times more likely to die from asthma related causes than the non-Hispanic white population.

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.

How does asthma affect the black community? ›

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.

Where are the highest rates of asthma in America? ›

Out of the 100 Cities AAFA Ranked, These Are the Top 20 Most Challenging Places to Live With Asthma:
  • Poughkeepsie, New York. ...
  • Harrisburg, Pennsylvania. ...
  • Charleston, South Carolina. ...
  • Fresno, California. ...
  • Lakeland, Florida. ...
  • Allentown, Pennsylvania. ...
  • Cleveland, Ohio. ...
  • Detroit, Michigan.

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.

Is poverty a risk factor for asthma? ›

Participants with low incomes were more likely to be hospitalized for asthma exacerbations (7.2% vs. 2.3%; p=0.03).

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.

What are the risk factors for asthma in children? ›

Risk factors

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.

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.

What is the burden of asthma in children? ›

1 in 12. About 6 million children in the US ages 0-17 years have asthma. 50%.

What lung disease is common in African Americans? ›

African-Americans are three times more likely to be diagnosed with sarcoidosis than Caucasians and tend to have more severe disease. In severe cases, sarcoidosis can be life-threatening if it progresses to heart or severe lung disease.

Which child is more likely to develop asthma a child who lives in the city? ›

They also found that Black children with asthma were more likely to have a family history of asthma and lived in an urban setting.

Why is asthma most common in children? ›

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.

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.

What populations are at risk for asthma? ›

Those who grew up or live in urban areas have a higher risk for asthma. Children and adults who are overweight or obese are at a greater risk of asthma. Although the reasons are unclear, some experts point to low-grade inflammation in the body that occurs with extra weight.

Is asthma more common in urban areas? ›

Background. Asthma prevalence is generally lower in rural locations with some indication of an urban-rural gradient. However, among children with asthma, certain rural exposures thought to protect against the development of asthma could aggravate the condition.

Why is asthma common in urban areas? ›

In summary, exposure to both indoor and outdoor air pollution are high in urban areas and contribute to excess asthma incidence and morbidity.

What state has the best climate for asthma? ›

Best places for asthma
RankingMetropolitan areaAsthma prevalence
1Provo, UTbetter than average
2Winston-Salem, NCbetter than average
3Colorado Springs, CObetter than average
4Raleigh, NCbetter than average
6 more rows
Mar 28, 2023

What is the best climate for asthma? ›

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.

What states are bad for asthma? ›

Top 5 worst cities for asthma sufferers
  • #5: Louisville, Kentucky.
  • #4: Philadelphia, Pennsylvania.
  • #3: Dayton, Ohio.
  • #2: Richmond, Virginia.
  • #1: Springfield, Massachusetts.
Aug 4, 2018

What causes asthma? ›

Common Triggers

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)

What environments can cause asthma? ›

Examples of Triggers Reported by Asthma Patients
  • 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.

What are the five worst cities to live in if you have asthma? ›

5 Worst Cities For People With Asthma
  • Oklahoma City, Oklahoma. Oklahoma City is not going to be a pleasant and easy-to-live-in location for people with asthma due to its low air quality and a high level of pollen. ...
  • Detroit, Michigan. ...
  • Philadelphia, Pennsylvania. ...
  • Richmond, Virginia. ...
  • Memphis, Tennessee.
Oct 19, 2018

What social factors contribute to asthma? ›

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.

What causes asthma in low income communities? ›

Children who live in substandard housing are more likely to be exposed to asthma triggers like mold or pests at home, particularly in urban and low-income communities. When children are exposed to certain triggers in the home early in life, they may be at increased risk of being diagnosed with asthma.

Is obesity a risk factor for asthma? ›

Obesity is a risk factor for the development of asthma

Obesity is associated significantly with the development of asthma, worsening asthma symptoms, and poor asthma control. This leads to increase medication use and hospitalizations.

Is asthma an immune deficiency disease? ›

Asthma is an inflammatory condition, not an autoimmune disease, although there are some indications that some forms of asthma may have an autoimmune component. Asthma is caused mainly by your immune system overreacting, as happens with an allergic reaction.

Can you grow out of asthma? ›

It's common for kids to appear to have outgrown asthma by the time they enter school. But experts have studied the condition enough to now know that we don't really outgrow asthma. In fact, once you have asthma, you have it the rest of your life.

What genes are linked to asthma? ›

Specific genes commonly implicated in asthma include: ORMDL3 (ORMDL Sphingolipid Biosynthesis Regulator 3) is a gene that is strongly associated with early-onset asthma – leading to high levels of IgE.

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.

How can asthma be prevented? ›

How to avoid common asthma triggers
  1. Quit smoking and avoid secondhand smoke.
  2. Wear a mask when painting, doing construction work or yard work.
  3. Get your flu shot.
  4. Use HEPA filters in your vacuum, furnace and air conditioner.
  5. Use protective bedding and pillow cases to reduce allergies.
  6. Keep pets out of your home.

What is the black box effect? ›

In data analysis, the 'Black Box Effect' refers to an artificial intelligence (AI) system, device, or program that provides useful information without revealing any information about its internal workings. The explanations for its results and conclusions remain hidden or 'black.

What does black box effect mean? ›

In science, computing, and engineering, a black box is a device, system, or object which produces useful information without revealing any information about its internal workings. The explanations for its conclusions remain opaque or “black.”

Can asthma be triggered by emotions or environment? ›

Physical exercise; some medicines; bad weather, such as thunderstorms or high humidity; breathing in cold, dry air; and some foods, food additives, and fragrances can also trigger an asthma attack. Strong emotions can lead to very fast breathing, called hyperventilation, that can also cause an asthma attack.

What age is asthma most common? ›

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.

Why vaping is bad for your lungs? ›

E-cigarettes produce a number of dangerous chemicals including acetaldehyde, acrolein, and formaldehyde. These aldehydes can cause lung disease, as well as cardiovascular (heart) disease. E-cigarettes also contain acrolein, a herbicide primarily used to kill weeds.

What is causing the rise in black lung disease? ›

Black lung disease can develop when coal dust is inhaled over a long period of time. Coal dust is made of dangerous carbon-containing particles that coal miners are at risk of inhaling, which is why it is mostly considered an occupational disease.

Who is at risk for black lung disease? ›

Coal workers' pneumoconiosis (CWP), commonly known as "black lung disease," occurs when coal dust is inhaled. Over time, continued exposure to the coal dust causes scarring in the lungs, impairing your ability to breathe. Considered an occupational lung disease, it is most common among coal miners.

Why is asthma more common in children? ›

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.

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 organ is affected by asthma? ›

The organ system affected by asthma is the lungs. The lungs consist of lobes and segments, with the right lung having ten segments, and the left lung has eight or nine, depending on the division of the lobe.

What triggers asthma? ›

Sinus infections, allergies, pollen, breathing in some chemicals, and acid reflux can also trigger attacks. Physical exercise; some medicines; bad weather, such as thunderstorms or high humidity; breathing in cold, dry air; and some foods, food additives, and fragrances can also trigger an asthma attack.

Does black lung still exist? ›

Black lung is still prevalent in coal workers today. Additionally, without treatment, black lung can cause serious complications such as heart failure, tuberculosis, and lung cancer.

What is the most common cause of black lung disease? ›

Coal workers' pneumoconiosis (CWP), commonly known as "black lung disease," occurs when coal dust is inhaled. Over time, continued exposure to the coal dust causes scarring in the lungs, impairing your ability to breathe. Considered an occupational lung disease, it is most common among coal miners.


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