Exposure to community violence and caregiver stress: An investigation of multiple social determinants of childhood asthma severity

Background: Research suggests that exposure to community violence and psychosocial stress may impact childhood asthma disparities.  However, the relationship between community violence, caregiver stress and asthma severity remains unclear.  Further, the differential impact of police-reported versus caregiver-perceived community violence remains unexplored.

Methods: We conducted an 18-month longitudinal study among children 8-15 yrs with physician-diagnosed asthma.  Data on asthma burden, caregiver stress, and child-caregiver exposure to violence were collected.  Incidence of community violence was obtained from the Chicago Police Department.  Simple regression and multiple logistic regression analyses were performed to estimate the effect of police- and parent-reported violence and caregiver stress on childhood asthma severity.

Results: Data were obtained from 561 children. 41% of participants (N=321) had severe asthma; the remainder had intermittent/mild asthma.  Odds of severe asthma were most significantly associated with caregiver-reported stress, even after adjusting for potential confounders including race [OR 2.00, 95% CI (1.13-3.56)].  Odds were also higher among children from communities with high incidence of police-reported violent crime after adjusting for age, gender, familial asthma and SES [OR 1.48 (1.01-2.18)]. Unadjusted models demonstrated an association between severe asthma and children whose caregivers reported seeing violence in their community [OR 1.79, (1.17-2.76)].  No association was identified in unadjusted models between severe asthma and parental report of hearing violence [OR 1.44, (1.00-2.07)] nor parental report of the child witnessing violence [OR 1.30, (0.85-1.99)].

Conclusions:  Increased caregiver stress and police-reported community violence were consistently associated with severe childhood asthma, whereas parent-reported exposure to community violence demonstrated no such association.