Journal of Immigrant Health

, Volume 7, Issue 3, pp 165–173 | Cite as

Asthma Prevalence and Severity in Arab American Communities in the Detroit Area, Michigan

  • Mary Johnson
  • Jerome NriaguEmail author
  • Adnan Hammad
  • Kathryn Savoie
  • Hikmet Jamil


Immigrant populations provide a unique intersection of cultural and environmental risk factors implicated in asthma etiology. This study focuses on asthma prevalence and severity in 600 Arab American households in metro Detroit, the largest immigrant reception zone for Arab Americans in North America. The survey method introduced a number of novel features: (a) a ranking scheme for the key environmental risk factors for asthma was used to derive an aggregated environmental risk index (ERI) for each household, and (b) an aggregate measure of asthma severity based on symptom frequency and intensity. Environmental risk factors and surrogates for socioeconomic status (SES) were found to be stronger predictors of asthma prevalence than asthma severity, while demographic variables such as English fluency and birth in the United States were better predictors of asthma severity than asthma prevalence. These results suggest that SES variables may be more reflective of environmental exposures in communities involved in this study, while English fluency and birth in the United States may be linked to health care access and utilization behavior that can influence the asthma management. We also found a significant relationship between asthma prevalence and degree of acculturation. Asthma prevalence was highest among moderately acculturated immigrants compared with new immigrants and those who were well acculturated, suggesting that among Arab Americans in the Detroit area, risk factors associated with new immigrant status are replaced by “western” risk factors as the population becomes more acculturated.

