Skip to main content

Advertisement

SpringerLink
Log in

Stress and the City: Housing Stressors are Associated with Respiratory Health among Low Socioeconomic Status Chicago Children

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

Abstract

Asthma disproportionately affects non-whites in urban areas and those of low socioeconomic status, yet asthma's social patterning is not well-explained by known risk factors. We hypothesized that disadvantaged urban populations experience acute and chronic housing stressors which produce psychological stress and impact health through biological and behavioral pathways. We examined eight outcomes: six child respiratory outcomes as well as parent and child general health, using data from 682 low-income, Chicago parents of diagnosed and undiagnosed asthmatic children. We created a continuous exposure, representing material, social and emotional dimensions of housing stressors, weighted by their parent-reported difficulty. We compared the 75th to the 25th quartile of exposure in adjusted binomial and negative binomial regression models. Higher risks and rates of poor health were associated with higher housing stressors for six of eight outcomes. The risk difference (RD) for poor/fair general health was larger for children [RD = 6.28 (95% CI 1.22, 11.35)] than for parents [RD = 3.88 (95% CI −1.87, 9.63)]. The incidence rate difference (IRD) for exercise intolerance was nearly one extra day per 2 weeks for the higher exposure group [IRD = 0.88 (95% CI 0.41, 1.35)]; nearly one-third extra day per 2 weeks for waking at night [IRD = 0.32 (95% CI 0.01, 0.63)]; and nearly one-third extra day per 6 months for unplanned medical visits [IRD = 0.30 (95% CI 0.059, 0.54)]. Results contribute to the conceptualization of urban stress as a “social pollutant” and to the hypothesized role of stress in health disparities. Interventions to improve asthma outcomes must address individuals' reactions to stress while we seek structural solutions to residential stressors and health inequities.

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

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Figure 1
Figure 2

Similar content being viewed by others

References

  1. Akinbami LJ. The state of childhood asthma, United States, 1980-2005. Advance data from vital and health statistics. 2006; 381.

  2. Gold DR, Wright R. Population disparities in asthma. Annu Rev Public Health. 2005;26:89–113.

    Article  PubMed  Google Scholar 

  3. Marder D, Targonski P, Orris P, Persky V, Addington W. Effect of racial and socioeconomic factors on asthma mortality in Chicago. Chest. 1992;101(6 Suppl):426S–429S.

    Article  CAS  PubMed  Google Scholar 

  4. Thomas SD, Whitman S. Asthma hospitalizations and mortality in Chicago: an epidemiologic overview. Chest. 1999;116(4 Suppl 1):135S–141S.

    Article  CAS  PubMed  Google Scholar 

  5. Persky VW, Slezak J, Contreras A, et al. Relationships of race and socioeconomic status with prevalence, severity, and symptoms of asthma in Chicago school children. Ann Allergy Asthma Immunol. 1998;81(3):266–271.

    Article  CAS  PubMed  Google Scholar 

  6. Weiss KB, Wagener DK. Geographic variations in US asthma mortality: small-area analyses of excess mortality, 1981–1985. Am J Epidemiol. 1990;132(1 Suppl):S107–S115.

    CAS  PubMed  Google Scholar 

  7. Weiss KB, Wagener DK. Changing patterns of asthma mortality. Identifying target populations at high risk. JAMA. 1990;264(13):1683–1687.

    Article  CAS  PubMed  Google Scholar 

  8. Weiss KB. Eliminating asthma disparities: introduction to the Chicago story. Chest. 2007;132(5 Suppl):856S–857S.

    Article  PubMed  Google Scholar 

  9. Cagney KA, Browning CR. Exploring neighborhood-level variation in asthma and other respiratory diseases: the contribution of neighborhood social context. J Gen Intern Med. 2004;19(3):229–236.

    Article  PubMed  Google Scholar 

  10. Sandel M, Wright RJ. When home is where the stress is: expanding the dimensions of housing that influence asthma morbidity. Arch Dis Child. 2006;91(11):942–948.

