Relationship Between Parental Psychosocial Stress and Asthma Outcomes Among Urban African-American Children

Relationship Between Parental Psychosocial Stress and Asthma Outcomes Among Urban African-American Children Background: Increased psychosocial stress among parents and children has been associated with worse asthma outcomes, especially in urban children. However, few studies have evaluated the impact of longitudinal changes in psychosocial stress on pediatric asthma outcomes. Objective: To compare asthma outcomes in children with respect to their parents’ reported stress at baseline and changes in their parents’ stress over a 12 month intervention period. Design/Methods: A secondary analysis was performed on data from a recently completed randomized trial of an intervention to mitigate psychosocial stress in African American parents of children with persistent asthma. Children were 4-11 years old, with persistent asthma, and on Medicaid. Asthma outcomes in the children were compared based on (a) baseline levels of self-reported Perceived Stress Scale (PSS) scores in the parents and (b) the change of parental PSS scores from baseline to 12 month follow-up. The primary outcome was change in the child\u27s symptom-free-days (SFDs) over the course of the trial with SFDs being determined from 14-day recall. Results: A total of 217 African American parent-child dyads were available for analysis. With respect to parental baseline stress, children of parents in the highest tertile of baseline stress had the greatest improvements in SFDs (2.3±5.1) during the 12 month intervention as compared to children of parents in the middle (2.0±4.6) and lowest (1.4±4.3) tertiles (Figure 1, p=0.4 for comparison of highest and lowest tertiles). With respect to change in parental stress during the 12 month trial, children of parents who reported a reduction in stress had an improvement of 2.7±4.9 SFDs during the trial as compared to an improvement of only 1.5±4.8 SFDs in children of parents who reported an increase in stress during the trial (Figure 2, p=0.06). Conclusions: Over the course of this intervention trial, there were consistent trends towards better asthma outcomes in children who had caregivers that either (a) had higher baseline stress scores or (b) had better improvements in stress scores at the completion of the trial. This may indicate that stress reduction interventions should be targeted for families with higher levels of stress