Psychosocial stressors in asthma incidence and morbidity in children
Background Few studies have examined the association between parenting quality and behavioral adjustment in children and asthma incidence. Medication non-adherence is a proposed mechanism for the association between caregiver stress and asthma morbidity, but research on the association is limited. Aims To examine the association between parent-child relationship and child’s behavioral adjustment and asthma incidence, and to explore the association between caregiver stress and medication non-adherence in children with asthma. Methods Secondary analyses were conducted in two study populations: a birth cohort study in the United Kingdom and an intervention trial of children with asthma in inner-city New Orleans. The first two analyses defined asthma by parent report and current asthma medication use at five or seven years. Mother-child relationship and child’s behavioral adjustment were measured with the Child-Parent Relationship Scale (CPRS) and the Strengths and Difficulties Questionnaire (SDQ), respectively, at three years. Caregiver stress and medication non-adherence were measured using Cohen’s Perceived Stress Scale (PSS-4) and caregiver self-report, respectively, at baseline and twelve months. Results Among families with the most major life events, children with mothers reporting poorest compared to best CPRS had an adjusted OR=2.8 (95% CI: 2.3-3.6) for asthma. Adjusted odds ratios for the association between abnormal versus normal SDQ at 3 years and asthma at 5 or 7 years was 1.2 (95% CI: 1.0-1.5). Adjusted odds ratios for non-adherence due to running out of medications were 6.8 (95% CI: 1.0-47.6) in high versus normal stress caregivers. Conclusions Increased risk of asthma was observed among those with the poorest mother-child relationships and the most major life events, and in children with abnormal behavioral adjustment. A statistically significant adjusted association between caregiver stress and overall medication non-adherence was not observed, but an association between increased caregiver stress and non-adherence due to running out of medications was suggested.