Social environment has long been thought to be an important factor in asthma manifestations in youth, but few studies have empirically tested social factors at the family, peer and neighbourhood levels and their implications for childhood asthma.

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Edith Chen, PhD, of the University of British Columbia, and other researchers set out to determine whether, and to what extent, social factors influence asthma symptoms and lung function.

They reported their results in the first issue for October in the American Journal of Respiratory and Critical Care Medicine, published by the American Thoracic Society.

Neighbourhood, family lead to asthma morbidity
The researchers hypothesised that greater neighbourhood problems and a lack of peer and family support would all relate to greater asthma morbidity.

Furthermore, they hypothesised that social factors would work by altering either biological systems, such as inflammation, or behaviours, such as smoking.

How the study was done
They recruited 78 children who had physician-diagnosed asthma without other chronic illnesses, and assessed the extent to which youth perceived support from family, support from peers and problems in their neighbourhood, such as crime and violence.

They measured their lung function using standardised spirometry techniques, and assessed their asthma symptoms based on interviews and daily diaries that the subjects kept.

They also assessed behaviours, including smoking and compliance with medications, and evaluated biological markers of inflammation including IgE, eosinophil count and IL-4 production.

The investigators found a correlation between social environment and asthma symptoms and lung function.

Results of the study
Asthma symptoms were greater among children who reported less family support and lived in worse neighbourhoods; lung function also was poorer among children who reported less family support.

To determine possible reasons for these associations, the researchers performed statistical analyses of pathways linking family support and neighbourhood problems to asthma symptoms and lung function.

They found that family support and asthma outcomes were linked via inflammation, but not behaviours.

That is, low levels of family support were associated with greater inflammation, and, in turn, greater inflammation was associated with poorer asthma outcomes.

In contrast, family support did not appear to change children’s behaviours.

Neighbourhood problems linked to behaviour
Neighbourhood problems and asthma symptoms were linked through behavioural pathways, but not through inflammation.

The more problematic neighbourhoods were associated with greater rates of child smoking and exposure to smoke.

In turn, smoking was associated with poorer asthma outcomes. In contrast, neighbourhood characteristics did not appear to change children’s inflammatory profiles.

“Poor family relations may foster psychological experiences with direct physiologic consequences, whereas problematic neighbourhoods may operate by providing role models for maladaptive behaviours,” wrote Dr Chen.

Interestingly, peer group support had no significant effects on asthma symptoms or lung function. These findings suggest that among children with asthma, family and one’s neighbourhood play a more important role in asthma morbidity than do peers.

More research still needed
Dr Chen noted that the study group was small and that the cross-sectional design of the study precluded drawing a direct causal relationship, stressing that more research is necessary before drawing any definitive conclusions.

If these findings are confirmed in future research, however, they could have important implications for asthma interventions.

For example, interventions that target family interaction patterns may help improve children’s asthma by altering biological profiles.

The neighbourhood effects suggest the potential utility of making community-wide changes that could help shape the health behaviours of children with asthma.

“To test these implications, future research is needed that investigates the effects of experimental manipulations of social factors on childhood asthma morbidity,” said Dr Chen. – (EurekAlert)

Read more:
How do you treat asthma in children?
Teen smoking spurs asthma
 

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