Sandel M, Wright RJ. When home is where the stress is: expanding the dimensions of housing that influence asthma morbidity

Boston University School of Medicine, Boston, MA, USA.
Archives of Disease in Childhood (Impact Factor: 2.9). 12/2006; 91(11):942-8. DOI: 10.1136/adc.2006.098376
Source: PubMed


The influence of physical housing quality on childhood asthma expression, especially the effect of exposure to moulds, allergens, and pollutants, is well documented. However, attempts to explain increasing rates and severity of childhood asthma solely through physical environmental factors have been unsuccessful, and additional exposures may be involved. Increasing evidence has linked psychological stress and negative affective states to asthma expression. At the same time, recent scholarship in the social sciences has focused on understanding how social environments, such as housing, "get under the skin" to influence health, and suggests that psychological factors play a key role. While there is relevant overlapping research in social science, psychology, economics, and health policy in this area, findings from these disciplines have not yet been conceptually integrated into ongoing asthma research. We propose to expand the dimensions of housing considered in future asthma research to include both physical and psychological aspects which may directly and indirectly influence onset and severity of disease expression. This synthesis of overlapping research from a number of disciplines argues for the systematic measure of psychological dimensions of housing and consideration of the interplay between housing stress and physical housing characteristics in relation to childhood asthma.

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    • "Regarding the interplay between parenting stress and asthma severity, some previous studies in asthma did indicate that greater parenting stress was associated with higher asthma severity (Kaugars, Klinnert, & Bender, 2004; Sandel & Wright, 2006), poorer illness management, poorer adherence to medication (Celano, Klinnert, Holsey, & McQuaid, 2011), and poor house dust mite control (Joseph, Adams, Cottrell, Hogan, & Wilson, 2003). Moreover, it has been indicated that negative life events increase the risk of children's asthma attacks (Sandberg et al., 2000) and that caregiver stress predicts wheeze in early childhood (Wright, Cohen, Carey, Weiss, & Gold, 2002). "

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    • "The mediator domains (and component variables) include: mental health (psychological distress scale, behavior problems index; see (Osypuk et al., 2012a, 2012b) for details on items and construction of these measures); smoking (adult in home smokes, youth ever smoked); housing disarray (cluttered rooms, presence of pet fur, index of negative interior-of-home characteristics); interviewer-observed housing quality (wall-to-wall carpeting, broken plaster/peeling paint, cracks/holes in windows or walls, general condition of housing unit, index of negative exterior-of-home characteristics); adult-reported housing quality (broken locks, peeling paint/wallpaper , vermin, broken windows, count of housing problems, rating of housing as good or excellent); housing hardship (problems with heating, problems with plumbing, utilities were shut off, household head was evicted, household head was homeless/doubled up, problems paying rent/mortgage, problems paying for utilities); housing mobility (moved once since baseline, moved two or more times since baseline). The housing measures were grouped together into 5 domains based on prior empirical evidence (Sandel and Wright, 2006; Suglia et al., 2010). We tested health care access and neighborhood domains (i.e., neighborhood disorder, safety, and satisfaction, and census variables) as mediators, yet none was significant (results not shown). "
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    • "Specific environmental characteristics known to affect health include: green space (Kuo, 2001), noxious land uses (Maantay, 2007), food deserts (Larsen & Gilliland, 2008), walkability (Cutts, Darby, Boone, & Brewis, 2009) air pollution (Burnett et al., 2004), soil contamination (Lambert, Boehmer, Feltham, Guyn, & Rizwan, 2011), local climate change impacts (Patz, Campbell-Lendrum, Holloway, & Foley, 2005), noise pollution (Evans & Marcynyszyn, 2004), and low quantity and quality of affordable housing (Sandel & Wright, 2006). Moreover, these studies consistently show that the pattern of conditions and impacts is not random, but is known to vary geographically alongside socioeconomic and ethnoracial distributions. "
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