Social, Environmental and Behavioral Determinants of Asthma Symptoms in Brazilian Middle School Students-A National School Health Survey (Pense 2012)

Association of Socioeconomic Status and a Broad Combination of Lifestyle Factors With Adult-Onset Asthma: A Cohort Study

BACKGROUND

The prevalence of asthma is gradually increasing worldwide, and there are socioeconomic inequalities in the risk of developing asthma.

OBJECTIVE

To evaluate whether the lifestyle is associated with asthma in adults, as well as whether and to what extent healthy lifestyles may modify socioeconomic status (SES) inequities in asthma.

METHODS

This study included a total of 223,951 participants from the UK Biobank. Smoking, physical activity, alcohol consumption, healthy diet patterns, sedentary time, and sleep duration items were used to construct the lifestyle score. Income, education, and occupation were used to assess SES. Cases of adult-onset asthma were identified on the basis of electronic health records. The Cox proportional hazards regression was used to explore the association of socioeconomic inequality and lifestyle factors with asthma.

RESULTS

Compared with the most healthy lifestyle category, the hazard ratios (95% CIs) of the moderately healthy lifestyle and least healthy lifestyle categories for asthma were 1.08 (1.01-1.15) and 1.29 (1.20-1.39), respectively. A significant interaction (Pinteraction < .05) was found between lifestyle categories and SES, and the association between them was more pronounced in participants with low SES (hazard ratioleast healthy vs most healthy, 1.58; 95% CI, 1.40-1.80). The joint analysis revealed that the risk of asthma was highest among participants with the lowest SES and the least healthy lifestyles (hazard ratio, 2.02; 95% CI, 1.74-2.33).

CONCLUSIONS

Unhealthy lifestyle factors are associated with an increased risk of asthma in adults, and socioeconomically disadvantaged groups are more negatively affected by unhealthy lifestyles. Public health strategies for asthma prevention may need to be tailored according to SES, and social policies to reduce poverty are needed alongside lifestyle interventions in areas of deprivation.

Community violence and asthma: A review

Over the past 2 decades, epidemiologic studies have identified significant associations between exposure to violence, as a psychosocial stressor, and the incidence or exacerbation of asthma. Across diverse populations, study designs, and measures of community violence, researchers have consistently identified adverse associations. In this review, the published epidemiologic evidence is summarized with special attention to research published in the last 5 years and seminal papers. Hypothesized mechanisms for the direct effects of violence exposure and for how such exposure affects susceptibility to physical agents (eg, air pollution and extreme temperature) are discussed. These include stress-related pathways, behavioral mechanisms, and epigenetic mechanisms. Finally, clinical implications and recommendations are discussed.

Association among friendship skills, involvement in after-school activities, and flourishing for adolescents with asthma and comorbid emotional and behavioral problems

OBJECTIVES

Primary objectives were to examine the relations among abilities for making and keeping friends, involvement in after-school activities, and flourishing for adolescents with current asthma, as well as comorbid behavior problems, anxiety, or depression.

METHODS

Data from the 2021 National Survey of Child Health was analyzed. Parents provided data on one child. Multinomial logistic regression analyses, both unadjusted and adjusted for the sampling weight, were conducted for adolescents with current asthma and comorbid behavior problems, anxiety, or depression. Predictors of flourishing included difficulty in making and keeping friends and involvement in after-school activities. Sex, age, race/ethnic group, and having been bullied were covariates. To examine differences for children with varied comorbid emotional and behavioral problems, relations were tested separately for children with asthma and behavior problems, children with asthma and anxiety, and children with asthma and depression.

RESULTS

Skills for making and keeping friends were positively related to flourishing of adolescents with current asthma for all three types of mental health concerns. The relationship between involvements in after-school activities was less clear-cut, as this predictor was not always positively related to flourishing.

CONCLUSIONS

Abilities to make and keep friends were related to flourishing, indicating that peer support is a resilience factor. Conversely, it was not clear that involvement in after-school activities was a resilience factor and more research about factors constituting successful after-school involvement for adolescents with asthma is needed. Future research, illuminating how social support from peers and involvement in activities promote flourishing will extend knowledge.

Understanding and controlling asthma in Latin America: A review of recent research informed by the SCAALA programme

Asthma is an important health concern in Latin America (LA) where it is associated with variable prevalence and disease burden between countries. High prevalence and morbidity have been observed in some regions, particularly marginalized urban populations. Research over the past 10 years from LA has shown that childhood disease is primarily non-atopic. The attenuation of atopy may be explained by enhanced immune regulation induced by intense exposures to environmental factors such as childhood infections and poor environmental conditions of the urban poor. Non-atopic symptoms are associated with environmental and lifestyle factors including poor living conditions, respiratory infections, psychosocial stress, obesity, and a diet of highly processed foods. Ancestry (particularly African) and genetic factors increase asthma risk, and some of these factors may be specific to LA settings. Asthma in LA tends to be poorly controlled and depends on access to health care and medications. There is a need to improve management and access to medication through primary health care. Future research should consider the heterogeneity of asthma to identify relevant endotypes and underlying causes. The outcome of such research will need to focus on implementable strategies relevant to populations living in resource-poor settings where the disease burden is greatest.

From War to Change, from Resistance to Resilience: Vicariance, Bricolage and Exaptation as New Metaphors to Frame the Post COVID-19 Era

In complex societal contexts, resilience seems the only way to survive and prosper. This is even truer when considering the present COVID-19 pandemic and its detrimental effects on global health systems and on every aspect of life. The impact was so deep that the World Health Organization (WHO) declared a global emergency on 30 January 2020. Accordingly, governments declared border closures, travel restrictions, and quarantines in the world’s largest economies, also giving rise to socio-economic recessions. There is wide literature on the pandemic’s impacts on people’s minds and societies, yet still few studies have investigated this topic holistically, examining how language shapes both human and social sides of COVID-19’s impacts. To fill this gap, this work discusses the need for new metaphorical clusters—bricolage, vicariance, and exaptation—as social sense makers to reframe a positive socially resilient response after COVID-19.

External Environmental Pollution as a Risk Factor for Asthma

Air pollution is a worrisome risk factor for global morbidity and mortality and plays a special role in many respiratory conditions. It contributes to around 8 million deaths/year, with outdoor exposure being responsible for more than 4.2 million deaths throughout the world, while more than 3.8 million die from situations related to indoor pollution. Pollutant agents induce several respiratory symptoms. In addition, there is a clear interference in numerous asthma outcomes, such as incidence, prevalence, hospital admission, visits to emergency departments, mortality, and asthma attacks, among others. The particulate matter group of pollutants includes coarse particles/PM₁₀, fine particles/PM_2.5, and ultrafine particles/PM_0.1. The gaseous components include ground-level ozone, nitrogen dioxide, sulfur dioxide, and carbon monoxide. The timing, load, and route of allergen exposure are other items affecting allergic disease phenotypes. The complex interaction between pollutant exposures and human host factors has an implication in the development and rise of asthma as a public health problem. However, there are hiatuses in the understanding of the pathways in this disease. The routes through which pollutants induce asthma are multiple, and include the epigenetic changes that occur in the respiratory tract microbiome, oxidative stress, and immune dysregulation. In addition, the expansion of the modern Westernized lifestyle, which is characterized by intense urbanization and more time spent indoors, resulted in greater exposure to polluted air. Another point to consider is the different role of the environment according to age groups. Children growing up in economically disadvantaged neighborhoods suffer more important negative health impacts. This narrative review highlights the principal polluting agents, their sources of emission, epidemiological findings, and mechanistic evidence that links environmental exposures to asthma.