The Racial and Ethnic Dimensions of Asthma Diagnosis in U.S. School-Age Children

• In Event: Public health

Proposal

Dr. Robert Bullard, commonly referred to as the Father of Environmental Justice, is credited as being the first to define environmental justice as the principle that all people, regardless of race, color, or national origin, are entitled to equal protection of environmental laws (Bullard, 2000). With origins in the United States, the environmental justice movement soon emerged as an international initiative through the 1992 Earth Summit and the eventual establishment of the Earth Charter in 2000. Today, Sustainable Development Goals established by the United Nations attempt to address environmental justice through “legal transformations aimed at curbing abuses of power that result in the poor and vulnerable suffering disproportionate impacts of pollution and lacking equal opportunity to access and benefit from natural resources” (United Nations Development Programme, 2014, p. 6). While poor and vulnerable populations often contribute significantly less to environmental problems, they are significantly more likely to suffer from adverse economic and health effects caused by environmental problems. Poor children, who are often children of color, are particularly vulnerable to environmental health disparities. Despite pioneering the environmental justice movement, the United States still lags far behind other developed nations in its commitment to the equitable distribution of environmental laws. Particularly in light of the current political climate, more effort is being made to limit the power of the Environmental Protection Agency to limit the release of toxic substances into the environment. This paper examines the association of access to neighborhood outdoor recreational amenities with high rates of asthma in African-American and Latino children in the United States.
Asthma is a chronic disorder of the airways that affects more than 7 million children in the U.S. (CDC, n.d.; Sampson, 2012). Asthma also disproportionately impacts minority children, affecting 1 in 6 African American children as well as large numbers of Latino, particularly Puerto Rican, children (Asthma and Allergy Foundation of America, n.d.; Gaffron & Niemeier, 2015; Mohai et al., 2015). Children from these cultural groups are also three times more likely to die from asthma complications than white children (Asthma and Allergy Foundation of America, n.d., CDC, n.d.). Not surprisingly, homes and schools with the highest concentrations of outdoor and indoor air pollution are more likely to be inhabited by poor, minority, particularly African American and Puerto Rican children (Hopkins, 2017; Gaffron & Niemeier, 2015; Mohai et al., 2015; Cohen 2010).
Although near-road air pollution is linked to asthma attacks in children, children with asthma are more likely to ride in cars or school buses to get to school (Foty et al., 2013) and less likely to engage in outdoor activity. Parents of children who live in inner cities are also more likely to limit their children’s time outdoors, often citing neighborhood violence and crime as a deterrent (Sampson, 2012; Yinusa-Nyahkoon, Cohn, Cortes & Bokhour, 2010). There is growing evidence, however, that outdoor air may have more restorative qualities than indoor air, thus having a positive effect on children’s overall health (Sampson, 2012). Furthermore, engaging in active transportation, such as walking or riding bicycles, may significantly reduce the number of vehicles on the road that may lead to a reduction in near-air pollution (EPA, 2015). Therefore, the purpose of this paper is to investigate whether there is an association between neighborhood outdoor recreational amenities and asthma diagnosis in school-aged African American and Latino children.
This paper uses archived survey data from the 2016 National Survey of Children’s Health, a large national study that examines the physical and emotional health of children up to 17 years of age. The survey is sponsored by the U.S. Department of Health and Human Services, Maternal and Child Health Bureau, and is conducted by the U.S. Census Bureau. Data were collected from 50,212 surveys nationally, representing an average of 985 surveys from each of the 50 states with an overall weighted response weight of 40.7% (Child and Adolescent Health Measurement Initiative, 2017). Using a cross-sectional, complex sample design, data were weighted to represent the population of non-institutionalized children living in housing units nationally and in each state. In households with more than one child, one child was randomly selected as subject of the main questionnaire (Child and Adolescent Health Measurement Initiative, 2017). The variable, neighborhood recreational amenities, is operationalized to determine whether sidewalks and walkways, park, and recreational centers exist in the children’s residential communities. Univariate analyses are performed to provide descriptive information of the overall sample. After describing the sample, the main focus of the analysis is to test the hypothesis that African American and Latino children who live in neighborhoods with recreational amenities are less likely to be diagnosed with asthma than children who live in neighborhoods without recreational amenities. Logistic regression analysis is used to determine whether lack of neighborhood recreational amenities is a contributing factor of asthma diagnosis in African American and Latino children.
The economic cost of asthma is approximately $56 million per year, of which the majority is the cost associated with hospital stays (Asthma and Allergy Foundation of America, n.d.). Furthermore, approximately 12% of African American and Puerto Rican children are absent from school at least one day per month due to asthma (Asthma and Allergy Foundation of America, n.d.). Generally, children who miss significant days from school have lower academic performance than children with more regular attendance, even after controlling other demographic factors (Gaffron & Niemeier, 2015). This paper assumes that if neighborhood outdoor recreational amenities are available, the community will take advantage of them. One limitation is that while parents identify these amenities in their neighborhoods, there is no data that measures whether their children use these amenities. Another limitation is that there is no measure of outdoor air pollution levels, therefore, excessive levels of air pollution cannot be confirmed in either communities with or without recreational amenities. Still, there are potentially more overall health benefits than risks to children who engage in outdoor activities. This research has important policy implications, as it might inform future community planning, school-siting guidelines and safe routes to schools.

Authors

• Shelby Gilbert, Florida Gulf Coast University

• Simone O'Bryan, Florida Gulf Coast University