Abstract: Characterization of Stress in Low-Income, Inner-City Mothers of Children with High-Risk Asthma (Society for Social Work and Research 21st Annual Conference - Ensure Healthy Development for all Youth)

Schedule:

Friday, January 13, 2017: 2:05 PM

Preservation Hall Studio 7 (New Orleans Marriott)

* noted as presenting author

Melissa Bellin, PhD, Associate Professor, University of Maryland at Baltimore, Baltimore, MD

Philip Osteen, PhD, Assistant Professor, Florida State University, Tallahassee, FL

Joan Kub, PhD, Associate Professor, Johns Hopkins University, Baltimore, MD

Angelica Newsome, BA, Research Assistant, University of Maryland at Baltimore, Baltimore, MD

Kathryn S. Collins, PhD, MSW, Associate Professor, University of Maryland at Baltimore, Baltimore, MD

Arlene Butz, ScD, Professor, Johns Hopkins University, Baltimore, MD

Background: The impact of poorly controlled asthma reverberates throughout the family system, with caregivers particularly affected by this burden. Raising a child with asthma in the context of poverty heightens risk for caregiver stress related to housing instability, utilities insecurities, and exposure to community violence (Crespo, Carona, Silva, Canavarro, & Dattilio, 2011; Sampson et al., 2013). However, current evidence does not address whether illness-related demands or dimensions of living in poverty undergird the elevated rates of life stress observed in this population.

Methods: Inner-city, low-income mothers (N=276) of young children with asthma completed self-report measures at baseline, 6 and 12 months that ascertained daily life stress, child asthma characteristics (severity and control level), use of asthma-related emergency services, social support (SS) and CRYSIS in Family Systems subscales (financial; home issues; safety in home and community; relationships), which is an validated index of contemporary sources of life stress. Nested latent growth curve models (LGCM) were used to test the relationships between risk and protective factors and stress over time.

Results: Participants were primarily single (73%), unemployed (45%), and poor with 52% reporting an annual income <$10,000. Children were young (mean age=5.9years), African American (96%), Medicaid eligible (92%), and nearly all (94%) were categorized as having poorly controlled asthma based on symptom frequency and emergency room/urgent visit usage rates.

LGCM fit was acceptable (RMSEA=0.03,CFI =0.95,TLI=.91,SRMR=02). Model findings indicated that financial problems were a significant predictor of stress at baseline (b=21, se=.09,p=.02), 6-months (b=.21, se=.10,p=.03), and 12-months (b=.20, se=.09,p=.03). Concerns about safety in the community was likewise associated with stress at baseline (b=.30.se=.11,p=.04) and 12-months (b=.23,se=..12,p<.06). Home issues (e.g., rodent infestation, housing insecurity) were a significant predictor at 6-months (b=.39,se=.19,p<.04). Safety in the home was a significant predictor at 12-months (b=.94,se=.51,p<.06). The only asthma-related risk factor supported in the model was healthcare usage, with more child asthma emergency services predictive of higher scores for stress at baseline (b=.06, se=.02,p<.005). Social support had an inverse relationship with stress, with higher levels of social support associated with lower levels of stress across all time points [b=-.06(se=.02, p=.001) at baseline, b=-.08(se=.04, p<.001) at 6-months, and b=-.06(se=.03, p=.04) at 12-months]. Effect sizes (R²) ranged from .15-.54 over time.

Conclusions: Multi-faceted stressors impact mothers caring for children with high-risk asthma in the context of poverty. Findings suggest challenges associated with residence in inner-city, low-income communities, and not asthma-related variables, are the primary sources of stress in this population. Public health social workers are positioned to ameliorate this burden by assessing and intervening on life stress linked to poverty including housing, financial, and community violence concerns.

Crespo, C., Carona, C., Silva, N., Canavarro, M.C., & Dattilio, F. (2011). Understanding the quality of life for parents and their children who have asthma: Family resources and challenges. Contemporary Family Therapy, 33,179-196.

Sampson, M.N.R., Parker, E.A., Cheezum, M.R.R., Lewis, T.C., O’Toole, M.A., Patton, M.J.,……& Keirns, C. C. (2013). A life course perspective on stress and health among caregivers of children with asthma in Detroit. Family & Community Health, 36(1), 51-62.