The Role of the Social Environment in Children and Adolescents with Asthma

Abstract

Rationale: Biopsychosocial models of asthma have been proposed in the literature, but few empirical tests of social factors at various levels of influence have been conducted. Objectives: To test associations of neighborhood, peer, and family factors with asthma outcomes in youth, and to determine the pathways through which these social factors operate. Methods: Observational study of youths with asthma (n 5 78). Measurements and Main Results: Youths completed questionnaires about neighborhood problems, peer support, and family support. Biological (IgE, eosinophil count, production of IL-4) and behavioral ( youth smoking, exposure to smoke, adherence to medications) pathways were measured. Asthma symptoms and pulmonary function were assessed in the laboratory and at home for 2 weeks. Lower levels of family support were associated with greater symptoms (b coefficients: 20.26 to 20.33, P , 0.05) and poorer pulmonary function (b: 0.30, P , 0.05) via biological pathways (Z statistics from 1.19 to 1.51, P , 0.05). Higher levels of neighborhood problems were associated with greater symptoms (b coefficients: 0.27-0.33, P , 0.05) via behavioral pathways related to smoking (Z statistics 5 1.40, P , 0.05). Peer support was not associated with symptoms or pulmonary function. Conclusions: This study indicates that family factors may affect youths' asthma via physiologic changes, whereas community factors may help shape the health behaviors of youths with asthma.Keywords: support; behaviors; inflammatory markers; children; adolescentsThe social environment has long been viewed as an important determinant of asthma outcomes in youth. Consistent with biopsychosocial approaches to conceptualizing the onset and course of asthma (1, 2), research indicates that factors such as exposure to violence (3), abrasive family relationships (4, 5), and psychological stress (6-8) all relate to adverse outcomes in youths with asthma.However, most previous studies have focused on social factors at a single level (e.g., the family). At the broadest level of social influence, the neighborhood, factors such as greater violence in the neighborhood and lower socioeconomic status of neighborhoods have been associated with greater asthma morbidity and heightened allergic inflammatory responses (9-11). At a more circumscribed level of social influence, one's peers, high stress in combination with low levels of social support increases risk for asthma exacerbations (12). At the most proximal level of social influence, the family, parenting difficulties and parental stress have been associated with markers of inflammation and high risk for onset of childhood asthma (5, 6, 13).By contrast, fewer studies have provided a more complete picture of the relative contributions of neighborhood, peer, and family factors, or asked whether they influence asthma through similar versus different mechanisms. Understanding these contributions has important implications for interventions. For example, associations between neighborhood factors and asthma may suggest the...

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