Neighborhood Assessment of

Asthma in South Boston

Amanda Shortell
SB 820: Assessment and Planning for Health Promotion
Final Assignment
April 28th, 2010

Executive Summary
Today, development of South Bostons waterfront with skyscrapers, commercial
investment, and luxury condominiums is growing. Much of this development, however, is
localized to areas of higher-income and these improvements abut some of South Bostons six
project housing developments creating a clear geographic demarcation between low- and highincome communitiesevidence of disparities in the physical, economic, social and service
environments. Conversely, Southie has a vast network of community resources and many are
located near low-income areas, bringing services to the populations who may need them most.
While asthma affects individuals of all ages, children lack control over many aspects of
their lives and are especially vulnerable. Children, therefore, should receive particular attention
for asthma prevention and intervention efforts in South Boston. According to the 2003-2005
Boston Public Health Commission Report, South Boston has the 8th highest rate of asthma
hospitalizations for children under 5 years old out of the fifteen neighborhoods identified.
Some risk factors of asthma are well documented and consistent: persistent exposure to
airborne allergens, respiratory infections in childhood, genetics, exposure to outdoor air pollution
and environmental tobacco smoke, age and occupational exposure to irritants can all lead to
asthma. These present a good starting point upon which to build asthma prevention and
intervention efforts. Resources in Boston such as the Boston Urban Asthma Coalition, South
Boston Community Health Center programs, Healthy Homes and Asthma Control and
Prevention programs, the Boston Asthma Initiative, and the Healthy Schools Initiative, suggest
local capacity and support to take action to reduce the presence of asthma triggers and the
number of new asthma cases in South Boston.

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Introduction
South Boston is conveniently nuzzled between Midtown to the north, North Dorchester to
the south, Old Harbor to the east, and Bostons South End to the west. Southie is often noted
for its Irish working-class neighborhood, pride in its traditions and strong sense of community.
However, development of South Bostons waterfront with skyscrapers, commercial investment,
and luxury condominiums is growing. With these improvements abutting some of South
Bostons six project housing developments, a clear geographic demarcation between Southies
low- and high-income neighborhoods is evidence of disparities not only in the physical
environment, but also in the economic, social and services environments as well. South Boston
has many assets to offer residents, yet many of these assets are only available in certain
neighborhoods, namely Citypoint and the waterfront communities. In addition to this lack of
access to many of the resources available only blocks away, the lower-income communities, in
the southern areas of South Boston toward Columbia Road, are also home to many barriers to
healthy living.
One particular aspect of healthy living is the ability to breath freely, but this can often be
affected by triggers of asthma. In South Boston, one out of every ten people reports a lifetime
asthma diagnosis.

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Asthma is a chronic respiratory condition. Characterized as intrinsic

(allergic) or extrinsic (non-allergic), asthma presents differently depending on many individual

characteristics, but is often exacerbated by triggers in the environment. Children are particularly
vulnerableasthma is the most common chronic childhood illness.

10

The Healthy People

2010 Report identified reducing not only asthma deaths but also reducing hospitalizations,
hospital emergency visits, missed school and work days, and activity limitations for people living
with asthma as important goalsevidence that asthma is a major public health concern in the

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United States. However, asthma is a serious public health concern, not simply because of these
morbidity measures and its prevalence, but also because of the intricate role ones environment
plays in disease development and in triggering asthma symptoms. The many triggers of asthma
create various potential pathways for intervention and prevention, as risk and protective factors
exist at several ecological levels.
This paper aims to present the neighborhood of South Boston through a lens of both
assets and barriers to healthy living, identifying community strengths as well as needs pertaining
to asthma prevention and the reduction of environmental asthma triggers. Data to demonstrate
the specific asthma burden in South Boston as well as asthma prevention and intervention needs
of residents will be presented against a backdrop of the Social Ecological Model to showcase the
many levels for potential intervention. Important risk and protective factors of asthma
development and exacerbation will be presented within the context of the effects ones
environment can have on health. Lastly, this paper aims to present the magnitude and
significance of asthma in South Boston in a way that allows for an incorporation of the unique
individual within a neighborhood as well as in the public health practice of assessment.
Description of South Boston
South Boston is one of Bostons oldest neighborhoods, annexed in 1804.

15

Once

referred to as Dorchester Neck, South Boston was at one time a predominantly Irish, Catholic
neighborhood home to many immigrants seeking to be a part of South Bostons industrial growth
in the mid-1800s (Ibid). Today, South Boston still remains the center of the Irish community in
Boston. South Boston is bordered to the east by Dorchester Bay and Old Harbor providing many
picturesque waterfront views. Midtown to the north, North Dorchester to the south, and Bostons

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South End to the west occupy the remaining borders of South Boston. See the South Boston
Map in Appendix for more detail.
The South Boston population of 29,938 residents makes up about five percent of the total
city of Boston population of 589,141 people. The largest portion of the South Boston population
is between the ages of 25 and 44 years old (40.1%), following a similar age distribution in the
United States (30.2%), Massachusetts (31.3%), and the city of Boston (35.8%). The majority of
South Bostons population identifies as White, however according to the 2008 Health of Boston
Report, the percentage of White residents in South Boston decreased from 95.5% in 1990 to
84.4% in 2000.

