Social Determinants of Childhood Asthma Symptoms: An Ecological Study in Urban Latin America

Fattore, Gisel Lorena; Santos, Carolina de Sousa Américo Batista; Barreto, Maurício L.

doi:10.1007/s10900-013-9769-7

Cited by 9 publications

(14 citation statements)

References 29 publications

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“…Hispanic America faces unique challenges, as a high proportion of its population is now urban in the context of high rates of poverty, a polluted environment, and limited access to sanitation (4, 52). Consistent with worldwide literature (53), low socioeconomic status (SES) in/near urban areas, high levels of inequality, and urbanization are associated with childhood asthma in Hispanic America (54)(55)(56)(57).…”

Section: Socioeconomic Status and Urbanizationsupporting

confidence: 60%

Asthma in Hispanics. An 8-Year Update

Rosser

Forno

Cooper

et al. 2014

Am J Respir Crit Care Med

121

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This review provides an update on asthma in Hispanics, a diverse group tracing their ancestry to countries previously under Spanish rule. A marked variability in the prevalence and morbidity from asthma remains among Hispanic subgroups in the United States and Hispanic America. In the United States, Puerto Ricans and Mexican Americans have high and low burdens of asthma, respectively (the "Hispanic Paradox"). This wide divergence in asthma morbidity among Hispanic subgroups is multifactorial, likely reflecting the effects of known (secondhand tobacco smoke, air pollution, psychosocial stress, obesity, inadequate treatment) and potential (genetic variants, urbanization, vitamin D insufficiency, and eradication of parasitic infections) risk factors. Barriers to adequate asthma management in Hispanics include economic and educational disadvantages, lack of health insurance, and no access to or poor adherence with controller medications such as inhaled corticosteroids. Although considerable progress has been made in our understanding of asthma in Hispanic subgroups, many questions remain. Studies of asthma in Hispanic America should focus on environmental or lifestyle factors that are more relevant to asthma in this region (e.g., urbanization, air pollution, parasitism, and stress). In the United States, research studies should focus on risk factors that are known to or may diverge among Hispanic subgroups, including but not limited to epigenetic variation, prematurity, vitamin D level, diet, and stress. Clinical trials of culturally appropriate interventions that address multiple aspects of asthma management in Hispanic subgroups should be prioritized for funding. Ensuring high-quality healthcare for all remains a pillar of eliminating asthma disparities.

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Section: Socioeconomic Status and Urbanizationsupporting

confidence: 60%

Asthma in Hispanics. An 8-Year Update

Rosser

Forno

Cooper

et al. 2014

Am J Respir Crit Care Med

121

View full text Add to dashboard Cite

show abstract

“…A similar study was done with data from the Latin American International Study of Asthma and Allergies in Childhood to analyze multiple factors relating to asthma prevalence (Fattore, Santos, & Barreto, 2014). This study also found that the Gini index, which is a measure of income distribution similar to SES, along with crowding, sanitation, infant mortality rate, and homicide rate, explains 75% of the variability in asthma prevalence between 31 Latin American urban centers (Fattore et al, 2014). This study, along with the two discussed earlier, utilized a cross-sectional design that prevents any causational inferences to be drawn.…”

Section: Resultsmentioning

confidence: 99%

“…Fattore, Santos, and Barreto (2014) measured socioeconomic and environmental determinants of wheezing in children in Latin America as described above. Similarly, Holt, Theall, and Rabito (2013) and Keet et al (2015) analyzed data on the sociodemographic, neighborhood, familial, and individual level.…”

Section: Resultsmentioning

confidence: 99%

“…However, as the connection between SES and asthma was not the specific focus of this review, analyzing more research in this area would help support or refute these findings. Fattore et al (2014) recommended continuing prevalence studies discriminating between phenotypes of asthma, addressing the geographic and individual level, and incorporating variables related to socioeconomics and urbanization. On that note, as it was suggested several times, outdoor air pollution data need to use more individualized methods (Buonanno et al, 2013; Vieira et al, 2012).…”

Section: Methodsmentioning

confidence: 99%

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Neighborhood-Level Factors Related to Asthma in Children Living in Urban Areas