    Article  CAS  PubMed  Google Scholar 

  11. Wright RJ, Subramanian SV. Advancing a multilevel framework for epidemiologic research on asthma disparities. Chest. 2007;132(5 Suppl):757S–769S.

    Article  PubMed  Google Scholar 

  12. Wright RJ, Cohen RT, Cohen S. The impact of stress on the development and expression of atopy. Curr Opin Allergy Clin Immunol. 2005;5(1):23–29.

    Article  PubMed  Google Scholar 

  13. Cohen S, Kessler R, Underwood GL. Measuring stress: a guide for health and social scientists. New York: Oxford University Press; 1995.

    Google Scholar 

  14. Wright RJ, Cohen S, Carey V, Weiss ST, Gold DR. Parental stress as a predictor of wheezing in infancy: a prospective birth-cohort study. Am J Respir Crit Care Med. 2002;165(3):358–365.

    PubMed  Google Scholar 

  15. Wright RJ, Finn P, Contreras JP, et al. Chronic caregiver stress and IgE expression, allergen-induced proliferation, and cytokine profiles in a birth cohort predisposed to atopy. J Allergy Clin Immunol. 2004;113(6):1051–1057.

    Article  CAS  PubMed  Google Scholar 

  16. Wright RJ. Stress and atopic disorders. J Allergy Clin Immunol. 2005;116(6):1301–1306.

    Article  PubMed  Google Scholar 

  17. Wright RJ. Prenatal maternal stress and early caregiving experiences: implications for childhood asthma risk. Paediatr Perinat Epidemiol. 2007;21(Suppl 3):8–14.

    Article  PubMed  Google Scholar 

  18. Mrazek DA, Klinnert M, Mrazek PJ, et al. Prediction of early-onset asthma in genetically at-risk children. Pediatr Pulmonol. 1999;27(2):85–94.

    Article  CAS  PubMed  Google Scholar 

  19. Ippoliti F, De Santis W, Volterrani A, et al. Psychological stress affects response to sublingual immunotherapy in asthmatic children allergic to house dust mite. Pediatr Allergy Immunol. 2006;17(5):337–345.

    Article  PubMed  Google Scholar 

  20. Chen E, Chim LS, Strunk RC, Miller GE. The role of the social environment in children and adolescents with asthma. Am J Respir Crit Care Med. 2007;176(7):644–649.

    Article  PubMed  Google Scholar 

  21. Sandberg S, Jarvenpaa S, Penttinen A, Paton JY, McCann DC. Asthma exacerbations in children immediately following stressful life events: a Cox's hierarchical regression. Thorax. 2004;59(12):1046–1051.

    Article  CAS  PubMed  Google Scholar 

  22. Sandberg S, Paton JY, Ahola S, et al. The role of acute and chronic stress in asthma attacks in children. Lancet. 2000;356(9234):982–987.

    Article  CAS  PubMed  Google Scholar 

  23. Annett RD, Bender BG, DuHamel TR, Lapidus J. Factors influencing parent reports on quality of life for children with asthma. J Asthma. 2003;40(5):577–587.

    Article  PubMed  Google Scholar 

  24. Archea C, Yen IH, Chen H, et al. Negative life events and quality of life in adults with asthma. Thorax. 2007;62(2):139–146.

    Article  CAS  PubMed  Google Scholar 

  25. Booker CL, Gallaher P, Unger JB, Ritt-Olson A, Johnson CA. Stressful life events, smoking behavior, and intentions to smoke among and multiethnic sample of sixth graders. Ethn Health. 2004;9(4):369–397.

    Article  PubMed  Google Scholar 

  26. Bartlett SJ, Kolodner K, Butz AM, Eggleston P, Malveaux FJ, Rand CS. Maternal depressive symptoms and emergency department use among inner-city children with asthma. Arch Pediatr Adolesc Med. 2001;155(3):347–353.

