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Community violence and urban childhood asthma: a multilevel analysis.

ABSTRACT: We examined the association between community violence exposure and childhood asthma risk in a multilevel, multimethod, longitudinal study controlling for individual- and neighbourhood-level confounders and pathway variables. Analyses included 2,071 children aged 0-9 yrs at enrolment from the Project on Human Development in Chicago Neighborhoods. Multilevel logistic regression models estimated the likelihood of asthma, controlling for individual-level (child's age, sex, race/ethnicity, maternal asthma, socioeconomic status and family violence in the home) and neighbourhood-level confounders (concentrated disadvantage, collective efficacy and social disorder), and pathway variables (maternal smoking, breastfeeding). In adjusted analyses, medium (OR 1.60, 95% CI 1.17-2.19) and high levels (OR 1.56, 95% CI 1.12-2.18) of community violence were associated with increased asthma risk, relative to low levels. The increased asthma risk remained for African Americans when models included community violence and all other individual-level covariates, but attenuated to borderline nonsignificance when further adjusting for collective efficacy. Community violence is associated with asthma risk when controlling for individual- and neighborhood-level confounders. Neither community violence, nor the other individual-level factors, fully accounted for the excess asthma burden among African Americans. These data suggest that public health interventions outside the biomedical model may be needed to reduce asthma in disadvantaged populations.

SUBMITTER: Sternthal MJ

PROVIDER: S-EPMC4811341 | biostudies-literature | 2010 Dec

REPOSITORIES: biostudies-literature

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Community violence and urban childhood asthma: a multilevel analysis.

Sternthal M J MJ Jun H-J HJ Earls F F Wright R J RJ

The European respiratory journal 20100422 6

We examined the association between community violence exposure and childhood asthma risk in a multilevel, multimethod, longitudinal study controlling for individual- and neighbourhood-level confounders and pathway variables. Analyses included 2,071 children aged 0-9 yrs at enrolment from the Project on Human Development in Chicago Neighborhoods. Multilevel logistic regression models estimated the likelihood of asthma, controlling for individual-level (child's age, sex, race/ethnicity, maternal ...[more]

PMID: 20413538

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Project description:BackgroundAsthma burden in the US is not evenly distributed. Although asthma prevalence varies widely across urban neighborhoods, little attention has been paid to the community as a key contributor.ObjectiveTo determine the effect of positive socio-environmental community factors on childhood asthma prevalence in Chicago.MethodsFrom 2003 to 2005, an asthma screening survey was conducted among children attending Chicago Public/Catholic schools from kindergarten through eighth grade. One hundred five schools participated, yielding a stratified representation of 4 race-income groups. Positive community factors, such as social capital, economic potential, and community amenities, were assessed by using the Metro Chicago Information Center's Community Vitality Index.ResultsOf the surveys returned, 45,177 (92%) were geocoded into 287 neighborhoods. Neighborhoods were divided into quartile groups by asthma prevalence (mean, 8%, 12%, 17%, 25%). Community vitality (54% vs 44%; P < .0001) and economic potential (64% vs 38%; P < .0001) were significantly higher in neighborhoods with low asthma prevalence. Neighborhood interaction (36% vs 73%; P < .0001) and stability (40% vs 53%; P < .0001) were significantly higher in neighborhoods with high asthma prevalence. Overall, positive factors explained 21% of asthma variation. Childhood asthma increased as the black population increased in a community (P < .0001). Accordingly, race/ethnicity was controlled. In black neighborhoods, these factors remained significantly higher in neighborhoods with low asthma prevalence. When considered alongside socio-demographic/individual characteristics, overall community vitality as well as social capital continued to contribute significantly to asthma variation.ConclusionAsthma prevalence in Chicago is strongly associated with socio-environmental factors thought to enrich a community. A deeper understanding of this impact may lend insight into interventions to reduce childhood asthma.

Project description:BackgroundIntimate partner violence against women is a prevailing public health problem in Tanzania, where four of ten women have a lifetime exposure to physical or sexual violence by their male partners. To be able to suggest relevant and feasible community and health care based interventions, we explored community members' understanding and their responses to intimate partner violence.MethodsA qualitative study using focus group discussions with 75 men and women was conducted in a community setting of urban Tanzania. We analysed data using a grounded theory approach and relate our findings to the ecological framework of intimate partner violence.ResultsThe analysis resulted in one core category, "Moving from frustration to questioning traditional gender norms", that denoted a community in transition where the effects of intimate partner violence had started to fuel a wish for change. At the societal level, the category "Justified as part of male prestige" illustrates how masculinity prevails to justify violence. At the community level, the category "Viewed as discreditable and unfair" indicates community recognition of intimate partner violence as a human rights concern. At the relationship level, the category "Results in emotional entrapment" shows the shame and self-blame that is often the result of a violent relationship. At the individual level, the risk factors for intimate partner violence were primarily associated with male characteristics; the category "Fed up with passivity" emerged as an indication that community members also acknowledge their own responsibility for change in actions.ConclusionsPrevailing gender norms in Tanzania accept women's subordination and justify male violence towards women. At the individual level, an increasing openness makes it possible for women to report, ask for help, and become proactive in suggesting preventive measures. At the community level, there is an increased willingness to intervene but further consciousness-raising of the human rights perspective of violence, as well as actively engaging men. At the macro level, preventive efforts must be prioritized through re-enforcement of legal rights, and provision of adequate medical and social welfare services for both survivors and perpetrators.

Dataset Information

Community violence and urban childhood asthma: a multilevel analysis.

Publications

Community violence and urban childhood asthma: a multilevel analysis.

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