DePriest

Butz

2016

The Journal of School Nursing

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Asthma disproportionately affects children who are non-White and of low socioeconomic status. One innovative approach to address these health disparities is to investigate the child’s neighborhood environment and factors influencing asthma symptoms. The purpose of this integrative review is to critique research investigating the relationships between neighborhood-level factors and asthma morbidity in urban children. Three literature databases were searched using the terms “asthma,” “child,” “neighborhood,” and “urban.” The articles included were organized into six themes within the larger domains of prevalence, physical, and social factors. Literature tables provide in-depth analysis of each article and demonstrate a need for strengthening analysis methods. The current research points to the necessity for a multilevel study to analyze neighborhood-level factors that are associated with increased asthma morbidity in urban children. School nurse clinicians, working within children’s neighborhoods, are uniquely positioned to assess modifiable neighborhood-level determinants of health in caring for children with asthma.

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“…For example, cooking in the same room where the family lives may increase the exposure to particulate matters (PM 2.5 ) which can exacerbate asthma (14). Other triggers include use of detergent such as bleach (sodium hypochlorite), which is widely used in Syria (15) and amongst the shelter dwellers, exposure to SHS (16,17) and poverty (17,18) (the study participants had an average daily income of less than 2 USD/day). Finally, our spirometry data also suggested that both asthma and COPD were severely under-diagnosed, and thus not adequately managed.…”

Section: Discussionmentioning

confidence: 99%

Uncontrolled and under-diagnosed asthma in a Damascus shelter during the Syrian crisis

et al. 2017

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Background: Studies have shown that poor shelter or dwelling conditions may lead to deteriorations in health. Those with asthma may be more susceptible to compromised living conditions and stress leading to a higher risk of asthma exacerbations. To describe the asthma control and quality of life of individuals with diagnosed asthma living in a shelter in Damascus, Syria and estimate the prevalence of respiratory symptoms in shelter dwellers without diagnosed asthma. Methods:In this cross-sectional study, all individuals 5 years and older living in Al-Herjalleh shelter with diagnosed asthma were recruited to complete a questionnaire, which included items related to their respiratory symptoms, asthma exacerbations, exposure to asthma triggers, medication use, and health-related quality of life before and since entering the shelter. A representative sample of shelter dwellers without diagnosed asthma also completed a questionnaire to establish their demographics, respiratory symptoms, environment and chronic disease co-morbidities, in order to identify factors associated with under-diagnosed asthma. All participants underwent spirometry to measure their lung function. Descriptive statistics were calculated, and chi-square tests and Student's t-tests were used to compare individuals with asthma before and since entering the shelter, as well as to compare those with under-diagnosed asthma and individuals without asthma.Results: The prevalence of asthma at the Al-Herjalleh shelter in those aged 5 years and older was approximately 8.5%. Nearly 70% of the asthma group felt their asthma had worsened since entering the shelter, and there was a significant drop in the proportion of individuals using inhaled corticosteroids (ICS), with only 4.3% using daily ICS in the shelter (P<0.0001). The proportion of individuals experiencing a severe asthma attack did not change after entering the shelter (P=0.97), but almost all individuals with asthma (94.4%) reported worsening in their health-related quality of life. In the non-asthma group, 44.2% of participants reported episodes of wheezing, coughing and breathlessness at night, consistent with underdiagnosed asthma. A higher proportion of those with under-diagnosed asthma had allergic rhinitis (57.1%), symptoms of post-traumatic stress disorder (PTSD) (35.1%), and abnormal spirometry (60.0%), compared to those without asthma. Conclusions:The findings of our study highlight the need for asthma programs in Syrian shelters as significant gaps exist in both the screening and management of chronic respiratory diseases to minimize asthma deterioration in Syrian shelter dwellers.

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Social Determinants of Childhood Asthma Symptoms: An Ecological Study in Urban Latin America

Cited by 9 publications

References 29 publications

Asthma in Hispanics. An 8-Year Update

Asthma in Hispanics. An 8-Year Update

Neighborhood-Level Factors Related to Asthma in Children Living in Urban Areas

Uncontrolled and under-diagnosed asthma in a Damascus shelter during the Syrian crisis

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