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Exploring neighborhood-level variation in asthma and other respiratory diseases - The contribution of neighborhood social context
Abstract
We explore differences in the prevalence of asthma and other respiratory diseases at the neighborhood level. In addition to traditional metrics of neighborhood structure (e.g., concentrated disadvantage, residential stability), we incorporate residents' evaluations of neighborhood context. We examine the extent to which indicators such as disorder (observable signs of physical and social decay) and collective efficacy (trust and shared expectations for beneficial community action) account for differences in the prevalence of asthma and other respiratory diseases.
We examine 338 Chicago neighborhoods, combining 3 data sources from the 1990s: 1) the Metropolitan Chicago Information Center Metro Survey; 2) the Decennial Census; and 3) the Project on Human Development in Chicago Neighborhoods Community Survey. We use a multilevel statistical approach to disentangle neighborhood- from individual-level effects.
A survey-based response to whether a physician has diagnosed asthma, bronchitis, emphysema, or other breathing problems.
Findings indicate that individual- and neighborhood-level factors are associated with asthma/breathing problems. At the individual level, female gender, smoking, and a weight problem are positively associated with asthma/breathing problems, while Latino ethnicity is protective. At the neighborhood level, collective efficacy is protective against asthma/breathing problems. Residential stability is positively associated only when levels of collective efficacy are controlled.
Neighborhood context, particularly collective efficacy, may be an underlying factor that reduces vulnerability to asthma and other respiratory diseases. Collective efficacy may enhance the ability to garner health-relevant resources, eliminate environmental hazards that trigger asthma, and promote communication among residents which, in turn, enables dissemination of information relevant to respiratory ailments.
... Studies that have focused on the effect of collective efficacy on communities suggest that communities high on collective efficacy have lower levels of both violent and property crime Social cohesion and trust may relate to a community's ability to protect health (Cagney and Browning 2004). In the case of lead exposure, communities high in collective efficacy may be more likely to address neighborhood conditions that lead to poor health outcomes (Cagney and Browning 2004). ...
... Studies that have focused on the effect of collective efficacy on communities suggest that communities high on collective efficacy have lower levels of both violent and property crime Social cohesion and trust may relate to a community's ability to protect health (Cagney and Browning 2004). In the case of lead exposure, communities high in collective efficacy may be more likely to address neighborhood conditions that lead to poor health outcomes (Cagney and Browning 2004). Residents may draw upon publicly available information to monitor the amount of lead released in their geographic area and lobby against the release of additional lead based emissions. ...
... Residents in these neighborhoods may more closely monitor what children (theirs and others) put in their mouths. They may also be more likely to secure and encourage others to secure proper medical testing, prevention, and treatment (Cagney and Browning 2004), such as regular tests for lead exposure for early intervention. Conversely, residents in communities with low collective efficacy may not trust local health authorities or may not receive informal social pressure to secure treatment. ...
A growing body of environmental justice research consistently demonstrates an association between area race, class and the presence/level of environmental hazards. However, the mechanisms that create these environmental inequities are less understood. In the current study, we draw on criminological research on neighborhood social process to extend the environmental justice literature. Specifically, we use community survey (rather than census proxies) and public health data to explore the relationship between concentrated disadvantage, collective efficacy, organizational capacity and lead exposure in ecologically cohesive neighborhoods in the city of Chicago. Concentrated disadvantage is associated with lead exposure and the effect is mediated by neighborhood collective efficacy. The effect of organizational capacity is minimal. The theoretical and policy implications of these results are discussed. Acknowledgements:
... Indeed, it is associated with other important social outcomes such as education and the well being of children (Bryk and Schneider 2002;Morenoff 2003;Sampson, Morenoff and Earls 2003;Simons et al. 2005). It has also been extended to health outcomes such as premature mortality (Cohen, Farley and Mason 2003), asthma, and other respiratory diseases (Cagney and Browning 2004). Thus, the mutual trust and cohesion captured by the concept of collective efficacy seems to enable residents to address a variety of community problems, not just crime and delinquency. ...
... Social cohesion and trust may relate to a community's ability to protect health (Cagney and Browning 2004). In the case of lead exposure, communities high in collective efficacy may be more likely to address neighborhood conditions that lead to poor health outcomes (Cagney and Browning 2004). ...
... Social cohesion and trust may relate to a community's ability to protect health (Cagney and Browning 2004). In the case of lead exposure, communities high in collective efficacy may be more likely to address neighborhood conditions that lead to poor health outcomes (Cagney and Browning 2004). Residents may draw upon publicly available information to monitor the amount of lead released in their geographic area and lobby against the release of additional lead based emissions. ...
A growing body of environmental justice research consistently demonstrates an association between area race, class and the presence/level of environmental hazards. However, the mechanisms that create these environmental inequities are less understood. In the current study, we draw on criminological research on neighborhood social process to extend the environmental justice literature. Specifically, we use community survey (rather than census proxies) and public health data to explore the relationship between concentrated disadvantage, collective efficacy, organizational capacity and lead exposure in ecologically cohesive neighborhoods in the city of Chicago. Concentrated disadvantage is associated with lead exposure and the effect is mediated by neighborhood collective efficacy. The effect of organizational capacity is minimal. The theoretical and policy implications of these results are discussed.
Gibbs, Carole and Pizarro, Jesenia and Maxwell, Christopher D., Environmental Inequities and Neighborhood Social Process: Exploring the Mechanisms of Differential Lead Exposure in Chicago Neighborhoods (March 3, 2012). Available at SSRN: https://ssrn.com/abstract=2912934
... Recent experimental (Katz, Kling, and Liebman 2001) and observational studies (Cagney and Browning 2004;Juhn, Sauver, Katusic, Vargas, Weaver, and Yunginger 2005;Pearlman et al. 2006) support the theory that living in disadvantaged neighborhoods may be related to asthma prevalence and its associated morbidity, independent of individual factors. However, because asthma is a developmental disease primarily arising during childhood, these studies predominately focus on childhood asthma. ...
... Finally, Cagney and Browning (2004) explored differences in asthma and other respiratory diseases among adults living in 338 Chicago neighborhoods, using multilevel techniques. Interestingly, they found no relationship between neighborhood structural characteristics (concentrated disadvantage, neighborhood stability) and respiratory diseases; however, neighborhood-level measures of collective efficacy were negatively associated with asthma and breathing difficulties. ...
... Interestingly, none of the neighborhood characteristics predicted asthma, either when looking at the full sample or the subsample of those with a history of asthma. The absence of a significant effect for asthma, though striking in its consistency, is congruent with Cagney and Browning (2004), who found no relationship between neighborhood structural characteristics (concentrated disadvantage, residential stability) and breathing difficulties and asthma. Notably, the authors did identify a significant protective effect of health-related collective efficacy on breathing difficulties, and hypothesized that the social organization of the neighborhood-rather than poverty itself-may be the most salient predictor of asthma. ...
The goal of this dissertation is to examine contextual determinants of racial disparities in health across the life course. I progress from ???downstream??? to ???upstream??? processes by focusing in one chapter on the prenatal context, in another on health behaviors and family context, and in the third, on the neighborhood context.
Chapter 2 examines the relationship between lifetime exposure to abuse among pregnant women in the Boston area and elevated cord blood IgE. Results demonstrate that greater exposure to violence throughout the mother???s life course is associated with increased risk of offspring elevated IgE at birth, after adjusting for maternal and family-level confounders. Abuse occurring more proximate to pregnancy is not correlated with elevated cord blood IgE, suggesting that the cumulative exposure to violence (i.e., chronic abuse) may have the most salient fetal effects. The results indicate that the detrimental effects of violence may a) accumulate over the life course and b) transmit across generations through the fetal environment.
Chapter 3 explores the intergenerational transmission of disadvantage by examining the relationship between teen childbearing and offspring health among a nationally representative sample of children ages 5-19. Logistic regressions reveal no increased risk of low birthweight, chronic illness, obesity or asthma among offspring of teens versus non-teens and a slight decrease in obesity among offspring of teens, suggesting that the timing of one???s pregnancy may matter less than other contextual factors in influence offspring health.
Chapter 4 uses multilevel methods to investigate the extent to which one???s residential environment is linked to currently active asthma. No association is found between neighborhood sociodemographic factors and asthma. Random-slope models demonstrate significant effects of affluence and immigrant concentration for non-blacks; however, the unexpected direction of the coefficients and the small sample size call into question the reliability and validity of these findings.
Emerging from these three studies is a complex picture of how contextual factors may affect health disparities. The findings confirm the value of incorporating social contexts in studying health disparities, while underscoring the pitfalls in overlooking the diversity in age, ethnicity, life stage, and health outcomes within such research.
... 4 In a Chicago study, the prevalence of asthma was inversely associated with neighborhood collective efficacy, while individual SES was unrelated. 5 While associations between various aspects of neighborhood and adverse health outcomes (eg, mortality, 6 diabetes, 7 obesity 8,9 ) have been observed, specific mechanisms linking neighborhood and health have not been explicated. 10 An imbalance of health-related compositional fac-tors -ie, characteristics of neighborhood residents -could explain some or all of disparities in a health outcome, such as asthma, between disadvantaged and advantaged neighborhoods. ...
... [36][37][38] To our knowledge, no previous study has assessed the association of adult asthma incidence with neighborhood SES, but two have assessed adult asthma prevalence and neighborhood SES. 4,5 A study in Chicago that used an index of neighborhood SES similar to the one used in our study found no association of that index with the prevalence of asthma/ breathing problems, with adjustment for individual SES and other covariates (eg, smoking, weight). 5 In a Boston study, neighborhood SES was classified into three categories according to population of the zip code living below the poverty level (<10%, 10%-19%, and ≥20%). ...
... 4,5 A study in Chicago that used an index of neighborhood SES similar to the one used in our study found no association of that index with the prevalence of asthma/ breathing problems, with adjustment for individual SES and other covariates (eg, smoking, weight). 5 In a Boston study, neighborhood SES was classified into three categories according to population of the zip code living below the poverty level (<10%, 10%-19%, and ≥20%). 4 The odds ratio for asthma prevalence in the lowest compared with highest SES areas was 1.3 (95% CI .9-2.0) when adjusted only for smoking, sex, and race; when individual income and education were added, the odds ratio was 1.10 (95% CI .8-1.7). 4 Of note, in this same study, the odds ratio for asthma prevalence among children living in the highest poverty neighborhoods was 7.6 (95% CI 2.4-23.5), ...
p> Objective : Individual socioeconomic status (SES) has been associated with asthma incidence but whether neighborhood
SES has an influence is unknown. We assessed the contributions of neighborhood socioeconomic status (SES), neighborhood housing density, neighborhood racial composition, and individual SES to the development of adult-onset asthma in Black
women, accounting for other known or suspected risk factors.
Design and Participants : Prospective cohort study conducted among 47,779 African American women followed with biennial health questionnaires from 1995 to 2011.
Methods and Main Outcome Measures : Incident asthma was defined as new selfreport of doctor-diagnosed asthma with
concurrent use of asthma medication. We assessed neighborhood SES, indicated by census variables representing income,
education, and wealth, and housing density and % African American population, as well as individual SES, indicated by highest education of participant/spouse. Cox proportional hazards models were used to derive multivariable hazard ratios (HRs) and
95% CIs for the association of individual SES and neighborhood variables with asthma incidence.
Results : During a 16-year follow-up period, 1520 women reported incident asthma. Neighborhood factors were not associated
with asthma incidence after control for individual SES, body mass index, and other factors. Compared with college graduates,
the multivariable HR for asthma was 1.13 (95% CI 1.00-1.28) for women with some college education and 1.23 (95% CI 1.05-
1.44) for women with no more than a high school education.
Conclusions : Individual SES, but not neighborhood SES or other neighborhood factors, was associated with the incidence
of adult-onset asthma in this population of African American women. Ethn Dis . 2016;26(1):113-122; doi:10.18865/
ed.26.1.113
</p
... Researchers have documented the geographic disparity of the burden of asthma and how social characteristics of neighborhoods such as poverty, racial/ethnic segregation, psychosocial stress, and collective efficacy contribute to asthma [10][11][12]. Beyond social characteristics of neighborhoods, studies have identified environmental pollutants associated with asthma to suggest that particularly vulnerable (e.g., low-income, youth, racial/ethnic minorities) populations demonstrate a greater health response to environmental exposures [13,14]. ...
... Recent studies have found neighborhood-level associations with asthma and are similar to our finding. For example, several studies in urban Chicago have found the clustering of foreign-born populations provides protective effects on asthma [10,33]. Moreover, collective efficacy and social cohesion have been theorized as a mechanistic pathway from neighborhood to health [33,34]. ...
The CalEnviroScreen created by the Office of Environmental Health Hazard Assessment, Sacramento, USA, is a place-based dataset developed to measure environmental and social indicators that are theorized to have cumulative health impacts on populations. The objective of this study was to examine the extent to which the composite scores of the CalEnviroScreen tool are associated with pediatric asthma hospitalization. This was a retrospective analysis of California hospital discharge data from 2010 to 2012. Children who were hospitalized for asthma-related conditions, were aged 0–14 years, and resided in California were included in analysis. Rates of hospitalization for asthma-related conditions among children residing in California were calculated. Poisson multilevel modeling was used to account for individual- and neighborhood-level risk factors. Every unit increase in the CalEnviroScreen Score was associated with an increase of 1.6% above the mean rate of pediatric asthma hospitalizations (rate ratio (RR) = 1.016, 95% confidence interval (CI) = 1.014–1.018). Every unit increase in racial/ethnic segregation and diesel particulate matter was associated with an increase of 1.1% and 0.2% above the mean rate of pediatric asthma, respectively (RR = 1.011, 95% CI = 1.010–1.013; RR = 1.002, 95% CI = 1.001–1.004). The CalEnviroScreen is a unique tool that combines socioecological factors and environmental indicators to identify vulnerable communities with major health disparities, including pediatric asthma hospital use. Future research should identify mediating factors that contribute to community-level health disparities.
... Asthma is associated with urban living, disproportionately affecting African Americans living in low-income neighborhoods (Cagney and Browning, 2004;CDC, 2011). The prevalence of asthma in the U.S. continues to rise, currently with 25 million diagnosed individuals, which grew by 4.3 million between 2001 and 2009 alone (CDC, 2011;Milligan et al., 2016). ...
