The Association between Parental Perception of Neighborhood Safety and Asthma Diagnosis in Ethnic Minority Urban Children

Abstract

Low-income populations, minorities, and children living in inner cities have high rates of asthma. Recent studies have emphasized the role of psychosocial stress in development of asthma. Residence in unsafe neighborhoods is one potential source of increased stress. The study objective was to examine the association between parental perception of neighborhood safety and asthma diagnosis among inner city, minority children. Cross-sectional data from a community-based study of 6-8-year-old New York City children were used. Asthma was defined as parental report of physician-diagnosed asthma and at least one asthma-related symptom. Parental perceptions of neighborhood safety were assessed with a questionnaire. Associations between perceived neighborhood safety and asthma were examined using chisquared tests. Multivariate logistic regression analyses were then performed. Five hundred four children were included with 79% female, 26.5% non-Hispanic Black, and 73.5% Hispanic. Asthma was present in 23.8% of children. There was an inverse association between feeling safe walking in the neighborhood and asthma with 45.7% of parents of asthmatic children reporting they felt safe compared to 60.9% of parents of non-asthmatic children (p=0.006). Fewer parents of asthmatic children than of non-asthmatic children reported that their neighborhood was safe from crime (21.7% versus 33.9%, p=0.018). In multivariate analyses adjusting for race/ethnicity, age, gender, socioeconomic status, number of smokers in the home and breastfeeding history, parents reporting feeling unsafe walking in the neighborhood were more likely to have a child diagnosed with asthma (OR=1.89, 95%CI 1.13-3.14). Psychosocial stressors such as living in unsafe neighborhoods may be associated with asthma diagnosis in urban ethnic minority children. Addressing the increased asthma burden in certain communities may require interventions to decrease urban stressors.

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

“…Vangeepuram et al found that when parents were asked about various aspects of neighborhood safety, both safety while walking in the neighborhood and safety from crime were associated with a diagnosis of asthma among their children. However, other aspects of neighborhood safety such as conditions of sidewalks and adequacy of street lighting were not . Thus exposure to violence may play an important role in explaining the association between perceived neighborhood safety and asthma morbidity in our study.…”

“…Asthma is one of the most common chronic diseases affecting children in the United States, 1 particularly among those living in poor, urban environments. 2 It is therefore essential to understand factors that lead to disparities and worsened outcomes in this population. Among the many elements that affect asthma morbidity, exposure to psychosocial stress appears to be very important.…”

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

“…These data only account for reported crime, so prevalence of asthma may be underestimated. This study demonstrated the utility of directly measuring crime, while Coutinho, McQuaid, and Koinis-Mitchell (2013) and Vangeepuram, Galvez, Teitelbaum, Brenner, and Wolff (2012) measured perceived safety.…”

“…Measuring safety was done both directly by looking at crime data (Gupta et al, 2010) and indirectly by measuring the perception of safety (Coutinho, McQuaid, & Koinis-Mitchell, 2013; Koinis-Mitchell et al, 2012; Vangeepuram, Galvez, Teitelbaum, Brenner, & Wolff, 2012). Gupta et al (2010) utilized surveys of children from kindergarten through eighth grade ( N = 45,371).…”

“…The data from the United States also frequently accounted for SES. It was operationalized in different ways; Northridge et al (2010), Holt et al (2013), and Keet et al (2015) used census data as a proxy for neighborhood SES, some discussed if sample participants lived above or below the poverty line (Sampson et al, 2013; Yinusa-Nyahkoon et al, 2010), one was not able to get SES information due to the type of data they were using (Li et al, 2011), and several mentioned “controlling for SES” in analysis (Coutinho et al, 2013; Gupta et al, 2010; Mathilda-Chiu et al, 2012; Ownby et al, 2015; Vangeepuram et al, 2012). More than half of the studies from the United States sampled specifically African American and/or Puerto Rican children due to the high prevalence of disease among this race and ethnicity.…”