Author ORCID Identifier


Defense Date


Document Type


Degree Name

Doctor of Philosophy



First Advisor

Robin S. Everhart, PhD

Second Advisor

Eric Benotsch, PhD

Third Advisor

Marcia Winter, PhD

Fourth Advisor

Suzanne Mazzeo, PhD

Fifth Advisor

Leigh Small, PhD


Pediatric asthma disproportionately affects racial/ethnic minority children and children living in low-income, urban areas. Many families living in low-income, urban areas experience a number of stressors that can place children/adolescents at risk for worse asthma outcomes. This study examined the impact of a cumulative risk model of stressors (e.g., ED visits, quick-relief medication use, lung function, asthma control, QOL) in urban children (7-12 years) with persistent asthma. This study further aimed to examine both the original cumulative risk model and an adolescent-specific cumulative risk model as predictors of asthma outcomes in a sample of 60 adolescents (13-17 years). Asthma-related caregiver support was examined as a potential buffer in the association between stress and asthma outcomes. Secondary data analyses were completed on sixty-one caregiver and child dyads (7-12 years old). Data were collected from a separate sample of 60 urban families of adolescents with asthma (13-17 years old). The two cohorts were also combined for analyses.

The original cumulative risk model developed for the younger children (7-12 years) was a predictor of child QOL in the younger cohort, and QOL and asthma control in the adolescent cohort. However, this finding in the younger cohort (7-12 years) was not supported in pooled data analyses. The original cumulative risk model predicted QOL, asthma control, and quick-relief medication use in the combined cohort analyses (children 7-17 years). The adolescent-specific cumulative risk model was a significant predictor of adolescent QOL and asthma control. Asthma-related caregiver support was only a significant moderator of the association between cumulative risk and asthma control among adolescents. Child age did not moderate associations between cumulative risk and asthma outcomes in the combined cohort. Overall, findings suggest that the accumulation of stress can have a negative impact on asthma outcomes, especially for urban adolescents with asthma. Further research is needed to determine the most central sources of stress that urban school-aged children with asthma experience and to replicate findings for adolescent with asthma. The buffering role of asthma-related caregiver support in the association between cumulative stress and asthma outcomes needs to be examined further in children and adolescents with asthma.


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