... The prevalence of asthma in the U.S. continues to rise, currently with 25 million diagnosed individuals, which grew by 4.3 million between 2001 and 2009 alone (CDC, 2011;Milligan et al., 2016). African American children suffer the largest burden, with a prevalence rate that is 2.4-fold greater and mortality rates that are 4-6 times those of white children (Cagney and Browning, 2004;Milligan et al., 2016). The root causes of the increase remains unknown (CDC, 2011), heightening the demand for research focused on understanding socioeconomic and neighborhood risk factors. ...
Objective:
To determine the influence of individual and neighborhood factors that combined are associated with asthma and diabetes in a sample of urban Philadelphians using data mining, a novel technique in public health research.
Methods:
We obtained secondary data collected between May 2011 and November 2014 on individual's health and perception of neighborhood characteristics (N = 450) and Philadelphia LandCare Program data that provided relevant environmental data for the analysis (N = 676). RapidMiner open access data mining software was used to perform decision tree analyses.
Results:
Individual- and neighborhood-level environmental factors were intricately related in the decision tree models, having varying influence on the outcomes of asthma and diabetes. The decision trees had high specificity (95-100) and classified factors that were associated with an absence of disease (diabetes/asthma).
Conclusion:
Improved neighborhood-level conditions related to social and physical disorder were consistently found to be associated with an absence of both asthma and diabetes in this urban population.
Policy implications:
This study illustrates the potential utility of applying data mining techniques for understanding complex public health issues.
... Contextual studies have noted consistency in these studies documenting ''independent'' effects of neighborhood socioeconomic environment after controlling for individual-level factors on various health outcomes (Diez-Roux, 2001;Pickett & Pearl, 2001). But if we restrict these studies only to multilevel models that have adjusted for more than one individual level measure of socioeconomic status, though the overall effect suggests independent effects of neighborhood SES on various health outcomes (depression, Ross, 2000;heart disease, Diez-Roux et al., 2003;drug use, Boardman, Finch, Ellison, Williams, & Jackson, 2001;insulin resistance, Diez-Roux, Jacobs, & Kiefe, 2002;cardiovascular risk factors, Davey Smith, Hart, Watt, Hole, & Hawthorne, 1998;Duncan, Jones, & Moon, 1999;Lee & Cubbin, 2002;child mental health, Xue, Leventhal, Brooks-Gunn, & Earls, 2005; self-rated health, Patel, Eschbach, Rudkin, Peek, & Markides, 2003;mortality, Davey Smith et al., 1998), neighborhood socioeconomic predictors are frequently weak (Aneshensel & Sucoff, 1996;Borrell, Diez-Roux, Rose, & Clark, 2004;Cagney & Browning, 2004;Diez-Roux et al., 1999;Reijneveld, 1998;Robert, 1998;Robert & Reither, 2004;Van Lenthe & Mackenbach, 2002), and sometimes inconsistent across gender (Diez-Roux et al., 1997, 2002Robert & Reither, 2004;Van Lenthe & Mackenbach, 2002) and race/ethnicity (Borrell et al., 2004;Diez-Roux et al., 1997;Lee & Cubbin, 2002) and across different study samples in the US (Aneshensel & Sucoff, 1996;Boardman et al., 2001;Borrell et al., 2004;Cagney & Browning, 2004;Diez-Roux et al., 1997, 2002Kleinschmidt, Hills & Elliott, 1995;Lee & Cubbin, 2002;Patel et al., 2003;Reagan & Salsberry, 2005;Robert, 1998;Robert & Reither, 2004;Xue et al., 2005) and Europe (Davey Smith et al., 1998;Duncan et al., 1999;Ecob & Jones, 1998;Reijneveld, 1998;Van Lenthe & Mackenbach, 2002). It is easy to view these mixed results and query the role of residential neighborhoods in health (Diez-Roux, 2001Kawachi & Berkman, 2003;Pickett & Pearl, 2001). ...
... Contextual studies have noted consistency in these studies documenting ''independent'' effects of neighborhood socioeconomic environment after controlling for individual-level factors on various health outcomes (Diez-Roux, 2001;Pickett & Pearl, 2001). But if we restrict these studies only to multilevel models that have adjusted for more than one individual level measure of socioeconomic status, though the overall effect suggests independent effects of neighborhood SES on various health outcomes (depression, Ross, 2000;heart disease, Diez-Roux et al., 2003;drug use, Boardman, Finch, Ellison, Williams, & Jackson, 2001;insulin resistance, Diez-Roux, Jacobs, & Kiefe, 2002;cardiovascular risk factors, Davey Smith, Hart, Watt, Hole, & Hawthorne, 1998;Duncan, Jones, & Moon, 1999;Lee & Cubbin, 2002;child mental health, Xue, Leventhal, Brooks-Gunn, & Earls, 2005; self-rated health, Patel, Eschbach, Rudkin, Peek, & Markides, 2003;mortality, Davey Smith et al., 1998), neighborhood socioeconomic predictors are frequently weak (Aneshensel & Sucoff, 1996;Borrell, Diez-Roux, Rose, & Clark, 2004;Cagney & Browning, 2004;Diez-Roux et al., 1999;Reijneveld, 1998;Robert, 1998;Robert & Reither, 2004;Van Lenthe & Mackenbach, 2002), and sometimes inconsistent across gender (Diez-Roux et al., 1997, 2002Robert & Reither, 2004;Van Lenthe & Mackenbach, 2002) and race/ethnicity (Borrell et al., 2004;Diez-Roux et al., 1997;Lee & Cubbin, 2002) and across different study samples in the US (Aneshensel & Sucoff, 1996;Boardman et al., 2001;Borrell et al., 2004;Cagney & Browning, 2004;Diez-Roux et al., 1997, 2002Kleinschmidt, Hills & Elliott, 1995;Lee & Cubbin, 2002;Patel et al., 2003;Reagan & Salsberry, 2005;Robert, 1998;Robert & Reither, 2004;Xue et al., 2005) and Europe (Davey Smith et al., 1998;Duncan et al., 1999;Ecob & Jones, 1998;Reijneveld, 1998;Van Lenthe & Mackenbach, 2002). It is easy to view these mixed results and query the role of residential neighborhoods in health (Diez-Roux, 2001Kawachi & Berkman, 2003;Pickett & Pearl, 2001). ...
... It is a social determinant of health that influences health outcomes [11][12][13]. Strong social networks have resulted in important health-related benefits in the context of prenatal, asthma, and mental health care, among others [14][15][16]. However, the relationship between social capital and health often depends on the quality process through which social capital shaped the responses of Hispanics/Latinos during the pandemic in the U.S. ...
The coronavirus pandemic has drastically impacted many groups that have been socially and economically marginalized such as Hispanics/Latinos in the United States (U.S.). Our aim was to understand how bonding social capital, bridging social capital, and trust played a role in Hispanics/Latinos over the course of the COVID-19 outbreak, as well as explore the negative consequences of social capital. We performed focus group discussions via Zoom (n = 25) between January and December 2021 with Hispanics/Latinos from Baltimore, MD, Washington, DC, and New York City, NY. Our findings suggest that Hispanics/Latinos experienced bridging and bonding social capital. Of particular interest was how social capital permeated the Hispanic/Latino community’s socioeconomic challenges during the pandemic. The focus groups revealed the importance of trust and its role in vaccine hesitancy. Additionally, the focus groups discussed the dark side of social capital including caregiving burden and spread of misinformation. We also identified the emergent theme of racism. Future public health interventions should invest in social capital, especially for groups that have been historically marginalized or made vulnerable, and consider the promotion of bonding and bridging social capital and trust. When prospective disasters occur, public health interventions should support vulnerable populations that are overwhelmed with caregiving burden and are susceptible to misinformation.
... Res. Public Health 2022, 19, 12095 2 of 18 respiratory diseases [1], cardiovascular disease [2], diabetes [3], and overall mortality [4]. In addition to physical diseases and concerns, neighborhood characteristics can influence behavioral and psychological health. ...
Built environment neighborhood characteristics are difficult to measure and assess on a large scale. Consequently, there is a lack of sufficient data that can help us investigate neighborhood characteristics as structural determinants of health on a national level. The objective of this study is to utilize publicly available Google Street View images as a data source for characterizing built environments and to examine the influence of built environments on chronic diseases and health behaviors in the United States. Data were collected by processing 164 million Google Street View images from November 2019 across the United States. Convolutional Neural Networks, a class of multi-layer deep neural networks, were used to extract features of the built environment. Validation analyses found accuracies of 82% or higher across neighborhood characteristics. In regression analyses controlling for census tract sociodemographics, we find that single-lane roads (an indicator of lower urban development) were linked with chronic conditions and worse mental health. Walkability and urbanicity indicators such as crosswalks, sidewalks, and two or more cars were associated with better health, including reduction in depression, obesity, high blood pressure, and high cholesterol. Street signs and streetlights were also found to be associated with decreased chronic conditions. Chain link fence (physical disorder indicator) was generally associated with poorer mental health. Living in neighborhoods with a built environment that supports social interaction and physical activity can lead to positive health outcomes. Computer vision models using manually annotated Google Street View images as a training dataset were able to accurately identify neighborhood built environment characteristics. These methods increases the feasibility, scale, and efficiency of neighborhood studies on health.
... In OHC for long-term management, the continuous interaction and ongoing relational work among members in groups affect their collective efficacy (Vassilev et al., 2019). The latter has been related to several positive health outcomes, such as higher parental efficacy (Bilha Davidson et al., 2020) as well as better perceived overall health (Browning & Cagney, 2002), decreased asthma/breathing problems (Cagney & Browning, 2004) and greater physical activity (Dlugonski et al., 2017). These previous findings indicate that self-efficacy in healthcare can be enhanced through increased collective efficacy in OHC. ...
Aim
To identify a serial multiple mediation effect of social support in online health communities and collective empowerment on the relationship between diabetes‐related burden (DRB) and self‐efficacy, among mothers using a continuous glucose monitoring device for children with type 1 diabetes (T1D).
Design
A secondary analysis, cross‐sectional, descriptive study.
Methods
Data were obtained from 198 mothers of children with T1D via a web survey, from August to September 2020. Measures used were the Collective Empowerment in the Online Health Community Scale, a modified version of the Multidimensional Scale of Perceived Social Support, Problem Areas in Diabetes Survey—Parent Revised version and a modified version of the Maternal Self‐efficacy for Diabetes Management Scale. Data were analysed using SPSS 25.0, and PROCESS MACRO for SPSS v3.5.
Results
A serial multiple mediation model was used. The indirect effects of both social support in online health communities and collective empowerment were identified in the relationship between DRB and diabetes self‐efficacy (DSE). However, there was no indirect effect of social support in online health communities on these relationships.
Conclusion
These findings suggest that online social support alone has a limited role in chronic disease management self‐efficacy. Collective empowerment should be a strategic component in intervention development using online health communities to strengthen DSE in mothers of children with T1D.
Impact
This study provides novel insights into the functional mechanism of online health communities for T1D. Peer mentor coaching by parents of children with T1D effectively helps other children's parents with its recent diagnosis. The findings recognize a need for strategies enhancing collective empowerment among parents of children with T1D. Along with peer coaching, these strategies should strengthen knowledge of resources and methods to impact social change as well as resource mobilization for collective actions.
... Neighborhood social cohesion is typically defined as trusting relationships and shared values among residents in a neighborhood (Lin, 2001;Sampson et al., 1997). It has been identified as a protective factor for health and well-being among families living in low-income neighborhoods (Brisson et al., 2014;Cagney & Browning, 2004;Xue et al., 2005). Specifically, neighborhood social cohesion buffers the impact of harsh parenting on externalizing behavior problems (Silk et al., 2004). ...
Previous research suggests that aggregate neighborhood-level measures of socioeconomic disadvantage are related to social and medical outcomes. To date, these measures have primarily been used in health-related research, with far fewer applications to developmental psychology and education. This study used a measure of neighborhood socioeconomic disadvantage, the Area Deprivation Index, to examine relationships between neighborhood disadvantage, family risk factors, and perceptions of neighborhood safety, social cohesion, and social status in Early Head Start families. Results suggest that neighborhood disadvantage is important to consider in efforts to support the health and well-being of low-income families with young children and that the Area Deprivation Index is appropriate for this use. Neighborhood disadvantage predicted economic hardship and pressure, perceived neighborhood safety and social cohesion, and subjective social status. This has implications for planning and implementation of family supports offered through programs like Early Head Start.
... Macro-social Context Factors-We measured macro-social context of the patient's place of residence using the Index of Concentrated Disadvantage (Cagney & Browning, 2004) and perceived neighborhood social disorder. The Index of Concentrated Disadvantage calculated using 2010 census data combines percentages below poverty, unemployed, in female-headed households, under age 18 years, and nHBlack. ...
This study attempts to clarify the associations between macro-social and social network factors and the continuing racial disparities in breast cancer survival. The study improves on prior methodologies by using a neighborhood disadvantage measure that assesses both economic and social disadvantage and an ego-network measurement tool that assesses key social network characteristics. Our population-based sample included 786 breast cancer patients (nHWhite=388; nHBlack=398) diagnosed during 2005-2008 in Chicago, IL. The data included census-derived macro-social context, self-reported social network, self-reported demographic and medically abstracted health measures. Mortality data from the National Death Index (NDI) were used to determine 5-year survival. Based on our findings, neighborhood concentrated disadvantage was negatively associated with survival among nHBlack and nHWhite breast cancer patients. In unadjusted models, social network size, network density, practical support, and financial support were positively associated with 5-year survival. However, in adjusted models only practical support was associated with 5-year survival. Our findings suggested that the association between network size and breast cancer survival is sensitive to scaling of the network measure, which helps to explain inconsistencies in past findings. Social networks of nHWhites and nHBlacks differed in size, social support dimensions, network density, and geographic proximity. Among social factors, residence in disadvantaged neighborhoods and unmet practical support explained some of the racial disparity in survival. Differences in late stage diagnosis and comorbidities between nHWhites and nHBlacks also explained some of the racial disparity in survival. Our findings highlight the relevance of social factors, both macro and inter-personal in the racial disparity in breast cancer survival. Findings suggest that reduced survival of nHBlack women is in part due to low social network resources and residence in socially and economically deprived neighborhoods. To improve survival among breast cancer patients social policies need to continue improving health care access as well as racially patterned social and economic disadvantage.