    CAS  PubMed  Google Scholar 

  27. Christiaanse ME, Lavigne JV, Lerner CV. Psychosocial aspects of compliance in children and adolescents with asthma. J Dev Behav Pediatr. 1989;10(2):75–80.

    Article  CAS  PubMed  Google Scholar 

  28. Cluley S, Cochrane GM. Psychological disorder in asthma is associated with poor control and poor adherence to inhaled steroids. Respir Med. 2001;95(1):37–39.

    Article  CAS  PubMed  Google Scholar 

  29. Haavet OR, Straand J, Saugstad OD, Grunfeld B. Illness and exposure to negative life experiences in adolescence: two sides of the same coin? A study of 15-year-olds in Oslo, Norway. Acta Paediatr. 2004;93(3):405–411.

    Article  CAS  PubMed  Google Scholar 

  30. Weil CM, Wade SL, Bauman LJ, Lynn H, Mitchell H, Lavigne J. The relationship between psychosocial factors and asthma morbidity in inner-city children with asthma. Pediatrics. 1999;104(6):1274–1280.

    Article  CAS  PubMed  Google Scholar 

  31. Wright RJ, Mitchell H, Visness CM, et al. Community violence and asthma morbidity: the Inner-City Asthma Study. Am J Public Health. 2004;94(4):625–632.

    Article  PubMed  Google Scholar 

  32. 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. Pediatrics. 2006;117(5):e940–e948.

    Article  PubMed  Google Scholar 

  33. Wood PR, Smith LA, Romero D, Bradshaw P, Wise PH, Chavkin W. Relationships between welfare status, health insurance status, and health and medical care among children with asthma. Am J Public Health. 2002;92(9):1446–1452.

    Article  PubMed  Google Scholar 

  34. Riley AW, Finney JW, Mellits ED, et al. Determinants of children's health care use: an investigation of psychosocial factors. Med Care. 1993;31(9):767–783.

    Article  CAS  PubMed  Google Scholar 

  35. Wright RJ. Health effects of socially toxic neighborhoods: the violence and urban asthma paradigm. Clin Chest Med. 2006;27(3):413–421. v.

    Article  PubMed  Google Scholar 

  36. Kozyrskyj AL, Mai XM, McGrath P, Hayglass KT, Becker AB, Macneil B. Continued exposure to maternal distress in early life is associated with an increased risk of childhood asthma. Am J Respir Crit Care Med. 2008;177(2):142–147.

    Article  PubMed  Google Scholar 

  37. Suglia SF, Ryan L, Laden F, Dockery DW, Wright RJ. Violence exposure, a chronic psychosocial stressor, and childhood lung function. Psychosom Med. 2008;70(2):160–169.

    Article  PubMed  Google Scholar 

  38. Turyk ME, Hernandez E, Wright RJ, et al. Stressful life events and asthma in adolescents. Pediatr Allergy Immunol. 2008;19(3):255–263.

    Article  PubMed  Google Scholar 

  39. Shalowitz MU, Berry CA, Quinn KA, Wolf RL. The relationship of life stressors and maternal depression to pediatric asthma morbidity in a subspecialty practice. Ambul Pediatr. 2001;1(4):185–193.

    Article  CAS  PubMed  Google Scholar 

  40. Miller GE, Chen E. Life stress and diminished expression of genes encoding glucocorticoid receptor and beta2-adrenergic receptor in children with asthma. Proc Natl Acad Sci USA. 2006;103(14):5496–5501.

    Article  CAS  PubMed  Google Scholar 

  41. Kilpelainen M, Koskenvuo M, Helenius H, Terho EO. Stressful life events promote the manifestation of asthma and atopic diseases. Clin Exp Allergy. 2002;32(2):256–263.

    Article  CAS  PubMed  Google Scholar 

  42. Maslov AH. A theory of human motivation. Psychological Review. 1943;50:370–396.

    Article  Google Scholar 

  43. U.S. Environmental Protection Agency, Office of Research and Development, National Center for Environmental Assessment. Child-Specific Exposure Factors Handbook (Interim Report). 2002; EPA-600-P-00-002B.

