Perceptions of Neighborhood Safety and Asthma among Children and Adolescents in Los Angeles: A Multilevel Analysis

Citation metadata

From: PLoS ONE(Vol. 9, Issue 1)
Publisher: Public Library of Science
Document Type: Article
Length: 3,584 words
Lexile Measure: 1820L

Document controls

Main content

Article Preview :

Author(s): Marlene Camacho-Rivera 1, Ichiro Kawachi 2, Gary G. Bennett 3, S. V. Subramanian 2,*


While prior research examining the impact of neighborhoods on asthma has primarily focused on environmental exposures and the physical environment such as housing conditions there has been increasing interest in the role of the social environment.[1]-[5] Researchers have taken an increased interest in the role of neighborhood violence and have linked exposure to neighborhood violence to asthma onset, hospital emergency room visits, and symptoms. [6], [7] The Inner-City Asthma Study demonstrated an association between higher levels of perceived neighborhood violence and increased caretaker-reported asthma symptoms among children ages 5 to 12 years. [7] Additional aspects of neighborhood violence, such as measures of crime and presence of gangs, have also been associated with childhood asthma symptoms and hospital visits. [8], [9] Retrospective studies have also found lifetime exposure to neighborhood violence to be associated with an increased risk of asthma and wheezing. [10] A longitudinal study of children living in Chicago neighborhoods found a robust positive association between exposure to community violence and risk of asthma development [11].

Much of the research linking exposure to neighborhood violence and asthma stems from the work of Wright and colleagues, who hypothesize that exposure to violence may affect asthma through direct and indirect pathways. [10] Directly, exposure to violence may increase psychological stress experienced by those who witness or are victims of violence.[12]-[14] Numerous studies have pointed to the link between over-activation of immune-inflammatory systems and increased susceptibility to respiratory illnesses. [15], [16] However, some studies that have examined the association between neighborhood factors and asthma have found associations through behavioral pathways [9].

Indirect pathways may include increased exposure to indoor allergens or adverse parental behaviors. The association between exposure to indoor allergens, such as dust, cockroach, and mold and asthma related outcomes has been well documented. [17], [18] Parental report of keeping their children indoors because of fear of neighborhood violence was related to increased risk of wheeze and asthma among children living in inner-city Boston. [7] High violence rates and other adverse life events may influence parents' behaviors, including missing medical visits, failing to obtain medications, or smoking. [19] At the family level, there is strong evidence that family conflict, parenting difficulties, and parental stress are associated with wheezing in infancy, asthma onset and hospitalizations. [7], [20]-[22].

While studies have shown associations between neighborhood social stressors and childhood asthma, only two studies have explicitly examined perceptions of neighborhood safety and asthma. Prior studies have been unable to control for features of the home environment as well as other neighborhood characteristics associated with asthma, such as neighborhood poverty. [23], [24] We investigated the association between various measures of neighborhood safety perception and reported lifetime asthma using data from Wave 1 of the Los Angeles Family and Neighborhood Survey (L.A.FANS). We examined whether primary caregiver's perception of neighborhood safety is associated with asthma morbidity in children, controlling for individual and family characteristics and whether experience of crime within...

Source Citation

Source Citation   

Gale Document Number: GALE|A478851000