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.

Download full-text


Available from: Megan Sandel
  • Source
    • "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). "

    Full-text · Dataset · Sep 2015
  • Source
    • "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). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Literature on neighborhood effects on health largely employs non-experimental study designs and does not typically test specific neighborhood mediators that influence health. We address these gaps using the Moving to Opportunity (MTO) housing voucher experiment. Research has documented both beneficial and adverse effects on health in MTO, but mediating mechanisms have not been tested explicitly. We tested mediation of MTO effects on youth asthma (n = 2829). MTO randomized families living in public housing to an experimental group receiving a voucher to subsidize rental housing, or a control group receiving no voucher, and measured outcomes 4–7 years following randomization. MTO had a harmful main effect vs. controls for self-reported asthma diagnosis (b = 0.24, p = 0.06), past-year asthma attack (b = 0.44, p = 0.02), and past-year wheezing (b = 0.17, p = 0.17). Using Inverse Odds Weighting mediation we tested mental health, smoking, and four housing dimensions as potential mediators of the MTO–asthma relationship. We found no significant mediation overall, but mediation may be gender-specific. Gender-stratified models displayed countervailing mediation effects among girls for asthma diagnosis by smoking (p = 0.05) and adult-reported housing quality (p = 0.06), which reduced total effects by 35% and 42% respectively. MTO treatment worsened boys' mental health and mental health reduced treatment effects on asthma diagnosis by 27%. Future research should explore other potential mediators and gender-specific mediators of MTO effects on asthma. Improving measurement of housing conditions and other potential mediators may help elucidate the “black box” of neighborhood effects.
    Full-text · Article · Apr 2014 · Social Science [?] Medicine
  • Source
    • "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. "
    [Show abstract] [Hide abstract]
    ABSTRACT: In this paper, we report the results of a three-year research project (2008-2011) that aimed to identify urban environmental health inequities using a photography-mediated qualitative approach adapted for comparative neighbourhood-level assessment. The project took place in Vancouver, Toronto, and Winnipeg, Canada and involved a total of 49 inner city community researchers who compared environmental health conditions in numerous neighbourhoods across each city. Using the social determinants of health as a guiding framework, community researchers observed a wide range of differences in health-influencing private and public spaces, including sanitation services, housing, parks and gardens, art displays, and community services. The comparative process enabled community researchers to articulate in five distinct ways how such observable conditions represented system level inequities. The findings inform efforts to shift environmental health intervention from constricted action within derelict urban districts to more coordinated mobilization for health equity in the city.
    Full-text · Article · Jun 2012 · Social Science [?] Medicine
Show more