  44. Adler NE, Conner Snibbe A. The role of psychosocial processes in explaining the gradient between socioeconomic status and health. Curr Dir Psychol Sci. 2003;12(4):119–123.

    Article  Google Scholar 

  45. Evans GW. The environment of childhood poverty. Am Psychol. 2004;59(2):77-92. doi:10.1037/0003-066X.59.2.77.

    Article  PubMed  Google Scholar 

  46. Williams DR, Sternthal M, Wright RJ. Social determinants: taking the social context of asthma seriously. Pediatrics. 2009;123(Suppl 3):S174-S184. doi:10.1542/peds.2008-2233H.

    Article  PubMed  Google Scholar 

  47. Williams DR. Race, socioeconomic status, and health. The added effects of racism and discrimination. Ann N Y Acad Sci. 1999;896:173–188.

    Article  CAS  PubMed  Google Scholar 

  48. McLeod JD, Kessler RC. Socioeconomic status differences in vulnerability to undesirable life events. J Health Soc Behav. 1990;31(2):162–172.

    Article  CAS  PubMed  Google Scholar 

  49. Marmot MG, Wilkinson RG. Social determinants of health. Oxford; New York: Oxford University Press; 1999:291.

    Google Scholar 

  50. Cohen S, Kaplan GA, Salonen JG. The role of psychological characteristics in the relation of socioeconomic status and perceived health. J Appl Soc Psychol. 1999;29:445–468.

    Article  Google Scholar 

  51. Gee GC, Payne-Sturges DC. Environmental health disparities: a framework integrating psychosocial and environmental concepts. Environ Health Perspect. 2004;112(17):1645–1653.

    PubMed  Google Scholar 

  52. Kessler RC. Stress, social status, and psychological distress. J Health Soc Behav. 1979;20(3):259–272.

    Article  CAS  PubMed  Google Scholar 

  53. Taylor SE, Repetti RL, Seeman T. Health psychology: what is an unhealthy environment and how does it get under the skin? Annu Rev Psychol. 1997;48:411–447.

    Article  CAS  PubMed  Google Scholar 

  54. Hertzman C. The biological embedding of early experience and its effects on health in adulthood. Ann N Y Acad Sci. 1999;896:85–95.

    Article  CAS  PubMed  Google Scholar 

  55. Fullilove MT, Fullilove RE 3rd. What's housing got to do with it? Am J Public Health. 2000;90(2):183–184.

    Article  CAS  PubMed  Google Scholar 

  56. Wolf RL, Berry CA, Quinn K. Development and validation of a brief pediatric screen for asthma and allergies among children. Ann Allergy Asthma Immunol. 2003;90(5):500–507.

    Article  PubMed  Google Scholar 

  57. Berry CA, Quinn K, Wolf R, Mosnaim G, Shalowitz M. Validation of the Spanish and English versions of the asthma portion of the Brief Pediatric Asthma Screen Plus among Hispanics. Ann Allergy Asthma Immunol. 2005;95(1):53–60.

    Article  PubMed  Google Scholar 

  58. Greenland S, Pearl J, Robins JM. Causal diagrams for epidemiologic research. Epidemiology. 1999;10(1):37–48.

    Article  CAS  PubMed  Google Scholar 

  59. Maldonado G, Greenland S. Simulation study of confounder-selection strategies. Am J Epidemiol. 1993;138(11):923–936.

    CAS  PubMed  Google Scholar 

  60. Baum A. Stress, intrusive imagery, and chronic distress. Health Psychol. 1990;9(6):653–675.

    Article  CAS  PubMed  Google Scholar 

  61. Nolen-Hoeksema S. The role of rumination in depressive disorders and mixed anxiety/depressive symptoms. J Abnorm Psychol. 2000;109(3):504–511.

