Relationships between Community Violence and Sensitization and Exposure to Cockroach Allergen among Asthmatic Inner-City Children

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  • March 22, 2019
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  • Sever, Michelle L.
    • Affiliation: Gillings School of Global Public Health, Department of Epidemiology
Abstract
  • Background: Asthma, a chronic respiratory disease which affects more than 10 million children in the United States, disproportionately affects minority and socioeconomically disadvantaged children. The Inner City Asthma Study (ICAS) was one of the first multicenter intervention trials intended to reduce allergen exposure and subsequent asthma morbidity among inner-city children. The intervention was successful in reducing both cockroach allergen exposure and asthma morbidity. In ICAS, children exposed to high levels of violence in their neighborhood had higher asthma morbidity at baseline, even after controlling for other risk factors. The relationship between violence exposure and asthma morbidity is thought to be mediated by either the physiologic response to violence or by increased exposure to indoor allergens due to increased time spent indoors because of violence in the neighborhood. Methods: We examined whether the relationship between community violence and asthma morbidity differed by allergen exposure and sensitization status, and whether crime data could be used as a surrogate for respondents' perceptions of community violence assessed by questionnaire. We used linear mixed models to determine if the effect of the ICAS intervention varied with community violence exposure and allergy to cockroaches. Results: Violence and cockroach exposure/sensitization were found to interact: children exposed to high levels of community violence had more asthma symptom days, but only if they were also exposed and sensitized to cockroach allergen (pinteraction = 0.07). The same trend was observed with crime data when evaluating the number of assaults per census tract (p=0.14), but not when evaluating census tract assault rate (p=0.22). Children sensitized to cockroach allergen with the highest violence exposure had the greatest reduction in asthma morbidity following a decrease in cockroach allergen exposure in their bedroom. The children not sensitized to cockroach allergen also had a decrease in their asthma symptom days but the decrease in symptom days did not vary by level of violence exposure. Conclusions: These findings support the hypothesis that higher asthma morbidity seen in children exposed to violence in their neighborhoods is due, at least in part, to them spending more time indoors leading to higher exposure to indoor allergens, specifically cockroach allergen.
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  • ... in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the Department of Epidemiology.
Advisor
  • Thomas, James C.
Degree granting institution
  • University of North Carolina at Chapel Hill
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