Dissertations and Theses

Date of Degree

6-3-2021

Document Type

Thesis

Degree Name

Doctor of Public Health (DPH)

Department

Epidemiology and Biostatistics

Advisor(s)

Luisa Borrell

Committee Members

Luisa Borrell

Sheng Li

Andrew Moroko

Stephanie Lovinski-Desir

Subject Categories

Public Health

Keywords

childhood asthma, psychosocial stressors, social support, bullying, racial discrimination

Abstract

ABSTRACT

Background: Asthma is recognized as a major public health issue for US children. Evidence suggests that psychosocial stressors experienced by parents and caretakers of children and the children themselves can also be associated with childhood asthma prevalence. Psychosocial stressors such as parents’ perception of neighborhood safety/support, as well as experiencing bullying and/or racial/ethnic discrimination can cause physiologic changes in the body favorable for asthma symptoms. However, there is a paucity of evidence regarding associations of these specific psychosocial stressors with the prevalence of childhood asthma. The goals of this study were to investigate the association between three common psychosocial stressors and the prevalence of asthma in children less than 17 years of age participating in the 2018 National Survey of Children’s Health. We examined the association of parent’s perception of neighborhood safety and support, experience of bullying by the child over the last year and experience of racial/ethnic discrimination with the prevalence of asthma in children younger than 17 years of age after controlling for select individual and state level variables.

Methods: We used a nationally representative sample of US youth younger than 17 years of age who participated in the National Survey of Children’s Health (NSCH) linked to data from the American Community Survey, and the Environmental Protection Agency. The exposures for Aim 1 are parents’ perception of neighborhood safety (recoded as safe, somewhat safe, and not safe) and parents’ perception of neighborhood support (supportive or unsupportive). The exposure for Aim 2 is frequency of bullying as experienced over the past 12 months in children aged 6 to 17 years with responses re-coded as follows: never, 1-2 times in the past 12 months, 1-2 times per month, and more than four times per month over the past 12 months. The exposure for Aim 3 was perceived racial/ethnic discrimination experienced by the survey child (yes or no). Descriptive statistics were used to calculate the prevalence of the exposure for select variables for Aims 1,2, and 3.The outcome for Aims 1, 2, and 3 was lifetime asthma of the survey child with answers of ‘yes’ or ‘no’.

Descriptive statistics for select individual and state level variables were calculated for the total study population and by asthma status. The prevalence estimates for asthma were calculated for select variables. Chi-square tests of independence were used to determine associations of each covariate with asthma, whereas t-tests were used to determine mean differences of state level variables for each aim by asthma status. We used multilevel logistic regression to quantify the associations of each exposure with the prevalence of lifetime asthma before and after controlling for select individual- and state-level factors. In addition, we tested for interactions of 1) neighborhood support and safety with nativity status of the survey child; 2) bullying with the sex of the survey child and family socioeconomic status indicators; and 3) racial/ethnic discrimination with the race/ethnicity of the survey child in the fully adjusted model. All analyses accounted for the complex sampling design of the NSCH.

Results: We found that children living in a somewhat safe neighborhood had a 21% (95% CI:1.01, 1.46) greater probability of having asthma when compared to children living in neighborhoods that the survey respondent described as safe after adjusting for individual-level characteristics and state-level characteristics. Children living in a neighborhood classified as not safe had a 38% (95% CI: 0.94, 2.00) greater chance of having asthma when compared to children living in safe neighborhoods, however, this association failed to reach significance. Children living in neighborhoods classified as non-supportive by the survey respondent had a 26% (95% CI: 1.07, 1.48) greater probability of having asthma when compared to children living in supportive neighborhoods. The associations of neighborhood support and safety with asthma were not modified by nativity status of the child, or the educational level of the survey respondent.

Frequent bullying over the past 12 months was associated with greater probability of having asthma. Children reporting being bullied once or twice per year had a 28% (95% CI: 1.06, 1.55) higher probability of having asthma when compared to children who did not experience bullying after adjusting for individual-level variables and state-level variables. Children who were bullied up to two times per month had a 57% (95% CI:1.14, 2.15) increased probability of having asthma when compared to their non-bullied counterparts. Children who reported being bullied more than four times per month had a 61% (95% CI: 1.23, 2.11) greater probability of having asthma when compared to those children who were not bullied at all. These associations were not modified by the sex of the survey child or the socioeconomic status indicators of the survey child’s family: parental educational level, receipt of government food/cash assistance, and poverty level.

The probability of asthma was almost twofold (PR 1.80; 95% CI: 1.28, 2.54) greater among children who’s survey respondent reported the child experienced racial/ethnic discrimination as compared with those who’s survey respondent reported the child did not experience racial/ethnic discrimination after adjusting for individual-level variables and state level variables. However, this association did not vary with the race/ethnicity of the survey child.

Discussion: Our study findings suggest a link between psychosocial stressors experienced by parents/caretakers and directly by children with the prevalence of asthma in US children. Thus, our findings lend support to previous studies suggesting that well known factors affecting asthma prevalence do not entirely account for the burden of asthma in US children. This work provides the foundation for further investigation regarding how psychosocial stressors can shape the physiology and biology of children with asthma. It is important to consider these psychosocial factors when dealing with children with asthma symptomatology that is unresponsive to conventional treatment. Subsequent studies are needed to further investigate the association of various psychosocial stressors and the prevalence of asthma in US children.

Available for download on Wednesday, May 24, 2023

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