... 64 In adult studies, social support has shown an inverse association with asthma morbidity. 53,66 The effect of social support on adult asthma hospitalizations remained even after correcting for demographics, socioeconomic characteristics, physical health, and lifestyle. 67 Frequent residential moves also impair neighborhood collective efficacy, or the level of trust and attachment between community residents and their capacity for mutually beneficial action, which has been found to be protective against asthma through the community's capacity to mobilize existing social resources. ...
Introduction
Limited work has directly compared the role of different neighborhood factors or examined their interactive effects on pediatric asthma outcomes. Our objective was to quantify the main and interactive effects of neighborhood deprivation and residential instability (RI) on pediatric asthma outcomes.
Methods
We conducted a retrospective cross‐sectional study of patients with a primary diagnosis of asthma hospitalized at a tertiary care pediatric hospital. Residential addresses at the index hospitalization were linked to the state area deprivation index (ADI). RI was coded as the number of residences in the past 4 years. Logistic and ordinal regression and Cox regression survival analyses were used to estimate the effect on the primary outcomes of chronic asthma severity (intermittent, mild persistent, moderate persistent, severe persistent/other) as defined by the National Heart, Lung, and Blood Institute, severe hospitalization (requiring continuous albuterol or intensive care unit care), and time to emergency department (ED) readmission and rehospitalization within 365 days of the index visit, respectively.
Results
In the sample (N = 664), 21% had severe persistent/other asthma, 22% had severe hospitalization, 37% were readmitted to the ED, and 19% were rehospitalized. Increasing RI was independently associated with more severe chronic asthma (odds ratio = 1.18, 95% confidence interval [CI] = 1.05, 1.32, P = .004), greater risk of 365‐day ED readmission (hazard ratio [HR] = 1.10, 95% CI = 1.05, 1.15, P < .0001), and greater risk of 365‐day rehospitalization (HR = 1.09, 95% CI = 1.03, 1.14, P = .002). There were no significant associations between ADI and these outcomes. Further, we did not find significant evidence of interactive effects.
Conclusions
RI appears to be modestly associated with pediatric asthma outcomes, independent of current neighborhood deprivation.
... Studies have found associations between specific neighborhood characteristics and cardiovascular disease, 1 self-rated health, 2 walking and other forms of physical activity, 3 obesity, 4-8 lower-body functional limitations, 9,10 symptoms of depression, anxiety, and conduct disorders. [11][12][13] , asthma, 14,15 and crime and violence. 1,16,17 Neighborhood environment studies present practical challenges, especially in studies using large and geographically dispersed samples. ...
Background:
Assessing aspects of intersections that may affect the risk of pedestrian injury is critical to developing child pedestrian injury prevention strategies, but visiting intersections to inspect them is costly and time-consuming. Several research teams have validated the use of Google Street View to conduct virtual neighborhood audits that remove the need for field teams to conduct in-person audits.
Methods:
We developed a 38-item virtual audit instrument to assess intersections for pedestrian injury risk and tested it on intersections within 700 meters of 26 schools in New York City using the Computer Assisted Neighborhood Visual Assessment System (CANVAS) with Google Street View imagery.
Results:
Six trained auditors tested this instrument for inter-rater reliability on 111 randomly selected intersections and for test-retest reliability on 264 other intersections. Inter-rater kappa scores ranged from -0.01 to 0.92, with nearly half falling above 0.41, the conventional threshold for moderate agreement. Test-retest kappa scores were slightly higher than but highly correlated with inter-rater scores (Spearman rho=0.83). Items that were highly reliable included presence of a pedestrian signal (K=0.92), presence of an overhead structure such as an elevated train or a highway (K=0.81), and intersection complexity (K=0.76).
Conclusions:
Built environment features of intersections relevant to pedestrian safety can be reliably measured using a virtual audit protocol implemented via CANVAS and Google Street View.
... Researchers have also attempted to understand both physical and mental health problems of residents in disadvantaged, high crime areas (Aneshensel & Sucoff, 1996;Diez Roux & Mair, 2010;Fitzpatrick, Piko, Wright, & LaGory, 2005;Foster & Giles-Corti, 2008;Lorenc et al., 2012;Natsuaki et al., 2007). There is a vast area of research that has shown that residents who live in areas with high levels of crime and poverty are also at higher risk for mental health problems (Kim, 2008;Latkin & Curry, 2003;Mair, Diez Roux, & Galea, 2008;Ross, 2000;Truong & Ma, 2009), substance use (Boardman, Finch, Ellison, Williams, & Jackson, 2001;Karriker-Jaffe, 2011;Stockdale et al., 2007), and chronic diseases such as asthma (Cagney & Browning, 2004), obesity, and cardiovascular disease (Boardman, Saint Onge, Rogers, & Denney, 2005;Browning, Cagney, & Iveniuk, 2012;Chaix, 2009;Chang, Hillier, et al., 2009). Residents of these areas also have higher mortality rates compared to those who do not live in disadvantaged areas (Fang, Madhaven, Bosworth, & Alderman, 1998;Haan, Kaplan, & Camacho, 1987;Jackson, Anderson, Johnson, & Sorlie, 2000). ...
Similar to concentrations of crime, mental health calls have been found to concentrate at a small number of places, but few have considered the context of places where mental health calls occur. The current study examines the influence of the physical and social context of street segments, particularly the role of service providers, land use features of the street and nearby area, and characteristics of residents on the likelihood of a mental health crisis call to the police occurring on the street. The findings demonstrate that the social context, such as offending and drug use among residents, levels of social cohesion and community involvement, and drug and violent crime influenced the occurrence of mental health crisis calls. Findings from this study make theoretical and practical contributions to a number of disciplines by improving our understanding of where mental health crisis calls occur and why they are found at specific places.
... 14 Currently, only two studies have assessed the relationship between asthma and neighbourhood disadvantage using a composite score and only one included adolescents. 10,15 The two studies produced conflicting results, 10,15 necessitating further specific work to better understand adolescent health conditions. Additional research is needed to determine if the association between asthma and age differs with varying levels of neighbourhood disadvantage. ...
Introduction:
Significant health disparities exist in asthma and obesity for African American youths. Successful interventions present an opportunity to address these disparities but require detailed study in order to ensure generalizability. This study investigated the intersection of obesity, neighbourhood disadvantage, and asthma.
Methods:
Data were extracted from 129 African American females ages 13 to 19 years (mean = 15.6 years [SD = 1.9]). Obesity was measured via body mass index (BMI). Asthma status was based on clinical diagnosis and/or results of the International Study of Asthma and Allergies during Childhood (ISAAC) questionnaire. The concentrated disadvantage index (CDI) assessed neighbourhood disadvantage.
Results:
Findings showed that 21.5% (n = 28) of participants were clinically defined as having asthma, 76.2% (n = 99) had obesity, and 24.9% (n = 31) were classified without obesity. The mean BMI was 35.1 (SD = 9.1) and the mean CDI was 1.0 (SD = 0.9). CDI and obesity were significantly associated in participants without asthma, but not in those with asthma. Multivariable linear regression results showed a significant interaction between CDI and asthma (t value = 2.2, P = .03).
Conclusion:
In sum, results from this study found that asthma moderated the relationship between neighbourhood disadvantage and obesity.
... All data employed in the current study were located at the census tract unit of analysis, as regional or metropolitan scales potentially mask effects of community-level environmental indicators (Cagney and Browning, 2004). The utilized data included (1) age adjusted AEDVs per 10,000 persons of the population for 2011-2013, which were calculated for ZIP Codes and reapportioned to census tract rates (CEHTP, 2014); (2) spatial distribution of gridded DPM for a summer day in July 2012 calculated via EMFAC2013 on-road emissions models and CEPAM emissions forecasting system for off-road emissions estimates, wherein weighted averages were allocated to census tracts (CARB, 2013) and subsequently min-max normalized; (3) percent population living below two times the federal poverty level between 2011 and 2015, obtained from the U.S. Census Bureau (2015); and (4) percent population under the age of 10, also obtained from the U.S. Census Bureau (2010) ...
Los Angeles County (LAC) low-income communities of color experience uneven asthma rates, evidenced by asthma emergency department visits (AEDV). This has partly been attributed to inequitable exposure to diesel particulate matter (DPM). Promisingly, public parks and open space (PPOS) contribute to DPM mitigation. However, low-income communities of color with limited access to PPOS may be deprived of associated public health benefits. Therefore, this novel study investigates the AEDV, DPM, PPOS nexus to address this public health dilemma and inform public policy in at-risk communities. Optimized Hotspot Analysis was used to examine geographic clustering of AEDVs, DPM, and PPOS at the census tract unit of analysis in LAC. Ordinary Least Squares (OLS) regression analysis was used to examine the extent to which DPM and PPOS predict AEDVs. Finally, Geographic Weighted Regression (GWR) was employed to account for spatial dependence in the global OLS model. Optimized Hotspot Analysis confirmed significant clustering of elevated AEDVs and DPM in census tracts with reduced PPOS. After controlling for pertinent demographic characteristics (poverty, children, race/ethnicity), regression analysis confirmed that DPM was significantly positively associated with AEDVs, whereas PPOS was significantly negatively associated with AEDVs. Furthermore, GWR revealed that 71.5% of LACs census tracts would benefit from DPM reductions and 79.4% would benefit from PPOS increases toward redressing AEDVs. This is the first study to identify AEDV reductions in census tracts with higher concentrations of PPOS. Thus, reducing DPM and increasing PPOS may serve to improve asthma outcomes, particularly in low-income communities of color.
... 9,29 It has also been suggested that, among adults, collective efficacy may decrease vulnerability to asthma by enhancing adult residents' ability to access resources, mitigating physical environmental hazards that trigger asthma symptoms, and promote health-related communication among residents. 30 Relatively little research, however, looks at the relationship between collective efficacy (including social cohesion and informal control) and child asthma. One noteworthy exception by Quinn and colleagues 31 examined low-income, inner-city children with asthma in Chicago. ...
Despite the knowledge that children in low-income neighborhoods are particularly vulnerable to asthma, few studies of child asthma focus on variation among low-income neighborhoods. We examined the relationship between child asthma and features associated with neighborhood poverty including safety, social cohesion, informal social control, collective efficacy, and disorder, across a sample of children from low-income neighborhoods (N = 3010; 2005-2007). Results show that the relationship between asthma and poverty is accounted for by family-level characteristics, but informal social control remains significantly and positively related to asthma after accounting for family-level characteristics. We discuss the importance of neighborhood environmental features for children's asthma.
... For the respiratory health outcomes, the results were less strong but the trend showing higher prevalence among children in deprived boroughs remained. This is in agreement with previous reports on factors describing the social environment, such as deprived borough and cardiovascular and respiratory health outcomes, even after controlling for individual cofactors [21][22][23][30][31][32]. ...
Worldwide, cardiovascular and respiratory diseases are increasing. Environmental noise and the socioeconomic and sociodemographic situation are important factors for the diseases. Using borough health claims data from 2011 in the city of Hamburg, ecological analyses with principal component analyses were conducted to describe the relationship of road traffic noise Lden (day, evening, and night) > 65 dB(A), physician density, and social deprivation with regional prevalence rates of heart failure and hypertension (n = 67 boroughs). Additionally, associations between the considered factors with borough prevalence rates of acute bronchitis and asthma in children up to 14 years old were analyzed. The multivariate regression analyses (ANCOVA) indicated that the socioeconomic and sociodemographic borough background might be associated with cardiovascular and respiratory diseases, showing the strongest association among hypertensive female patients with 9.90 percent (p < 0.0001) in the highest social deprivation category, when compared to the group of low social deprivation. However, associations between noise, physician density, and the respective health outcomes were negligible. Results will serve as a basis for further investigations. By using data from two surveys, future studies will focus on individual level data to assess the validity of our model, and to develop strategies to reduce the prevalence of cardiovascular and respiratory diseases.
... For self-reported asthma and chronic lung disease, between-neighborhood variation hardly changes across the different models suggesting that background characteristics fail to explain away the neighborhood differences. This underscores the importance of contextual factors in the epidemiology of asthma and other respiratory diseases, as discussed in various other settings (Cagney and Browning, 2004;Wright and Subramanian, 2007). On the other hand, for self-reported physician-diagnosed diabetes, the variation attributed to neighborhoods is reduced from 21% in the null model to 2% in the full model. ...
We establish a rationale for a multilevel approach in examining health among older adults. Using data on a nationally representative sample of 6560 Indian adults aged 50 years and older, we examine the extent of contextual variation between neighborhoods, after accounting for the compositional effect of individuals’ background characteristics, across multiple dimensions of elderly health. The variance apportioned to neighborhoods in null intercept-only models varied widely across different health outcomes examined in the elderly – while neighborhoods accounted for only 4% of the total variation in high blood pressure at exam, 23% of the total variation in self-rated poor quality of life could be attributed to neighborhood-level differences. In models that accounted for state, place of residence, and demographic and socioeconomic characteristics of individuals, the contribution of neighborhood to the total variation for most health outcomes was attenuated (2–11%) but persisted to exist. Our findings underscore the importance of neighborhoods in studying the health and well-being of the elderly in India.
... Violence, in turn, not only threatens the health of those individuals directly involved, but also other residents who witness such incidents (Dupéré, Leventhal, and Vitaro 2012). Research has linked lower levels of collective efficacy to perceptions of danger and subsequent reductions in outdoor play and other forms of physical activity as well as with related increases in overweight/obesity and other stress-related conditions, such as depression, asthma, and cardiovascular disease (Burdette and Needham 2012;Cagney and Browning 2004). Theory and prior scholarship imply similar regulatory effects of collective efficacy on other problem behaviors, including illicit substance use, alcohol abuse, child neglect and abuse, and delinquency (Browning and Cagney 2002;Molnar et al. 2008;Simons et al. 2005). ...