Key words

asthma prevalence severity indoor air pollution Arab Americans 


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  1. 1.
    Meliker JR, Nriagu JO, Hammad AS, Savoie KL, Jamil H, Devries JM: Spatial clustering of emergency department visits by asthmatic children in an urban area: Southwest Detroit, Michigan. Ambul Child Health 2001; 7:297–312CrossRefGoogle Scholar
  2. 2.
    Beasley R, Crane J, Lai CK, Pearce N: Prevalence and etiology of asthma. J Allergy Clin Immunol 2000; 105 (2, Pt 2):S466–S472CrossRefPubMedGoogle Scholar
  3. 3.
    Tobias A, Soriano JB, Chinn S, Anto JM, Sunyer J, Burney P: European Community Respiratory Health Survey. Symptoms of asthma, bronchial responsiveness and atopy in immigrants and emigrants in Europe. Eur Respir J. 2001; 18(3):459–465Google Scholar
  4. 4.
    Powell CV, Nolan TM, Carlin JB, Bennett CM, Johnson PD: Respiratory symptoms and duration of residence in immigrant teenagers living in Melbourne, Australia. Arch Dis Childhood 1999; 81(2):159–162Google Scholar
  5. 5.
    Strachan DP, Anderson HR, Limb ES, O’Neil A, Wells N: A national survey of asthma prevalence, severity, and treatment in Great Briatin. Arch Dis. Childhood 1994; 70:174–178Google Scholar
  6. 6.
    Leung RC, Carlin JB, Burdon JG, Czarny D: Asthma, allergy and atopy in Asian immigrants in Melbourne. Med J Austr 1994; 61(7):418–425Google Scholar
  7. 7.
    Eggleston PA: Environmental causes of asthma in inner city children. The National Cooperative Inner City Asthma Study. Clin Rev Allergy Immunol 2000; 18(3):311–324Google Scholar
  8. 8.
    Nriagu JO, Robins T, Gary L, Liggans G, Davila R, Supuwood K, Harvey C, Jinabhai CC, Naido R: Prevalence of asthma and respiratory symptoms in south-central Durban, South Africa. Eur J Epidemiol 1999; 15:747–755CrossRefPubMedGoogle Scholar
  9. 9.
    Sarafino EP, Goldfedder J. 1995. Genetic factors in the presence, severity, and triggers of asthma. Arch Dis Childhood 1995; 73(2):112–116Google Scholar
  10. 10.
    Sarafino EP: Connections among parent and child atopic illnesses. Pediatr Allergy Immunol 2000; 11:80–86CrossRefPubMedGoogle Scholar
  11. 11.
    Parker EA, Israel BA, Williams M, Brakefield-Caldwell W, Lewis TC, Robins T, Ramirez E, Rowe Z, Keeler G: Community action against asthma: Examining the partnership process of a community-based participatory research project. J Gen Int Med 2003; 18(7):558–567CrossRefGoogle Scholar
  12. 12.
    O’Fallon LR, Dearry A: Community-based participatory research as a tool to advance environmental health sciences. Environ Health Perspect 2002; 110(Suppl 2):155–159PubMedGoogle Scholar
  13. 13.
    Johnson M: Risk factors for asthma among Arab American immigrants in the Metro Detroit area. Doctoral Thesis. 2005Google Scholar
  14. 14.
    Keeler GJ, Dvonch T, Yip FY, Parker EA, Isreal BA, Marsik FJ, Morishita M, Barres JA, Robins TG, Brakefield-Caldwell W, Sam M: Assessment of personal and community-level exposures to particulate matter among children with asthma in Detroit, Michigan, as part of Community Action Against Asthma (CAAA). Environ Health Perspect 2002; 110(Suppl 2):173–181PubMedGoogle Scholar
  15. 15.
    Clark NM, Brown RW, Parker E, Robins TG, Remick DG Jr, Philbert MA, Keeler GJ, Israel BA: Childhood asthma. Environ Health Perspect 1999; 107(Suppl 3):421–429PubMedGoogle Scholar
  16. 16.
    Clark NM, Brown R, Joseph CL, Anderson EW, Liu M, Valerio M, Gong M: Issues in identifying asthma and estimating prevalence in an urban school population. J Clin Epidemiol. 2002; 55(9):870–881Google Scholar
  17. 17.
    Joseph CL, Foxman B, Leickly FE, Peterson E, Ownby D: Prevalence of possible undiagnosed asthma and associated morbidity among urban schoolchildren. J Pediatr 1996; 129(5):735–742PubMedGoogle Scholar
  18. 18.
    American College of Allergy, Asthma and Immunology (ACAAI): Nationwide Asthma Screening Program. 2003. Available at
  19. 19.
    University of Michigan Health Services: 2004. Available at
  20. 20.
    Robins TG, Parker EA, Israel BA, Brown RW, Lewis TC, CAAA Steering Committee: Use of a screening questionnaire to estimate prevalence of diagnosed and undiagnosed asthma among minority children in Detroit. Presentation at American Thoracic Society Presentation: San Francisco, CA; 2001Google Scholar
  21. 21.
    Joffres M, Williams T, Sabo B, Fox RA: Environmental sensitivities: Prevalence of major symptoms in a referral center: The Nova Scotia Environmental Sensitivities Research Center study. Environ Health Perspect 2001; 109:161–165PubMedGoogle Scholar
