Perceived neighborhood safety and asthma morbidity in the School Inner‐City Asthma Study

Abstract

Summary Aim: The aim of this study was to investigate whether neighborhood safety as perceived by primary caregivers is associated with asthma morbidity outcomes among inner-city school children with asthma. Methods: School children with asthma were recruited from 25 inner-city schools between 2009 and 2012 for the School Inner-City Asthma Study (N = 219). Primary caregivers completed a baseline questionnaire detailing their perception of neighborhood safety and their children’s asthma symptoms, and the children performed baseline pulmonary function tests. In this cross-sectional analysis, asthma control was compared between children whose caregivers perceived their neighborhood to be unsafe versus safe. Results: After adjusting for potential confounders, those children whose primary caregivers perceived the neighborhood to be unsafe had twice the odds of having poorly controlled asthma (odds ratio [OR] adjusted = 2.2, 95% confidence interval [CI] = 1.2–3.9, P = 0.009), four times the odds of dyspnea and rescue medication use (OR adjusted = 4.7; 95% CI = 1.7–13.0, P = 0.003, OR adjusted = 4.0; 95% CI = 1.8–8.8, P < 0.001, respectively), three times as much limitation in activity (OR adjusted = 3.2; 95% CI = 1.4–7.7, P = 0.008), and more than twice the odds of night-time symptoms (OR adjusted = 2.2; 95% CI = 1.3–4.0, P = 0.007) compared to participants living in safe neighborhoods. There was no difference in pulmonary function test results between the two groups. Conclusions: Primary caregivers’ perception of neighborhood safety is associated with childhood asthma morbidity among inner-city school children with asthma. Further study is needed to elucidate mechanisms behind this association, and future intervention studies to address social disadvantage may be important.

Social Disadvantage and Asthma Control in Children

“…Caregiver report of violence and perception of unsafe neighbourhoods have been associated with increased asthma symptoms in inner-city children. 17, 18 Across cultures, children who report being victimized or feeling unsafe have higher odds of having an asthma episode, medication and healthcare use. 19, 20 The healthcare use tends to be weighted towards emergency services, despite reportedly good access to the primary physician’s office.…”

A Child’s View: Social and Physical Environmental Features Differentially Predict Parent and Child Perceived Neighborhood Safety

“…Among adults, feeling unsafe is associated with adopting poorer health habits (e.g., increases in sedentary behavior, decreased physical activity, and active transportation), and experiencing poorer mental (e.g., anxiety, deteriorated psychological wellbeing, and social withdrawal) and physical (e.g., poorer self-reported health, stressrelated diseases, and chronic conditions) health. [7][8][9][10] With respect to child health, parent perceived unsafety is associated with asthma, 11 sleep problems, 12 psychological distress, 13 and weight-related behaviors (e.g., physical activity). 14 Parents' perceptions of safety may influence child health by impacting the household environment and parenting decisions (e.g., restricting children's outdoor activities).…”

Inner City Asthma

“…32 Smith et al reported that suboptimal asthma control and controller medication underuse were highly associated with potentially modifiable risk factors, especially low parental expectations for functioning and symptom control, discordant estimation of asthma control, lack of routines for administering medication, and concerns about asthma medications. 39 Psychosocial factors, particularly the mental health of children and caregivers, are significant factors in predicting asthma morbidity. Increased exposure to violence predicts increased symptomatology in a graded fashion.…”