Asthma is a chronic disease that disrupts a person’s airways to the lungs leading to “wheezing, breathlessness, chest tightness and coughing” and can affect daily life if not cared for properly (Centers for Disease Control and Prevention, 2011, p. 1).  Since 2001, there has been a 1% increase in the amount of people diagnosed with asthma.  In 2001, 7% of the population had asthma, or approximately one in 14 people.  This number jumped in 2009 to 8%, or approximately one in 12 people (Centers for Disease Control and Prevention, 2011).  Of those who had been diagnosed, 53% had an asthma attack in 2008, more commonly in children. Since children have smaller airways, asthma attacks are not only more common, but more dangerous than in adults (Medline Plus, 2012).

By 2009, one in 10 children were diagnosed with asthma (Centers for Disease Control and Prevention, 2011).  According to the Centers for Disease Control, “over 10 million U.S. children aged 17 years and under, have ever been diagnosed with asthma; 7 million children still have asthma” (Sondik et. al., 2011, p.12).  While asthma is a nationwide problem affecting many populations of children, “the greatest rise in asthma rates was among black children by almost a 50% increase from 2001 through 2009” (Centers for Disease Control and Prevention, 2011). Of these children, diagnoses of asthma were found more in boys than in girls (Center for Disease Control and Prevention, 2011).  The National Center for Health Statistics reported that more African American children were hospitalized due to asthma per 100 persons than Caucasians as well as more deaths per 1,000 persons than Caucasians (Akinbami et. al., 2012).  Among all children, “asthma is the leading cause for hospitalizations” (National Academy on Aging Society, 2000, p. 4).
 

According to Saha and colleagues (2005), “asthma is now the most common chronic childhood disease, occurring in approximately 54 of 1,000 children” and disproportionately affects more black children (p. 739).  Black children have a 4% higher prevalence rate than white children across gender, but boys are at a 9% increased risk for asthma than girls, whether black or white (Saha et. al., 2005).  While asthma is more prominently found in children living in an urban setting, according to Horner (2008), even rural African American males are affected more by asthma and its symptoms leading to chronic absenteeism from school.  Likewise, emergency room visits, hospitalizations and mortality rates are up to four times higher for African Americans children than Caucasians (Joseph et. al., 2005). 

The increasing prevalence rate of asthma in African American boys can be attributed to multiple factors.  Due to the young age of those infected, there are no specifically linked individual determinant of asthma, but rather family and social determinants seem to affect why this particular population is targeted (Wamboldt, 2008).  For example, behaviors and choices of the family, as opposed to the individual, can largely influence why more African American boys are diagnosed with asthma (Wamboldt et. al., 2008).  Wamboldt and his colleagues (2008) studied how smoking bans across diversified homes effect exposure to secondhand smoke, and from their research found that African Americans were the least likely group to already have or be willing to place a smoking ban within their home.  This becomes problematic because “the two most common settings in western society where children are exposed to second hand smoke are in their homes or while travelling by private motor vehicles” (Kabir & Clancy, 2010, p. 177).  The United States Surgeon General gathered a casual link between second hand smoke and asthma in 2006 (Kabir & Clancy, 2010). 
 

Besides family dynamics and their effects, there are also social determinants that concern the increasing prevalence rate of asthma in African American boys.  Racism has been linked to one of the leading causes of why African Americans are most subjective to asthma (Betancourt, 2003).  In American society, according to Jones (2000), we have a measurable amount of institutional racism that “manifests itself both in material conditions and in access to power” (p. 1212).  Both of these can lead to lack of access to proper medical care, thus mediating how likely it is for African American children to be diagnosed with asthma and unable to adequately care for the chronic disease.  According to Collins and associates (2008), racism can manifest itself in different forms, whether overt and blunt or covert and subtle, yet the effects are usually the same.  Research has shown that experiencing everyday discrimination, in any form, can cause chronic stress in African American adult women (Strain, 2008).  Chronic stress can adversely affect various health outcomes within a population due to the wear and tear it creates on organs and the entire body (Strain, 2008). 
 

For African American women, chronic stress from everyday discrimination has a cost (Collins et. al, 2004).  Black college educated women are almost three times as likely to have premature births than white college graduates, as well as a higher rate of experiencing pre-term labor than white women who never finished high school (Strain, 2008).  Chronic stress affects pregnancy even before conception, because the body becomes overloaded with stress hormones, which can lead to early labor (Strain, 2008).  When looking at premature birth in African American females, even women with the same level of education or socioeconomic status as a white woman, their likelihood of having a premature and low birth weight baby is drastically higher due to racism (Strain, 2008). 
 

Premature births create a variety of adverse health effects, including “chronic respiratory morbidity” according to Dr. Greenough (2008, p. 324).  Greenough’s (2008) research exhibits that continual respiratory symptoms and needed treatment are found more commonly in premature children, especially those who develop bronchopulmonary dysplasia, also known as BPD.  Many African American women who are forced into premature birth undergo caesarian sections to get the fetus out quickly and safely, but the effects of caesarian section are risky and can produce harmful health effects to the child, including continuous respiratory problems (Greenough, 2008).  The most likely causal link between premature birth and asthmatic symptoms is that with premature birth, particularly among the more premature babies born, lung development is significantly halted (Greenough, 2008).
 