15

This differs slightly from the race distribution in the city of Boston in which

54.5% of the population identifies as White. In the city of Boston, 25.3% of the population
identifies as Black, compared to only 2.3% in South Boston. About 87.6% of South Boston
residents are U.S. citizens which is similar to proportions in the United States (88.9%) and in
Massachusetts (87.8%), but is slightly higher than the proportion of the city of Boston population
that are U.S. citizens (74.2%). Another notable difference between South Boston and the United
States, Massachusetts, and the city of Boston is the proportion of the population with an income
less than $20,000. In South Boston, 29.0% of the population reports an income less than
$20,000, which is higher than in the United States (22.1%), Massachusetts (19.5%), and the city
of Boston (23.5%). See Demographics Table in Appendix.
Due to major gentrification efforts and development, South Boston continues to see the
presence of economic investment with the building of many new office buildings, restaurants,
condos and hotels. Southies easy access to downtown Boston and the South End make it an
ideal location for new development projects. The Institute of Contemporary Art, the Seaport
World Trade Center and the Boston Convention and Exhibition Center are located in South

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Bostons waterfront area, evidence of economic investment. While this economic investment in
South Boston brings about opportunity for employment, the presence of commercial services,
and an attractive appearance, much of this development, however, is localized to areas of higherincome. One major barrier to some residents of South Boston is the lack of access to economic
opportunity for all classes which manifests itself in a lack of mixed income housing as well as a
lack of diversity in commercial services in some areas, particularly lower-income neighborhoods.
Driving the streets of South Boston, a noticeable difference between the commercial services
available to low- versus high- income areas exists: from pay-day loan establishments,
convenience stores, fast-food restaurants, and small shops in the former to luxury condominiums,
extravagant hotels, skyscrapers, and picturesque water-front views in the latter.
One of South Bostons core assets is its strong sense of community. Southies large Irish,
Catholic population displays great pride in the neighborhood and has a history of successful
neighborhood events, namely the St. Patricks Day parade. Also, South Bostons multiple
churches, community centers, and locally-owned businesses indicate the presence of social
cohesion and the potential for community leadership. While South Boston certainly has the
capacity for social support and networks, Southies strong sense of community is often
underscored by the distinction between its tight-knit communities within the larger South Boston
neighborhood. The clear geographic demarcations between low- and high-income areas within
South Boston contribute to a lack of social cohesion between communities. When the physical
environment is unsupportive of cohesion between social groups, a sort of us versus them
atmosphere is often a result, widening the divide initially created by the physical differences in
neighborhoods.

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A key asset to South Bostons physical environment is its access to public transportation.
The MBTA red and silver lines as well as the number five, seven, nine, ten, and eleven buses
provide access in and out of South Boston. The streets of South Boston are well organized on a
grid system making automobile or bicycle transportation convenient and efficient. Access to
parks and recreation, equipped with playgrounds, benches, picnic tables, and running paths, is
another appealing feature of South Boston. Southie is home to Castle Island, Pleasure Bay, L
and M Street Beaches, Carson Beach, and Moakley Park. Just down the road, however, from
some of these beautiful beaches and parks is Exelon-New Boston L.L.C., Suffolk Countys
fourth leading air polluter.

14

While investment in neighborhood maintenance is evident in many areas of South Boston

by manicured and litter-free sidewalks, speed bumps, and clearly marked crosswalks, this upkeep
is not consistent throughout South Boston. Potholes on roadways, graffiti, boarded up buildings,
lack of consistent sidewalks, bus stops in industrials area without bus shelters or benches, and
sidewalks not clearly marked on busy streets abound in low-income areas, particularly near
project housing developments. Another barrier in these low-income areas is a lack of access to
nutritious food from chain grocery stores. Many neighborhoods have access to only small corner
stores or convenience stores to purchase food. These neighborhoods also tend to be filled with
fast-food restaurants.
South Boston has a vast network of community resources, home to South Boston
Neighborhood House, Boys & Girls Club, YMCA, ABCD South Boston Action Center, two
public library branches (one within the Old Colony project housing development), and two
community health centers. Many of these community resources are located near low-income
areas and project housing developments, bringing these services to the populations who may

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need them most. South Boston also has two local fire stations and one local police department.
The presence of public safety has contributed to a decrease in total crime by ten percent from
2007 in South Boston. Nonetheless, crime still exists in Southie and accounted for five percent
of Bostons citywide violent crime and seven percent of citywide property crime in 2008.
South Bostons many project housing developments contribute to the accessibility of
affordable housing for low-income residents. West Broadway, Old Colony, and Mary Ellen
McCormack developments as well as West Ninth Street, Foley, and Monsignor Powers
developments for elderly and disabled residents are all located in South Boston. South Boston
also has 2-Dollar-A-Bag sites in two locations in addition to seasonal farmers markets that
provide access to low-cost, fresh fruits and vegetables as well as other foods in times of need.
These services improve access, but utilization depends on the motivation of community members
to attend. See the Assets and Barriers Tables and Health Indicator Grading Table in Appendix.
Magnitude of Asthma
Death rates from asthma for the U.S., Massachusetts, and Boston presented in this report
may be difficult to compare and limit the reliability of conclusions drawn due to the varying
years from which the rates are calculated. Taking this into consideration, however, reflecting on
these rates at the national, state, and city level presents an important view, although limited, of
the public health burden of asthma. For example, the asthma mortality rate in Massachusetts (0.8
deaths per 100,000 people) is substantially lower than in the United States (1.72 asthma deaths
per 100,000 people), and Boston (1.3 asthma deaths per 100,000 people). In Massachusetts and
Boston, the asthma mortality rate for males is substantially less than the asthma mortality rate for
females. For example, the asthma mortality rate for males in Massachusetts is 0.5 asthma deaths
per 100,000 people while the asthma mortality rate for females is 1.1 asthma deaths per 100,000