Evidence suggests that living in a socioeconomically deprived neighborhood is associated with worse health. Yet most research relies on cross-sectional data, which implicitly ignore variation in longer-term exposure that may be more consequential for health. Using data from the 1970 to 2011 waves of the Panel Study of Income Dynamics merged with census data on respondents’ neighborhoods (N = 1,757), this study estimates a marginal structural model with inverse probability of treatment and censoring weights to examine: (1) whether cumulative exposure to neighborhood disadvantage from birth through age 17 affects self-rated health in early adulthood, and (2) the extent to which variation in such exposure helps to explain racial disparities therein. Findings reveal that prolonged exposure to neighborhood disadvantage throughout childhood and adolescence is strikingly more common among nonwhite versus white respondents and is associated with significantly greater odds of experiencing an incidence of fair or poor health in early adulthood.
... Collective efficacy is tied to lower levels of depression and mental illness (Ahern & Galea, 2011;Araya et al., 2006). It has been found to be protective against asthma (Cagney & Browning, 2004), obesity and overweight (Cohen et al., 2006;Kayitsinga, Martinez, & Villarruel, 2009;Kimbro, Brooks-Gunn, & McLanahan, 2011), cardiovascular disease , and premature mortality (Lochner et al., 2003). Generally, people who live in high collective efficacy communities report higher self-rated health (Browning & Cagney, 2002) and have lower rates of premature mortality . ...
Violence is a critical health issue that compromises the strength of communities and permanently damages the lives of individuals and families. The impact of violence on health and well-being is particularly devastating in disadvantaged and minority communities, leading to negative health outcomes, including premature death. However, research suggests that communities can prevent violence and negative health outcomes by developing collective efficacy, which happens when neighbors share norms and values, trust one another, and are willing to intervene to address problems. Despite the importance of collective efficacy in preventing violence and improving health, almost no research has investigated actionable strategies to build collective efficacy in disadvantaged neighborhoods. This article describes a theoretical and conceptual model that illustrates how collective efficacy impacts community violence and related health outcomes. We begin by reviewing other approaches to community violence prevention, including criminal justice and developmental approaches. We then discuss how collective efficacy works and why it matters, including theoretical and empirical research explaining collective efficacy and its impact on community violence and health. We then discuss a research-based intervention that social workers can use to facilitate collective efficacy, including our conceptual model and the key components of the intervention. Finally, we discuss implications for social workers who are working with communities to address violence and related health issues.
... 37,57,62 For example, trust may influence a neighborhood's ability to protect against environmental hazards and benefit from resources, and may encourage pro-health communication that decreases asthma risk and improves asthma management. 67,68 Similarly, aspects of trust have been proposed as a mechanism through which neighborhoods affect educational outcomes through monitoring or sanctioning of certain behaviors that maintain social order according to shared norms and values of the neighborhood. 38 Through repeated interactions, neighborhood residents build a foundation of mutual respect and responsibility that make it more likely that community members will share norms and values that create an environment that supports education. ...
Community schools link students, families, and communities to educate children and strengthen neighborhoods. They have become a popular model for education in many US cities in part because they build on community assets and address multiple determinants of educational disadvantage. Since community schools seek to have an impact on populations, not just the children enrolled, they provide an opportunity to improve community health. Community schools influence the health and education of neighborhood residents though three pathways: building trust, establishing norms, and linking people to networks and services. Through such services as school-based health centers, nutrition education, family mental health counseling, violence prevention, and sexuality education, these schools build on the multiple reciprocal relationships between health and education. By developing closer ties between community schools and neighborhood health programs, public health professionals can help to mobilize a powerful new resource for reducing the health and educational inequalities that now characterize US cities. We suggest an agenda for research, practice, and policy that can build the evidence needed to guide such a strategy.
... The final variable for analysis consisted of the total number of different issues reported. Lastly, neighborhood social cohesion was assessed by measuring the respondent's level of agreement (on a 5-point Likert type scale) with a set of questions proposed by Cagney and colleagues [44]: 1) "People around here are willing to help their neighbors"; 2) "This is a close-knit neighborhood"; 3) "People in this neighborhood can be trusted"; and 4) "People in this neighborhood generally don't get along with each other" (reverse coded). These questions were then summed to provide a total score, where higher scores indicated higher neighborhood social cohesion. ...
Background
Adverse childhood experiences (ACE) have been previously linked to quality of life, health conditions, and life expectancy in adulthood. Less is known about the potential mechanisms which mediate these associations. This study examined how ACE influences adult health-related quality of life (HRQoL) in a low-income community in Florida.
Methods
A community-based participatory needs assessment was conducted from November 2013 to March 2014 with 201 residents of Tampa, Florida, USA. HRQoL was measured by an excessive number of unhealthy days experienced during the previous 30-day window. Mediation analyses for dichotomous outcomes were conducted with logistic regression. Bootstrapped confidence intervals were generated for both total and specific indirect effects.
Results
Most participants reported ‘good to excellent health’ (76 %) and about a fourth reported ‘fair to poor health’ (24 %). The mean of total unhealthy days was 9 days per month (SD ±10.5). Controlling for demographic and neighborhood covariates, excessive unhealthy days was associated with ACE (AOR = 1.23; 95 % CI: 1.06, 1.43), perceived stress (AOR = 1.07; 95 % CI: 1.03, 1.10), and sleep disturbance (AOR = 8.86; 3.61, 21.77). Mediated effects were significant for stress (β = 0.08) and sleep disturbances (β = 0.11) as they related to the relationship between ACE and excessive unhealthy days.
Conclusion
ACE is linked to adult HRQoL. Stress and sleep disturbances may represent later consequences of childhood adversity that modulate adult quality of life.
... There is also growing evidence that stronger perceived collective efficacy within neighborhoods is associated with better child and adolescent behavioral and health outcomes (Sternthal et al., 2010;Kim, 2010;Browning et al., 2004;Cagney & Browning, 2004), and better self-reported overall health (Browning & Cagney, 2002). Less is known, however, about how perceived neighborhood factors shape substance use behavior and furthermore, results vary widely across studies. ...
Background
This study examines the association between perceived neighborhood violence, perceived neighborhood collective efficacy, and binge drinking among Mexican Americans residing on the U.S.–Mexico border.Methods
Data were collected from a multistage cluster sample of adult Mexican Americans residing in the U.S.–Mexico border areas of California, Arizona, New Mexico, and Texas (N = 1,307). The survey weighted response rate was 67%. Face-to-face interviews lasting approximately 1 hour were conducted in respondents' homes in English or Spanish. Path analysis was used to test whether collective efficacy mediated the impact of perceived neighborhood violence on binge drinking.ResultsAmong 30+-year-old women, perceived neighborhood collective efficacy mediated the effects of perceived neighborhood violence on binge drinking in a theoretically predicted way: Lower perceptions of violence predicted an increased perception of collective efficacy, which in turn, predicted less binge drinking. Direct effects of violence perceptions on binge were nonsignificant. Younger 18- to 29-year-old women showed a similar (but nonsignificant) pattern of effects. Perceived collective efficacy also mediated the effects of perceived violence on binge drinking among men, but in opposite ways for older and younger men. Older men showed the same mediating effect as older women, but the effect reversed among younger men due to a strong, positive relation between collective efficacy and binge drinking. There were also age differences in the direct effect of violence perceptions on binge drinking: Perceptions of violence predicted more binge drinking among young men, but less among older men.Conclusions
These results highlight the complexity of people's responses to neighborhood characteristics in regard to their drinking. Young men in particular seem to react very differently to perceptions of collective efficacy than other groups. However, among both men and women, collective efficacy may come to play an increasingly important protective role in health outcomes with age.
... Studies have found associations between specific neighborhood characteristics and cardiovascular disease, 1 self-rated health, 2 walking and other forms of physical activity, 3 obesity, 4-8 lower-body functional limitations, 9,10 symptoms of depression, anxiety, and conduct disorders. [11][12][13] , asthma, 14,15 and crime and violence. 1,16,17 Neighborhood environment studies present practical challenges, especially in studies using large and geographically dispersed samples. ...
BACKGROUND: Research indicates that neighborhood environment characteristics such as physical disorder influence health and health behavior. In-person audit of neighborhood environments is costly and time-consuming. Google Street View may allow auditing of ...
... Mutual trust and solidarity are lower in areas with residential instability, low socioeconomic level, high degree of urbanization and heterogeneous populations, and informal social control and support are less available (Shaw & McKay, 1942;McCulloch, 2003Sampson, 2012). Lack of these resources in neighborhoods has been related to a range of adverse (mental) health outcomes in many studies (Morenoff, 2003;Cagney & Browning, 2004;De Silva et al. 2005). ...
Background:
Environmental factors such as urban birth and ethnic minority position have been related to risk for psychotic disorders. There is some evidence that not only individual, but also neighborhood characteristics influence this risk. The aim of this study was to investigate social disorganization of neighborhoods and incidence of psychotic disorders.
Method:
The research was a 7-year first-contact incidence study of psychotic disorders in The Hague. Neighborhood characteristics included continuous, dichotomous and cumulative measures of socio-economic level, residential mobility, ethnic diversity, proportion of single person households, voter turnout, population density and crime level. Using multilevel Poisson regression analysis, incidence rate ratios (IRRs) and 95% confidence intervals (CIs) of psychotic disorders were calculated for the indicators of neighborhood social disorganization.
Results:
A total of 618 incident cases were identified. Neighborhood socio-economic level and residential mobility had the strongest association with incidence of psychotic disorders [individual-level adjusted Wald χ2 1 = 13.03 (p = 0.0003) and 5.51 (p = 0.02), respectively]. All but one (proportion of single person households) of the dichotomous neighborhood indicators were significantly associated with a higher IRR. The cumulative degree of neighborhood social disorganization was strongly and linearly associated with the incidence of psychotic disorders (trend test, Wald χ2 5 = 25.76, p = 0.0001). The IRR in neighborhoods with the highest degree of social disorganization was 1.95 (95% CI 1.38-2.75) compared with the lowest disorganization category.
Conclusions:
The findings suggest that the risk for developing a psychotic disorder is higher for people living in socially disorganized environments. Longitudinal studies are needed to investigate causality.
Importance:
Structural racism has been implicated in the disproportionally high asthma morbidity experienced by children living in disadvantaged, urban neighborhoods. Current approaches designed to reduce asthma triggers have modest impact.
Objective:
To examine whether participation in a housing mobility program that provided housing vouchers and assistance moving to low-poverty neighborhoods was associated with reduced asthma morbidity among children and to explore potential mediating factors.
Design, setting, and participants:
Cohort study of 123 children aged 5 to 17 years with persistent asthma whose families participated in the Baltimore Regional Housing Partnership housing mobility program from 2016 to 2020. Children were matched to 115 children enrolled in the Urban Environment and Childhood Asthma (URECA) birth cohort using propensity scores.
Exposure:
Moving to a low-poverty neighborhood.
Main outcomes:
Caregiver-reported asthma exacerbations and symptoms.
Results:
Among 123 children enrolled in the program, median age was 8.4 years, 58 (47.2%) were female, and 120 (97.6%) were Black. Prior to moving, 89 of 110 children (81%) lived in a high-poverty census tract (>20% of families below the poverty line); after moving, only 1 of 106 children with after-move data (0.9%) lived in a high-poverty tract. Among this cohort, 15.1% (SD, 35.8) had at least 1 exacerbation per 3-month period prior to moving vs 8.5% (SD, 28.0) after moving, an adjusted difference of -6.8 percentage points (95% CI, -11.9% to -1.7%; P = .009). Maximum symptom days in the past 2 weeks were 5.1 (SD, 5.0) before moving and 2.7 (SD, 3.8) after moving, an adjusted difference of -2.37 days (95% CI, -3.14 to -1.59; P < .001). Results remained significant in propensity score-matched analyses with URECA data. Measures of stress, including social cohesion, neighborhood safety, and urban stress, all improved with moving and were estimated to mediate between 29% and 35% of the association between moving and asthma exacerbations.
Conclusions and relevance:
Children with asthma whose families participated in a program that helped them move into low-poverty neighborhoods experienced significant improvements in asthma symptom days and exacerbations. This study adds to the limited evidence suggesting that programs to counter housing discrimination can reduce childhood asthma morbidity.
Background:
Research suggests demographic, economic, residential, and health-related factors influence vulnerability to environmental exposures. Greater environmental vulnerability may exacerbate environmentally-related health outcomes. We developed a neighborhood environmental vulnerability index (NEVI) to operationalize environmental vulnerability on a neighborhood-level.
Objective:
We explored the relationship between NEVI and pediatric asthma emergency department (ED) visits (2014-2019) in three US metropolitan areas: Los Angeles (LA) County, California (CA); Fulton County, Georgia (GA); and New York City (NYC), New York (NY).
Methods:
We performed separate linear regression analyses examining the association between overall NEVI score and domain-specific NEVI scores (demographic, economic, residential, health status) with pediatric asthma ED visits (per 10,000) across each area.
Results:
Linear regression analyses suggest that higher overall and domain-specific NEVI scores were associated with higher annual pediatric asthma ED visits. Adjusted R-squared values suggest that overall NEVI scores explained at least 40% of the variance in pediatric asthma ED visits. Overall NEVI scores explained more of the variance in pediatric asthma ED visits in Fulton County. NEVI scores for the demographic, economic, and health status domains explained more of the variance in pediatric asthma ED visits in each area, compared to the NEVI score for the residential domain.
Conclusion:
Greater neighborhood environmental vulnerability was associated with greater pediatric asthma ED visits in each area. The relationship differed in effect size and variance explained across the areas. Future studies can use NEVI to identify populations in need of greater resources to mitigate the severity of environmentally-related outcomes, such as pediatric asthma.
Background:
Rates of asthma-related emergency department visits have been shown to vary significantly by place (i.e. neighborhood) and race/ethnicity. The moderating factors of asthmatic events among Hispanic/Latino-specific populations are known to a much lesser degree.
Objective:
To assess the extent to which housing moderates the effect of poverty on Hispanic/Latino-specific asthma-related emergency department (ED) visits at an ecological level.
