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Violence, Abuse, and Asthma in Puerto Rican Children

¹ Channing Laboratory, Brigham and Women's Hospital, and ² Harvard Medical School, Boston, Massachusetts; ³ Behavioral Sciences Research Institute, University of Puerto Rico, San Juan, Puerto Rico; ⁴ Division of Child and Adolescent Psychiatry, Columbia University, New York, New York; and ⁵ Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts

Correspondence and requests for reprints should be sent to Robyn T. Cohen, M.D., M.P.H., St. Christopher's Hospital for Children, Erie at Front Street, Philadelphia, PA 19134. E-mail: robyn.cohen{at}drexelmed.edu

Rationale: Puerto Ricans have the highest prevalence of and morbidity from asthma of all ethnic groups in the United States. One potential contributor to the high burden of asthma in Puerto Rican children is exposure to stress and violence.

Objectives: To examine whether exposure to stress and violence is associated with an increased risk of asthma among Puerto Rican children.

Methods: This study was a population-based probability sample of children in the San Juan and Caguas metropolitan areas in Puerto Rico. Information was collected in a household survey of 1,213 children and their primary caretakers.

Measurements and Main Results: The prevalence of lifetime physician-diagnosed asthma was 39.6%. In the year before the survey, 14% of children had witnessed an act of violence, 7% had been victims of violence, and 6% had been victims of physical or sexual abuse. Although stressful life events and exposure to neighborhood violence were not associated with asthma, a history of physical or sexual abuse was associated with approximately twice the odds of current asthma (odd ratio [OR], 2.52; 95% confidence interval [CI], 1.27–5.00), health care use for asthma (OR, 1.95; 95% CI, 0.96–3.96), and medication use for asthma (OR, 2.35; 95% CI, 1.05–5.26).

Conclusions: Physical or sexual abuse is associated with high asthma morbidity among Puerto Rican children. To our knowledge, this is the first report of an association between childhood abuse and asthma. Our findings highlight the importance of screening for asthma among victims of childhood abuse, and to be aware of the possibility of physical or sexual abuse among children with asthma.

Key Words: asthma • children • stress • violence • abuse

AT A GLANCE COMMENTARY Scientific Knowledge on the Subject Stress and violence have been associated with asthma in children. This association has never been examined specifically in Puerto Rican children, who bear a disproportionate burden of asthma morbidity compared with other groups. What This Study Adds to the Field Physical or sexual abuse was associated with high asthma morbidity among children living in urban areas of Puerto Rico. These findings highlight the importance of screening for asthma among victims of childhood abuse, and vice versa.