    Article  CAS  PubMed  Google Scholar 

  62. Lyubomirsky S, Tucker KL, Caldwell ND, Berg K. Why ruminators are poor problem solvers: clues from the phenomenology of dysphoric rumination. J Pers Soc Psychol. 1999;77(5):1041–1060.

    Article  CAS  PubMed  Google Scholar 

  63. Barton C, Clarke D, Sulaiman N, Abramson M. Coping as a mediator of psychosocial impediments to optimal management and control of asthma. Respir Med. 2003;97(7):747–761.

    Article  PubMed  Google Scholar 

  64. Rauh VA, Landrigan PJ, Claudio L. Housing and health: intersection of poverty and environmental exposures. Ann N Y Acad Sci. 2008;1136:276–288.

    Article  PubMed  Google Scholar 

  65. Quinn K, Shalowitz MU, Berry CA, Mijanovich T, Wolf RL. Racial and ethnic disparities in diagnosed and possible undiagnosed asthma among public-school children in Chicago. Am J Public Health. 2006;96(9):1599–1603.

    Article  PubMed  Google Scholar 

  66. Shalowitz MU, Sadowski LM, Kumar R, Weiss KB, Shannon JJ. Asthma burden in a citywide, diverse sample of elementary schoolchildren in Chicago. Ambul Pediatr. 2007;7(4):271–277.

    Article  PubMed  Google Scholar 

  67. Wright RJ, Steinbach SF. Violence: an unrecognized environmental exposure that may contribute to greater asthma morbidity in high risk inner-city populations. Environ Health Perspect. 2001;109(10):1085–1089.

    Article  CAS  PubMed  Google Scholar 

  68. Wright RJ. Further evidence that the wealthier are healthier: negative life events and asthma-specific quality of life. Thorax. 2007;62(2):106–108.

    Article  CAS  PubMed  Google Scholar 

  69. Clougherty JE, Levy JI, Kubzansky LD, et al. Synergistic effects of traffic-related air pollution and exposure to violence on urban asthma etiology. Environ Health Perspect. 2007;115(8):1140-1146. doi:10.1289/ehp.9863.

    Article  CAS  PubMed  Google Scholar 

  70. Wright RJ. Exploring biopsychosocial influences on asthma expression in both the family and community context. Am J Respir Crit Care Med. 2008;177(2):129–130.

    Article  PubMed  Google Scholar 

  71. Frankel K, Wamboldt MZ. Chronic childhood illness and maternal mental health—why should we care? J Asthma. 1998;35(8):621–630.

    Article  CAS  PubMed  Google Scholar 

  72. Gustafsson PA, Kjellman NI, Bjorksten B. Family interaction and a supportive social network as salutogenic factors in childhood atopic illness. Pediatr Allergy Immunol. 2002;13(1):51–57.

    Article  PubMed  Google Scholar 

  73. Hamlett KW, Pellegrini DS, Katz KS. Childhood chronic illness as a family stressor. J Pediatr Psychol. 1992;17(1):33–47.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

This analysis is based on data collected for the Social Factors and the Environment in Pediatric Asthma Study, which was funded by the National Institute of Environmental Health Sciences of the National Institutes of Health (grant 1 R01 ES10908). Carolyn A. Berry, PhD, Center for Healthcare Strategies, Inc. and Steven Wing, PhD, Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, provided guidance with this study and this manuscript.

Author information

Authors and Affiliations

  1. Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA

    Kelly Quinn & Karin B. Yeatts

  2. Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada

    Jay S. Kaufman

  3. Department of Health Behavior and Health Education, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA

    Arjumand Siddiqi

Authors
  1. Kelly Quinn
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jay S. Kaufman
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Arjumand Siddiqi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Karin B. Yeatts
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kelly Quinn.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Quinn, K., Kaufman, J.S., Siddiqi, A. et al. Stress and the City: Housing Stressors are Associated with Respiratory Health among Low Socioeconomic Status Chicago Children. J Urban Health 87, 688–702 (2010). https://doi.org/10.1007/s11524-010-9465-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11524-010-9465-1

Keywords

Search

Navigation