Stress and Quality of Life in Caregivers of Inner-City Minority Children with Asthma

Background/Purpose: Asthma, the most common childhood health condition, is a leading cause of health disparities. Inner-city, low-income African American children are disproportionately impacted by asthma morbidity and mortality (Gold & Wright, 2005). Given its potential impact on the child's disease management and decisions about healthcare utilization, increasing caregiver quality of life (QOL) by intervening on associated risk factors has been identified as a major goal of interventions for this population. However, the complex stressors that families of low-income inner-city children with asthma encounter (e.g., housing instability, community violence) may be overlooked in interventions with a restricted focus on reducing asthma caregiving demands (Williams, Sternthal, & Wright, 2009). The objective of this interdisciplinary research was to examine the relationships between caregiver QOL, daily life stress, and asthma caregiving stress in families of inner-city minority children with poorly controlled asthma. It was hypothesized that QOL would be significantly associated with perceived daily life stress and asthma caregiving stress, after accounting for asthma severity and caregiver education.

Methods: Families of 130 inner-city minority children aged 3 to 10 years and diagnosed with persistent asthma were recruited from local pediatric emergency departments (ED). Research assistants conducted home visits to administer a questionnaire comprised of demographics and standardized measures of QOL (Pediatric Asthma Caregiver's Quality of Life Questionnaire) and daily stress (Perceived Stress Scale) to the primary caregiver. Asthma caregiving stress was measured using a self-report 10-cm horizontal Visual Analogue Scale. Hierarchical regression analysis was performed to evaluate the unique contributions of asthma caregiving stress and daily life stress in explaining variability in caregiver QOL.

Results: Participating children were primarily African American (98.4%), male (63%), with a mean age 5.5 (SD=2.4) years. Most had > 2 symptom days/week (54%) and >1 ED visits/6 months (95.4%) per caregiver report. The overall model inclusive of the demographic and severity covariates and stress variables explained a significant amount of variance in caregiver QOL (Adjusted R2=.20, F=8.92, p<.001) and was in the range of medium-to-large effect size (f2=.25). Both perceived daily life stressors (β=-.25, p=.002) and asthma caregiving stress (β= -.24, p=.004) were significant predictors of caregiver QOL, with greater levels of stress reported for each factor associated with poorer QOL. A higher number of asthma symptom days in the last two weeks was also associated with lower caregiver QOL (β=-.23, p=.004).

Conclusions/Implications: While the noted associations are limited due to common method variance and the cross-sectional nature of the data, findings lend support to screening for diverse sources of stress in caregivers of inner-city minority children with poorly controlled with asthma. Both asthma-specific caregiver demands and more general daily life stressors placed caregivers at risk for poor QOL and warrant attention in family-centered interventions with this vulnerable population.

Gold, D. R., & Wright, R. (2005). Population disparities in asthma. Annual Review of Public Health, 26, 89-113.

Williams, D. R., Sternthal, M., Wright, R. J. (2009) Social determinants: Taking the social context of asthma seriously. Pediatrics 123(Suppl. 3), S174-S184.