Parent Perceptions of Neighborhood Stressors Are Associated with General Health and Child Respiratory Health Among Low-Income, Urban Families

Background. This cross-sectional study examines parents' perceptions of their neighborhoods and general and respiratory health among low-income Chicago families. Asthma disproportionately affects nonwhite, urban, and low socioeconomic status (SES) populations, but Chicago's burden, and the national epidemic, are not well explained by known risk factors. Urban dwellers experience acute and chronic stressors that produce psychological distress and are hypothesized to impact health through biological and behavioral pathways. Identifying factors that covary with lower SES and minority-group status-e.g., stress-is important for understanding asthma's social patterning. Methods. We used survey data from 319 parents of children 5-13 years with asthma/respiratory problems and principal components analysis to create exposure variables representing parents' perceptions of two aspects of neighborhoods: collective efficacy (CE) and physical/social order (order). Adjusted binomial regression models estimated risk differences (RDs) and 95% confidence intervals (CIs) for eight binary outcomes. Results. Magnitude was generally as expected, i.e., RD for low- versus high- (most favorable) exposure groups (RDlow v. high) was larger than for the middle versus high contrast (RDmid v. high). Parent general health was strongly associated with CE (RDlow v. high = 20.8 [95% CI: 7.8, 33.9]) and order (RDmid v. high = 11.4 [95% CI: 2.1, 20.7]), unlike child general health, which had nearly null associations. Among respiratory outcomes, only waking at night was strongly associated with CE (RDlow v. high = 16.7 [95% CI: 2.8, 30.6]) and order (RDlow v. high = 22.2 [95% CI: 8.6, 35.8]). Exercise intolerance (RDlow v. high = 15.8 [95% CI: 2.1, 29.5]) and controllability (RDmid v. high = 12.0 [95% CI: 1.8, 22.3]) were moderately associated with order but not with CE, whereas school absences, rescue medication use, and unplanned visits had nearly null associations with both exposures. Conclusions. More negative perceptions tended to be associated with higher risk of undesirable outcomes, adding to evidence that the social environment contributes to health and supporting research on stress' health impact among disadvantaged populations. Interventions must address not only traditional environmental factors, but also individuals' reactions to stress and attempt to mitigate effects of stressors while structural solutions to health inequities are sought.