  22. 22.
    Savoie K, Nriagu J: Air Pollution Health Risk Assessment of the Arab American Community in Dearborn, Michigan. Report to US EPA, Region 5, Air and Radiation Division; 1999Google Scholar
  23. 23.
    Mannino DM, Homa DM, Akinbami LJ, Moorman JE, Gwynn C, Redd SC: Surveillance for asthma–United States, 1980–1999. Morb Mortal Wkly Rep. Surveillance Summaries 2002; 51(1):1–13Google Scholar
  24. 24.
    Rhodes L, Bailey CM, Moorman JE: Surveillance for asthma–United States, 1980–1999. Morb Mortal Wkly Rep. Surveillance Summaries 2004; 53(07):145–148Google Scholar
  25. 25.
    CDC National Center for Chronic Disease Prevention and Health Promotion: The Selected Metropolitan/Micropolitan Area Risk Trends (SMART); 2002. Project: http://apps. = 2002& MMSA = 26&cat = AS&qkey = 290&grp = 0
  26. 26.
    Rhodes L, Moorman JE, Redd SC, Mannino DM: Self-reported asthma prevalence and control among adults—United States, 2001. Morb Mortal Wkly Rep. Surveillance Summaries 2003; 52(17):381–384Google Scholar
  27. 27.
    WHO Regional Office for the Eastern Mediterranean: Non-communicable disease s-regional situation report; 2004 Available at Situation-Asthma.htm
  28. 28.
    Silverman RA, Stevenson L, Hastings HM: Age-related seasonal patterns of emergency department visits for acute asthma in an urban environment. Ann Emergency Med 2003; 42(4):577–586Google Scholar
  29. 29.
    Crighton EJ, Mamdani MM, Upshur RE: A population based time series analysis of asthma hospitalisations in Ontario, Canada: 1988 to 2000. BMC Health Serv Res 2001; 1(1):7PubMedGoogle Scholar
  30. 30.
    Kimbell-Dunn M, Pearce N, Beasley R: Seasonal variation in asthma hospitalizations and death rates in New Zealand. Respirology 2000; 5(3):241–246PubMedGoogle Scholar
  31. 31.
    Nichols T, Hansell A, Strachan D: The contribution of ‘holiday deaths’ to seasonal variations in asthma mortality in England and Wales. Clin Exp Allergy1999; 29(10):1415–1417PubMedGoogle Scholar
  32. 32.
    Dales RE, Schweitzer I, Toogood JH, Drouin M, Yang W, Dolovich J, Boulet J: Respiratory infections and the autumn increase in asthma morbidity. Eur Respir J 1996; 9(1):72–77PubMedGoogle Scholar
  33. 33.
    Kimes D, Levine E, Timmins S, Weiss SR, Bollinger ME, Blaisdell C: Temporal dynamics of emergency department and hospital admissions of pediatric asthmatics. Environ Res 2004; 94(1):7–17PubMedGoogle Scholar
  34. 34.
    Gergen PJ, Mitchell H, Lynn H: Understanding the seasonal pattern of childhood asthma: Results from the National Cooperative Inner-City Asthma Study (NCICAS). J Pediatr 2002; 141(5):631–6PubMedGoogle Scholar
  35. 35.
    Bardana EJ, Jr: Indoor pollution and its impact on respiratory health. Ann Allergy Asthma Immunol 2001; 87(6, Suppl 3):33–40Google Scholar
  36. 36.
    Lanphear BP, Kahn RS, Berger O, Auinger P, Bortnick SM, Nahhas RW: Contribution of residential exposures to asthma in us children and adolescents. Pediatrics 2001; 107(6):E98PubMedGoogle Scholar
  37. 37.
    Lanphear BP, Aligne CA, Auinger P, Weitzman M, Byrd RS: Residential exposures associated with asthma in US children. Pediatrics 2001; 107(3):505–511PubMedGoogle Scholar
  38. 38.
    Maier WC, Arrighi HM, Morray B, Llewellyn C, Redding GJ: Indoor risk factors for asthma and wheezing among Seattle school children. Environ Health Perspect 1997; 105(2):208–214PubMedGoogle Scholar
  39. 39.
    McConnell R, Berhane K, Gilliland F, Islam T, Gauderman WJ, London SJ, Avol E, Rappaport EB, Margolis HG, Peters JM: Indoor risk factors for asthma in a prospective study of adolescents. Epidemiology 2002; 13(3):288–295PubMedGoogle Scholar
  40. 40.
    Somerville M, Mackenzie I, Owen P, Miles D: Housing and health: Does installing heating in their homes improve the health of children with asthma? Public Health 2000; 114(6):434–439PubMedGoogle Scholar
  41. 41.
    Johnston SL, Holgate ST. Asthma: Critical Issues. London: Blackwell; 2002Google Scholar
  42. 42.
    Lemanske RF, Jr: Issues in understanding pediatric asthma: Epidemiology and genetics. J Allergy Clinical Immunol. 2002; 109(6, Suppl):S521–S524Google Scholar
  43. 43.
    Hjern A, Haglund B, Bremberg S, Ringback-Weitoft G: Social adversity, migration and hospital admissions for childhood asthma in Sweden. Acta Paediatrica 1999; 88(10):1107–1112PubMedGoogle Scholar
  44. 44.
    Aber JL, Bennett NG, Conley DC, Li J: The effects of poverty on child health and development. Ann Rev Public Health 1997; 18:463–483Google Scholar
