Parent Perceptions of Neighborhood Stressors Are Associated with General Health and Child Respiratory Health Among Low-income, Urban Families
Overview
Pulmonary Medicine
Affiliations
Background: This cross-sectional study examines parents' perceptions of their neighborhoods and general and respiratory health among low-income Chicago families. Asthma disproportionately affects nonwhite, urban, and low socioeconomic status (SES) populations, but Chicago's burden, and the national epidemic, are not well explained by known risk factors. Urban dwellers experience acute and chronic stressors that produce psychological distress and are hypothesized to impact health through biological and behavioral pathways. Identifying factors that covary with lower SES and minority-group status-e.g., stress-is important for understanding asthma's social patterning.
Methods: We used survey data from 319 parents of children 5-13 years with asthma/respiratory problems and principal components analysis to create exposure variables representing parents' perceptions of two aspects of neighborhoods: collective efficacy ("CE") and physical/social order ("order"). Adjusted binomial regression models estimated risk differences (RDs) and 95% confidence intervals (CIs) for eight binary outcomes.
Results: Magnitude was generally as expected, i.e., RD for low- versus high- (most favorable) exposure groups (RD(low v. high)) was larger than for the middle versus high contrast (RD(mid v. high)). "Parent general health" was strongly associated with "CE" (RD(low v. high) = 20.8 [95% CI: 7.8, 33.9]) and "order" (RD(mid v. high) = 11.4 [95% CI: 2.1, 20.7]), unlike "child general health," which had nearly null associations. Among respiratory outcomes, only "waking at night" was strongly associated with "CE" (RD(low v. high) = 16.7 [95% CI: 2.8, 30.6]) and "order" (RD(low v. high) = 22.2 [95% CI: 8.6, 35.8]). "Exercise intolerance" (RD(low v. high) = 15.8 [95% CI: 2.1, 29.5]) and "controllability" (RD(mid v. high) = 12.0 [95% CI: 1.8, 22.3]) were moderately associated with "order" but not with "CE," whereas "school absences," "rescue medication use," and "unplanned visits" had nearly null associations with both exposures.
Conclusions: More negative perceptions tended to be associated with higher risk of undesirable outcomes, adding to evidence that the social environment contributes to health and supporting research on stress' health impact among disadvantaged populations. Interventions must address not only traditional "environmental" factors, but also individuals' reactions to stress and attempt to mitigate effects of stressors while structural solutions to health inequities are sought.
Neighborhood-Level Factors Related to Asthma in Children Living in Urban Areas.
DePriest K, Butz A J Sch Nurs. 2016; 33(1):8-17.
PMID: 27756873 PMC: 5258670. DOI: 10.1177/1059840516674054.
Mental Health Disparities Among Low-Income US Hispanic Residents of a US-Mexico Border Colonia.
Marquez-Velarde G, Grineski S, Staudt K J Racial Ethn Health Disparities. 2016; 2(4):445-56.
PMID: 26863552 DOI: 10.1007/s40615-015-0091-1.
Carroll-Scott A, Gilstad-Hayden K, Rosenthal L, Eldahan A, McCaslin C, Peters S Am J Public Health. 2015; 105(12):2496-502.
PMID: 26469652 PMC: 4638273. DOI: 10.2105/AJPH.2015.302882.
Bellin M, Osteen P, Collins K, Butz A, Land C, Kub J J Urban Health. 2014; 91(4):677-89.
PMID: 24889008 PMC: 4134443. DOI: 10.1007/s11524-014-9883-6.
Challenges in providing preventive care to inner-city children with asthma.
Butz A, Kub J, Bellin M, Frick K Nurs Clin North Am. 2013; 48(2):241-57.
PMID: 23659811 PMC: 3651828. DOI: 10.1016/j.cnur.2013.01.008.