This study's objective is to determine if there is an association between rates of violence and rates of childhood asthma in Los Angeles County communities.
Methods.
Rates of hospitalization for assault and for asthma were calculated for each ZIP Code and city in Los Angeles County. Linear regression was used to determine the effect of assault rates on asthma rates while controlling for potential confounders such as poverty and racial/ethnic distribution. At the city level, crime rates were included in the model as additional measures of community violence.
Results.
Hospitalization rates for childhood asthma and assaults were significantly correlated at both the city (r=0.80) and the ZIP Code (r=0.54) levels. The association remained significant when controlling for poverty and racial/ethnic distribution with linear regression (p<0.0001). At the city level, the variables measuring the crime rate were not significant predictors of asthma hospitalizations.
Conclusions.
Community violence as measured by the rate of assault hospitalizations is associated with childhood asthma in Los Angeles County. Health care providers should consider their asthmatic patients' social environments when devising treatment plans.
References
1.
NeriMSpanevelloA.Chronic bronchial asthma from challenge to treatment: Epidemiology and social impact. Thorax2000; 55(suppl 2):S57–8.
2.
ArrighiHM. US asthma mortality: 1941 to 1989. Ann Allergy Asthma Immunol1995; 74:321–6.
3.
Platts-MillsTPerzanowskiMCarterMCWoodfolkJA. The rising prevalence and severity of asthma in western society: Are the causes of asthma the causes of the increase? In: Platts-MillsT, editor. Asthma: Causes and mechanisms of an epidemic inflammatory disease. Boca Raton (FL): Lewis Publishers; 1999. p. 1–21.
4.
Surveillance for asthma—United States, 1980–1999. MMWR Surveill Summ2002; 51(SS-01):1–13.
5.
RayNThamerMFadilliogluBGergenP.Race, income, urbanicity, and asthma hospitalization in California. Chest1998; 113:1277–84.
6.
RosenwasserL. The contribution of genes and environment to asthma. In: Platts-MillsT, editor. Asthma: Causes and mechanisms of an epidemic inflammatory disease. Boca Raton (FL): Lewis Publishers; 1999. p. 225–31.
7.
ReesWL. Etiological factors in asthma. Psychiatr J Univ Ottawa1980; 5:250–4.
8.
HeymanPAlarconADZambranoJRakesG.The risk of developing asthma during childhood. In: Platts-MillsT, editor. Asthma: Causes and mechanisms of an epidemic inflammatory disease. Boca Raton (FL): Lewis Publishers; 1999. p. 49–62.
9.
EtzelRA. How environmental exposures influence the development and exacerbation of asthma. Pediatrics2003; 112(1 Pt 2):233–9.
10.
WissowLGittelsohnASzkloMStarfieldBMussmanM.Poverty, race, and hospitalization for childhood asthma. Am J Public Health1988; 78:777–82.
11.
GottliebDBeiserAO'ConnorG.Poverty, race, and medication use are correlates of asthma hospitalization rates. Chest1995; 108: 28–35.
12.
HynesHPBruggeDOsgoodNDSnellJVallarinoJSpenglerJ.“Where does the damp come from?” Investigations into the indoor environment and respiratory health in Boston public housing. J Public Health Policy2003; 24:401–26.
13.
VolmerT. The socio-economics of asthma. Pulm Pharmacol Ther2001; 14:55–60.
14.
StevensonLAGergenPJHooverDRRosenstreichDManninoDMMatteTD. Sociodemographic correlates of indoor allergen sensitivity among United States children. J Allergy Clin Immunol2001; 108:747–52.
15.
RosenstreichDLEgglestonPKattanMBakerDSlavinRGGergenP, The role of cockroach allergy and exposure to cockroach allergens in causing morbidity among inner-city children with asthma. New Engl J Med1997; 336:1356–63.
16.
EvansDMellinsRLobachKRamos-BonoanCPinkett-HellerMWeisemannS, Improving care for minority children with asthma: Professional education in public health clinics. Pediatrics1997; 99:252–4.
17.
CarrWZeitelLWeissK.Variations in asthma hospitalizations and deaths in New York City. Am J Public Health1992; 82:59–65.
18.
WrightRMitchellHVisnessCCohenSStoutJEvansRGoldDR. Community violence and asthma morbidity: The Inner-City Asthma Study. Am J Public Health2004; 94:625–32.
19.
WeissKBGergenPJCrainEF. Inner-city asthma: The epidemiology of an emerging US public health concern. Chest1992; 101(6 Suppl):362S–367S.
20.
WrightRJSteinbachSF. Violence: An unrecognized environmental exposure that may contribute to greater asthma morbidity in high risk inner-city populations. Environ Health Perspect2001; 109: 1085–9.
21.
HurtHMalmudEBrodskyNLGiannettaJ.Exposure to violence: Psychological and academic correlates in child witnesses. Arch Pediatr Adolesc Med2001; 155:1351–6.
22.
TaylorLZuckermanBHarikVMcAlister-GrovesB.Witnessing violence by young children and their mothers. J Dev Behav Pediatr1994; 15(2):120–3.