One of the various reasoning’s behind premature births to asthmatic diagnoses is the link to cesarean sections (Asthma, 2005). There is “new insight into why cesarean delivery may predispose an infant to having asthma” (“Asthma,” 2005, p. 64).  Surgery required for cesarean sections to make an emergency birth of a baby will likely impact the bacteria created within the gut (“Asthma,” 2005).  
 

Some investigators suggest that modification of the bacterial colonization by cesarean  delivery may hinder the infant's tolerance to allergenic substances and increases the risk  of asthma, in agreement with the hygiene hypothesis.  When analyzed separately, Debley and colleagues found a significant association between cesarean delivery and asthma  hospitalization in premature infants, but not in full-term infants.  They also  reported that, since women with asthma have higher rates of both premature infants and  cesarean delivery, premature infants are more likely than full-term infants to have a  maternal genetic predisposition for asthma. (“Asthma,” 2005, p. 64)
 

Premature as opposed to full term birth babies were much more likely to have asthmatic symptoms (“Asthma,” 2005).  According to Greenough’s (2008) research, while premature infants were most exposed to oxygen dependency and other effects of bronchopulmonary dysplasia, asthmatic symptoms may alleviate with aging after the second year of life, but school aged children exemplifying more severe asthmatic symptoms exhibit “recurrent respiratory symptoms, evidence of poor airway growth assistance” (p. 326).  School aged children with asthma were 10% likely to wheeze and over a one-third likely to have chronic coughing, symptomatic with asthmatic diagnostics’ (Greenough, 2008). 
 

Alongside racism, housing availability for those living in poverty, also are subjects of the drastic asthmatic diagnoses and symptoms during childhood (Coreil, 2010).  Saha and colleagues (2005) found that exposure to socioeconomic and environmental factors has been leading to higher asthma disparities.  Many African American are disproportionally faced with poverty level living conditions, most likely public housing, due to socioeconomic status (Betancourt, 2003).  When public housing is the best available and affordable living conditions for family’s means living in and around “crowding, rat and insect infestation, leaky roofs, and lead paint,” which are just some of the health hazards African American adult and children face on a daily basis, which can lead to adverse health conditions, such as asthma, as well as a problem with recurring attacks if healthy management of the disease cannot be sustained (Coreil, 2010, p. 53).  Public housing is usually built in the poorest neighborhoods where there is: greater asthma morbidity, specifically a larger number of hospitalizations due to asthma,  more frequent episodes of wheezing, and more frequent night symptoms due to asthma  have been associated with the presence of moisture, mildew, and cockroach allergen in  homes. (Northridge et. al., 2010, p. 212).  Unsafe housing, such as those with exposure to daily health hazards, has also been linked to living in “close proximity to environmental hazards” such as landfills (Betancourt, 2003, p. 287). According to Betancourt (2003), “three of the five largest landfills in the country” were discovered in primarily African American and Latino neighborhoods that associatively had significantly higher rates of pediatric asthma (p. 287).  The reasoning behind these linkages have been connected to ever-increasing morbidity and mortality rates of asthma in urban populations since the birth of the Industrial Revolution (Delfino, 2002).  According to Delfino (2002), “asthma seen in developed countries may be attributable to some components of urbanization, including automobile and truck traffic” (p. 584). In studying asthma and air toxins, Delfino (2002) found that children exposed to formaldehyde in their home had a statistically “significant higher prevalence of physician-diagnosed asthma” (p. 584). 
 

Among many of the environmental hazards children of poverty are exposed too,  Joseph and colleagues (2005) found that lead poisoning is one of leading health hazards of African American as well as other minority children.  Studies have shown that that “African American blood lead levels were four times higher than those of Caucasians after controlling for income and urban status” (Joseph, 2005, p. 900).  Lead poisoning and asthma can lead to dismal daily life effects for those who suffer from one or both, especially among urban youth in the United States (Joseph et. al., 2005).   From a study conducted by Dr. Joseph and colleagues (2005), both lead poisoning and asthmatic diagnoses were linked to socioeconomic status, yet there has been no direct relation between blood lead levels and asthmatic diagnoses yet.  Regardless of casual linkages, there was a noticeable “elevated risk of asthma among children exposed to lead” (Joseph et. al., 2005, p. 902). 
Various statistics and studies exhibit that African American boys have been found to be a target population of asthma, and the prevalence rate continues to climb (Center for Disease Control and Prevention, 2011).  Familial factors such as second hand smoke (Kabir & Clancy, 2010) as well as social determinants like racism (Fortier et. al. 2008) and housing availability and lack of health safety for American Americans all contribute to the alarming rates of asthma found in this population (Betancourt, 2003; Delfino, 2002; Joseph et. al., 2005; Northridge et. al., 2010).  The increasing prevalence of asthma within this target population is a problem that needs to be addressed if there is any hope of reducing its glaring rates. 

 

 

 

 

 

REFERENCES

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Asthma in Children (2012).  Medline Plus. Retrieved from  http://www.nlm.nih.gov/medlineplus/asthmainchildren.html.
 

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