Skip to main content

Advertisement

SpringerLink
Log in

Characterization of Stress in Low-Income, Inner-City Mothers of Children with Poorly Controlled Asthma

  • Published:
Journal of Urban Health Aims and scope Submit manuscript

Abstract

The goal of this longitudinal analysis was to characterize factors associated with the experience of life stress in low-income, inner-city mothers of minority children with high-risk asthma.Participants (n = 276) reported on family demographics, child asthma control and healthcare utilization, social support, contemporary life difficulties (housing, finances, violence exposure) measured by the validated Crisis in Family Systems scale, and daily stress. Latent growth curve modeling examined predictors of life stress across 12 months as a function of home and community difficulties, asthma-specific factors, and social support. Mothers were primarily single (73%), unemployed (55%), and living in extreme poverty with most (73%) reporting an annual family income <$20,000 (73%). The children were young (mean age = 5.59, SD = 2.17), African-American (96%), and had poorly controlled asthma (94%) at study enrollment. Higher daily stress was associated with financial difficulties, safety concerns in the home and community, and housing problems. Access to social support was consistently related to reduced stress. The only asthma-specific factor associated with life stress was healthcare utilization, with more emergency services for asthma related to higher daily stress. Findings underscore the clinical significance of assessing diverse home and community stressors and social support in low-income, inner-city caregivers of children with poorly controlled asthma.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Akinbami LJ, Moorman JE, Bailey C, Zahran HS, King M, Johnson CA, Liu X. (2012) Trends in asthma prevalence, health care use, and mortality in the United States, 2001–2010. NCHS data brief, no 94. Hyattsville, MD: National Center for Health Statistics.

  2. Bloom B, Jones LI, Freeman G. Summary health statistics for U.S. children: National Health Interview Survey. National Center for Health Statistics. Vital Health Stat. 2013;10(258):1–73.

    Google Scholar 

  3. Thakur N, Oh SS, Nguyen EA, Martin M, Roth LA, Galanter J, et al. Socioeconomic status and childhood asthma in urban minority youths. The GALA II and SAGE II studies. Am J Respir Crit Care Med. 2013;188(10):1202–9.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Akinbami L, Moorman J, Lui X. (2011) Asthma Prevalence, Health Care Use, and Mortality United States, 2005–2009. Hyattsville, MD: U.S. Dept. of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics.

  5. Celano MP, Holsey CN, Kobrynski LJ. Home-based family intervention for low-income children with asthma: a randomized controlled pilot study. J Fam Psychol. 2012;26(2):171–8.

    Article  PubMed  Google Scholar 

  6. Amaral LMD, Moratelli L, Palma PV, Leite ICG. The quality of life of Brazilian adolescents with asthma: associated clinical and sociodemographic factors. J Asthma. 2014;51:660–6.

    Article  PubMed  Google Scholar 

  7. Booster GD, Oland AA, Bender BG. Psychosocial factors in severe pediatric asthma. Immunol Allergy Clin N Am. 2016;36(3):449–60.

    Article  Google Scholar 

  8. Wildhaber J, Carroll WD, Brand PL. Global impact of asthma on children and adolescents’ daily lives: the room to breathe survey. Pediatr Pulmonol. 2012;47(4):346–57.

    Article  PubMed  Google Scholar 

  9. Dean BB, Calimlim BM, Kindermann SL, Khandker RK, Tinkelman D. The impact of uncontrolled asthma on absenteeism and health-related quality of life. J Asthma. 2009;46(9):861–6.

    Article  PubMed  Google Scholar 

  10. Dean BB, Calimlim BC, Sacco P, Aguilar D, Maykut R, Tinkelman D. Uncontrolled asthma: assessing quality of life and productivity of children and their caregivers using a cross-sectional internet-based survey. Health Qual Life Outcomes. 2010;8:1–10.

    Article  Google Scholar 

  11. Kopel LS, Gaffin JM, Ozonoff A, Rao DR, Sheehan WJ, Friedlander JL, Pl P, Baxi SN, Fu C, Subramanian SV, Gold DR, Phipatanakul W. Perceived neighborhood safety and asthma morbidity in the school inner-city asthma study. Pediatr Pulmonol. 2015;50(1):17–24.

    Article  PubMed  Google Scholar 

  12. Authors. The influence of community violence and protective factors on asthma morbidity and healthcare utilization in high-risk children. J Urban Health (2014); 91:677–689.

  13. Authors. Caregiver perception of asthma management of children in the context of poverty. J Asthma 2016; 15 (June), 1–11 .

