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When home is where the stress is: expanding the dimensions of housing that influence asthma morbidity
  1. M Sandel1,
  2. R J Wright2
  1. 1Boston University School of Medicine, Boston MA, Center for Healthy Homes and Neighborhoods, Boston University School of Public Health and Boston Medical Center, Boston, MA, USA
  2. 2Channing Laboratory, Brigham and Women’s Hospital, Harvard Medical School, and Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, MA, USA
  1. Correspondence to:
    Dr M Sandel
    91 E. Concord St, Boston, MA 02118, USA; megan.sandel{at}


The influence of physical housing quality on childhood asthma expression, especially the effect of exposure to moulds, allergens, and pollutants, is well documented. However, attempts to explain increasing rates and severity of childhood asthma solely through physical environmental factors have been unsuccessful, and additional exposures may be involved. Increasing evidence has linked psychological stress and negative affective states to asthma expression. At the same time, recent scholarship in the social sciences has focused on understanding how social environments, such as housing, “get under the skin” to influence health, and suggests that psychological factors play a key role. While there is relevant overlapping research in social science, psychology, economics, and health policy in this area, findings from these disciplines have not yet been conceptually integrated into ongoing asthma research. We propose to expand the dimensions of housing considered in future asthma research to include both physical and psychological aspects which may directly and indirectly influence onset and severity of disease expression. This synthesis of overlapping research from a number of disciplines argues for the systematic measure of psychological dimensions of housing and consideration of the interplay between housing stress and physical housing characteristics in relation to childhood asthma.

  • housing
  • mental health
  • stress
  • violence
  • asthma

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  • Funding: Dr Sandel is supported by a grant from the Medicine as Profession Open Society Institute, Soros Foundation, and the National Institutes of Health, 1K23 ES013173-02. During preparation of this manuscript Dr Wright was supported by the National Heart, Lung, and Blood Institute, U01 HL072494, and the National Institutes of Environmental Health Sciences, R01 ES10932.

  • Competing interests: None.

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