Perception of Neighborhood Safety and Reported Childhood Lifetime Asthma in the United States (US): A Study Based on a National Survey
Perception of Neighborhood Safety and Reported Childhood Lifetime Asthma in the United States (US): A Study Based on a National Survey
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DOI：
10.1371/journal.pone.0006091
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发表时间：
2009-06-30
期刊：
影响因子：
3.7
通讯作者：
Kennedy, Malinda H.
中科院分区：
文献类型：
--
作者：
Subramanian, S. V.;Kennedy, Malinda H.
背景资料：最近的研究强调了心理社会压力源作为哮喘的决定因素的作用，而社区可能是这种压力源的潜在来源。我们调查了父母对邻里安全的看法和报告的儿童终生哮喘之间的关联。方法/主要发现：该研究的数据来自2003-04年全国儿童健康调查（NSCH），一个全国代表性的横断面样本的儿童年龄为0-17岁。人口统计学、社会经济学和行为学协变量纳入研究。模型估计后，考虑到加权和复杂的调查设计。父母是否曾被医生诊断为哮喘的报告被用来定义结果。父母对邻里安全的感知报告是主要的暴露。在未校正的模型中，与生活在被认为总是安全的社区相比，生活在被认为有时或从不安全的社区报告哮喘的比值比（OR）为1.36（95%置信区间[CI] 1.21，1.53）。调整协变量，包括暴露于二手烟草烟雾，母亲的自评健康，儿童的体力活动和电视观看减弱了这种关联（OR 1.25，95%CI 1.08，1.43）。在调整后的模型中，在那些认为社区通常是安全的人中，报告哮喘的优势比也更高（OR 1.15 95% CI 1.06，1.26），与始终安全相比，提示剂量-反应关系，通常安全和从不安全的差异具有统计学显著性结论：心理社会应激因素可能是影响哮喘发病的重要危险因素，通过神经免疫机制和社会机制触发哮喘的加重，从而促进哮喘的发病。
Background: Recent studies have emphasized the role of psychosocial stressors as a determinant of asthma, and neighborhoods can be a potential source of such stressors. We investigated the association between parental perception of neighborhood safety and reported lifetime asthma among children.Methodology/Principal Findings: Data for the study came from the 2003-04 National Survey of Children Health (NSCH); a nationally representative cross-sectional sample of children aged 0-17 years. Demographic, socioeconomic and behavioral covariates were included in the study. Models were estimated after taking account of weighting and complex survey design. Parental report of whether the child has ever been diagnosed with asthma by a physician was used to define the outcome. Parental report of perception of neighborhood safety was the main exposure. In unadjusted models, the odds ratio (OR) for reporting asthma associated with living in neighborhoods that were perceived to be sometimes or never safe was 1.36 (95% confidence intervals [CI] 1.21, 1.53) compared to living in neighborhoods that were perceived to be always safe. Adjusting for covariates including exposure to second hand tobacco smoke, mother's self-rated health, child's physical activity and television viewing attenuated this association (OR 1.25, 95% CI 1.08, 1.43). In adjusted models, the increased odds ratio for reporting asthma was also higher among those who perceived neighborhoods as being usually safe (OR 1.15 95% CI 1.06, 1.26), as compared to always safe, suggestive of a dose-response relationship, with the differentials for usually safe and never safe being statistically significant (p = 0.009).Conclusion: Psychosocial stressors may be important risk factors that may impact the pathogenesis of asthma and/or contribute to asthma morbidity by triggering exacerbations through neuroimmunologic mechanisms, as well as social mechanisms.