Asthma, Neighborhood Stress, and CBPR: Engaging Community and Healthcare Provider Perceptions of Contextual Influences on Childhood Asthma

Introduction: Disproportionately high asthma morbidity and mortality exists among socioeconomically disadvantaged children living in urban areas. Growing evidence shows that exposure to chronic stress predicts future asthma exacerbations in children. However, the influence of neighborhood-level factors on stress and asthma morbidity among urban youth remains poorly understood. Methods: This mixed methods study was guided by principles of CBPR and utilized concept mapping methods to engage residents of two underserved communities as well as primary healthcare practitioners to identify and prioritize neighborhood factors that may influence, positively or negatively, childhood asthma. Study activities included brainstorming, sorting, rating and cluster mapping activities that characterized perceptions of the factors influencing the care and control of childhood asthma.

Results: Participants from the first site identified 72 discrete neighborhood level items that were related to asthma care and control. Construct items included pollution, stress, shootings, teasing, dust, health insurance, and smoking. Items were organized and prioritized by the group into 5 distinct clusters, including environmental triggers, community awareness of asthma and stressors. Data collection from a second site and from healthcare providers will be completed June 2011.

Conclusion: Utilization of a community partnered research approach led to the contextualization of a range of unique neighborhood-level factors not identified in existing literature. Results will generate testable hypotheses regarding neighborhood influences on childhood asthma care and inform the design of behavioral and public health asthma care and control programs for youth.