Researchers and clinicians have known for years that there’s a solid connection between certain aspects of a child’s life—race, poverty and allergen-heavy environments—and asthma. Using that work as a starting point, as well as her suspicion that there was a lot more to the story, Robert Wood Johnson Foundation (RWJF) Physician Faculty Scholar (2009-2012) Ruchi Gupta, M.D., M.P.H., an assistant professor of pediatrics at Northwestern University School of Medicine, decided to find out more about environment and asthma. “We originally found that Chicago childhood asthma rates varied from 1 to 44 percent, depending on the neighborhood a child lives in.” Gupta explained, “This made us very curious about what neighborhood factors were causing these wide differences.”
Asthma takes a tremendous toll on children’s health. Nationally, 6.7 million kids have the disease. In Chicago, where Gupta conducted her research, the rate in some neighborhoods is as high as 40 percent. Previous studies have suggested that the association between location and asthma prevalence or severity in children comes from environmental allergens such as cigarette smoke or animal dander. To learn more, Gupta took a more creative approach to considering potential asthma triggers in and around the home.
“Using data from the Chicago Initiative to Raise Asthma Health Equity (CHIRAH), we looked at asthma rates in 50,000 children and mapped them to correspond with Chicago neighborhoods. We then compared those neighborhood asthma rates to Chicago police crime report data,” Gupta said of her study, “The Association between Community Crime and Childhood Asthma Prevalence in Chicago,” published in the April issue of the Annals of Allergy, Asthma and Immunology. “We found a significant relationship between violent crime and childhood asthma rates even after controlling for race and income,” Gupta explained. “We then looked at data from an 18-month longitudinal study of 600 children with asthma. Using caregiver interviews and police reports, we reviewed perceived violence, actual violence, perceived caregiver stress and their relationship to childhood asthma severity. We found that children with moderate to severe asthma lived in communities with significantly higher rates of violent crime, increased perceived violence and increased caregiver stress.”
“There were studies before ours showing that perceived violence on the part of caregivers was correlated with more severe asthma in a child,” Gupta said, “but we were the first to show that the number of actual violent incidents—taken from police reports—could affect asthma prevalence and severity in children.”
Gupta and her colleagues uncovered other surprises that challenge some of the findings of existing research. “Our data showed that there seems to be a strong connection between asthma and violence,” Gupta said. “We controlled for a for a wide range of factors--race, gender, age, family history of the disease and economic status and found that there were still higher rates of asthma in the children in a given geographical area, if violent crime was high as well. It became clear that this was not simply the impact of poverty or race but specifically something connected to neighborhood violence was affecting childhood asthma.”
“We also looked at the specific type of crime,” Gupta added. “The presence of drug trafficking or property damage crimes had no impact on asthma rates after controlling for race and poverty. But violent crime, including homicide, sexual assault or assault and battery was clearly correlated with the disease. Violent crime explained about 15 percent of the neighborhood variability of childhood asthma rates. One explanation for this could be increased stress in the caregiver and child which would add to the body of research on the connection between stress and asthma.”
Investigating Further and Helping Kids
After looking at the full range of data, Gupta decided it was time to change the direction of her research and let the children tell the story of asthma and community violence, rather than the statistics. She will invest part of her grant in a new neighborhood program to do just that.
“Using my funding from RWJF, we are developing an afterschool program for kids with asthma,” said Gupta of her upcoming, community-based participatory research project. “We will teach kids to use photography or video as a tool to talk about what factors in their neighborhood may affect their asthma. I want to hear what they have to say about what they think is influencing their health. We may find that violence is just a piece of the puzzle,” she said. “This is a change in my project, but after the first study, I realized that I really needed to get out into the neighborhood and talk to the kids to understand their lives. And having the support and mentorship I received through the RWJF program was key because it helped my ideas take shape. Three of my current mentors are former Scholars,” Gupta said.
“I’m really excited about what I’m doing next. I want to see what types of issues come out and what the kids are telling us. I want to see if our theories hold true after we listen to their experiences.” Gupta said. “That’s when we will really know what neighborhood factors have an impact on a child’s asthma and what we can best do to improve it.”
The Robert Wood Johnson Foundation Physician Faculty Scholars program provides opportunities for physicians in junior faculty positions to gain valuable research experience and become academic leaders in their fields. Through mentoring, protected time, networking and the opportunity to gain valuable research experience, young faculty members are given support at a critical point in their academic careers.