Methods:
Using data from the Office of Statewide Health Planning and Development (OSHPD) and the 2016-2017 U.S. Census, a cross-sectional ecological analysis at the census tract-level was conducted. Crosswalk files from the U.S. Department of Housing and Urban Development were used to associate zip codes to census tracts. Negative binomial regression was used to estimate rate ratios.
Results:
The effect of poverty on asthma-related ED visits was significantly moderated by the median year of housing structures built. The effect of mid-level poverty (RR = 1.57, 95% CI 1.27, 1.95) and high-level poverty (RR = 1.47, 95% CI 1.22, 1.78) in comparison to low-level poverty, was significantly greater among census tracts with housing built prior to 1965 in comparison to census tract with housing built between 1965 and 2020.
Conclusion:
Communities with older housing structures tend to be associated with increased Hispanic/Latino ED visits apart from affluent communities.
Despite a growing evidence base documenting associations between neighborhood characteristics and the risk of developing high blood pressure, little work has established the role played by neighborhood social organization exposures in racial/ethnic disparities in hypertension risk. There is also ambiguity around prior estimates of neighborhood effects on hypertension prevalence, given the lack of attention paid to individuals' exposures to both residential and nonresidential spaces. This study contributes to the neighborhoods and hypertension literature by using novel longitudinal data from the Los Angeles Family and Neighborhood Survey to construct exposure-weighted measures of neighborhood social organization characteristics-organizational participation and collective efficacy-and examine their associations with hypertension risk, as well as their relative contributions to racial/ethnic differences in hypertension. We also assess whether the hypertension effects of neighborhood social organization vary across our sample of Black, Latino, and White adults. Results from random effects logistic regression models indicate that adults living in neighborhoods where people are highly active in informal and formal organizations have a lower probability of being hypertensive. This protective effect of exposure to neighborhood organizational participation is also significantly stronger for Black adults than Latino and White adults, such that, at high levels of neighborhood organizational participation, the observed Black-White and Black-Latino hypertension differences are substantially reduced to nonsignificance. Nonlinear decomposition results also indicate that almost one-fifth of the Black-White hypertension gap can be explained by differential exposures to neighborhood social organization.
This study aims to investigate the joint effect of neighborhood disadvantages on asthma prevalence and evaluate whether individual-level variables protect residents against neighborhood disadvantages. Data from the Chicago Multiethnic Prevention and Surveillance Study between 2013 and 2020 were analyzed. Eight neighborhood characteristics were measured using the Chicago Health Atlas, including neighborhood unsafety, limited access to healthy food, neighborhood alienation, severe rent-burden, vacant housing, single-parent household, neighborhood poverty, and unemployment. A structured questionnaire measured asthma diagnosis (childhood or adulthood) and individual-level variables including sex, age, income, education, and race. Weighted quantile sum (WQS) regression was used to evaluate the impact of neighborhood disadvantages. Stratified analysis was performed by income and education. A total of 6592 participants (mean age: 53.5±11.1) were included. Most of the study population were non-Hispanic black (82.5%) and reported an annual household income <$15,000 (53%). Asthma prevalence was 23.6%. The WQS index, which represents the overall neighborhood disadvantages, was associated with asthma prevalence (odds ratio = 1.10, 95% CI: 1.03, 1.18) when adjusted for individual-level confounders. Neighborhood poverty contributed 40.8% to the overall impact, followed by vacant housing (23.1%) and neighborhood alienation (22.9%). When stratified by individual-level income or education, no difference was observed for the association between WQS index and asthma prevalence.
INACITY is a platform that integrates Geo-located Imagery Databases (GIDs), Geographical Information Systems (GIS), digital maps, and Computer Vision (CV) to collect and analyze urban street-level images. The platform’s software architecture is a client–server model, where the client-side is a simple Web page that allows the user to select regions of a map and select filters to analyze and visualize urban features. The server side is a Django-powered Web service with PostgreSQL and Neo4j databases. Users can select a region of a map, an image filter, and geographical features to analyze relevant urban characteristics as trees, for instance, using the platform. An open-source implementation of the platform is available. The architecture is extensible, and it is easy to add new modules or replace the existing ones with new digital maps, GIS databases, other CV filters, or other GIDs.
Introduction:
Individual-level socioeconomic status (SES) has been shown to be an important determinant of lung function. Neighborhood level SES factors may increase psychological and physiologic stress and may also reflect other exposures that can adversely affect lung function, but few studies have considered neighborhood factors.
Objective:
Our aim was to assess the association between neighborhood-level SES and lung function.
Methods:
We cross-sectionally analyzed 6168 spirometry test results from participants in the Gulf long-term Follow-up Study, a large cohort of adults enrolled following the largest maritime oil spill in US history. Outcomes of interest included the forced expiratory volume in one second (FEV1; mL), the forced vital capacity (FVC; mL), and the FEV1/FVC ratio (%). Neighborhood deprivation was measured by linking participant home addresses to an existing Area Deprivation Index (ADI) and categorized into quartiles. Individual-level SES measures were collected at enrollment using a structured questionnaire and included income, educational attainment, and financial strain. We used multilevel regression to estimate associations between ADI quartiles and each lung function measure.
Results:
Greater neighborhood deprivation was associated with lower FEV1: βQ2vsQ1: 30 mL (95% CI: 97, 36), βQ3vsQ1: 70 mL (95% CI: 135, -4) and βQ4vsQ1: 104 mL (95% CI: 171, -36). FVC showed similar patterns of associations with neighborhood deprivation. No associations with the FEV1/FVC ratio were observed.
Conclusion:
Neighborhood deprivation, a measure incorporating economic and other stressors, was associated with lower FEV1 and FVC, with magnitudes of associations reaching clinically meaningful levels. The impact of this neighborhood SES measure persisted even after adjustment for individual-level SES factors.
Objectives
Uncontrolled asthma may be life-threatening. Poor understanding of disease process and appropriate medication use appears to influence community attitude in facing asthmatic patients in an emergency, thereby contributing to increasing the risk of mortality. This study aimed to analyze community-level knowledge about asthma and attitude towards asthma management.
Methods
This observational, cross-sectional study was conducted among the community in Gresik, Indonesia, from March to July 2019. Participants included in this study were adults, who could read, write, and communicate well. Data were collected through questionnaires to evaluate the level of knowledge and attitude towards asthma.
Results
In total, 100 respondents were selected with 91% of women, with a mean age of 49.11 ± 14.42 years and with various levels of education. The respondents had good knowledge by getting a score of 76%. Knowledge regarding recognition of asthma symptoms was scored the highest (83%). However, knowledge about medication use for asthma was lacking, especially in identifying the medicine choice (21%) and inhaler use (48%). The respondents also showed a ‘positive’ attitude with a score of 89%. Most respondents (72%) agreed that when inhaled drugs were unable to relieve the asthma attack, they need to bring the patient to a hospital.
Conclusions
The level of respondent’s knowledge in recognizing asthma symptoms was good, but there were misconceptions about asthma medication, especially in inhaler use. Overall, the respondents had a positive attitude towards asthma perception and management.
Residing in neighborhoods characterized by objective measures of disadvantage has been associated with poorer health outcomes, above and beyond individual characteristics. This study tests a partial mediational model by which the association between neighborhood disadvantage (census-level poverty, undereducation, and unemployment), and the volume of weekly alcohol consumption, binge drinking, and alcohol use disorder (AUD) among Puerto Ricans in San Juan, Puerto Rico, is partially mediated by perceived neighborhood collective efficacy (social cohesion and social control). Data are from a household random sample of 1,510 adults in San Juan, Puerto Rico (response rate, 83%). The direct effect of collective efficacy on the alcohol-related outcomes was not statistically significant. Census-level education and unemployment had no direct influence on collective efficacy. For both men and women, there were no indirect effects of the three census-level indicators of disadvantage on collective efficacy and, in turn, on binge drinking, weekly consumption, and lifetime or past-year AUD. Men residing in areas with high undereducation were less likely to report past-year AUD, and women living in these areas were less likely to report lifetime AUD. Women residing in high poverty areas also reported higher rates of lifetime AUD. The effect of neighborhood disadvantage on drinking outcomes was not explained by collective efficacy. Other factors such as family cohesion or social support may be more important than collective efficacy in mediating the effects of neighborhood disadvantage on drinking outcomes in Puerto Rico. © 2019 2019 Global Alliance for Behavioral Health and Social Justice.
In this article, we seek to identify whether the relationship between health disparities and crime occurs at a micro-geographic level. Do hot spot streets evidence much higher levels of mental and physical illness than streets with little crime? Are residents of crime hot spots more likely to have health problems that interfere with their normal daily activities? To answer these questions, we draw upon a large National Institutes of Health study of a sample of hot spots and non-hot spots in Baltimore, Maryland. This is the first study we know of to report on this relationship, and accordingly, we present unique descriptive data. Our findings show that both physical and mental health problems are much more likely to be found on hot spot streets than streets with little crime. This suggests that crime hot spots are not simply places with high levels of crime, but also places that evidence more general disadvantage. We argue that these findings have important policy implications for the targeting of health services and for developing proactive prevention programs.
Objectives
This study estimated the health impacts of neighbourhood socioeconomic position (SEP) among public housing residents. Because applicants to public housing were assigned to housing projects primarily based on factors other than personal choice, we capitalised on a quasirandom source of variation in neighbourhood of residence to obtain more valid estimates of the health impacts of neighbourhood SEP.
Design
Quasiexperimental study.
Setting
Greater Metropolitan Toronto area, Canada.
Participants
Residents (24 019–28 858 adults age ≥30 years in 1994 for all outcomes except for asthma, for which the sample was expanded to 66 627 individuals age ≥4 years) of public housing on 1 January 1994.
Outcome measures
Incident hypertension, diabetes, asthma, and acute myocardial infarction (MI) and all-cause mortality between 1 January 1994 and 31 December 2006. We used multivariate Cox proportional hazards models to estimate hazard ratios (HRs) for the associations between the quartile of census tract-level SEP and the risk of diagnosis of each health outcome as well as death from any cause.
Results
Living in a public housing project in the second highest neighbourhood SEP quartile (Q3) was associated with lower hazards of acute MI (HR=0.76, 95% CI 0.54 to 1.07; P=0.11), incident asthma (HR=0.80, 95% CI 0.67 to 0.96; P=0.02) and all-cause mortality (HR=0.86, 95% CI 0.73 to 1.01; P=0.06) compared to living in the lowest neighbourhood SEP quartile (Q1), although only the trend for incident asthma reached statistical significance (P for trend=0.04). By contrast, the associations corresponding to living in the highest versus lowest quartile of median household income (Q4 vs Q1) were neither consistent in direction nor significant. The inconsistent associations may partly be attributed to selection and status incongruity.
Conclusion
This study provides new evidence compatible with protective influences of higher neighbourhood SEP on health outcomes, particularly asthma.
Background:
California's San Joaquin Valley is a region with a history of poverty, low health care access, and high rates of pediatric asthma. It is important to understand the potential barriers to care that challenge vulnerable populations.
Objective:
The objective was to describe pediatric asthma-related utilization patterns in the emergency department (ED) and hospital by insurance coverage as well as to identify contributing individual-level indicators (age, sex, race/ethnicity, and insurance coverage) and neighborhood-level indicators of health care access.
Methods:
This was a retrospective study based on secondary data from California hospital and ED records 2007-2012. Children who used services for asthma-related conditions, were aged 0-14 years, Hispanic or non-Hispanic white, and resided in the San Joaquin Valley were included in the analysis. Poisson multilevel modeling was used to control for individual- and neighborhood-level factors.
Results:
The effect of insurance coverage on asthma ED visits and hospitalizations was modified by the neighborhood-level percentage of concentrated poverty (RR = 1.01, 95% CI = 1.01-1.02; RR = 1.03, 95% CI = 1.02-1.04, respectively). The effect of insurance coverage on asthma hospitalizations was completely explained by the neighborhood-level percentage of concentrated poverty.
Conclusions:
Observed effects of insurance coverage on hospital care use were significantly modified by neighborhood-level measures of health care access and concentrated poverty. This suggests not only an overall greater risk for poor children on Medi-Cal, but also a greater vulnerability or response to neighborhood social factors such as socioeconomic status, community cohesiveness, crime, and racial/ethnic segregation.
There is substantial evidence linking child health and neighborhood of residence. However, most studies focus on poverty, paying less attention to other social and environmental factors that vary across low-income neighborhoods. Using data from the Making Connections initiative, we examine the relationship between child health and neighborhood factors, including safety, social cohesion, informal social control, collective efficacy, disorder, and poverty, across a sample of children living in low-income neighborhoods (N = 3,013). We use multilevel modeling to account for clustering at the household and block level. Results show that neighborhood disorder is related to child health in an unexpected direction: More disorder is related to lower odds of a child having fair or poor health. Similarly, informal social control and safety are related to greater odds of child fair or poor health. We underscore the importance of neighborhood conditions for child health and highlight the unexpected direction of these relationships.
Research on collective efficacy in urban neighborhoods has focused predominantly on whether a community can regulate local behavior and spaces and less on how they do so. This study pursues the latter question by examining the social regularities that create collective efficacy, measured as the behavioral composition of a neighborhood (i.e., the extent to which each individual contributes to a social regularity). This perspective is applied to the database of requests for non-emergency government services received by Boston, MA's 311 system in 2011 (>160,000 requests). The analysis categorized custodians who have used the system to combat physical disorder in the public space (e.g., requesting graffiti removal) into two groups—“typical custodians” who have made one or two requests in a year, and “exemplars” who have made three or more. A neighborhood's collective efficacy in reporting public issues was identified through audits of sidewalk quality and streetlight outages. Analyses revealed a collaborative model of maintenance in which typical and exemplar custodians were each necessary and non-substitutable. A second analysis found that the two types of custodian were associated with different contextual factors, articulating two different pathways from demographic and social characteristics to collective efficacy, suggesting implications for theory and practice.
Objective:
Childhood asthma is a major public health problem and its development is multifactorial. We examined whether neighborhood cohesion and disorder were associated with caregiver-report of asthma at age 5 years.
