Five Things to Know about the Role of 'Place' in Asthma Research
February 24, 2015
A recent study published in the Journal of Allergy and Clinical Immunology claims that the long-held belief that asthma is more common in urban areas is not accurate.
In fact, the study, which was titled “Neighborhood Poverty, Urban Residence, Race/Ethnicity, and Asthma: Rethinking the Inner-city Asthma Epidemic,” found that, although the prevalence of asthma is high in some inner-city areas, this is largely explained by demographic factors and not by living in an urban neighborhood.
Alison Kenner, PhD, an assistant professor in the College of Arts and Sciences’ Department of History & Politics and a faculty member in Drexel’s Center for Science Technology and Society, is an anthropologist who specializes in the study of contemporary health practices and how biomedical science and emerging technologies shape the way we understand and care for chronic disease conditions. Her current research examines the experiences of asthmatics and how asthma is cared for in various areas across the country.
We checked in with Kenner for her response to this new study. Here are her five takeaways:
- Demographics are a greater driver of asthma disparities than residence. The study suggests that racial, ethnic and socioeconomic differences are more significant for understanding asthma prevalence than urban residence. Evidence of the contemporary asthma epidemic (emerging in the mid-1980s) first identified inner-cities as asthma hot spots. Since this initial observation, the assumption has been that inner-cities produce higher rates of asthma; the authors’ suggest that asthma studies don’t always account for changes in U.S. metropolitan characteristics and demographics. Their study indicates that asthma is just as prevalent and problematic outside inner-cities, particularly with the suburbanization of poverty and among the rural poor.
- More research is needed on asthma prevalence, morbidity and care in rural and suburban contexts. Even though demographics and poverty appear to be more significant for asthma prevalence, more research is needed on rural and suburban contexts, and whether these areas present different risk factors, or even protective mechanisms. Much of what we know today about asthma and its risk factors comes from studies conducted in urban environments.
- Environmental health conditions, like asthma, are complex and difficult to study. The study’s second objective (after investigating whether asthma prevalence was higher in inner-city versus non-inner-city areas) was to “disentangle the effects of urban residence, neighborhood-level poverty, race/ethnicity and household poverty on asthma prevalence.” Yet these are only a few of the dynamics that need to be parsed out. It remains difficult to determine how environmental exposures and genetic susceptibility play into known and potential risk factors, such as urban residence, race/ethnicity and poverty.
- Poverty plays a major role in U.S. asthma prevalence. Researchers found that both neighborhood and household-level poverty are associated with increased asthma prevalence. Poverty is associated with some of the most common asthma risk factors, such as smoking, indoor allergens, outdoor pollution, poor diet and psychological stress. Poverty also impacts people’s ability to access and afford care, as well as their ability to implement environmental management recommendations. (The relationship between poverty and asthma care, however, were not mentioned in this particular study.)
- Standard metrics are needed in the field of asthma research. The study authors pointed out that the lack of standards in the field of asthma research – primarily in how census and metropolitan data are used, for example, but even in asthma diagnostics – continues to be a challenge for comparing one study to the next. Several professional associations are working with the National Heart, Lung, and Blood Institute to address the issue of standardization in asthma research.
“It will be interesting to see how this study impacts entrenched assumptions about urban environments and asthma,” said Kenner. “On the other hand, its findings should be considered alongside research that uses different methodologies to show that asthma prevalence may be underestimated in low-income urban communities.”
According to Kenner, a 2012 paper published by Tyra Bryant-Stephens, MD, at the Children’s Hospital of Philadelphia showed that childhood asthma prevalence in North and West Philadelphia was more than twice the national average. “Bryant-Stephens and her colleagues tested two different methods, door-to-door screening and school-based screenings, which may be more effective in assessing asthma prevalence among disadvantaged population groups that are harder to reach via national phone surveys,” she said.
“Overall, both papers suggest that researchers need to attend to and refine the role of ‘place’ in asthma research.”
The Asthmatic Spaces project, led by Kenner, investigates how place is conceptualized and defined in asthma research in the United States. Part of the Asthmatic Spaces project tracks where federally funded and peer-reviewed research is sited. In part, the project is designed to investigate how the legacy of the inner-city asthma epidemic, which focused on atopic asthma in children, continues to shape what we know about asthma today.
Kenner’s forthcoming book project, “Asthmatic Spaces: Emplaced Care in the Late Industrialism,” argues for embodied and place-based approaches to the asthma epidemic, approaches that acknowledge the shared, community-based dynamics of environmental health conditions.
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