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people. Likewise, the asthma mortality rate for females in Boston is 1.9 asthma deaths per
100,000, which is more than triple that of the asthma mortality rate for males (0.6 asthma deaths
per 100,000 people).
Among the races considered (Non-Hispanic White, Non-Hispanic Black, Hispanic and
other races), the asthma mortality rate is highest for Non-Hispanic Blacks in the U.S.,
Massachusetts, and Boston. Also, the asthma mortality rate is substantially higher for people 65
years of age or older than any other age category in the U.S. (6.99 asthma deaths per 100,000
people), Massachusetts (4.2 asthma deaths per 100,000 people), and Boston (5.0 asthma deaths
per 100,000 people). See Mortality Table in Appendix.
Asthma is a chronic respiratory condition with which those diagnosed may live for their
entire lives. For this reason, other morbidity measures of asthma such as lifetime diagnosis or
hospitalization may be more appropriate ways of considering asthmas impact on the publics
health. For this report, lifetime asthma prevalence is used to compare the burden of asthma on
national, state, city, and neighborhood levels. Lifetime prevalence counts and rates include data
from people who self-report ever having received a diagnosis of asthma from a health care
professional. When considering asthma morbidity, lifetime prevalence proves to be an important
marker for asthmas public health impact because this measure not only includes those with a
current diagnosis, but also those who may have been diagnosed earlier in their lives, such as
during childhood.
In many ways, asthma morbidity data mirrors asthma mortality data. For example,
lifetime asthma prevalence rates are highest among females in the U.S. (14.9 per 100 people
compared to 11.6 per 100 people for males), Massachusetts (17.7 per 100 people compared to
11.8 per 100 people for males) and Boston (16.0 per 100 people compared to 11.6 per 100 people

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for males). Also, among the races considered, Non-Hispanic Blacks have the highest lifetime
asthma prevalence across the U.S., Massachusetts, and Boston levels. While the asthma
mortality rate in Massachusetts is substantially lower than in the United States and Boston, the
lifetime asthma prevalence in Massachusetts (14.9 per 100 people) is higher than both the United
States (13.3 per 100 people) and Boston (13.9 per 100 people). Also, lifetime asthma prevalence
is highest among the 18 to 24 year old age group in the U.S., Massachusetts, and Boston.
Another important measure of asthma morbidity is hospitalization rate. The asthma
hospitalization rate for children under 5 years old in South Boston is 7.9 per 1,000 people and the
asthma hospitalization rate for children 5 to 17 years old is 2.7 per 1,000 people. The 2003-2005
Boston Public Health Commission Report revealed that of the 15 neighborhoods identified in the
report, South Boston has the 8th highest rate of asthma hospitalizations for children under age 5
years. This data supports the need for children to receive particular attention and special focus
for asthma interventions due to their particular vulnerability and lack of control over their
environmental conditions. See Morbidity Table in Appendix.
Risk and Protective Factors for Asthma by Social-Ecological Level
Multiple personal characteristics, behaviors, and environmental conditions exist as
asthma causes, as well as triggers exacerbating asthma for individuals already diagnosed. Yet,
asthma protective and risk factors do not always represent causal relationships; some are
associated with or mediate the relationship between factor and asthma development. Certain risk
factors of asthma are well documented and consistent: persistent exposure to airborne allergens,
respiratory infections in childhood, genetics (parents who have asthma), exposure to outdoor air
pollution and environmental tobacco smoke, age and occupational exposure to irritants can all
lead to asthma.

12

However, some asthma risk factors present more intricate associations.

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Consider, for example, hygiene and asthma. While untidy home environments can foster many
airborne allergens such as dust mites, cockroaches, and pet dander, conditions that are too
sanitary may also be a cause of asthma. 2 The hygiene hypothesis proposes that the especially
sanitary conditions of Western life lead to a lack of environmental exposures and infections in
childhood, which in turn affect immune system development and may increase the risk of
asthma.

Gender also has an unique relationship with asthma. In children, more boys than

girls have asthma, yet in adults, more women than men have asthma. This trend is consistent in
Massachusetts as well as Boston (BRFSS Data, 2004).
An interpersonal asthma risk factor is exposure to environmental tobacco smoke, or
secondhand smoke. While the choice to smoke cigarettes is left up to the smoker, many
exposures to environmental tobacco smoke are experienced innocently without control over the
situation. Consider, for example, children whose parents smoke cigarettes. Children lack power
as well as influence and cannot dictate the behavior of their parents. When parents choose to
smoke in the vicinity of their children such as in the car or home, for instance, children are
exposed unwillingly. This is also the case for many individuals working in restaurants, bars, and
other establishments that do not regulate the smoking behavior of their patrons. Workers right to
a smoke-free working environment is violated with the exposure to environmental tobacco
smoke and therefore, their risk of developing asthma is increased.

12

Building quality, a neighborhood factor, also influences asthma risk. The poor quality
and unsafe housing or community structures, such as schools, community centers, or office
buildings in which community members spend extended periods of time, may harbor airborne
allergens. Similarly, the trend to build energy-efficient homes may potentially trap and keep
allergens inside the house. This intricate relationship of building quality and asthma

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development is complicated by trends to spend more time indoors. In modern societies, ninety
percent of time is spent indoors.