  14. Sampson MNR, Parker EA, Cheezum MRR, Lewis TC, O’Toole MA, Patton MJ, Keirns CC. A life course perspective on stress and health among caregivers of children with asthma in Detroit. Fam Community Health. 2013;36(1):51–62. 6.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Shalowitz MU, Mijanovich T, Berry CA, Clark-Kauffman E, Quinn KA, Perez EL. Context matters: a community-based study of maternal mental health, life stressors, social support, and children’s asthma. Pediatr. 2006;117:e940–8.

    Article  Google Scholar 

  16. Williams DR, Sternthal M, Wright RJ. Social determinants: taking the social context of asthma seriously. Pediatr. 2009;123(Suppl.3):S174–84.

    Article  Google Scholar 

  17. Kub J, Jennings JM, Donithan M, Walker JM, Land CL, Butz A. Life events, chronic stressors, and depressive symptoms in low-income urban mothers with asthma children. Public Health Nurs. 2009;26:297–306.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Everhart RS, Fiese BH, Smyth JM. A cumulative risk model predicting caregiver quality of life in pediatric asthma. J Pediatr Psychol. 2008;33(8):809–18.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Kiser LJ, Medoff DR, Black MM. The role of family processes in childhood traumatic stress reactions for youths living in urban poverty. Traumatology. 2010;26:33–42.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Patterson JM, McCubbin HI. The impact of family life events and changes on the health of a chronically ill child. Fam Relat. 1983;32:255–64.

    Article  Google Scholar 

  21. Kiser LJ, Donohue A, Hodgkinson S, Medoff D, Black MM. Strengthening family coping resources: the feasibility of a multifamily group intervention for families exposed to trauma. J Trauma Stress. 2010;23:802–6.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Shalowitz MU, Berry CA, Rasinski KA, Dannhausen-Brun CA. A new measure of contemporary life stress: development, validation, and reliability of the CRISYS. Health Serv Res. 1998;33(5):1381–402.

    CAS  PubMed  PubMed Central  Google Scholar 

  23. Clawson AH, Borrelli B, McQuaid EL, Dunsiger S. The role of caregiver social support, depressed mood, and perceived stress in changes in pediatric secondhand smoke exposure and asthma functional morbidity following an asthma exacerbation. Health Psychol. 2016;35(6):541–51.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Scheckner B, Arcoleo K, Feldman JM. The effect of parental social support and acculturation on childhood asthma control. J Asthma. 2015;52:606–13.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Authors. Improving preventive care in high risk children with asthma: Lessons learned. J Asthma 2014; 51:498–507.

  26. U.S. Department of Health and Human Services. (2007) The National Asthma Education and Prevention Program. Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma. Washington, DC.

  27. Lesage FX, Beriot S, Deschamps F. Clinical stress assessment using a visual analogue scale. Occup Med. 2012;62:600–5.

    Article  Google Scholar 

  28. Berry C, Shalowtiz M, Quinn K, Wolf R. Validation of the crisis in family systems-revised, a contemporary measure of life stressors. Psychol Report. 2001;88:713–24.

    Article  CAS  Google Scholar 

  29. Sherbourne CD, Stewart AL. The MOS social support survey. Soc Sci Med. 1991;32:705–14.

    Article  CAS  PubMed  Google Scholar 

  30. Muthén LK, Muthén BO. Mplus User’s Guide (6th ed.) 2011. Los Angeles, CA: Muthén & Muthén.

  31. Preacher KJ, Coffman DL. (2006) Computing power and minimum sample size for RMSEA [Computer software]. Available from http://quantpsy.org/.

  32. Soper DS. (2013) A-priori sample size calculator for structural equation models [Software]. Available from http://www.danielsoper.com/statcalc

  33. Hu L, Bentler PM. Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Struct Equ Modeling. 1999;6:1–55.

    Article  Google Scholar 

  34. Kline RB. Principles and Practices of Structural Equation Modeling 2005. New York, NY: Guilford Press.

  35. Chen S-H, Huang J-L, Yeh K-W, Tsai Y-F. The stress of caring for children with asthma: a qualitative study of primary caregivers. J Nurs Res. 2015;23:298–307.

    PubMed  Google Scholar 

  36. Laster N, Holsey CN, Shendell DG, McCarty FA, Celano M. Barriers to asthma management among urban families: caregiver and child perspectives. J Asthma. 2009;46:731–9.

    Article  PubMed  Google Scholar 

  37. Cloutier MM. Considerations in culturally directed asthma disease management programs. Dis Manag Health Out. 2008;16(2):95–105.

