Exposure to Violence, Chronic Stress, and Asthma in Puerto Rican Children

Abstract

Ethnic minority groups are both commonly exposed to chronic psychosocial stressors and disproportionately affected by asthma. Although exposure to violence and chronic stress have been each associated with asthma, little is known about their potential synergistic effects on childhood asthma in children. We hypothesized that children who are highly exposed to violence and chronic stress are at higher risk of asthma and reduced bronchodilator response (BDR).METHODS: Cross-sectional study of 472 Puerto Rican children with (n=235) and without (n=237) asthma, ages 9-14 years. We assessed chronic stress using the Checklist of Children's Distress Symptoms (CCDS) scale, and lifetime exposure to violence using the Children's Exposure to Community Violence (ETV) scale. Spirometry was performed following ATS recommendations for children. Asthma was defined as physician-diagnosed asthma and at least one episode of wheeze in the previous year. BDR was defined as percent change in FEV1 after administration of a short-acting bronchodilator. Logistic or linear regression was used for the multivariable analysis of asthma and BDR, which were adjusted for age, gender, annual household income, and exposure to second-hand smoke.RESULTS: In a multivariable analysis, each 1-point increment in the lifetime ETV scale was associated with 11% increased odds of asthma (95% confidence interval for odds ratio= 1.01-1.22, P=0.03), even after adjusting for high levels of chronic stress (i.e. in the upper quartile of the CCDS) and other covariates (Table 1, Panel A). In a separate multivariable analysis (Table 1, Panel B), children with high levels of chronic stress had 4.35% significantly lower BDR than those without high levels of chronic stress (standard error=1.57, P <0.01). Lifetime ETV was not significantly associated with BDR, and high levels of chronic stress were not significantly associated with asthma. There was no significant interaction between ETV and chronic stress on asthma or BDR. CONCLUSION: In Puerto Rican children, lifetime ETV is associated with asthma, independently of high levels of chronic stress. In these children, high levels of chronic stress are linked to reduced BDR, independently of lifetime ETV. Future longitudinal studies are needed to better define the mechanisms or pathways underlying the observed associations.