Characterization of Environmental Risk Factors Among Inner-City Schoolchildren with Physician Diagnosed Asthma from the Pittsburgh Region
Saturday, March 5, 2016
South Exhibit Hall H (Convention Center)
Paige E. Dewhirst, MPH, Jennifer Paden Elliott, PharmD, Albert Presto, PhD, Tricia Morphew, MSc, Erica Butler, BS,CCRC, Nicole Pleskovic, BS, David P. Skoner, MD, Deborah A. Gentile, MD
Rationale: Pediatric asthma remains a public health concern among inner-city schoolchildren from Pittsburgh.  The purpose of this study was to determine the prevalence of physician diagnosed asthma and the relationship between certain environmental risk factors and diagnosis among this population.

Methods: This study was approved by the Allegheny Singer Research Institute-Allegheny Health Network Institutional Review Board. Informed consent/assent was obtained from all subjects prior to participation. Fifth grade students were recruited from twelve Pittsburgh schools.  Physician diagnosed asthma was ascertained using a standardized, validated survey.  Relationships between physician diagnosed asthma and environmental risk factors, including obesity (BMI), poverty (public health insurance), outdoor air pollution (NOx), psychological stress (salivary cortisol), and  tobacco smoke exposure (salivary cotinine) were analyzed using  logistic regression.    

Results: 267 subjects were enrolled  (37.5 % African American, 47.6% female).   The prevalence of physician diagnosed asthma was 28.7%.  Factors influencing odds of physician diagnosed asthma included elevated BMI (p=0.032) public vs private health insurance (p=0.002), NOx exposure (p=0.023), and salivary cortisol (p=0.34).  A strong interaction was identified between poverty and psychological stress (p=0.004) such that the odds of physician diagnosed asthma was 6.88 times greater (p=0.002) in subjects with public health insurance and elevated salivary cortisol levels (>1 SD above mean).  Conclusions: Results indicate a high estimated prevalence of physician diagnosed asthma among participants.  Obesity, poverty, outdoor air pollution, and psychological stress  were identified risk factors.   Future efforts need to focus on improving asthma outcomes in this at-risk population.