Methods:
This study is a secondary data analysis of the 2011-2012 United States National Survey of Children's Health. Data were available for 4680 children, age 5 years old born at term or preterm with birthweight >2500 g. Neighborhood disorder and cohesion were assessed based on caregivers' responses to validated questionnaires. Child asthma diagnosis was reported by the caregiver. Multivariable logistic regression was used to examine the relationship between these neighborhood factors and caregiver-report of child asthma, while accounting for individual level covariates.
Results:
Approximately two-thirds of the 4680 children were White and lived in households with income >400% of federal poverty line. Asthma was present in 399 (9%) children. Child female sex was associated with reduced risk of caregiver-reported asthma while non-Hispanic Black race and having smokers in the household were independently associated with increased risk in multivariable models. In these models, neighborhood disorder was significantly associated with asthma (adjusted Odds Ratio [aOR] 1.70, 95% Confidence Interval [CI] 1.04-2.78), while neighborhood cohesion was not (aOR 0.93, 95% CI 0.51-1.68).
Conclusion:
Even after adjustment for several individual level factors, neighborhood disorder was associated with caregiver-report of asthma in this nationally representative sample of 5-year-old children. Further research is needed to better understand how risk factors at different levels of the socio-ecological framework may interact to affect childhood asthma development.
This chapter focuses on what is known about socioeconomic disparities (SES) in child health and different types of exposures during childhood, in utero, and from the previous generation that may contribute to those disparities. SES disparities in child health appear to be substantial, begin at very young ages, persist, and compound over the lifecourse. Few types of exposures specifically during childhood appear to be promising explanations for observed linkages between SES and child health, although neighborhood and city characteristics, environmental toxins, parent behaviors, and children’s epigenetic responses to exposures deserve more scrutiny. An increasing number of studies point to the importance of in utero and intergenerational exposures, suggesting that health disparities emerge earlier than previously thought. Maternal nutrition (in utero, prior to conception, and during the mother’s own fetal development and childhood) is a promising area of research for understanding SES disparities in child health, as are prenatal and preconceptional exposures to toxins through occupations and residential environments. For significant advances to be made in understanding health disparities among both children and adults, we need a better conceptualization of the process leading to health disparities, more knowledge about determinants of health, and better conceptualization and measurement of health, particularly among children.
We draw on theories of neighborhood social organization and environmental stress in an effort to explain variation in cardiovascular risk in a large urban population. We focus on the role of rapid increases in the crime rate (“crime spikes”) in influencing an indicator of inflammatory processes related to cardiovascular health – C-reactive protein (CRP). Employing data from the Dallas Heart Study (2000–2002), a large-scale probability study of adults aged 18–65 years old, we examine the association between measures of census tract level burglary rates and CRP. Neighborhood fixed effects models reveal that both changes in the overall prior-year burglary rate and short-term change in the burglary rate between the first and last 6 months of the prior year are positively associated with CRP. Above a threshold of four burglaries per 1,000 population, a one burglary increase in the short-term burglary rate change measure is associated with a 9% increase in CRP, net of individual controls, time-invariant neighborhood characteristics, and calendar month. These findings offer additional evidence supporting the hypothesis that contextual stressors have implications for cardiovascular health and suggest that short-term changes in environmental stressors may independently shape health risk outcomes.
Informal social control is considered a vital component of the well-being of urban communities. Though some argue that the actions that constitute this social process are often said to reflect territoriality, little else is known about how individuals contribute to it. The current study leverages a database of over 600,000 requests for government services received by the city of Boston, MA's 311 system as a way to answer such questions, focusing particularly on reports of issues in the public space arising from incivilities. In order to establish construct validity for the “big data” of the 311 system, they are combined with the “small data” of a survey of 311 users, permitting the simultaneous analysis of objective reporting behaviors with self-report attitudes. The analysis occurs in two parts. First, reporting of incivilities is distinguished behaviorally from reporting public issues arising from natural deterioration, and people are found to specialize in one or the other. Second, the survey is used to test whether the reports are a reflection of territoriality. Reports of incivilities were unique in their association with a desire to enforce local social norms. They were also associated with a second territorial motivation to benefit the community. Implications for future research are discussed.
Purpose Transitioning to independence may be problematic for persons with spina bifida (SB). Experiences of young persons with SB may provide insights into this group's needs for support. Therefore, the aim of this study was to investigate children's and adolescents' experiences of living with SB, their social and emotional adjustment, and their thoughts about becoming independent adults. Method Semi-structured interviews were conducted with young persons with SB (N = 8, age range 10-17 years). Social and emotional problems were assessed using Beck Youth Inventories. The interview transcripts were analyzed using qualitative content analysis. Results Three main themes were found: being a person with SB; everyday living as a person with SB; and preparing for life as an adult with SB. Indications of emotional and social problems were most prominent among participants with milder physical disability. Conclusions The findings indicate that young persons with SB may overestimate their independence. Other potentially problematic areas were lack of motivation, planning and preparedness for becoming independent. Research on transition to independence in this group should consider assistance at an early age in planning and executing strategies for independence. In addition, the potentially difficult situation for young persons with mild SB should be investigated further. Implications for rehabilitation Children and adolescents with spina bifida might lack the motivation and skills for planning their future and health care programmes should therefore include preparations for life as an adult. Clinical assessment of the level of independence should specifically distinguish between the activities they know how to do and what tasks they actually execute independently. Routine follow-ups should include screening for problems with social and emotional adjustment. Be aware of a potential condition-severity paradox whereby those with less severe impairment might have an increased risk of developing symptoms of social and emotional problems.
Although health researchers have made progress in detecting place effects on health, existing work has largely focused on the local residential neighborhood and has lacked a temporal dimension. Little research has integrated both time and space to understand how exposure to multiple contexts - where adults live, work, shop, worship, and seek healthcare - influence and shape health and well-being. This study uses novel longitudinal data from the Los Angeles Family and Neighborhood Survey to delve deeper into the relationship between context and health by considering residential and activity space neighborhoods weighted by the amount of time spent in these contexts. Results from multilevel cross-classified logistic models indicate that contextual exposure to disadvantage, residential or non-residential, is independently associated with a higher likelihood of reporting poor or fair health. We also find support for a contextual incongruence hypothesis. For example, adults living in the most disadvantaged neighborhoods are more likely to report poor or fair health when they spend time in more advantaged neighborhoods than in more disadvantaged ones, while residents of more advantaged neighborhoods report worse health when they spend time in more disadvantaged areas. Our results suggest that certain types of place-based cumulative exposures are associated with a sense of relative neighborhood deprivation that potentially manifests in worse health ratings.
Background:
We used an expanded conceptualization of ethnic density at the neighborhood level, tailored to Hispanic majority communities in the USA, and a robust measure of children's acculturation at the individual level, to predict Hispanic children's respiratory health.
Methods:
We conducted a cross-sectional survey of 1904 children in 2012 in El Paso, TX, USA. One thousand one hundred and seven Hispanic children nested within 72 census tracts were analyzed. Multilevel logistic regression models with cross-level interactions were used to predict bronchitis, asthma and wheezing during sleep.
Results:
A neighborhood-level ethnic density factor was a non-significant risk factor while individual-level acculturation was a significant risk factor for the three outcomes. Pest troubles and not having been breastfed as an infant intensified the positive association between ethnic density and bronchitis. Increases in ethnic density intensified the odds of wheezing in sleep if the child was not low birth weight or was not economically deprived.
Conclusions:
Results suggest that increasing individual-level acculturation is detrimental for US Hispanic children's respiratory health in this Hispanic majority setting, while high ethnic density neighborhoods are mildly risky and pose more significant threats when other individual-level factors are present.
To describe the use of a clinically enhanced maternal and child health (MCH) database to strengthen community-engaged research activities, and to support the sustainability of data infrastructure initiatives.
Population-based, longitudinal database covering over 2.3 million mother-infant dyads during a 12-year period (1998-2009) in Florida.
A community-based participatory research (CBPR) project in a socioeconomically disadvantaged community in central Tampa, Florida.
Case study of the use of an enhanced state database for supporting CBPR activities.
A federal data infrastructure award resulted in the creation of an MCH database in which over 92 percent of all birth certificate records for infants born between 1998 and 2009 were linked to maternal and infant hospital encounter-level data. The population-based, longitudinal database was used to supplement data collected from focus groups and community surveys with epidemiological and health care cost data on important MCH disparity issues in the target community. Data were used to facilitate a community-driven, decision-making process in which the most important priorities for intervention were identified.
Integrating statewide all-payer, hospital-based databases into CBPR can empower underserved communities with a reliable source of health data, and it can promote the sustainability of newly developed data systems.
© Health Research and Educational Trust.
Despite improved treatment regimens for asthma, the prevalence and morbidity from asthma are increasing, especially among underserved, minority children.
The purpose of this study was to identify barriers to the treatment of asthma among urban, minority children as perceived by parents.
Parents were recruited from 4 schools located in low-income, urban areas with high rates of asthma hospitalizations. Focus groups involving parents of children 5 to 12 years old with asthma were conducted using a standardized questionnaire. Parents' comments were analyzed to identify barriers, and 3 independent raters coded parents' comments to assess reliability of interpretation.
Forty parents who represented 47 children participated in the focus groups. All parents described their racial background as black. Parents' average age was 36.8 years, 92% were females, 70% were nonmarried, and 38% had less than a high school education. Forty-five percent of children had intermittent or mild asthma and 55% had moderate to severe asthma. The most frequent types of barriers identified by parents were patient or family characteristics (43%), followed by environmental (28%), health care provider (18%), and health care system (11%). Parents were specifically concerned about the use, safety and long-term complications of medications, the impact of limitation of exercise on their child's quality of life, and their own quality of life.
In contrast with the widespread beliefs that access to medical care, health insurance, and continuity of care are the major barriers to quality asthma care, the barriers most frequently reported by parents were related to patient and family characteristics, health beliefs, or to their social and physical environment. To improve asthma management and health outcomes for urban, minority children with asthma, it is critical to tailor education about asthma and its treatment, and address quality of life issues for both children and parents.
To investigate the possibility of gender specificity for the effect of body mass index (BMI) on development of asthma, the authors used the longitudinal data from the first and second cycles of the National Population Health Survey, conducted in Canada in 1994-1995 and 1996-1997, respectively. Data from 9,149 subjects (4,266 men and 4,883 women) aged 20-64 years who reported no asthma at baseline were used in this analysis. The 2-year cumulative incidence of asthma was estimated by using a bootstrap procedure to take sampling weights and design effects into account. During the 2-year study period, 1.6% of the men and 2.9% of the women developed asthma. Average changes in body weight and BMI over the 2-year observation period were relatively small and were not associated with asthma incidence. However, baseline BMI was a significant predictor for asthma incidence in women. The adjusted odds ratio for women whose baseline BMI was at least 30.0 kg/m(2) versus 20.0-24.9 kg/m(2) was 1.9 (95% confidence interval: 1.1, 3.4), whereas the corresponding odds ratio of 1.1 (95% confidence interval: 0.3, 3.6) for men was not significantly different from unity. The authors concluded that obesity was related to development of asthma in women but not in men.
The rising prevalence of asthma in developed nations may be associated with the rising prevalence of obesity in these same nations. The relationship between body mass index (BMI) and the development of an objective marker for asthma, methacholine airway hyperresponsiveness (AHR), was investigated in adult men.
Sixty one men who had no AHR at initial methacholine challenge testing but who developed AHR about 4 years later and 244 matched controls participated in the study. The effects of initial BMI and change in BMI on development of AHR were examined in conditional logistic regression models.
Initial BMI was found to have a non-linear relationship with development of AHR. Compared with men with initial BMI in the middle quintile, men with BMI in the lowest quintile (BMI=19.8-24.3 kg/m(2)) and those with BMI in the highest quintile (BMI >29.4 kg/m(2)) were more likely to develop AHR: OR=7.0 (95% CI 1.8 to 27.7) and OR=10.0 (95% CI 2.6 to 37.9), respectively. These results remained significant after controlling for age, smoking, IgE level, and initial FEV(1). In addition, there was a positive linear relationship between change in BMI over the period of observation and the subsequent development of AHR.
In this cohort of adult men, both a low BMI and a high BMI were associated with the development of AHR. For men with a low initial BMI the increased risk for development of AHR appears to be partly mediated by a gain in weight. The effect of BMI on AHR may suggest mechanisms in the observed associations between obesity and asthma.
Recent studies have suggested a relationship between asthma and obesity. Despite these reports, the effect of being underweight or overweight as a risk factor for airway obstructive diseases (AODs) is not clear.
To determine whether a relation of body mass index (BMI) to asthma, chronic bronchitis (CB), or emphysema exists (analysis 1), and, if so, whether the association between obesity and asthma is modified by gender (analysis 2).
Nested case-control study from the longitudinal cohort of the Tucson Epidemiologic Study of Airways Obstructive Diseases.
Analysis 1: physician-confirmed incident cases of asthma (n = 102), CB (n = 299), or emphysema (n = 72) who denied any prior AODs. Analysis 2: all 169 incident cases of asthma, regardless of any previous AODs, stratified by gender and by other potential effect modifiers. In both analyses, we selected only subjects at least 20 years old who had weight and height measured during the study.
BMI and other risk factors were assessed prior to the onset of the AOD (cases) or prior to the last completed survey (control subjects).
A diagnosis of emphysema was significantly associated with a BMI < 18.5 (odds ratio [OR], 2.97; 95% confidence interval [CI], 1.33 to 6.68, when compared to healthy control subjects). A BMI >/= 28 increased the risk of receiving a diagnosis of asthma (OR, 2.10; 95% CI, 1.31 to 3.36) and CB (OR, 1.80; 95% CI, 1.32 to 2.46). About 30% of the patients with asthma and 25% of the patients with CB (vs 16% of the control subjects, p < 0.001) were preobese or obese, regardless whether BMI was assessed before the diagnosis or before the onset of respiratory symptoms. The relation of elevated BMI to asthma was significant only among women.
Patients with emphysema are more likely to be underweight, and patients with CB are more likely to be obese. However, the temporal relationship between abnormal BMI and the onset of COPD is uncertain. Preobese and obese women are at increased risk of acquiring asthma. This relation, particularly if it is causal, has potentially relevant public health implications.
