摘要：Objectives. We investigated associations between perceived neighborhood problems and quality of life (QOL), physical functioning, and depressive symptoms among adults with asthma. Methods. Using cross-sectional data from adults with asthma in northern California (n=435), we examined associations between 5 types of perceived neighborhood problems (traffic, noise, trash, smells, and fires) and asthma-specific QOL (Marks instrument), physical functioning (Short Form-12 physical component summary), and depressive symptoms (Center for Epidemiological Studies–Depression). We used multivariate regression analysis. Results. When asthma severity and sociodemographics were taken into account, people reporting a score of 8 or higher on a scale of 0 to 25 for serious problems (the top quartile of seriousness) in their neighborhoods had significantly poorer QOL scores (mean difference=5.91; standard error [SE]=1.63), poorer physical functioning (mean difference=−3.04; SE=1.27), and almost a fivefold increase in depressive symptoms (odds ratio=4.79; 95% confidence interval=2.41, 9.52). Conclusions. A high level of perceived neighborhood problems was associated with poorer QOL, poorer physical functioning, and increased depressive symptoms among people with asthma when disease severity and sociodemographic factors were taken into account. Increasingly, public health researchers and practitioners are turning to the neighborhood as a potential target for population-based interventions to influence individual health. In 1993, Macintyre and colleagues 1 reviewed public health scientific studies on the role of neighborhoods, concluding that there was a need for direct study of local social and physical environments with regard to how they might influence health. Since that review appeared, several studies have documented links between neighborhoods and health. Neighborhood physical environment factors tied to health or health behaviors include air pollution, 2 , 3 types of stores and the presence of services, 4 – 6 general physical condition (e.g., crowding, cleanliness, level of noise), 7 , 8 and advertising. 9 – 11 Neighborhood social environment factors, such as the percentage of people with incomes below the poverty level in a census tract or census block group, percentage of adults with less than a high-school education, and percentage of adults who are unemployed, alone or in combination, have been linked to all-cause mortality, 12 – 18 cause-specific mortality, 19 – 21 coronary heart disease, 11 , 22 low birthweight, 7 , 23 – 26 perceived poor health, 27 and cardiovascular risk behaviors. 28 , 29 Environmental psychologists have identified several characteristics of the “built environment” that are potential sources of stress, such as noise, crowding, pollution, monotonous physical settings, extreme light or temperature, and crime and safety problems. 30 The physiological effects of stress stemming from the neighborhood experience (i.e., the concept of “urban press,” defined as the “stimuli related to the physical, social, visual, and aural aspects of environments” 30 ) may lead to adverse health outcomes, for example, an altered immune response. Few studies, however, have linked neighborhoods to the stress process. Elliot 31 suggested that the social environment is a source of both stressors and resources to cope with stressors. Steptoe and Feldman 32 reported that high levels of neighborhood stress (measured with perceptions of problems such as trash, noise, traffic, smells) were associated with poorer self-rated health; psychological distress; and a reduced ability to carry out activities of daily living. And the level of perceived problems was associated with social capital 33 and physical functioning in the elderly. 34 Asthma is a common chronic condition that affects millions of adults and children around the world. Asthma prevalence and associated morbidity are increasing. 35 , 36 Management of asthma symptoms and attacks, whether by regular use of medications, environmental interventions, stress reduction methods, or some combination of these is believed to be a key to maintaining a good quality of life (QOL). 37 , 38 The neighborhood environment has been linked with asthma, primarily through the physical features of the area studied, specifically ambient air quality. Most relevant studies have focused on children. Ambient air pollution was associated with asthma severity and asthma-associated medical care utilization, such as emergency department visits and hospital admissions. 39 – 42 In addition, studies have reported links between high traffic flows and increased medical attention for asthma 43 or an increased likelihood of wheezing in children with asthma. 44 , 45 In terms of neighborhood social environment and asthma, studies found associations between neighborhood deprivation and asthma prevalence in New Zealand 46 and childhood asthma hospitalizations in England. 47 We sought to investigate potential links between the neighborhood environment and asthma-related health by analyzing the association between the perceived neighborhood environment and health outcomes among adults with asthma. We focused our study on asthma-specific health-related QOL, depressive symptoms, and general physical functioning, 3 different but key health measures in asthma patients. If the perceived neighborhood environment is associated with QOL and mental and physical functioning among people with asthma, this link would provide more evidence supporting the hypothesized connections between the neighborhood and health status, further supporting the need for targeted interventions to promote health at this level.
