Exposure to gun violence and asthma among children in Puerto Rico

Abstract

Background and Objectives Although community violence may influence asthma morbidity by increasing stress, no study has assessed exposure to gun violence and childhood asthma. We examined whether exposure to gun violence is associated with asthma in children, particularly in those reporting fear of leaving their home. Methods Case-control study of 466 children aged 9 to 14 years with (n=234) and without (n=232) asthma in San Juan, Puerto Rico. Lifetime exposure to gun violence was defined as hearing a gunshot more than once. We also assessed whether the child was afraid to leave his/her home because of violence. Asthma was defined as physician-diagnosed asthma and wheeze in the prior year. We used logistic regression for the statistical analysis. All multivariate models were adjusted for age, gender, household income, parental asthma, environmental tobacco smoke, prematurity and residential distance from a major road. Results Cases were more likely to have heard a gunshot more than once than control subjects (n=156 or 67.2% vs. n=122 or 52.1%, P <0.01). In a multivariate analysis, hearing a gunshot more than once was associated with asthma (odds ratio [OR]=1.8, 95% confidence interval [CI]=1.1 to 1.7, P=0.01). Compared with children who had heard a gunshot not more than once and were not afraid to leave their home because of violence, those who had heard a gunshot more than once and were afraid to leave their home due to violence had 3.2 times greater odds of asthma (95% CI for OR=2.2 to 4.4, P <0.01). Conclusions Exposure to gun violence is associated with asthma in Puerto Rican children, particularly in those afraid to leave their home. Stress from such violence may contribute to the high burden of asthma in Puerto Ricans.

Gun Violence, African Ancestry, and Asthma

“…7,35 Because of sample size and statistical power, the analysis of African ancestry and asthma or total IgE was first conducted for the combined cohort and then conducted separately for each study site. 38 maternal history of asthma, 39 early-life exposure (in utero or before 2 years of age) to environmental tobacco smoke (ETS), 40 exposure to gun violence, 21 and (for the analysis of the combined cohort) study site. 3 The model for total IgE was further adjusted for case-control status.…”

“…17,[19][20][21][22][23] In a prior study of 1,213 Puerto Rican children, we reported that a history of child abuse was associated with 2.5 times increased odds of asthma (95% CI, 1.27-5.00; P ¼ .009). 20 These findings were later replicated in a large longitudinal cohort of adult African American women.…”

“…A positive exposure to gun violence was defined as hearing a gunshot more than once during the child's lifetime, as previously described. 21 This question was administered to participating children aged 9 years and older as part of the Exposure to Violence Survey. 19,[27][28][29] Internal consistency, test-retest reliability, and validity have been established for the English and Spanish versions of the Exposure to Violence Survey.…”

“…Exposure to violence is increasingly being recognized as a potentially modifiable risk factor for childhood asthma. 17,[19][20][21][22][23] We recently…”

“…21 On the basis of these findings, we hypothesized that African ancestry is associated with asthma in Puerto Rican children, but that this association would differ according to exposure to gun violence. To test this hypothesis, we analyzed data from a case-control study of asthma in 747 Puerto Rican children aged 9 to 14 years, living in San Juan (Puerto Rico) and Hartford (Connecticut).…”