23.
HaanMKaplanGSymeS.Socioeconomic status and health: Old observations and new thoughts. In: BunkerJGombyDKehrerB, editors. Pathways in health. Menlo Park (CA): Henry J. Kaiser Family Foundation; 1989. p. 76–135.
24.
Boney-McCoySFinkelhorD.Psychosocial sequelae of violent victimization in a national youth sample. J Consult Clin Psychol1995; 63:726–36.
25.
Cooley-QuilleMBoydRCFrantzEWalshJ.Emotional and behavioral impact of exposure to community violence in inner-city adolescents. J Clin Child Psychol2001; 30:199–206.
26.
MartinezPRichtersJE. The NIMH Community Violence Project: II. Children's distress symptoms associated with violence exposure. Psychiatry1993; 56:22–35.
27.
WilsonWCRosenthalBS. The relationship between exposure to community violence and psychological distress among adolescents: A meta-analysis. Violence Vict2003; 18:335–52.
28.
RietveldSEveraerdWCreerTL. Stress-induced asthma: A review of research and potential mechanisms. Clin Exp Allergy2000; 30: 1058–66.
29.
RitzTSteptoeADeWildeSCostaM.Emotions and stress increase respiratory resistance in asthma. Psychosom Med2000; 62:401–12.
30.
FlemingAWSterling-ScottRPCarabelloGImari-WilliamsIAllmondBFosterRS, Injury and violence in Los Angeles: Impact on access to health care and surgical education. Arch Surg1992; 127:671–6.
31.
FongRL. Violence as a barrier to compliance for the hypertensive urban African American. J Natl Med Assoc1995; 87:203–7.
32.
SampsonRJRaudenbushSWEarlsF.Neighborhoods and violent crime: A multilevel study of collective efficacy. Science1997; 277: 918–24.
33.
SmithPPerrinSYuleWRabe-HeskethS.War exposure and maternal reactions in the psychological adjustment of children from Bosnia-Hercegovina. J Child Psychol Psychiatry2001; 42:395–404.
34.
DempseyM. Negative coping as mediator in the relation between violence and outcomes: Inner-city African American youth. A J Orthopsychiatry2002; 72:102–9.
35.
International Classification of Diseases, 9th Revision, Clinical Modification, 5th ed.Los Angeles: Practice Management Information Corporation; 1999.
California Department of Justice. Office of the Attorney General. Criminal Justice Statistics Center. California criminal justice profile. Table 14: Domestic violence related calls for assistance, 2000 [cited 2006 Jul 26]. Available from: URL: http://stats.doj.ca.gov/cjsc_stats/prof00/19/14.pdf
39.
California Department of Justice. Office of the Attorney General. Criminal Justice Statistics Center. California Criminal Justice Profile. Table 11: California and FBI crime index, 2000 [cited 2006 Jul 26]. Available from: URL: http://stats.doj.ca.gov/cjsc_stats/prof00/19/11.pdf
ESRI. Arcview: Version 3.2a. Redlands (CA): 1992 −2000.
43.
SAS Institute, Inc.SAS: Version 8.02. Cary (NC): SAS Institute Inc.; 1999.
44.
GujaratiDN. Basic econometrics. New York: McGraw-Hill; 2003. p. 406–7.
45.
Von BehrenJKreutzerRSmithD. Asthma hospitalization trends in California, 1983–1996. J Asthma1999; 36:575–82.
46.
CesaroniGFarchiSDavoliMForasteireFPerucciCA. Individual and area-based indicators of socioeconomic status and childhood asthma. Eur Respir J2003; 22:619–24.
47.
RosenthalBSWilsonWC. The association of ecological variables and psychological distress with exposure to community violence among adolescents. Adolescence2003; 38:459–79.
48.
RennisonC. Violent victimization and race 1993–1998 [cited 2006 Jul 7]. Washington: Bureau of Justice Statistics; 2001. Available from: URL: http://www.ojp.usdoj.gov/bjs/pub/pdf/vvr98.pdf
49.
Department of Justice (US). Bureau of Justice Statistics. Criminal victimization in the United States, 1998 Statistical Tables. Table 61. Selected personal and property crimes, 1998 [cited 2006 Jul 26]. Available from: URL: http://www.ojp.usdoj.gov/bjs/pub/pdf/cvus98.pdf
50.
HartTCRennisonC.Reporting crime to the police, 1992–2000. Washington: Dept. of Justice, Bureau of Justice Statistics; 2003.
51.
HennekensCHBuringJE. Epidemiology in medicine. Boston: Little, Brown; 1987.
ChenEBloombergGRFisherEBJrStrunkRC. Predictors of repeat hospitalizations in children with asthma: The role of psychosocial and socioenvironmental factors. Health Psychol2003; 22:12–8.
54.
MorrisRDNaumovaENGoldringJHerschMMunasingheRLAndersonH.Childhood asthma surveillance using computerized billing records: A pilot study. Public Health Rep1997; 112:506–12.