    Article  Google Scholar 

  38. Wright RJ, Mitchell H, Visness CM, Cohen S, Stout J, Evans R, Gold DR. Community violence and asthma morbidity: the Inner-City Asthma Study. Am J Public Health 2004. 2004;94(4):625–32.

  39. Collins KS, Strieder FH, DePanfilis D, Tabor M, Clarkson-Freeman PA, Linde L, Greenberg P. Trauma Adapted Family Connections (TA-FC). Child Welfare. 2011;90(6):29–47.

    PubMed  Google Scholar 

  40. Sales J, Fivush R, Teague GW. The role of parental coping in children with asthma’s psychological well-being and asthma-related quality of life. J Ped Psychol. 2008;333(2):208–19.

    Google Scholar 

  41. Hoagwood KE, Cavaleri MA, Olin SS, Burns BJ, Slaton E, Gruttadaro D, Hughes R. Family support in children’s mental health: a review and synthesis. Clin Child Family Psychol Rev. 2010;13:1–45.

    Article  Google Scholar 

  42. Robbins V, Johnston J, Barnett H, Hobstetter W, Kutash K, Duchnowski AJ, Annis S. (2008) Parent to Parent: a Synthesis of the Emerging Literature. Tampa, FL: University of South Florida, The Louis de la Parte Florida Mental Health Institute, Department of Child & Family Studies.

  43. Martin MA, Press VG, Nyenhuis SM, Krishman JA, Erwin K, Mosnaim G, Margellos-Anast H, Paik SM, Ignoffo W, McDermott M. Chicago Plan Consortium. Care transition interventions for children with asthma in the emergency department. J Allergy Clin Immunol. 2016;138(6):1518–25.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Hughes HK, Matsui EC, Tschudy MM, Pollack CE, Keet CA. (2016) Pediatric asthma health disparities: race, hardship, housing, and asthma in a national survey. Acad Pediatr 19.

  45. Krieger J. Home is where the triggers are: increasing asthma control by improving the home environment. Pediatr Allergy Immunol Pulm. 2010;23(2):139–45.

    Article  Google Scholar 

  46. Kiser LJ, Black MM. Family processes in the midst of urban poverty: what does the trauma literature tell us? Aggress Violent Behav. 2005;10:715–50.

    Article  Google Scholar 

  47. Sharp LK, Curtis LM, Mosnaim G, Shalowitz MU, Catrambone C, Sadowski LS. The influence of caregiver’s psychosocial status on childhood asthma and obesity. Ann Allergy Asthma Immunol. 2009;103(5):386–94.

    Article  PubMed  Google Scholar 

  48. Martin MA, Thomas AM, Mosnaim G, Greve M, Swider SM, Rothschild SK. Home asthma triggers: barriers to asthma control in Chicago Puerto Rican children. J Health Care Underserved. 2013;24(2):813–27.

    Article  Google Scholar 

Download references

Acknowledgements

All phases of this study were supported by a National Institute of Nursing Research, NIH grant NR010546. This clinical trial is registered with www.clinicaltrials.gov and the registration number is NCT00860418. We thank the participating families for their time invested in the study.

Author information

Authors and Affiliations

  1. University of Maryland School of Social Work, 525 West Redwood Street, Baltimore, MD, 21201, USA

    Melissa H. Bellin, Kathryn S. Collins & Angelica Newsome

  2. Florida State University College of Social Work, Tallahassee, USA

    Philip Osteen

  3. Department of Nursing, University of Southern California, Los Angeles, USA

    Joan Kub

  4. Division of Pediatric Pulmonary and Allergy, University of Maryland School of Medicine, Baltimore, USA

    Mary Elizabeth Bollinger

  5. Division of General Pediatrics and Adolescent Medicine, Johns Hopkins University School of Medicine, Baltimore, USA

    Cassie Lewis-Land & Arlene M. Butz

Authors
  1. Melissa H. Bellin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kathryn S. Collins
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Philip Osteen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Joan Kub
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mary Elizabeth Bollinger
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Angelica Newsome
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Cassie Lewis-Land
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Arlene M. Butz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Melissa H. Bellin.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bellin, M.H., Collins, K.S., Osteen, P. et al. Characterization of Stress in Low-Income, Inner-City Mothers of Children with Poorly Controlled Asthma. J Urban Health 94, 814–823 (2017). https://doi.org/10.1007/s11524-017-0162-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11524-017-0162-1

Keywords

Search

Navigation