Exploring neighborhood-level variation in asthma and other respiratory diseases - The contribution of neighborhood social context

OBJECTIVE: We explore differences in the prevalence of asthma and other respiratory diseases at the neighborhood level. In addition to traditional metrics of neighborhood structure (e.g., concentrated disadvantage, residential stability), we incorporate residents' evaluations of neighborhood context. We examine the extent to which indicators such as disorder (observable signs of physical and social decay) and collective efficacy (trust and shared expectations for beneficial community action) account for differences in the prevalence of asthma and other respiratory diseases. METHODS: We examine 338 Chicago neighborhoods, combining 3 data sources from the 1990s: 1) the Metropolitan Chicago Information Center Metro Survey; 2) the Decennial Census; and 3) the Project on Human Development in Chicago Neighborhoods Community Survey. We use a multilevel statistical approach to disentangle neighborhood- from individual-level effects. MEASUREMENTS: A survey-based response to whether a physician has diagnosed asthma, bronchitis, emphysema, or other breathing problems. RESULTS: Findings indicate that individual- and neighborhood-level factors are associated with asthma/breathing problems. At the individual level, female gender, smoking, and a weight problem are positively associated with asthma/breathing problems, while Latino ethnicity is protective. At the neighborhood level, collective efficacy is protective against asthma/breathing problems. Residential stability is positively associated only when levels of collective efficacy are controlled. CONCLUSIONS: Neighborhood context, particularly collective efficacy, may be an underlying factor that reduces vulnerability to asthma and other respiratory diseases. Collective efficacy may enhance the ability to garner health-relevant resources, eliminate environmental hazards that trigger asthma, and promote communication among residents which, in turn, enables dissemination of information relevant to respiratory ailments.