At the Open Door Family Medical Center in Port Chester, Dr. Sharon Joseph, a pediatrician, and her colleagues see an exceptionally high incidence of childhood asthma.
Experts view asthma, one of the most common childhood illnesses, as multifactorial, primarily due to genetic and environmental factors. Yet, Dr. Joseph also sees another component to its cause and severity: psychosocial stress – which can be defined as a life situation that creates an unusual or intense level of stress that contributes to the development or aggravation of an illness or behavior.
She feels so strongly about this that she wrote her doctoral dissertation on the subject – having recently received her doctorate from the CUNY School of Public Health in June.
Facts About Asthma
Well-known asthma triggers include deteriorating housing, airborne particulate matter, dust mites, cockroaches, and animal dander. There is a similar association between ground level pollution and asthma in children, as there is with those children living in neighborhoods adjacent to heavy traffic intersections.
Characteristics of asthma include acute/chronic lung inflammation resulting in coughing, wheezing and shortness of breath. In 2018, 53.8% of children with asthma reported having at least one asthma attack. Children with asthma missed 13.8 million days of school that year.
According to the Centers for Disease Control, the prevalence of asthma is higher among non-Hispanic Blacks (18.1%), and Hispanics (12.4%), particularly among Puerto Rican children (23.6%)
According to Dr. Joseph’s thesis, studies have shown that psychosocial stressors in the body can create conditions favorable to increases in asthma and to adverse outcomes. These stressors can reset the balance in the body, causing the lungs to have increased reactivity to asthma triggers.
“Stress also changes the body's immune response by increasing airway inflammation and obstruction, resulting in decreased airflow,” she said. “Additionally, stress can also decrease the capacity of a child with asthma to respond to medications.”
She believes that racial/ethnic minority children and those living in poverty experience increased exposure to psychosocial stressors and greater asthma prevalence. Poor children are more likely to be exposed to higher levels of family adversity, violence, and disorganized household situations, according to research.
“Previous studies show that children living in low income urban neighborhoods experiencing such stressors have increased ER visits and are at greater risk to poor outcomes when compared with children who are not exposed to this.”
Wrap Around Services
She points to the benefit of comprehensive “wrap around” resources, such as those offered at Open Door, that support families in a holistic manner. These services extend beyond the medication by identifying triggers and keeping the condition under better control. This includes conducting assessments for such social determinants of health as food, education and housing insecurity, and advocating for these needs.
She believes it is possible that psychosocial stressors experienced both by parents/caretakers and their children, such as parental perception of neighborhood safety/support, and a child experiencing bullying and/or racial ethnic discrimination, can impact the prevalence of asthma.
“Ongoing psychosocial stress experienced by parents and caretakers can affect the likelihood of asthma in their children, and the psychosocial tension experienced by the parent/caregiver is a stronger indicator of asthma severity than stress perceived by children with asthma,” she said.
One source of such stress involves a parent's perception of living in a neighborhood without sufficient “social capital” (i.e. goodwill, fellowship, sympathy). Studies report a relationship between parents feeling safe in their neighborhoods and asthma prevalence in their children.
For example, one study found that children living in a neighborhood classified as unsafe had a 38% greater chance of having asthma when compared to children living in safe neighborhoods. Children living in neighborhoods classified as non-supportive had a 26% greater probability of having asthma when compared to children living in supportive neighborhoods. Children who reported bullying over the past 12 months had a 28% higher probability of having asthma.
“Kids today experience a lot of stress. Many have returned to school after not being in a classroom for a year and a half,” she said. “Also, we see many immigrant families at Open Door who have not gotten regular medical care.
She said as a result of her understanding of the link between stress and asthma, she now asks her young patients about their stress at home and at school, such as if they’re experiencing bullying. She refers families to Open Door’s behavioral health specialists when necessary.
“Asthma is a mixed bag. There is a genetic component and environmental component, but as pediatricians we also need to look at psychosocial factors that result in the sociocultural determinants of health also playing a role.”
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