title: Perceived neighborhood safety and asthma morbidity in the school inner-city asthma study.
abstract: OBJECTIVE
  The aim of this study was to investigate whether neighborhood safety as perceived by primary caregivers is associated with asthma morbidity outcomes among inner-city school children with asthma.
  
  
  METHODS
  School children with asthma were recruited from 25 inner-city schools between 2009 and 2012 for the School Inner-City Asthma Study (N = 219). Primary caregivers completed a baseline questionnaire detailing their perception of neighborhood safety and their children's asthma symptoms, and the children performed baseline pulmonary function tests. In this cross-sectional analysis, asthma control was compared between children whose caregivers perceived their neighborhood to be unsafe versus safe.
  
  
  RESULTS
  After adjusting for potential confounders, those children whose primary caregivers perceived the neighborhood to be unsafe had twice the odds of having poorly controlled asthma (odds ratio [OR] adjusted = 2.2, 95% confidence interval [CI] = 1.2-3.9, P = 0.009), four times the odds of dyspnea and rescue medication use (OR adjusted = 4.7; 95% CI = 1.7-13.0, P = 0.003, OR adjusted = 4.0; 95% CI = 1.8-8.8, P < 0.001, respectively), three times as much limitation in activity (OR adjusted = 3.2; 95% CI = 1.4-7.7, P = 0.008), and more than twice the odds of night-time symptoms (OR adjusted = 2.2; 95% CI = 1.3-4.0, P = 0.007) compared to participants living in safe neighborhoods. There was no difference in pulmonary function test results between the two groups.
  
  
  CONCLUSIONS
  Primary caregivers' perception of neighborhood safety is associated with childhood asthma morbidity among inner-city school children with asthma. Further study is needed to elucidate mechanisms behind this association, and future intervention studies to address social disadvantage may be important.
authors.affiliation: Division of Respiratory Diseases, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Lianne S
authors.initials: LS
authors.lastname: Kopel
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Gaffin
authors.forename: Al
authors.initials: A
authors.lastname: Ozonoff
authors.forename: Devika R
authors.initials: DR
authors.lastname: Rao
authors.forename: William J
authors.initials: WJ
authors.lastname: Sheehan
authors.forename: James L
authors.initials: JL
authors.lastname: Friedlander
authors.forename: Perdita
authors.initials: P
authors.lastname: Permaul
authors.forename: Sachin N
authors.initials: SN
authors.lastname: Baxi
authors.forename: Chunxia
authors.initials: C
authors.lastname: Fu
authors.forename: S V
authors.initials: SV
authors.lastname: Subramanian
authors.forename: Diane R
authors.initials: DR
authors.lastname: Gold
authors.forename: Wanda
authors.initials: W
authors.lastname: Phipatanakul
mesh_terms: D001249:Asthma / Q000453:epidemiology*; D002648:Child; D003430:Cross-Sectional Studies; D004417:Dyspnea / Q000453:epidemiology; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012111:Residence Characteristics; D012449:Safety; D014481:United States; D014505:Urban Population
keywords: asthma; disparities; inner-city; pediatrics; psychological; socioeconomic factors; stress