11

While indoor environments have the potential to foster good

health for their occupants, many shelter airborne allergens that trigger asthma.
From a societal prospective, policies and regulations can be protective against asthma.
For example, regulating where pollution producing enterprises can be located as well as how
much and what kinds of pollution can be emitted, has the power to reduce the threat of negative
health effects from exposure. In addition, strict policies regulating building quality and
maintenance can have a powerful impact on protecting community members from unhealthy
indoor environments. However, negligent or non-existent polices create environments in which
whole neighborhoods of people may be exposed to outdoor pollution and indoor allergens.
Location plays a key role in risk of asthma. Low-income, urban children are most likely
to suffer from indoor environment-induced asthma.

11

Social environments differ from place to

place, making some less protective against asthma than others. For example, Gottlieb, Beiser,
and O'Connor found in their analysis of asthma hospitalization rates in Boston that where and
under what circumstances one lives contribute greatly to ones experience with asthma.

Their

study revealed that asthma hospitalization rates in Boston were not only positively correlated
with the poverty rate, but also that asthma hospitalization rates in Boston were inversely
correlated to income (Ibid). See Web of Causation and Community Health Plan Worksheet in
Appendix.
Health Risk Behavior and Possible Points of Intervention
Smoking, namely while in the home and during pregnancy, can be a powerful contributor
to exposure to environmental tobacco smoke, especially for a particularly vulnerable group:
children. Smoking in the home exposes children to environmental tobacco smoke unwillingly

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and contributes to chronic exposure to indoor allergens that can cause as well as trigger asthma
symptoms in those already diagnosed. Likewise, smoking during pregnancy makes that child ten
times more likely to develop asthma. Therefore, smoking in the home and during pregnancy are
important health related behaviors that can be modified by intervention to reduce exposure to
asthma triggers and the development of new asthma cases in young children.
The estimated prevalence of current cigarette smoking among adults (greater than or
equal to eighteen years of age) is about eighteen percent in Massachusetts, and about twenty
percent in the greater Boston area (BRFSS Data 2006 and 2000, respectively). See BRFSS Table
in Appendix for more detail. While South Boston specific prevalence data is not available, some
inferences can be made. South Boston residents contribute to the twenty percent of adults who
consider themselves current cigarette smokers in the greater Boston area. Therefore, while
specific prevalence may differ slightly in South Boston from the greater Boston area, about one
in five adults are current cigarette smokers, many of who may smoke indoors and during
pregnancy.
One theory of health behavior change that could guide these adult smokers to change
their behavior is the Transtheoretical Model, or Stages of Change. The Stages of Change theory
emphasizes behavior change as a process in which intrinsic rewards or incentives are built to
sustain behavior change. In the Stages of Change theory, progress through a series of stages
guides behavior change in time, although progress does not always happen linearly. 13 The
Stages of Changes theory provides an appropriate lens through which to consider the process of
changing smoking behavior because it takes into account the emotional and physical steps an
individual takes in order to change, suggesting many potential pathways for supportive
intervention. Further, the Stages of Change theory is also important because it has the ability to

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incorporate relapse prevention, which is essential when working to change an addictive behavior
like cigarette smoking.
The stages proposed by this theory include pre-contemplation, contemplation,
preparation, action, maintenance, and termination. In pre-contemplation, an individual does not
have any intention of changing behavior in the near future, in this case does not intend to quit
smoking in the home or while pregnant. Individuals in the pre-contemplation stage may have
tried to change smoking behavior but without any success have become discouraged, they may
be uniformed about the consequences of their smoking behavior, and they may avoid activities in
which they would be forced to consider the risky nature of their behavior (Ibid). In
contemplation, individuals intend to change their behavior in the near future and engage in costbenefit considerations of that behavior. Preparation is the stage in which individuals create an
action plan for behavior change and begin taking steps to change their behavior. In the action
stage, individuals take specific, overt action to change behavior (Ibid). Maintenance of behavior
change involves working to prevent relapse and sustain behavior change. Lastly, termination is
the stage in which individuals no longer succumb to behavioral temptations and are confident in
themselves to maintain behavior change. Effective intervention strategies to encourage an
individual to change behaviors, such as smoking in the home or during pregnancy, will consider
the many stages through which one progresses to change and maintain that change, as the Stages
of Change theory suggests.
Other intervention strategies effective in reducing new asthma cases and triggers of
asthma symptoms include the Healthy Homes Program in Seattle, Washington which was
effective in reducing childrens asthma symptom days as well as use of urgent care services by
providing education and resources for improving housing quality and safety.

7 ,11

The Boston

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Public Health Commission also hosts a Healthy Homes program. Another effective intervention
strategy for those already suffering from asthma symptoms, a Disease Management Program,
provides asthma control that is supported by a care plan and the practitioner-patient relationship.
9

Housing codes and guidelines, complemented by ways for implementation and enforcement,

can also be effective ways to regulate building quality to be supportive of healthy indoor
environments. 7 Lastly, minimizing contact with asthma triggers and reducing exposure to
potentially harmful components of the home environment can be helpful both in controlling
asthma symptoms if already diagnosed and in protecting against future development of asthma.
See Community Health Plan Worksheet in Appendix.
Possibilities for Intervention in South Boston
South Boston is home to many assets and resources to aid in reducing the presence of
asthma triggers and the number of new asthma cases in South Boston. For example, South
Boston Community Health Center offers health education and smoking cessation programs, both
key efforts in keeping the residents of South Boston healthy because of their potential to inform
South Boston residents of the consequences and risks of smoking indoors or during pregnancy,
as well as can provide support in achieving and sustaining behavior change. Also, the Boston
Urban Asthma Coalition is dedicated to improving the problems asthma poses for Boston
residents through community collaborations, advocacy, and educational programs. Likewise, the
Boston Asthma Initiative provides education services to children and families living with asthma.
Efforts like those of the Boston Urban Asthma Coalition and the Boston Asthma Initiative
provide capacity and support at the local level to foster positive changes in Boston in order to
create environments conducive to asthma symptom- and trigger-free living. Asthma Control and
Prevention programs such as Healthy Homes and the Breath Easy At Home program of the

