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RESEARCH AND PRACTICE |
At the time of the study, the authors were with the Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Ga.
Correspondence: Requests for reprints should be sent to Monica H. Swahn, PhD, MPH, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy, Mail Stop K-50, Atlanta, GA 30341-3724 (email: mswahn{at}cdc.gov).
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ABSTRACT |
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 TOP ABSTRACT INTRODUCTIONMETHODSRESULTSDISCUSSIONReferences |
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We examined the associations between victimization, missed school because of feeling unsafe, and asthma episodes among US high-school students using the 2003 Youth Risk Behavior Survey. Cross-sectional analyses on adolescents with asthma (n=1943) showed that any victimization and missed school because of feeling unsafe significantly increased the odds of having an asthma episode in the past year (adjusted odds ratio [OR]=1.45; 95% confidence interval [CI] = 1.07, 1.95 and adjusted OR = 2.93; 95% CI = 1.90, 4.53, respectively). Victimization and feeling unsafe are important but poorly understood risk factors for asthma.
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INTRODUCTION |
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TOPABSTRACTINTRODUCTIONMETHODSRESULTSDISCUSSIONReferences |
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We examined whether victimization and having missed school because of feeling unsafe were associated with having an asthma episode; we used data from a nationally representative sample of US high-school students from 3 different metropolitan settings (urban, suburban, and rural).
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METHODS |
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TOPABSTRACTINTRODUCTIONMETHODSRESULTSDISCUSSIONReferences |
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Participants were asked 2 questions about asthma: (1) "Has a doctor or nurse ever told you that you have asthma?" (response options for this question were "yes" or "no") and (2) "During the past 12 months, have you had an episode of asthma or an asthma attack?" (response options were "I do not have asthma"; "No, I have asthma, but I have not had an episode of asthma or an asthma attack during the past 12 months"; or "Yes, I have had an episode of asthma or an asthma attack during the past 12 months"). Responses to these 2 questions determined the lifetime prevalence of asthma diagnosis, current asthma (whether a student still had asthma), and asthma episode in the past year (whether a student had an asthma attack or episode in the past year).7 The analyses we present are based on those students who reported that they had ever been diagnosed with asthma and who also stated that they currently had asthma (n=1943). The outcome variable was having had an asthma episode in the past year. The term asthma episode is used to refer to either an asthma episode or an asthma attack.
We computed 2 logistic regression analyses to test the associations between victimization in the past year or having missed school because of feeling unsafe in the past month and having had an asthma episode in the past year after we adjusted for demographic factors (i.e., grade, gender, race/ethnicity) and for other potential confounders (i.e., smoking cigarettes on 1 or more days in the past 30 days, describing self as slightly or very overweight, and exercising on 1 or more days in the past 7 days). All analyses are based on weighted data computed using SUDAAN statistical software (Research Triangle Institute, Research Triangle Park, NC).
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RESULTS |
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TOPABSTRACTINTRODUCTIONMETHODSRESULTSDISCUSSIONReferences |
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We computed stratified analyses to determine whether these associations varied by metropolitan status (Table 1
). Any victimization increased the odds of having had an asthma episode for students living in urban and rural areas but not for students living in suburban areas. Similarly, missed school because of feeling unsafe was significantly associated with having had an asthma episode for suburban and rural areas but not for urban areas.
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DISCUSSION |
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TOPABSTRACTINTRODUCTIONMETHODSRESULTSDISCUSSIONReferences |
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The findings in this report are subject to at least 4 limitations. First, all participants were high-school students, and results do not reflect the experiences of youths who have dropped out of school. Second, our measures, victimization, having missed school because of feeling unsafe, and having had an asthma episode, were self-reported and therefore subject to reporting bias. Poorly controlled asthma may be linked to stressful events, which make asthma episodes easier to recall. Third, the data do not permit an assessment of the temporal ordering between victimization, feeling unsafe, and asthma episodes. However, prospective research shows that a stressful life event quadruples the risk for an asthma episode in the 2 days immediately following the event.8 Finally, the analyses do not consider the many potential mediators and moderators that may be part of the complex mechanisms linking a stressor such as victimization with asthma.3,9
Future research and intervention efforts need to consider the role of psychosocial factors, including victimization, to better understand and potentially reduce asthma episodes and their severity. Moreover, the types and levels of exposure to violence as well as reactions to violence may differ across metropolitan regions, which also should be examined in future research. In addition, focus groups of adolescents with asthma who have experienced victimization may yield clinically useful information for the management and prevention of asthma episodes. Meanwhile, the findings from the current investigation can be used as additional empirical support for the need to broaden the scope of asthma research and practice to incorporate a wider range of behaviors and exposures.
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Acknowledgments |
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We thank Stephen C. Redd for his constructive and thoughtful review of an earlier version of the brief. We also thank the project staff involved in the Youth Risk Behavior Survey for conducting this important surveillance system.
Note. The findings and conclusions in this brief are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.
Human Participant Protection
The Youth Risk Behavior Survey received Centers for Disease Control and Prevention institutional review board approval.
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Footnotes |
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Contributors
M. H. Swahn planned and conducted the analyses and drafted the brief. R. M. Bossarte conducted analyses and reviewed drafts of the brief.
Accepted for publication April 22, 2005.
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References |
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TOPABSTRACTINTRODUCTIONMETHODSRESULTSDISCUSSIONReferences |
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2. America’s Children: Key National Indicators of Well-Being, 2001. Washington, DC: Federal Interagency Forum on Child and Family Statistics; 2001. Also available at: http://childstats.ed.gov/americaschildren/pdf/ac2001/special.pdf. Accessed January 19, 2006.
3. Wright RJ, Mitchell H, Visness CM, et al. Community violence and asthma morbidity: the Inner-City Asthma Study. Am J Public Health. 2004;94: 625–632.
4. Wright RJ, Steinbach SF. Violence: an unrecognized environmental exposure that may contribute to greater asthma morbidity in high risk inner-city populations. Environ Health Perspect. 2001;9: 1085–1089.
5. Weil CM, Wade SL, Mauman LJ, Lynn H, Mitchell H, Lavigne J. The relationship between psychosocial factors and asthma morbidity in inner city children with asthma. Pediatrics. 1999;104: 1274–1280.
6. Grunbaum JA, Kann L, Kinchen S, et al. Youth risk behavior surveillance—United States, 2003 [published erratum appears in MMWR Morb Mortal Wkly Rep. 53:536, 2004; 54:608, 2005]. MMWR Surveill Summ. 2004;53(SS-02):1–96.[Medline]
7. Merkle S, Everett Jones S, Wheeler L, Mannino D. Self-reported asthma among high school students—United States, 2003. MMWR Morb Mortal Wkly Rep. 2005;54:765–767.[Medline]
8. Sandberg S, Järvenpää S, Penttinen A, Paton JY, McCann DC. Asthma exacerbations in children immediately following stressful life events: a Cox’s hierarchical regression. Thorax. 2004;59:1046–1051.
9. Klinnert MD. Evaluating the effects of stress on asthma: a paradoxical challenge. Eur Respir J. 2003; 22:574–575.
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