  45. 45.
    Schwartz J, Gold D, Dockery DW, Weiss ST, Speizer FE: Predictors of asthma and persistent wheeze in a national sample of children in the United States. Am Rev Respir Dis 1990; 142:555–562PubMedGoogle Scholar
  46. 46.
    Krieger J, Higgins DL: Housing and health: Time again for public health action. Am J Public Health 2002; 92(5):758–768PubMedGoogle Scholar
  47. 47.
    Lester MR, Schneider LC: Atopic diseases and upper respiratory infections. Curr Opin Pediatrics 2000; 12(5):511–519Google Scholar
  48. 48.
    Grant EN, Alp H, Weiss KB: The challenge of inner-city asthma. Curr Opin Pulmon Med1999; 5(1):27–34Google Scholar
  49. 49.
    Miller JE: The effects of race/ethnicity and income on early childhood asthma prevalence and health care use. Am J Public Health 2000; 90(3):428–430PubMedGoogle Scholar
  50. 50.
    Rodriguez MA, Winkleby MA, Ahn D, Sundquist J, Kraemer HC: Identification of population subgroups of children and adolescents with high asthma prevalence: Findings from the third natinal health ad nutrition examination survey. Arch Pediatr Adolesc Med. 2002; 156(3)269–275PubMedGoogle Scholar
  51. 51.
    Newachek PW, Halfon N: Prevalence, impact, and trends in childhood disability due to asthma. Arch Pediatr Adolesc Med 2000; 154:287–293PubMedGoogle Scholar
  52. 52.
    Woodruff PG, Prescott SL, Holt PG, Fahy JV: Antenatal factors in the development of atopy and asthma. In: Johnson SL, Holgate ST, ed. London: Blackwell; pp.116–137; 2002Google Scholar
  53. 53.
    Jarvis D, Chinn S, Luczynska C, Burney P: Association of respiratory symptoms and lung function in young adults with use of domestic gas appliances. Lancet 1996; 347(8999):426–431PubMedGoogle Scholar
  54. 54.
    Peters JM, Avol E, Navidi W, London SJ, Gauderman WJ, Lurmann F, Linn WS, Margolis H, Rappaport E, Gong H, Thomas DC: A study of twelve Southern California communities with differing levels and types of air pollution. I. Prevalence of respiratory morbidity. Am J Respir Crit Care Med 1999; 159(3):760–767Google Scholar
  55. 55.
    Malo JL, Chan-Yeung M: Occupational asthma. J. Allergy Clin Immun 2001; 108(3):317–328PubMedGoogle Scholar
  56. 56.
    McDonnell WF, Abbey DE, Nishino N, Lebowitz MD: Long-term ambient ozone concentration and the incidence of asthma in nonsmoking adults: The AHSMOG Study. Environ Res 1999; 80(2, Pt 1):110–121PubMedGoogle Scholar
  57. 57.
    Lara M, Morgenstern H, Duan N, Brook RH: Elevated asthma morbidity in Puerto Rican children: A review of possible risk and prognostic factors. Western J Med 1999; 170(2):75–84Google Scholar
  58. 58.
    Ledogar RJ, Penchaszadeh A, Garden CCI, Acosta LG: Asthma and Latino cultures: Different prevalence reported among groups sharing the same environment. Am J Public Health 2000; 90(6):929–935PubMedGoogle Scholar
  59. 59.
    Johnson CC, Ownby DR, Zoratti EM, Alford SH, Williams LK, Joseph CL: Environmental epidemiology of pediatric asthma and allergy. Epidemiol Rev 2002; 24(2):154–175PubMedGoogle Scholar
  60. 60.
    Douwes J, Pearce N: Asthma and the westernization ‘package.’ Int J Epidemiol 2002; 31(6):1098–1102PubMedGoogle Scholar
  61. 61.
    Gern JE, Lemanske RF, Jr, Busse WW: Early life origins of asthma. J Clin Invest 1999; 104(7):837–843PubMedGoogle Scholar
  62. 62.
    Martinez FD: Maturation of immune responses at the beginning of asthma. J Allergy Clin Immunol 1999; 103(3, Pt 1):355–361PubMedGoogle Scholar
  63. 63.
    Martinez FD: Gene by environment interactions in the development of asthma. Clin Exp Allergy 1998; (28, Suppl 5):21–25Google Scholar
  64. 64.
    Spector SL, Surette ME: Diet and asthma: Has the role of dietary lipids been overlooked in the management of asthma? Ann Allergy Asthma Immunol 2003; 90(4):371–377PubMedGoogle Scholar

Copyright information

© Springer Science + Business Media, Inc. 2005

Authors and Affiliations

  • Mary Johnson
    • 1
  • Jerome Nriagu
    • 1
    • 4
    Email author
  • Adnan Hammad
    • 2
  • Kathryn Savoie
    • 2
  • Hikmet Jamil
    • 2
    • 3
  1. 1.Department of Environmental Health SciencesSchool of Public Health, University of MichiganAnn Arbor
  2. 2.ACCESS Community Health & Research CenterDearborn
  3. 3.Department of Family MedicineWayne State UniversityDetroit
  4. 4.Department of Environmental Health SciencesSchool of Public Health, University of MichiganAnn Arbor

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