Neighborhood Safety Could Impact Pediatric Asthma Exacerbation

Kelli DePriest, BSN, RN

Investigators have found an association between neighborhood safety and asthma prevalence among children.

Kelli DePriest, BSN, RN, and PhD candidate at John Hopkins University School of Nursing, told MD Magazine® she is currently working on another study evaluating the relationships between neighborhood greenspace, neighborhood safety, and children’s level of asthma control. The results of this most recent review are aiding DePriest and her colleagues in the development of that study.

Previous research, DePriest explained, shows children with asthma who experience chronic stress have a heightened inflammatory response profile that puts them at risk for asthma exacerbations. Lower socioeconomic status is also associated with increased chronic stress and higher production of inflammatory markers.

According to the US Centers for Disease Control and Prevention (CDC), about 6.3 million children have asthma in the US, while the US Department of Health and Human Services has previously reported that asthma disproportionately impacts both children living in poverty and children from racial and ethnic minority groups.

The data for this study encompassed research published between January 2010 and September 2017. Out of 25 full-text articles, 14 met the inclusion criteria. To indicate asthma control, 10 of the studies used parent or child reported asthma diagnosis, while 4 used guidelines from the National Asthma Education and Prevention Expert Panel Report (4 studies). Four of the 14 studies assessed neighborhood safety using a questionnaire asking the child or the primary caregiver if their neighborhood was safe and a separate questionnaire asking about exposure to violence as reported by the child.

A pair of longitudinal studies focused on parent reports of children’s exposure to violence and their risk of an asthma diagnosis. Four of the 14 articles analyzed population-level crime using police reports.

In addition to the association between living in an unsafe neighborhood and high asthma prevalence, the review also showed that increasing violence and higher crime rates are also associated with an increase in both asthma prevalence and emergency department visits.

On the neighborhood safety question, studies that questioned participants about how safe they felt, the results did not necessarily represent objective safety. In one study, a geographically homogenous group expressed different views of personal safety. Those who perceived their neighborhood as unsafe were more likely to have children with uncontrolled asthma.

The subjective perception of safety, not the actual safety of the neighborhood, is linked with asthma control, investigators noted. More studies need to compare objective and subjective perceptions of neighborhood safety to get more insight.

DePriest explained these results should not be interpreted outside of the limitations of the study design. A majority of the studies (n= 12) were cross-sectional, so it cannot be assumed that unsafe neighborhoods cause higher asthma prevalence or poor control, we only see that there is a relationship between the 2. Additional research needs to be conducted in this area.

“Until that research becomes available, healthcare providers should ask children and their families about their neighborhood experiences,” DePriest said. “Exposure to violence is a social determinant of health that may worsen children’s asthma.”

If patients are stressed from living in unsafe neighborhoods, DePriest advised providers work with them to either identify resources available to help them relocate, or to strategize ways to mitigate the effects of their environment on their health.

The study, “The Relationship Between Neighborhood Safety and Children’s Asthma: An Integrative Review,” was published online in the Journal of Pediatric Health Care.