"The Truly Disadvantagedshould spur critical thinking in many quarters about the causes and possible remedies for inner city poverty. As policy makers grapple with the problems of an enlarged underclass they—as well as community leaders and all concerned Americans of all races—would be advised to examine Mr. Wilson's incisive analysis."—Robert Greenstein,New York Times Book Review "'Must reading' for civil-rights leaders, leaders of advocacy organizations for the poor, and for elected officials in our major urban centers."—Bernard C. Watson,Journal of Negro Education "Required reading for anyone, presidential candidate or private citizen, who really wants to address the growing plight of the black urban underclass."—David J. Garrow,Washington Post Book World Selected by the editors of theNew York Times Book Reviewas one of the sixteen best books of 1987. Winner of the 1988 C. Wright Mills Award of the Society for the Study of Social Problems.
: This article analyzes the main issues and arguments contained in The Truly Disadvantaged: The Inner City, the Underclass, and Public Policy, by William J. Wilson (Chicago: University of Chicago Press, 1987) and takes issue with several methodological aspects of the book. Although Wilson's emphasis on the specific problems of inner city residents is generally insightful and useful, his adherence to a traditional liberal public policy approach limits the practically, applicability, and consistency of many of his themes. A more pluralistic approach may provide a more methodologically fruitful avenue for analyzing the problems of the underclass and the inner city while yielding more effective policy categories such as liberal and conservative, scholars and analysts can better acknowledge the relative roles of both institutional and subjective elements in the urban environment.
The social structure and personality perspective provides a theoretical and analytical framework for understanding the persisting association between socioeconomic status (SES) and health outcomes. Current research suggests that health behaviors, stress, social ties, and attitudinal orientations are critical links between social structure and health status. These psychosocial factors are linked more strongly to health status than is medical care and are related systematically to SES. The social distributions of these factors represent the patterned response of social groups to the conditions imposed on them by social structure. Accordingly the elimination of inequalities in health status ultimately may require changes not only in psychosocial factors or health care delivery, but also in socioeconomic conditions. Research is needed that will identify the critical features of SES which determine health, delineate the mechanism and processes whereby social stratification produces disease, and specify the psychological and interpersonal processes that can intensify or mitigate the effects of social structure.
Introduction
The Chicago Community Asthma Survey (CCAS-32) is an instrument forcharacterizing the general public's knowledge, attitudes, and beliefsrelated to asthma. The purpose of this study was to examine the effectsof asthma experience and social demographic characteristics on asthmaawareness among the general public.
Methods
TheCCAS-32 consists of 21 dichotomous items, designed primarily to testasthma knowledge, and 11 Likert-scale items, focusing on asthmaattitudes and beliefs. From December 1997 through February 1998, arandom-digit dialing method was used to administer the CCAS-32 via atelephone survey of Chicago-area (seven-county) residents ≥ 18 years. Each respondent's asthma experience was classified as “person withasthma,” “family/household experience,” or “no/low asthmaexperience.” Demographic variables included sex, age, education, race/ethnicity, urban vs suburban residence, and income.
Results
Five hundred sixty-eight Chicago-area residentscompleted the survey (response rate of 40.6%). Of these, 43.3% wereaged 35 to 64 years, 71.3% were women, 66.7% were white, and 71.3%had completed at least some college. Sixty-two percent had no or lowasthma experience, 28.5% had family or household experience, and 9.5%were persons with asthma. The mean percentage (± SE) of correct, ordesirable, responses to asthma knowledge questions was 71.9 ± 0.5%,with a range from 31.9 to 95.1%. The mean percentage of desirableresponses differed significantly between persons with no or low asthmaexperience, family or household asthma experience, and persons withasthma (70.0 ± 0.6%, 74.0 ± 0.9%, and 77.7 ± 1.2%,respectively, p < 0.01 for trend). Social demographic factors alsoappeared to result in statistically significant differences in theresponses to many items. Of the demographic variables studied, age andeducation appeared to have the strongest effect on responses toknowledge items, with statistically significant differences inresponses seen for 10 (47.6%) and 8 (38.1%) of the 21 dichotomousitems. Race or ethnicity and education were each associated withdifferences in responses for 7 of the 11 Likert-scale items(63%).
Conclusions
The results of this study suggestthat the CCAS-32 can detect meaningful differences between groups withdifferent degrees of asthma experience (ie,discriminative validity). Using the CCAS-32, it may be possible toidentify subpopulations with differences in asthma awareness, thusproviding guidance for the design of messages to target community andpublic awareness of asthma.
This paper discusses problems that are common to both the epidemiologic risk-factor approach and the demographic variable-based approach to studying population health. We argue that there is a shared reluctance to move away from a narrow variable-based thinking that pervades both disciplines, and a tendency to reify the multivariate linear procedures employed in both disciplines. In particular, we concentrate on the difficulties generated by classical variable-based approaches that are especially striking when one neglects selection processes and the use of strategies to minimize its effects. We illustrate these difficulties in terms of the so-called “Hispanic Paradox”, which refers to comparative health advantages that some Hispanic groups appear to have. We find that much of what is conceived by demographers and epidemiologists as a paradox may not be paradoxical at all.
On Thursday, July 13, 1995, Chicagoans awoke to a blistering day in which the temperature would reach 106 degrees. The heat index, which measures how the temperature actually feels on the body, would hit 126 degrees by the time the day was over. Meteorologists had been warning residents about a two-day heat wave, but these temperatures did not end that soon. When the heat wave broke a week later, city streets had buckled; the records for electrical use were shattered; and power grids had failed, leaving residents without electricity for up to two days. And by July 20, over seven hundred people had perished-more than twice the number that died in the Chicago Fire of 1871, twenty times the number of those struck by Hurricane Andrew in 1992âin the great Chicago heat wave, one of the deadliest in American history. Heat waves in the United States kill more people during a typical year than all other natural disasters combined. Until now, no one could explain either the overwhelming number or the heartbreaking manner of the deaths resulting from the 1995 Chicago heat wave. Meteorologists and medical scientists have been unable to account for the scale of the trauma, and political officials have puzzled over the sources of the city's vulnerability. In Heat Wave, Eric Klinenberg takes us inside the anatomy of the metropolis to conduct what he calls a "social autopsy," examining the social, political, and institutional organs of the city that made this urban disaster so much worse than it ought to have been. Starting with the question of why so many people died at home alone, Klinenberg investigates why some neighborhoods experienced greater mortality than others, how the city government responded to the crisis, and how journalists, scientists, and public officials reported on and explained these events. Through a combination of years of fieldwork, extensive interviews, and archival research, Klinenberg uncovers how a number of surprising and unsettling forms of social breakdownâincluding the literal and social isolation of seniors, the institutional abandonment of poor neighborhoods, and the retrenchment of public assistance programsâcontributed to the high fatality rates. The human catastrophe, he argues, cannot simply be blamed on the failures of any particular individuals or organizations. For when hundreds of people die behind locked doors and sealed windows, out of contact with friends, family, community groups, and public agencies, everyone is implicated in their demise. As Klinenberg demonstrates in this incisive and gripping account of the contemporary urban condition, the widening cracks in the social foundations of American cities that the 1995 Chicago heat wave made visible have by no means subsided as the temperatures returned to normal. The forces that affected Chicago so disastrously remain in play in America's cities, and we ignore them at our peril.
Recent reports have identified New York City as having asthma mortality rates that are substantially higher than expected based on US rates. This study investigates the problems of asthma morbidity and mortality in New York City.
Data on asthma hospitalizations (1982 to 1986) and deaths (1982 to 1987) among persons aged 0 to 34 years were studied. Descriptive and multivariate techniques were used to examine differences in rates among subgroups and across geographic areas.
The average annual hospitalization rate was 39.2 per 10,000; the mortality rate was 1.2 per 100,000. Hospitalization and death rates among Blacks and Hispanics were 3 to 5.5 times those of Whites. Large geographic variations in hospitalizations and mortality occurred. Asthma hospitalization and mortality rates were highly correlated (r = .67), with the highest rates concentrated in the city's poorest neighborhoods. Household income, percentage of population Black, and percentage of population Hispanic were significant predictors of area hospitalization rates (adjusted R2 = .75).
These findings provide a basis for focusing investigations of the causes of variations in asthma outcomes and targeting interventions to reduce the disproportionate morbidity and mortality borne by poor and minority populations.
US asthma mortality rates have been increasing during the past 10 years. Little is known about the geographic variation of this infrequent health event. Using US vital records for the 1981-1985 period, small-area variation of excess asthma mortality of young adults was studied. Several geopolitical definitions were used to define populations. A total of 22 single counties, 12 metropolitan statistical areas, 11 health service areas, and 29 state economic areas were identified as having mortality significantly in excess of that expected, based on US race/sex-specific rates. Significant variation in asthma mortality was found at several levels of geopolitical classification of the data. Elevated areas included the central plains states and three large urban metropolitan areas--Chicago, Illinois, New York, New York, and Phoenix, Arizona--as well as a few mostly suburban populations. Areas with excess mortality may provide a useful population base for further epidemiologic investigation into the risk factors associated with the more frequent morbid events of this disease, such as emergency room and hospital utilization.
This study analyzes data from the Second National Health and Nutritional Examination Survey to determine whether black children are more likely to have asthma or wheeze, even after adjusting for environmental and socioeconomic exposures. For children 6 months to 11 yr of age, the unadjusted prevalence for asthma was 3.0% among white children and 7.2% among blacks; prevalence of frequent wheeze was 6.2% among whites and 9.3% among blacks. In a logistic regression model including race, age, and sex, the relative odds (RO) of asthma for black children as compared to white children were 2.5 (95% confidence interval [Cl], 1.9 to 3.4). Other predictors of asthma in a stepwise logistic regression included age, sex (boys versus girls, RO = 1.4), younger maternal age (2 standard deviation [SD] drop in age, RO = 1.4), residence in the central city (RO = 1.6), and family income (RO for the lowest versus highest tertile, RO = 1.7). After adjusting for these risk factors, age and sex, black children still had a 1.7 RO (95% Cl, 1.2 to 2.1) of having asthma. Frequent wheeze was associated with race (black versus white, RO = 1.6), sex (boys versus girls, RO = 1.3), birth weight (2 SD deficit in birth weight, RO = 1.4), and triceps skinfold thickness (increase in odds of asthma for 2 SD increase in skinfold, RO = 1.6). The significant effect of maternal age and birth weight after adjusting for other confounding variables suggests that the in utero environment may be an important determinant of asthma.(ABSTRACT TRUNCATED AT 250 WORDS)
To determine the patterns of chronic outpatient management in urban patients with moderate and severe asthma, and to assess medical practice adherence to the Guidelines for the Diagnosis and Management of Asthma from the National Asthma Education Program (NAEP).
This is a cross-sectional survey of adult patients with asthma admitted to the general medical services at the Johns Hopkins Medical Institutes (Johns Hopkins Hospital and Johns Hopkins Bayview Medical Center) Baltimore, Maryland. Subjects were 101 adults admitted with an asthma exacerbation from February 1992 through January 1993. Using a validated questionnaire, these subjects were surveyed within 48 hours of admission concerning their chronic outpatient medical management and the measures patients or their physicians took to alleviate symptoms during the asthma exacerbation leading to hospitalization.
The average asthma admission rate in the past year for this group of patients was 2.5, indicative of moderate to severe disease. Less than half of these patients had been prescribed inhaled anti-inflammatory therapy. Of the patients who had previously been shown the metered dose inhaler technique by a health care professional, 11% could perform all components of this technique correctly. Only 28% of patients had been given an action plan by their physician in the event of an acute exacerbation. Sixty percent of patients who contacted their physician during the exacerbation that preceded admission had no changes made in their treatment regimen. In those whose exacerbation lasted at least 24 hours, the average beta-agonist metered dose inhaler use during the 24 hour prior to admission was 44.8 +/- 7.8 puffs (mean +/- standard error of the mean). Older age, (current smoking, and race (black) were the most significant correlates of inhaled beta-agonist use during this period.
This is the first documentation of multiple problems in conforming with the standards of care delineated by the NAEP as they relate to the outpatient management of inner-city patients with moderate to severe asthma in the United States. In this population of patients with asthma, management was characterized by underutilization of anti-inflammatory therapy, inability to use inhalation devices properly, inadequate communication between patient and physician of an action plan to be utilized in the event of an acute exacerbation and inadequate physician intervention during the acute stages of the exacerbation. There was also overutilization of inhaled beta-agonists during exacerbations. It is imperative that these aspects of management, for which the NAEP has set standards of care, are addressed as part of the effort to reduce asthma morbidity in the urban United States.
It is hypothesized that collective efficacy, defined as social cohesion among neighbors combined with their willingness to
intervene on behalf of the common good, is linked to reduced violence. This hypothesis was tested on a 1995 survey of 8782
residents of 343 neighborhoods in Chicago, Illinois. Multilevel analyses showed that a measure of collective efficacy yields
a high between-neighborhood reliability and is negatively associated with variations in violence, when individual-level characteristics,
measurement error, and prior violence are controlled. Associations of concentrated disadvantage and residential instability
with violence are largely mediated by collective efficacy.
The problem of asthma in Chicago remains a complex one, and it is too early to know whether any programs and efforts have had a discernible effect, but the Chicago Asthma Consortium continues to expand its membership and to define its mission. The successes have come from harnessing the passion of the individual members to move the projects forward. As the focus of the consortium moves to addressing system-wide problems in asthma care and the delivery of that care, the consortium is undertaking the construction of a guide for future efforts. In this way, the consortium will fulfill its vision of creating a comprehensive, community-wide plan for the management of asthma, impacting on the unacceptable current levels of morbidity and mortality of the disease.
The Chicago Community Asthma Survey (CCAS-32) is an instrument for characterizing the general public's knowledge, attitudes, and beliefs related to asthma. The purpose of this study was to examine the effects of asthma experience and social demographic characteristics on asthma awareness among the general public.
The CCAS-32 consists of 21 dichotomous items, designed primarily to test asthma knowledge, and 11 Likert-scale items, focusing on asthma attitudes and beliefs. From December 1997 through February 1998, a random-digit dialing method was used to administer the CCAS-32 via a telephone survey of Chicago-area (seven-county) residents > or = 18 years. Each respondent's asthma experience was classified as "person with asthma," "family/household experience," or "no/low asthma experience." Demographic variables included sex, age, education, race/ethnicity, urban vs suburban residence, and income.
