Effects of Cumulative Risk on Asthma Outcomes in Urban Children and Adolescents

Virginia Commonwealth University, Richmond VA

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Abstract

? DESCRIPTION (provided by applicant): Pediatric asthma disproportionately affects racial and ethnic minority children and children living in low-income, urban areas. In addition to increased asthma morbidity and healthcare use, children from urban areas are at risk for additional stressors (e.g., poverty, neighborhood stress) that can contribute to poor asthma outcomes. The continual activation of the stress response without adequate buffering (i.e., toxic stress) has been associated with the development of illnesses, including asthma. However, limited research has examined the processes related to toxic stress that may increase asthma morbidity in urban children who already carry an asthma diagnosis. The proposed study will use innovative technology (ecological momentary assessment [EMA] delivered via smartphone) to assess processes that place urban children at increased risk for poor asthma outcomes. Specifically, this study will investigate the association between a cumulative risk model of stress and child asthma outcomes (ages 7-12) in a low-income, urban sample of 60 families (87% African American), as well as the potential for caregiver support related to asthma care to serve as a protective factor in this association. Data collected from urban families with a child with persistent asthma as part of the CARE Study (Childhood Asthma in Richmond Families; Targeted Research Grant, Society of Pediatric Psychology; R. Everhart, PI) will be analyzed. This study will also examine whether a cumulative risk model is a stronger predictor of asthma outcomes in urban children than any one risk factor. Additionally, the proposed study will assess the ecological validity of two widely used stress measures. Given developmental differences between younger children and adolescents, the proposed study will also develop a new adolescent-specific cumulative risk model of stress and test its association with asthma outcomes in adolescents from urban settings. Original data will be collected from a sample of 60 urban adolescents with asthma (13-17 years) and their caregivers. Families will complete an initial research session and then adolescents will use a handheld spirometer for 14 days. Specifically the proposed study hypothesizes that: 1) more cumulative risk will be associated with poorer asthma outcomes in both groups (i.e., younger children and adolescents); 2) higher levels of caregiver support for the child's asthma care will minimize the effects of cumulative ris on child and adolescent asthma outcomes; 3) the cumulative risk model will be a stronger predictor of asthma outcomes than any one factor; 4) the adolescent-specific cumulative risk model will account for more variance in adolescent asthma outcomes than the model generated for the younger age group, and 5) higher scores on the baseline stress scales will be related to more stressors reported on the EMA daily surveys. Results will inform future research aimed at improving asthma outcomes among low-income, urban children and adolescents by better understanding the association between stress and asthma outcomes in a group most at risk for experiencing high rates of asthma morbidity and healthcare utilization.