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PEDIATRICS Vol. 104 No. 6 December 1999, pp. 1274-1280

The Relationship Between Psychosocial Factors and Asthma Morbidity in Inner-City Children With Asthma

Received Oct 6, 1997; accepted May 17, 1999.

Constance M. Weil*, Shari L. WadeDagger , Laurie J. Bauman§, Henry Lynnparallel , Herman Mitchellparallel , and John Lavigne*

From the * Northwestern University Medical School and Children's Memorial Hospital, Chicago, Illinois; Dagger  Department of Pediatrics, Case Western Reserve University and Rainbow Babies and Children's Hospital, Cleveland, Ohio; § Albert Einstein College of Medicine, Bronx, New York; and the parallel  New England Research Institute, Boston, Massachusetts.

Objective.  Children living in the inner city are affected disproportionately by asthma morbidity and mortality. Previous research has shown that behavioral and psychosocial factors affect asthma morbidity in children. The National Cooperative Inner-City Asthma Study investigated the factors that contribute to asthma morbidity among inner-city children. This article examines the relationship between psychosocial factors and asthma morbidity in this population.

Methods.  A total of 1528 English- and Spanish-speaking children 4 to 9 years of age with asthma and their primary caretakers were recruited from 8 research centers in 7 metropolitan inner-city areas in the United States. Psychosocial variables were assessed at baseline and included measures of child and caretaker mental health, caretaker's problems with alcohol, life stress, social support, and parenting style. Morbidity measures were evaluated at baseline and at 3-, 6-, and 9-month follow-up intervals. These included number of hospitalizations and unscheduled visits for asthma in the past 3 months and number of days of wheeze and functional status in the previous 2-week period.

Results.  Of the psychosocial variables assessed, mental health had the strongest relationship to children's asthma morbidity. Children whose caretakers had clinically significant levels of mental health problems were hospitalized for asthma at almost twice the rate as children whose caretakers did not have significant mental health problems. Children with clinically significant behavior problems had significantly more days of wheeze and poorer functional status in the follow-up period.

Conclusion.  Psychosocial factors, particularly the mental health of children and caretakers, are significant factors in predicting asthma morbidity. They may need to be included in intervention programs aimed at decreasing asthma morbidity in inner-city children with asthma in order for these programs to be successful.  Key words:  pediatric asthma, morbidity, psychosocial adjustment.




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