Five hundred sixty-eight Chicago-area residents completed the survey (response rate of 40.6%). Of these, 43.3% were aged 35 to 64 years, 71.3% were women, 66.7% were white, and 71.3% had completed at least some college. Sixty-two percent had no or low asthma experience, 28.5% had family or household experience, and 9.5% were persons with asthma. The mean percentage (+/- SE) of correct, or desirable, responses to asthma knowledge questions was 71.9 +/- 0.5%, with a range from 31.9 to 95.1%. The mean percentage of desirable responses differed significantly between persons with no or low asthma experience, family or household asthma experience, and persons with asthma (70.0 +/- 0.6%, 74.0 +/- 0.9%, and 77.7 +/- 1.2%, respectively, p < 0.01 for trend). Social demographic factors also appeared to result in statistically significant differences in the responses to many items. Of the demographic variables studied, age and education appeared to have the strongest effect on responses to knowledge items, with statistically significant differences in responses seen for 10 (47.6%) and 8 (38.1%) of the 21 dichotomous items. Race or ethnicity and education were each associated with differences in responses for 7 of the 11 Likert-scale items (63%).
The results of this study suggest that the CCAS-32 can detect meaningful differences between groups with different degrees of asthma experience (ie, discriminative validity). Using the CCAS-32, it may be possible to identify subpopulations with differences in asthma awareness, thus providing guidance for the design of messages to target community and public awareness of asthma.
We used national vital statistics data for 1990 through 1995 to examine both national and regional age-adjusted asthma mortality rates for U.S. Hispanics of Mexican, Cuban, and Puerto Rican heritage, as well as for non-Hispanic whites and non-Hispanic blacks. Nationally, Puerto Ricans had an age-adjusted annual asthma mortality rate of 40.9 per million, followed by Cuban-Americans (15. 8 per million) and Mexican-Americans (9.2 per million). In comparison, non-Hispanic whites had an age-adjusted annual asthma mortality rate of 14.7 per million and non-Hispanic blacks had a rate of 38.1 per million. Age-adjusted asthma mortality for Puerto Ricans was highest in the Northeast (47.8 per million); this region accounted for 81% of all asthma deaths among Puerto Ricans in the United States. In the U.S., Puerto Ricans had the highest asthma mortality rates among Hispanics, followed by Cuban-Americans and Mexican-Americans. In addition, among Hispanic national groups, mortality rates were consistently higher in the Northeast than the Midwest, South, or West regions. These results further support that Hispanics do not represent a uniform, discrete group in terms of health outcomes, and that further public health research and interventions should take Hispanic national origin into account.
Indoor inhaled allergens have been repeatedly demonstrated to worsen asthma in sensitized individuals, but their role in incident asthma is more controversial.
We investigated the relationship between exposure to allergens (dust mite, cat, and cockroach) measured in the home and incident doctor-diagnosed asthma and recurrent wheezing in children born to parents with asthma, allergies, or both.
From an ongoing longitudinal family and birth cohort study, we identified 222 siblings (median age, 2.87 years) of the index children. Allergen levels in the home were measured from dust samples obtained at the beginning of the study. Incident doctor-diagnosed asthma and recurrent wheezing were determined from questionnaires administered at 14 months and 22 months after the initial questionnaire.
Thirteen (5.9%) children were reported to have incident asthma, twenty (9.0%) children had recurrent asthmatic wheezing, and 18 (8.1%) had recurrent wheezing without asthma. Compared with children living in homes with Bla g 1 or 2 levels of less than 0.05 U/g, children exposed to Bla g 1 or 2 levels of 0.05 to less than 2 U/g had a relative risk for incident asthma of 8.27 (95% confidence interval, 1.04-66.04), whereas children exposed to Bla g 1 or 2 levels of 2 U/g or greater had a relative risk for incident asthma of 35.87 (95% confidence interval, 4.49-286.62). Cockroach allergen exposure was likewise a significant predictor for recurrent asthmatic wheezing. Neither dust mite nor cat allergen levels were significantly associated with either outcome. These findings remained after control for several covariates.
Exposure to cockroach allergen early in life may contribute to the development of asthma in susceptible children.
Asthma is one of the most common chronic respiratory diseases in the United States.1 More than 5000 persons died from asthma in 1995, and the trends in asthma mortality have been increasing in the United States over the past 2 decades.2This investigation focused on Erie and Niagara counties in western New York. These counties have a combined population of 1.2 million and, together, are classified as a metropolitan area. Asthma mortality data for 1991 to 1996 were obtained from the New York State Bureau of Biometrics. Asthma mortality was determined from death certificate information. SPSS (SPSS, Inc, Chicago, Ill) was used in conducting statistical analyses. All population rates were calculated per 100 000 persons.Between 1991 and 1996, 158 asthma deaths were recorded in western New York. Eighty percent of these deaths occurred in Erie and Niagara counties. Average ageadjusted annual mortality rates were 1.61 for Erie County and 1.53 for Niagara County. In comparison, New York State had an average annual rate of 2.48 asthma deaths per 100 000 population. The majority of deaths (58%) during 1991 to 1996 occurred among individuals 65 years or older.The highest mortality rate for the period was 2.49 (95% confidence interval [CI] = 1.60, 3.38) in 1995; this rate decreased to 1.90 (95% CI = 1.12, 2.68) in 1996. Women had higher asthma mortality rates than men in Erie and Niagara counties (see Table 1 ).TABLE 1—Deaths From Asthma in Erie and Niagara Counties, by Age Group and Sex, 1991–1996The city of Niagara Falls had an average annual asthma mortality rate of 2.96, almost 3 times that of the remainder of Niagara County (see Table 2 ). The city of Lockport had an annual mortality rate of 3.05, more than that of the rest of Erie County (1.09 per 100 000). Two zip codes in Buffalo's east side (14211 and 14215) accounted for 25% of the mortality from 1991 to 1996.TABLE 2—Deaths From Asthma, by Area: Western New York, 1991–1996As a region, western New York had mortality rates lower than those in most of New York State. However, regional grouping masks areas of high risk for mortality due to asthma. Mortality was greatest in the 2 most populous counties (i.e., Erie and Niagara) and rare in rural counties of western New York. In Erie and Niagara counties, mortality was greater in urban areas than in suburban or rural areas.Buffalo, the most urbanized area in the 2 counties, had the highest annual mortality rate, comparable to that of New York City. Buffalo accounts for 20% of western New York's population but was responsible for 50% of asthma mortality in the region during the study period. The 2 zip codes with the highest asthma mortality rates in Buffalo comprise areas with large African American populations.3 Many US cities have large minority populations living in poverty, among whom the prevalence and severity of asthma are high.4–6Given the reversibility of asthma and the availability of effective treatment strategies, deaths due to asthma are avoidable. The present report provides a basis for targeting interventions and evaluating their effectiveness.
This paper discusses problems that are common to both the epidemiologic risk-factor approach and the demographic variable-based approach to studying population health. We argue that there is a shared reluctance to move away from a narrow variable-based thinking that pervades both disciplines, and a tendency to reify the multivariate linear procedures employed in both disciplines. In particular, we concentrate on the difficulties generated by classical variable-based approaches that are especially striking when one neglects selection processes and the use of strategies to minimize its effects. We illustrate these difficulties in terms of the so-called "Hispanic Paradox", which refers to comparative health advantages that some Hispanic groups appear to have. We find that much of what is conceived by demographers and epidemiologists as a paradox may not be paradoxical at all.
Because they experience respiratory symptoms, adults with asthma might be expected to avoid cigarette smoking. However, previous studies have not adequately addressed whether adults with asthma have a lower prevalence of smoking than the general population. The authors sought to determine whether adult asthmatics are less likely to smoke cigarettes than members of the general population.
The authors used data from a random sample of 2,902 California adults ages 18 years or older,with oversampling of African Americans, Asian/Pacific Islanders, adults with disabilities, and adults aged 45 to 70 years. Sampling weights were used in all analyses. In this cross-sectional study, 217 participants (7.5%) reported a physician diagnosis of asthma.
The prevalence of "ever smoking" was similar among adults with asthma (48.3%) and those without asthma (43.0%) (risk difference 5.3%; 95% CI -1.6%, 12.2%). There was also no difference in the prevalence of "current smoking" among adults with asthma (20.2%) compared with the non-asthmatic subjects (18.8%) (risk difference 1.4%; 95% CI -4.2%, 6.9%). After controlling for age, gender, race, and education, there was no evidence that adults with asthma were less likely to ever smoke. Although the confidence intervals did not exclude "no association," asthma was actually associated with an increased risk of ever smoking (OR 1.3; 95% CI 1.0, 1.8). There was also no association between asthma and the risk of current smoking after controlling for covariates (OR 1.1; 95% CI 0.8, 1.6). Moreover, there were no differences in "age of smoking initiation," "duration of smoking," or "intensity of smoking" after adjusting for demographic characteristics. Redefining the referent group to exclude respondents with other chronic lung diseases did not appreciably change study conclusions.
Adults with asthma do not appear to selectively avoid cigarette smoking. Specific smoking prevention and cessation efforts should be targeted to adults with asthma.
Mounting evidence suggests that indoor allergens and irritants contribute to childhood asthma. National asthma guidelines highlight the importance of their reduction as part of comprehensive asthma treatment.
To assess the prevalence of potential environmental triggers, to identify risk factors for such exposures, and to determine whether prior parental education about trigger avoidance is associated with fewer such exposures.
Children with asthma in practices affiliated with 3 managed care organizations.
Parents of 638 children, aged 3 to 15 years, were interviewed on enrollment in a randomized trial of asthma care improvement strategies. Parents reported recent asthma symptoms and exposures to potential environmental triggers. Multivariate models were used to identify specific demographic risk factors for environmental exposures and to determine if prior education was associated with fewer such exposures.
Exposures to environmental triggers were frequent: 30% of households had a smoker, 18% had household pests, and 59% had furry pets. Other exposures included bedroom carpeting (78%) and forced-air heat (58%). Most children did not have mattress (65%) or pillow (84%) covers. Of the parents, 45% reported ever receiving written instructions regarding trigger avoidance and 11% reported them given in the past year. However, 42% reported discussing triggers in the home environment with a clinician in the past 6 months. In multivariate models, predictors of smoking at home included low annual family income and lower parental educational attainment. Dog ownership was associated with low educational attainment, and dog and cat ownership were less likely with black race. Reports of pests were increased for black children compared with white children. Black race was associated with lower rates of other exposures, including bedroom carpeting. After controlling for potential confounders, there was no association of reduced exposures with prior receipt of environmental control instructions.
Exposure to potential environmental triggers is common, and recommended trigger avoidance measures are infrequently adopted. While specific exposures may vary with demographic and socioeconomic variables, all children are at risk. New methods for educating parents to reduce such exposures should be tested.
Studies of the use of anti-inflammatory asthma therapy have been limited to selected populations or have been unable to assess the appropriateness of therapy for individuals.
We sought to describe the current use of asthma medication in the United States population and to examine the influence of symptoms and sociodemographics on medication use.
This study was based on a cross-sectional, national, random-digit-dial household telephone survey in 1998 designed to identify adult patients and parents of children with current asthma. Respondents were classified as having current asthma if they had a physician's diagnosis of asthma and were either taking medication for asthma or had asthma symptoms during the past year.
One or more persons met the study criteria for current asthma in 3273 (7.8%) households in which a screening questionnaire was completed. Of these, 2509 persons (721 children <16 years) with current asthma were interviewed. Current use of anti-inflammatory medication was reported by 507 (20.1%). Of these, most were using inhaled corticosteroids (72.5%), with use of antileukotrienes reported by 11.4% and use of cromolyn-nedocromil reported by 18.6%. Of persons with persistent asthma symptoms in the past month, 26.2% reported current use of some form of anti-inflammatory medication. In bivariate analysis persons reporting lower income, less education, and present unemployment, as well as smokers, were significantly (P <.001) less likely to report current anti-inflammatory use than were other populations. In a multiple regression model nonsmokers and those of white, non-Hispanic ethnicity, as well as persons reporting less asthma control, were more likely to report current anti-inflammatory medication use.
In the United States use of appropriate asthma therapy remains inadequate. Strategies to increase use of anti-inflammatory therapy among patients with asthma are needed. These might include methods to increase access to asthma care for minorities and the socioeconomically disadvantaged.
Asthma in the inner city impacts people of all ages and is most pronounced in African Americans and other minorities. During the past decade, the prevalence of asthma has increased by 42%, a rate consistently higher in African Americans. Along with the increase in asthma prevalence, the costs associated with this disease have also risen dramatically. In addition, asthma is the leading cause of school absenteeism and also contributes to lost productivity. This article focuses on the epidemiology of asthma in urban areas and identifies various risk factors that are important in achieving control of this disease. Suggestions for future interventions are discussed.
To the Editor: As commissioner of the Chicago Department of Public Health and an important figure in my book, Heat Wave, John Wilhelm has a distinctive view of whether he and the administration for which he works responded adequately to the 1995 disaster, which killed more than 700 people. In his review (Sept. 26 issue),1 Wilhelm claims that the people I interviewed for the two chapters assessing Chicago's social protection programs and emergency responses “were not there.” This is not true. Wilhelm, who was a leader in the city's effort to manage the crisis, was himself a source for the . . .
Our analyses examine the role neighborhood structural characteristics--including concentrated disadvantage, residential instability, and immigrant concentration--as well as collective efficacy in promoting physical health among neighborhood residents. Using data from the 1990 census, the 1994 Project on Human Development in Chicago Neighborhoods Community Survey, and the 1991-2000 Metropolitan Chicago Information Center-Metro Survey, we model the effects of individual and neighborhood level factors on self-rated physical health employing hierarchical ordered logit models. First, we find that neighborhood socioeconomic disadvantage is not significantly related to self-rated physical health when individual level demographic and health background are controlled. Second, individuals residing in neighborhoods with higher levels of collective efficacy report better overall health. Finally, socioeconomic disadvantage and collective efficacy condition the positive effects of individual level education on physical health.
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