By Teddi Fine
Asthma, the leading chronic illness among children and youth in the United States, is a growing problem of increasing concern to health professionals and families alike. It ranks among the top three causes of hospitalization for those younger than 15 and can contribute to lower levels of school attendance, physical activity, and fitness. Disproportionately higher rates of asthma are found among children living in urban settings, children of color, and children in families with limited economic resources.
While not preventable, asthma can be controlled not only through the regular use of medication but also by avoiding potential triggers in the environment, like tobacco smoke, chemicals, mold, small animals, and some household chemicals. Avoiding these triggers is not always easy or, at times, even possible for urban families of limited income. And faculty members Joan E. Kub, PhD, APHN, BC and Arlene Butz, ScD, PNP, collaborating with colleagues at the Johns Hopkins University School of Medicine and the University of Maryland School of Pharmacy, have found an ominous environmental factor that may have an adverse effect on a child’s asthma management. That factor is community violence.
Separately, violence and asthma pose risks for urban youth; together, they represent a considerable public health threat. African-American youngsters are twice as likely to die from asthma than their white counterparts, and homicide is the leading cause of death among these youth. Countless other youth and their families witness or fear neighborhood violence. Reporting in the Journal of Community Health, Kub and her colleagues describe their study of 231 urban-dwelling caregivers and their children with moderate, persistent asthma to examine family exposure to community violence, perceptions of feeling safe, and their children’s asthma symptoms and treatments. Families with greater exposure to community violence reported more asthma symptoms for their children than families with less exposure to violence. Further, children who saw violence were less likely to participate in primary care asthma follow-up and management after an emergency department visit, though the reasons are not clearly understood.
Kub and Butz observe, “By finding ways to reduce environmental barriers to regular asthma care, we can help improve the quality of life and breath for urban young people with asthma and their families. Because we are at the front door of community health care, nurses are in an ideal position to help promote better preventive care.” Their study’s findings suggest that when tailoring asthma treatment and education, health care providers should include an assessment of potential violence exposure and tailor recommended care protocols accordingly.