Defense Date

2016

Document Type

Dissertation

Degree Name

Doctor of Philosophy

Department

Counseling Psychology

First Advisor

Robin Everhart, PhD

Second Advisor

Matthew Bitsko, PhD

Third Advisor

Rosalie Corona, PhD

Fourth Advisor

Terri Sullivan, PhD

Fifth Advisor

Marcia Winter, PhD

Abstract

The purpose of the present study was to examine how low-income, racial and ethnic minority, urban families experience and manage their child’s asthma. The rationale for this study stems from existing literature on asthma disparities and documented predictors of increased asthma morbidity and mortality. In particular, this study considered how specific types of stress may disproportionately impact low-income, racial and ethnic minority, urban families that have a child with asthma. This study aimed to determine associations between urban stressors (stressful life events, perceived discrimination, subjective socioeconomic status) and child asthma outcomes (emergency department visits, school days missed, asthma control), and considered depressive symptoms and asthma self-efficacy as mediators in these associations. Analyses were conducted in a sample of 97 urban caregivers and their children in Richmond, Virginia.

Findings revealed that neighborhood stress was significantly associated with asthma control. Stressful life events were significantly associated with school days missed. Perceived discrimination and subjective SES were not significantly related to any child asthma outcomes. Bootstrapping procedures demonstrated that child depressive symptoms mediated the relation between neighborhood stress and asthma control. Child asthma self-efficacy did not significantly mediate associations between neighborhood stress and any child outcomes. Caregiver depressive symptoms and caregiver asthma self-efficacy did not significantly mediate any associations between caregiver-reported urban stressors and child asthma outcomes.

Results from the present study suggest that urban stressors, especially neighborhood stress and stressful life events, are important to consider in the context of child asthma management and subsequent health outcomes. Exposure to urban stressors may further contribute to pediatric asthma disparities because they are disproportionately experienced by low-income, racial and ethnic minority, urban families. Each urban stressor that was related to a child outcome was associated with a particular asthma outcome. Specifically, child-reported neighborhood stress was related to asthma control. Caregiver-reported stressful life events were associated with school days missed. These findings suggest that exposure to specific types of stress may impact asthma management differently. Future research should, therefore, explore the impact and contribution of specific stressors in greater depth. Further, child depressive symptoms significantly mediated the relation between neighborhood stress and asthma control, although caregiver depressive symptoms did not significantly mediate any associations between urban stressors and child asthma outcomes. Additionally, both child and caregiver depressive symptoms were significantly associated with multiple urban stressors and child asthma outcomes. Depressive symptoms may, therefore, be important to target in future research as possible explanatory variables or variables that contribute to stress appraisals and child asthma outcomes.

Rights

© The Author

Is Part Of

VCU University Archives

Is Part Of

VCU Theses and Dissertations

Date of Submission

3-17-2017

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