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

¹ Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada; and ² Division of Allergy and Pulmonary Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, Missouri

Correspondence and requests for reprints should be addressed to Edith Chen, Ph.D., University of British Columbia, 2136 West Mall, Vancouver, BC, Canada V6T1Z4. E-mail: echen{at}psych.ubc.ca

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 = 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 ( coefficients: –0.26 to –0.33, P < 0.05) and poorer pulmonary function (: 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 ( coefficients: 0.27–0.33, P < 0.05) via behavioral pathways related to smoking (Z statistics = 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.

Key Words: support • behaviors • inflammatory markers • children • adolescents

AT A GLANCE COMMENTARY Scientific Knowledge on the Subject 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. What This Study Adds to the Field 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.

 

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