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Boston Public Health Commission contribute to efforts to curb asthma triggers in Boston.
Lastly, the Massachusetts Coalition for Occupational Safety and Health hosts a program, Healthy
Schools Initiative, to promote healthy indoor air environments. This initiative is especially
important in protecting children, who spend much of their time in school environments and are
particularly vulnerable to asthma triggers. All of these programs, initiatives, and coalitions are
suggestive of local capacity to take action in reducing the presence of asthma triggers and the
number of new asthma cases in South Boston.
Unfortunately, the presence of Exelon New Boston, LLC, Suffolk Countys fourth
leading contributor of air pollution, undermines many of these efforts for a healthy community in
South Boston. With a lifetime asthma prevalence of ten cases per one hundred people in South
Boston, exposure to outdoor pollution from Exelon poses a threat to the respiratory health of
those living, working, and playing in surrounding areas (Health of Boston Report 2008). Also,
South Boston has a poverty rate of 17.3 percent (2000 Census of Population and Housing).
Many of the asthma triggers plaguing the low-income, urban children most likely to suffer from
indoor environment-induced asthma may be housed in the almost one out of five people living in
poverty in South Boston.
Conclusion
While asthma affects individuals of all ages, children lack control over many aspects of
their lives and are especially vulnerable to asthma risk factors and triggers. Children, therefore,
should receive particular attention for asthma prevention and intervention efforts in South
Boston. Furthermore, low-income, urban children are most likely to suffer from indoor
environment-induced asthma.

11

Therefore, key to protecting children from developing asthma

or from triggering asthma symptoms for those children already diagnosed will be ensuring safe

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physical environments supportive of health, such as home, school, daycare, playground, and
community centers.
Efforts to protect children should be creative and take place on many social, ecological
levels. For example, focus can be placed on changing individual behaviors such as encouraging
parents to refrain from smoking indoors or while pregnant. Changes could be made to the indoor
environment, reducing exposure to indoor allergens such as dust mites, cockroaches, and pet
dander, or on the neighborhood level, improving building quality to create safe and healthy
community environments for children. 2 Efforts could be aimed at improving the outdoor
environments of children and reducing outdoor asthma triggers such as pollution. This could be
fostered by strict policies and systems for regulation. Lastly, efforts could be aimed at more
systemic, mediating factors such as reducing disparities and inequalities among races, socioeconomic statuses, and neighborhoods within South Boston. For example, a clear geographic
demarcation exists in South Boston between low-income and high-income areas, with fewer
assets for and more barriers to healthy living existing in low-income areas. To reduce the
presence of asthma triggers and the number of new asthma cases in South Boston, it will be
important to engage many aspects of the lives of residents from personal behaviors to
neighborhood factors to upstream organizational and societal factors. Intervention and
prevention efforts must exits on all social, ecological levels in order to attain systemic change.
See Asthma Analysis Worksheet in Appendix.

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References
1. Asthma Overview. Asthma and Allergy Foundation of America website. www.aafa.org.
Accessed April 1st, 2010.
2. Diseases and Conditions Index: Asthma. National Heart, Lung and Blood Institute: National
Institutes of Health website. www.nhlbi.nih.gov. Accessed March 25th, 2010.
3. Disease and Conditions: Asthma. MayoClinic website. www.mayoclinic.org/asthma.
Accessed March 25th, 2010.
4. Franco Suglia S, Duarte CS, Sandel MT, Wright RJ. Social and environmental stressors in the
home and childhood asthma. J Epidemiol Community Health. 2009 Oct 20 (Epub ahead
of print).
5. Gottlieb DJ, Beiser AS, OConnor GT. Poverty, race, and medication use are correlates of
asthma hospitalization rates. A small area analysis in Boston. Chest. 1995;108(1):28-35.
6. Hill R, Williams J, Britton J, Tattersfield A. Can morbidity associated with untreated asthma
in primary school children be reduced?: A controlled intervention study. BMJ.
1991;303(6811):1169-74.
7. Krieger J, Higgins DL. Housing and health: time again for public health action. Am J Public
Health. 2002;92(5):758-768.
8. Lemmens KM, Nieboer AP, Huijsman R. A systematic review of integrated use of diseasemanagement interventions in asthma and COPD. Respir Med. 2009; 103(5):670-91.
9. Maciejewski ML, Chen SY, Au DH. Adult Asthma Disease Management: An Analysis of
Studies, Approaches, Outcomes, and Methods. Respir Care. 2009;54(7):844-6.
10. Simon, H. Asthma. HealthCentral website. www.healthcentral.com/asthma/causes.html.
Accessed March 25th, 2010.

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11. Wu F, Takaro TK. Childhood asthma and environmental interventions. Environ Health
Perspect. 2007;115(6):971-5.
12. Your Online Source for Credible Health Information: Asthma. Centers for Disease Control
and Prevention website. www.cdc.gov/asthma. Accessed March 25th, 2010.
13. Glanz, K., Schwartz, M. Stress, Coping, and Health Behavior. In: Glanz, K., Rimer, B.,
Viswanath, K., ed. Health Behavior and Health Education: Theory, Research, and
Practice. 4th ed. San Francisco, CA: Jossey-Bass; 2008: 98-101.
14. Pollution Report Card. Scorecard: The Pollution Information Site website.
www.scorecard.org. Accessed February 11th, 2010.
15. The Health of Boston 2008. Boston Public Health Commission: Research Office.
Boston, Massachusetts: 2008.

