Resilience in low-socioeconomic-status children with asthma: Adaptations to stress

• Published in: Journal of allergy and clinical immunology 2011-11, Vol.128 (5), p.970-976
• Main Authors: Chen, Edith, PhD, Strunk, Robert C., MD, Trethewey, Alexandra, BA, Schreier, Hannah M.C., MA, Maharaj, Nandini, BA, Miller, Gregory E., PhD
• Format: Article
• Language: English
• Subjects: Adolescent; Allergy and Immunology; Asthma; Asthma - immunology; Asthma - pathology; Asthma - psychology; Behavior; Biological and medical sciences; Child; children; Children & youth; Chronic obstructive pulmonary disease, asthma; Ethnicity; Families & family life; Female; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Humans; Immunopathology; Male; Medical sciences; Mental health; Mortality; Pneumology; psychological; Resilience, Psychological; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Social Class; Socioeconomic factors; Socioeconomic status; stress
• ISSN: 0091-6749; 1097-6825
• DOI: 10.1016/j.jaci.2011.06.040

Background Low socioeconomic status (SES) is a strong predictor of many health problems, including asthma impairment; however, little is understood about why some patients defy this trend by exhibiting good asthma control despite living in adverse environments. Objective This study sought to test whether a psychological characteristic, the shift-and-persist strategy (dealing with stressors by reframing them more positively while at the same time persisting in optimistic thoughts about the future), protects low-SES children with asthma. Methods One hundred twenty-one children aged 9 to 18 years with a physician’s diagnosis of asthma were recruited from medical practices and community advertisements (mean age, 12.6 years; 67% male; 61% white). Shift-and-persist scores and asthma inflammation (eosinophil counts and stimulated IL-4 cytokine production) were assessed at baseline, and asthma impairment (daily diary measures of rescue inhaler use and school absences) and daily peak flow were monitored at baseline and at a 6-month follow-up. Results Children who came from low-SES backgrounds but who engaged in shift-and-persist strategies displayed less asthma inflammation at baseline (β = 0.19, P  < .05), as well as less asthma impairment (reduced rescue inhaler use and fewer school absences; β = 0.32, P  < .01) prospectively at the 6-month follow-up period. In contrast, shift-and-persist strategies were not beneficial among high-SES children with asthma. Conclusion An approach that focuses on the psychological qualities that low-SES children develop to adapt to stressors might represent a practical and effective starting point for reducing health disparities. Moreover, the approaches that are effective in low-SES communities might be different from those that are optimal in a high-SES context.