Violence, abuse, and asthma in Puerto Rican children.
BACKGROUND
Puerto Ricans have the highest prevalence of and morbidity from asthma of all ethnic groups in the United States. One potential contributor to the high burden of asthma in Puerto Rican children is exposure to stress and violence.


OBJECTIVE
To examine whether exposure to stress and violence is associated with an increased risk of asthma among Puerto Rican children.


METHODS
This study was a population-based probability sample of children in the San Juan and Caguas metropolitan areas in Puerto Rico. Information was collected in a household survey of 1,213 children and their primary caretakers.


RESULTS
The prevalence of lifetime physician-diagnosed asthma was 39.6%. In the year before the survey, 14% of children had witnessed an act of violence, 7% had been victims of violence, and 6% had been victims of physical or sexual abuse. Although stressful life events and exposure to neighborhood violence were not associated with asthma, a history of physical or sexual abuse was associated with approximately twice the odds of current asthma (odd ratio [OR], 2.52; 95% confidence interval [CI], 1.27-5.00), health care use for asthma (OR, 1.95; 95% CI, 0.96-3.96), and medication use for asthma (OR, 2.35; 95% CI, 1.05-5.26).


CONCLUSIONS
Physical or sexual abuse is associated with high asthma morbidity among Puerto Rican children. To our knowledge, this is the first report of an association between childhood abuse and asthma. Our findings highlight the importance of screening for asthma among victims of childhood abuse, and to be aware of the possibility of physical or sexual abuse among children with asthma.
Channing Laboratory, Brigham and Women's Hospital , and Harvard Medical School, Boston, Massachusetts, USA. robyn.cohen@drexelmed.edu
Robyn T
RT
Cohen
Glorisa J
GJ
Canino
Hector R
HR
Bird
Juan C
JC
Celedón
D000293:Adolescent; D001249:Asthma / Q000208:ethnology* / Q000517:prevention & control; D002648:Child; D002649:Child Abuse / Q000208:ethnology*; D002650:Child Abuse, Sexual; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008403:Mass Screening; D015999:Multivariate Analysis; D015995:Prevalence; D011647:Puerto Rico / Q000453:epidemiology; D012307:Risk Factors; D012931:Social Environment; D013315:Stress, Psychological / Q000208:ethnology*; D014754:Violence / Q000208:ethnology*