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Appendices
Appendix A: Map of South Boston
Appendix B: Demographics Table
Appendix C: Assets and Barriers Tables
Appendix D: Health Indicator Grading Table
Appendix E: Mortality Table
Appendix F: Morbidity Table
Appendix G: Asthma Web of Causation
Appendix H: Community Health Plan Worksheet
Appendix I: BRFSS Table
Appendix J: Asthma Analysis Worksheet

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Appendix A: Map of South Boston

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Appendix B: Demographics Table

Total population
Sex
Females
Males
Age
0-17 years
18-24 years
25-44 years
45-64 years
65+ years
Ethnicity
Hispanic
Non-Hispanic
Race
White
Black
Asian
Other
Citizenship
US Citizen
Naturalized
Not a citizen
Household Income
Less than $20,000
$20,000-$59,999
$60,000-$99,999
$100,000 or more

United States
281,421,879

Massachusetts
6,349,097

Boston
589,141

South Boston
29,938

143,368,343
138,053,536

50.9%
49.1%

3,290,281
3,058,816

51.8%
48.2%

305,593
283,548

51.9%
48.1%

16,084
13,854

53.7%
46.3%

72,293,812
27,143,454
85,040,251
61,952,636
34,991,753

25.7%
9.6%
30.2%
22.0%
12.4%

1,500,064
579,328
1,989,783
1,419,760
860,162

23.6%
9.1%
31.3%
22.4%
13.5%

116,559
95,476
211,182
104,588
61,336

19.8%
16.2%
35.8%
17.8%
10.4%

5,385
2,751
12,007
5,798
3,997

18.0%
9.2%
40.1%
19.4%
13.4%

35,930,975
246,116,088

12.8%
87.5%

428,729
5,920,368

6.8%
93.2%

85,199
503,942

14.5%
85.5%

2,244
27,721

7.5%
92.6%

216,930,975
36,419,434
11,898,828
16,172,642

77.1%
12.9%
4.2%
5.7%

5,472,809
398,479
264,814
212,995

86.2%
6.3%
4.2%
3.4%

320,944
149,202
44,284
74,711

54.5%
25.3%
7.5%
12.7%

25,397
683
1,192
2,666

84.8%
2.3%
4.0%
8.9%

250,314,017
12,542,626
18,565,263

88.9%
4.5%
6.6%

5,576,114
337,617
435,366

87.8%
5.3%
6.9%

437,305
56,681
95,155

74.2%
9.6%
16.2%

26,221
1,169
2,548

87.6%
3.9%
8.5%

23,325,275
47,438,634
21,802,674
12,972,539

22.1%
45.0%
20.6%
12.3%

1,234,899
2,463,449
1,526,322
1,123,790

19.5%
38.8%
24.0%
17.7%

54,832
82,746
47,370
47,814

23.5%
35.6%
20.4%
20.5%

3,932
4,855
2,984
1,596

29.0%
37.0%
22.0%
12.0%

*U.S. Census Bureau, Current Population Survey: Demographics in the United States, Massachusetts, Boston, and South Boston Census Tracks: 2000.

-20-

Appendix C: Assets and Barriers Tables

Asset
Economic Environment
Presence of economic
investment

Investment in
youth/education
Access to higher education
opportunities
Social Environment
Access to community news
and networks
Efforts to prevent substance
abuse and support for
recovery
Strong sense of community

Presence of social cohesion

and potential
community leadership

Physical Environment
Economic investment in
physical environment
and infrastructure
Transportation and access
in/out of Southie
Access to parks and
recreation

SOUTH BOSTON ASSESTS

Evidenced by

Source

-The Institute of
Contemporary Art
-Boston Convention and
Exhibition Center
-New office buildings,
restaurants & condos
-World Trade Center
-Citypoint
-Location of many films
-Public: 3 high schools, 3
elementary schools, 1 K-8,
& 1 middle school
-Private: 2 K-8 schools
-University of
Massachusetts- Boston

-First-hand observation

-South Boston Tribune

-www.southbostoninfo.com

-South Boston
Collaborative Center

-www.southbostoncollab
orativecenter.org

-Large Irish culture

-Pride in neighborhood
-History of successful
neighborhood events
(St. Patricks Day parade)
-Multiple churches, mostly
Catholic
-Multiple community
centers
-Many locally-owned
businesses

-www.cityofboston.com
-First-hand observation

-The South Boston CSO

Storage Tunnel to clean up
S. Bostons storm drainage
and sewer system problems
-MBTA Red & Silver Line
and Buses (5, 7, 9, 10, 11)
-Streets well organized on a
grid system
- Parks: Castle Island,
Pleasure Bay, L & M Street

- www.southbostononline.c
om /articles/news/2007/1025-07 PaulMcDevitt
Sheehanaward.cfm
-First-hand observation
-www.mbta.com

-First-hand observation

-First-hand observation

-First-hand experience

-First-hand experience
-21-

Good water quality

Investment in neighborhood
maintenance
Service Environment
Presence of public safety

