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

Abstract

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.

Figure 1

Top figure: Interaction of socioeconomic status (SES: family savings) by shift-and-persist strategies predicting asthma inflammation composite at baseline. The inflammation composite reflects eosinophil counts and stimulated IL-4 production. Estimated values are plotted at ±1 SD of SES. Bottom panels: individual data points for low and high SES patients by median split. To obtain adjusted values for each participant, asthma inflammation was regressed onto covariates, and residualized scores were plotted by shift-and-persist values.

Figure 2

Top figure: Interaction of socioeconomic status (SES: family savings) by shift-and-persist strategies predicting asthma impairment at 6 month follow-up, controlling for time 1 values. Asthma impairment reflects school absences and rescue inhaler use. Estimated asthma impairment values are plotted at ±1 SD of SES. Bottom panels: individual data points for low and high SES patients by median split. To obtain adjusted values for each participant, asthma impairment was regressed onto covariates, and residualized scores were plotted by shift-and-persist values. Because these are standardized residuals, values can be less than 0.