The prevalence of asthma in urban environments varies by race as well as social-economic statusThis paper presents a critical review of the research investigating the relationships between neighborhood-level factors and asthma in urban children. Both physical and social factors associated with asthma were addressed. The studies included in this review were from 2010 to March 2016.
Findings indicated that the prevalence of asthma varies by race as well as social-economic status (SES), with asthma rates being significantly higher for African American and Puerto Rican children and for children living in poverty. One study found that a one-unit decrease in the household income to poverty ratio was associated with a 7% increase in the chances of having asthma. Another study considered SES along with crowding, sanitation, infant mortality rate, and homicide rate, and found that these factors explained 75% of the variability in asthma prevalence between 31 Latin American urban communities.
Physical factors investigated as possible contributors to the incidence of asthma included the air quality of both outdoor and indoor environments. Pollen exposure, automobile emissions, exposure to secondhand tobacco smoke, and housing related concerns (e.g., lack of air conditioning and presence of animal-related allergens) were all considered. Social factors investigated included outdoor safety and family stress issues. Safety was measured directly through crime statistics and indirectly by self-report perceptions of safety. Children with poorly controlled asthma reported higher levels of stress related to being afraid to go outside compared to children with well-controlled asthma. What was not clear from the research was whether or not being an “inner-city resident” places one at an increased risk for asthma. This, the researchers note, requires further investigation.
In addition to discussing the merits of the studies included in this review, the authors also offer some implications for future research. They suggest, for example, that school nurse clinicians, working within children’s neighborhoods, are in a unique position to assess modifiable neighborhood-level determinants of health in caring for children with asthma.
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