Investment in community
resources

Access to affordable
housing for lowincome groups

Access to low-cost, fresh

fruits, veggies, and
other foods in times of
need

Beaches, Carson Beach,

Moakley Park
- Every standard was met in
S. Boston water supply for
the 128 contaminants tested
-Manicured and litter-free
sidewalks in some areas
-Speed bumps
-2 local fire stations
-1 local police department
-Total crime in police
district C-6 is down 10%
from 2007
-South Boston
Neighborhood House
-Boys & Girls Club
-YMCA-South Boston
-ABCD South Boston
Action Center
-2 public library branches
-2 community health
centers
- West Ninth Street
(elderly/disabled), West
Broadway, Old Colony,
Mary Ellen McCormack
development, Foley
(disabled/elderly),
Monsignor Powers
(disabled/elderly)
-2-Dollar-A-Bag sites in
two locations
-Seasonal Farmers Market

-www.mwra.state.ma.us/
annual/waterreport/2008
results/metro/boston.pdf
-First-hand observation

-www.cityofboston.gov/
police/pdfs/2008Crime%20
Summary.pdf
-First-hand observation

-First-hand observation

-www.fairfood.org
- www.farmfresh.org/food/
farmersmarkets_details
.php?market=144

-22-

Barrier
Economic Environment
Lack of economic
opportunity for all
income classes
Social Environment
Lack of social cohesion

Physical Environment
Sources of pollution
Lack of investment in
neighborhood upkeep
Lack of access to nutritious
food from chain
grocery stores
Lack of commercial zoning
regulations to protect
youth
Lack of economic
investment in physical
environment and
infrastructure

Service Environment
Elements of crime

SOUTH BOSTON BARRIERS

Evidenced by

Source

-Lack of mixed income

housing
-Lack of diversity of
commercial services in
certain areas

-First-hand observation

-Clear geographic
demarcations between
wealthy and low-income
areas

-First-hand observation

-Exelon New Boston LLC

-First-hand observation
-www.scorecard.org
-First-hand observation

-Pot holes on roadways,

missing sidewalks in places,
graffiti, boarded up
buildings, etc.
-Access to only small
corner stores or
convenience stores in places
-Multiple fast-food
restaurants in areas
-Liquor store across the
street from a youth
community center
-Potholes on roadways, lack
of consistent sidewalks, bus
stops in industrial areas
without bus shelters or
benches, sidewalks not
clearly marked on busy
streets in areas
-District C-6 accounted for
5% of citywide violent
crime and 7% of citywide
property crime in 2008

-First-hand observation

-First-hand observation
-First-hand observation

-www.cityofboston.gov/
police/pdfs/2008Crime%20
Summary.pdf

-23-

Appendix D: Health Indicator Grading Table

Physical & Built Environment
Well-equipped and safe parks
Plentiful green spaces
Easily navigable for pedestrians and cyclists
Distance from freeways and heavy traffic
Distance from toxic sites and polluting industries
Thriving retail areas

Grade
B
B
ABD
B-

Social Environment
Fear of crime
High crime rate in relation to region
Number of noise complaints to police or perception of noise disturbance that
affects sleep or concentration
Range of community centers with active community participation
Integration (Are 50% or more of the residents of one race?)
Neighbors know and trust each other

Grade
C
D
B-

Economic Environment
Availability of farmers markets
Local supermarkets
Number of fast food restaurants
Affordable housing (Is rent less than 30% of income?)
Abandoned shops and foreclosed homes

Grade
BCC
B+
B

Service Environment
Major bus or train routes
Public libraries
Affordable healthcare clinics
Museums and other cultural institutions
Banking options

Grade
B
B
B+
C
C

Health Outcomes
Asthma rates
Obesity rates
Pedestrian safety
Levels of violent crime in the region

Grade
C
C
BC

A
D
A

-24-

Appendix E: Mortality Table

Deaths From Asthma for the U.S., Massachusetts, Boston, and South Boston
Data Source

United States

Massachusetts

Boston

Morbidity and Mortality

Weekly Report
Surveillance Summary,
1999

Three year aggregates:

2005-2007 Mortality
(Vital Records) ICD-10
based

Three year aggregates:

2005-2007 Mortality
(Vital Records) ICD-10
based

South Boston
*Unable to find
mortality data on the
neighborhood level.

Number
of cases

Number
of cases

Number
of cases
19

Rate per
100,000
people
1.3

Number
of cases

184

Rate per
100,000
people
0.8

Total

4,657

Rate per
100,000
people
1.72

Male
Female

1,620
3,037

1.31
2.04

48
136

0.5
1.1

4
15

0.6
1.9

White (Non-Hispanic)
Black (Non-Hispanic)
Hispanic
Other

3,328
1,145

1.42
3.87

184

2.04

141
25
15
30

0.7
2.6
2.0
0.6

6
12
1
0

0.8
3.5
0.8
0.0

0-4 years
5-14 years
15-34 years
35-64 years
65+ years

32
144
444
1,637
2,400

0.17
0.36
0.59
1.58
6.99

0
0
17
60
107

0.0
0.0
0.3
0.8
4.2

0
0
1
9
9

0.0
0.0
0.2
1.5
5.0

Rate per
100,000
people

-25-

Appendix F: Morbidity Table

Lifetime Asthma Prevalence in Adults for the U.S., Massachusetts, Boston, and South Boston
Data Source

United States

Massachusetts

Boston

South Boston

BRFSS Data-2004 (CDC)

BRFSS Data-2004 (CDC)

Mass. BRFSS Annual

Reports 2000-2005
*MassCHIP

The Health of Boston

Report 2008 (2004-2006)

