Community Violence and Asthma Morbidity: The Inner-City Asthma Study

Wright, Rosalind J.; Mitchell, Herman; Visness, Cynthia M.; Cohen, Sheldon; Stout, James; Evans, Richard; Gold, Diane R.

doi:10.2105/ajph.94.4.625

Cited by 280 publications

(274 citation statements)

References 51 publications

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“…Stress arising from conditions in low SEP communities (e.g. poor housing, violence, unemployment) also might have a role in asthma exacerbation and increased asthma rates (Chen, Hanson, Paterson, Griffin, Walker, & Miller, 2006;Liu, Coe, Swenson, Kelly, Kita, & Busse, 2002;Marmot, 2001;Wright, Mitchell, Visness, Cohen, Stout, Evans et al, 2004;Wright, Rodriguez, & Cohen, 1998). The range of contextual SEP in our communities did not represent the extremes found in inner cities, so associations with SEP in inner cities are not directly analogous for our study, nor could our results be expected to be generalizable to the inner city setting.…”

Section: Discussionmentioning

confidence: 65%

The association between contextual socioeconomic factors and prevalent asthma in a cohort of Southern California school children

Shankardass

McConnell

Milam

et al. 2007

Social Science & Medicine

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Spatial variation in childhood asthma and a recent increase in prevalence indicate that environmental factors play a significant role in the etiology of this important disease. Socioeconomic position (SEP) has been associated inversely and positively with childhood asthma. These contradictory results indicate a need for systematic research about SEP and asthma. Pathways have been suggested for effects of SEP on asthma at both the individual and community level. We examined the relationship of prevalent asthma to community-level indicators of SEP among 5762 children in 12 Southern California, using a multilevel random effects model. Estimates of community-level SEP were derived by summarizing census block group-level data using a novel method of weighting by the proportion of the block groups included in a community-specific bounding rectangle that contained 95% of local study subjects. Community © 2007 Elsevier Ltd. All rights reserved.Corresponding Author: shankard@usc.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript characteristics included measures of male unemployment, household income, low education (i.e. no high school diploma), and poverty. There was a consistent inverse association between male unemployment and asthma across the inter-quartile range of community unemployment rates, indicating that asthma rates increase as community SEP increases. The results were robust to individual-level confounding, methods for summarizing census block group data to the community level, scale of analysis (i.e. community-level vs. neighborhood-level) and the modeling algorithm. The positive association between SEP and prevalent childhood asthma might be explained by differential access to medical care that remains unmeasured, by the hygiene hypothesis (e.g. lower SES may associate with higher protective exposures to endotoxin in early life), or by SEP acting as a proxy for unmeasured neighborhood characteristics.

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Section: Discussionmentioning

confidence: 65%

The association between contextual socioeconomic factors and prevalent asthma in a cohort of Southern California school children

Shankardass

McConnell

Milam

et al. 2007

Social Science & Medicine

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“…44 Another possible explanation for this lack of relationship may instead be that caregivers have been shown to underestimate severity and underreport asthma symptoms. 45,46 In light of the lack of support for the asthma control and asthma symptoms models, future research would benefit from gathering neighborhood violence exposure data from more than one source (e.g., child and caregiver exposure), adding objective measures of community violence (e.g., census data and police records) and stress (e.g., cytokines), differentiating between indirect violence (e.g., observing violence without actual victimization) and direct violence, and including family level stressors in the model (e.g., caregiver depression, smoking, and intimate partner violence). Other limitations relate to the sample size, which precluded adding multiple indicators of neighborhood disadvantage.…”

Section: Discussionmentioning

confidence: 99%

The Influence of Community Violence and Protective Factors on Asthma Morbidity and Healthcare Utilization in High-Risk Children

et al. 2014

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We examined the longitudinal effects of community risk and protective factors on asthma morbidity and healthcare utilization. Three hundred urban caregivers of children with poorly controlled asthma were enrolled in a randomized controlled trial testing the effectiveness of a behavioral/educational intervention and completed measures of exposure to community violence (ECV), social cohesion (SC), informal social control (ISC), child asthma control, child asthma symptom days/nights, and healthcare utilization. Latent growth curve modeling examined the direct and interaction effects of ECV, SC, and ISC on the asthma outcomes over 12 months. Caregivers were primarily the biological mother (92 %), single (70 %), and poor (50 % earned less than $10,000). Children were African American (96 %) and young (mean age=5.5 years, SD=2.2). ECV at baseline was high, with 24.7 % of caregivers reporting more than two exposures to violence in the previous 6 months (M=1.45, SD=1.61). Caregiver ECV-predicted asthma-related healthcare utilization at baseline (b=0.19, SE= 0.07, p=0.003) and 2 months (b=0.12, s.e.=0.05, p=0.04). ISC and SC moderated the effect of ECV on healthcare utilization. Our findings suggest that multifaceted interventions that include strategies to curb violence and foster feelings of cohesion among low-income urban residents may be needed to reduce asthma-related emergency services.

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“…Our study extends upon previous findings 11,12 providing evidence that in a cohort of urban youth, socioeconomic factors as well as selected characteristics of the immediate physical and broader social environment are associated with the diagnosis of asthma. While previous researchers have highlighted the fact that forces acting at the neighborhood level (e.g., markers of poverty including crime, vacant housing, and/or increased rental units) could be important contributors to childhood asthma, 3,11,[21][22][23][24][25][26] data from the current study shows that after adjustment for individual-level socioeconomic characteristics and/or directly observed housing and block conditions, all of the neighborhood level characteristics considered-except education level-were no longer significant. These results suggest that in many cases, neighborhood level associations may be able to be reduced to characteristics more proximal to the individual.…”

Section: Discussionmentioning

confidence: 99%

Individual, Housing, and Neighborhood Correlates of Asthma among Young Urban Children

2012

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Using data from a large cohort of urban children, this study identified multilevel correlates of asthma to determine whether neighborhood attributes remain associated with asthma after adjustment for individual level and immediate housing characteristics. A cross-sectional analysis was conducted using data from the Fragile Families and Child Well-being Study and its substudy, the In-Home Longitudinal Study of Pre-Schooled Age Children (n=1,784). The primary outcome was asthma diagnosis by age 5. Sociodemographic measures were assessed via telephone survey, housing and block conditions recorded via direct observation, and neighborhood characteristics came from geocoded census tract data. After multivariable adjustment, non-Hispanic Black, Puerto Rican, or other Hispanic race, child's lack of insurance coverage, male gender, presence of allergies, the exterior condition of a child's home, mother's educational attainment, and the percent of the neighborhood population with a bachelor's degree remained significantly associated with having received an asthma diagnosis by age 5. The authors identified sociodemographic and economic factors at the individual, household, and neighborhood level which are correlates of childhood asthma in urban areas. After adjustment for more proximal characteristics, the effects of all neighborhood markers were minimal, with the exception of neighborhood education.

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Community Violence and Asthma Morbidity: The Inner-City Asthma Study

Abstract: Mechanisms linking violence and asthma morbidity need to be further explored.

Cited by 280 publications

References 51 publications

The association between contextual socioeconomic factors and prevalent asthma in a cohort of Southern California school children

The association between contextual socioeconomic factors and prevalent asthma in a cohort of Southern California school children

The Influence of Community Violence and Protective Factors on Asthma Morbidity and Healthcare Utilization in High-Risk Children

Individual, Housing, and Neighborhood Correlates of Asthma among Young Urban Children

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