Associations among Risk Factors, Individual Resources, and Indices of School-Related Asthma Morbidity in Urban, School-Aged Children: A Pilot Study

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ABSTRACT: This paper presents a conceptual model including examples of risk and resource factors associated with indices of school-related asthma morbidity (eg, missed sleep, participation in activities, school absences) in a group of urban, school-aged children with asthma from ethnic minority backgrounds. Specifically, the current longitudinal study examines relations between a contextual risk factor (ie, family life stressors), an asthma-related risk factor (ie, asthma symptoms), individual resources (ie, attention, children's problem-solving beliefs, and self-esteem), and aspects of asthma morbidity that have been shown to have an impact on children's academic performance. Participants of the study included 31 mother-child dyads from low-income, inner-city neighborhoods. Results of hierarchical regression analyses revealed that after controlling for risk factors (ie, asthma symptoms and family life stressors) at baseline, children's individual characteristics (ie, children's problem-solving beliefs and self-esteem) functioned as resource factors for some indices of asthma-related functioning (school absences, participation in activities, and missed sleep) at follow-up (1 year later). Results suggest that contextual and individual risk and resource factors should be further explored in studies including larger samples of urban children with asthma in order to help guide the development of preventive interventions in school-based and health care settings. (J Sch Health. 2005;75(10):375-383)

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Urban living and its associated family stressors can compromise children's school functioning. (1) Pediatric asthma should be a focus of attention in school systems due to its increased prevalence and morbidity in urban areas and its association with difficulties in children's psychosocial and academic functioning. (2) Asthma can influence school absences, emergency room visits, restrictions in physical activities, and missed sleep. (3) If not properly treated, asthma can negatively impact children's ability to learn when in school. (4) Given the heightened risks that urban children face, it is imperative for research to identify factors that might contribute to optimal asthma-related and psychological school functioning. An enhanced understanding of these issues may allow health providers and educators to promote children's academic and asthma-related functioning despite exposure to illness-related and urban stresses.

As a first step in this effort, the current pilot study tests a conceptual model in which children's individual characteristics (ie, attention, problem-solving beliefs, and self-esteem) are proposed to moderate the relation between contextual (family stress) and asthma-related (asthma symptoms) risk factors and indices of school-related asthma morbidity that are relevant to school performance (Figure 1).

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ACADEMIC FUNCTIONING OF CHILDREN IN URBAN ENVIRONMENTS

Children living in disadvantaged urban environments may face a number of stressors (eg, high rates of poverty, exposure to violence) that are risk factors for the development of academic problems. (5) Family life stressors related to urban living (eg, increase of mother's or father's time away from the family, needing to move, financial stressors) can have deleterious effects on children's well-being over time. (6)

Specific associations and pathways between contextual risk factors and academic functioning in urban children have been examined. Dornbusch, Ritter, and Steinberg (7) found that inner-city children in secondary school with lower socioeconomic resources have poorer grades than children who reside in neighborhoods with more resources. It has been found that 5- to 6-year-old children who lived in urban neighborhoods scored lower on intelligence tests than children from higher-income neighborhoods. (8) Longitudinal results showed that increased neighborhood risk in third grade (ie, income, violent crimes) was negatively associated with academic performance in fifth grade among children from urban, low-income neighborhoods. …