Number
of cases

Number
of cases

Total

29,064,305

Rate per
100
people
13.3

Number
of cases

743,248

Rate per
100
people
14.9

81,890

Rate per
100
people
13.9

Male
Female

12,248,661
16,779,644

11.6
14.9

279,148
464,100

11.8
17.7

32,891
48,894

11.6
16.0

White (Non-Hispanic)
Black (Non-Hispanic)
Hispanic
Other

20,418,529
3,121,759
3,298,292
1,339,670

13.4
14.6
11.2
13.6

614,985
29,880
61,435
25,027

14.9
17.5
15.3
12.2

Number
of cases
2,994

Rate per
100
people
10.0

14.2
13.0
14.2
11.1

18-24 years
4,961,160
17.4
114,915
19.0
15.2
25-34 years
5,457,718
13.7
147,458
16.5
35-44 years
5,495,790
12.4
143,930
13.8
11.9
45-54 years
5,273,390
13.1
124,244
13.9
14.1
55-64 years
3,832,287
13.7
94,324
15.0
12.5
65+ years
3,949,841
10.9
110,480
12.6
12.7
*Asthma hospitalizations for children under 5 years oldCount: 36 & Rate: 7.9 per 1,000 people
*Asthma hospitalizations for children 5-17 years oldCount: 32 & Rate: 2.7 per 1,000 people

-26-

Appendix G: Asthma Web of Causation

Hygiene
Age
Location

Gender

Genetics

Atopy
Respiratory Infections
in Childhood

Race

Exposure to Environmental
Tobacco Smoke
Low Birth
Weight
Exercise
Dietary
Habits

SocioEconomic
Status

Building
Quality

ASTHMA

Exposure to Airborne
Allergens
Amount of Time
Spent Indoors
Occupational
Exposure to Irritants

Policy/Regulations
Exposure to
Pollution

Cultural
Practices

Not breastfed
in Infancy

-27-

Appendix H: Community Health Plan Worksheet

Asthma in South Boston
Health Problem:
One out of every ten people living in South
Boston reports a lifetime asthma diagnosis
(Health of Boston Report 2008).
Risk Factors
Individual:
-Age 1, 2,3,10
-Gender 3
-Genetics 1, 2,3,10
-Low Birth Weight 3
-Socio-economic status 4,11
-Race 4
-Respiratory infections in childhood 3,10
-Dietary habits 10
-Exercise 1, 3
-More time spent indoors 10
-Not breastfed as infant 10
Interpersonal:
-Exposure to environmental tobacco smoke
2 , 3,11

Institutional/Organizational:
-Occupational exposure to irritants 1, 3
Neighborhood/Community:
-Building quality 7 ,10
-Exposure to airborne allergens 1, 2,3, 7 ,10 ,11
-Location 5,11
-Exercise 1, 3
-Exposure to pollution 1, 2,3,10
Societal:
-Policy/Regulations 7
Resources & Assets Available:
-Boston Urban Asthma Coalition
-South Boston Community Health Center
-Boston Public Health Commission Programs:
Healthy Homes & Asthma Control and
Prevention
-Boston Asthma Initiative provides education
services to children and families living with
asthma
-Massachusetts Coalition for Occupational
Safety and Health-Healthy Schools Initiative

Goal Statement:
-To reduce the presence of asthma triggers in
South Boston
-To reduce the number of new asthma cases in
South Boston
Protective Factors
Individual:
-Age: Asthma is the most common chronic
childhood illness. 10
-Breastfed as an infant 10
-Gender: In children, more boys than girls have
asthma and in adults, more women than men
have asthma. 3
Interpersonal:
-Not smoking in the home 11
Institutional/Organizational:
-Occupational safety 1, 3
Neighborhood/Community:
-Reduced opportunity for airborne allergen
exposure 7 ,11
Societal:
-Policy/Regulations 7

Effective Intervention Strategies:

-Healthy Homes Programs provide education
and resources for improving quality and safety
of the home 7
-Housing codes and guidelines as well as ways
for implementation and enforcement 7
-Disease Management Programs provide
asthma control which is supported by a care
plan and the practitioner-patient relationship 9

-28-

-Reduce exposure to potentially harmful

components of the home environment 11
-Minimize contact with asthma triggers 1
Barriers to Consider:
-Presence of Exelon New Boston, LLC: Suffolk Countys fourth leading contributor of air
pollution (www.scorecard.org)
-Lack of access to nutritious foods from chain grocery stores; Access limited to only small corner
stores, convenience stores, and fast food chains in some areas of South Boston
-10.0 lifetime asthma cases per 100 people in South Boston (Health of Boston Report 2008)
-South Bostons poverty rate is 17.3% (2000 Census of Population and Housing)

-29-

Appendix I: BRFSS Data

Estimated Prevalence of Current Cigarette Smoking Among Adults
(Greater Than or Equal to 18 Years of Age)

Male (%)
Female (%)
Total (%)

United States
2006

Massachusetts
2006

23.9
18.0
20.8

19.6
16.4
17.8

Boston/Worcester/
Lawrence/Lowell/
Brockton
2000
21.0
19.8
20.4

South Boston
*Data
unavailable.

-30-

Appendix J: Asthma Analysis Worksheet

Exposure to
Environmental Tobacco
Smoke

Environmental Triggers

Asthma

Exposure to Pollution

-Race
-Socio Economic Status
-Policy/Regulation
-Location

Exposure to Airborne
Allergens

-Race
-Socio Economic Status
-Building Quality
-Location

Amount of Time Spent

Indoors

Personal Behaviors

-Race
-Socio-Economic Status
-Policy/Regulations
-Building Quality
-Location

Diet & Exercise

Hygiene

-Race
-Socio-Economic Status
-Cultural Practices

-Race
-Socio-Economic Status
-Cultural Practices
-Smoking Behavior
-Location

-Race
-Socio-Economic Status
-Cultural Practices
-Location
-31-