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The Potential for Reducing Asthma Disparities Through Improved Family and Social Function and Modified Health Behaviors^*

^* From the Lung Health Center, University of Alabama at Birmingham, Birmingham, AL.

Correspondence to: Joan M. Mangan, PhD, MST, Lung Health Center, University of Alabama at Birmingham, 618 20th S St, OHB 138, Birmingham, AL 35233-7337; e-mail: jmangan{at}uab.edu

	Abstract

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The National Workshop To Reduce Asthma Disparities assembled a multidisciplinary group comprised of scientists, clinicians, and community representatives to examine factors related to asthma disparities. Attention was given to the importance of discerning family, social, and behavioral factors that facilitate or impede the use of health-care services suitable to the medical status of an individual. This review highlights select biopsychosocial factors that contribute to these disparities, the manner in which they may contribute or protect persons affected by asthma, and recommended directions for future research.

Key Words: asthma • coping • disparities • family • health behavior • knowledge • psychosocial factors • social networks • social support • stress

	Introduction

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Asthma is a serious cause of morbidity and mortality in the United States, affecting approximately 14 million people, including men and women, children and adults, and all racial and ethnic groups.¹²³⁴⁵ Despite major advances in understanding the etiology and pathophysiology of asthma and the development of new therapeutic modalities, the prevalence, severity, and mortality rates from asthma have all increased over the past decades.⁶ Hospitalizations for asthma have doubled in adults and increased fivefold for children over the past 20 years. Morbidity and mortality rates appear to be particularly high in urban and minority populations. African Americans are three times more likely to be hospitalized and four times more likely to die from asthma.^7891011 Comparable outcomes have been reported for US Hispanic populations, particularly Hispanics from Puerto Rico.³¹²

The role of health systems and their administrative and bureaucratic processes in disparities have been examined, as have genetic factors, the environment, and possible gene/environment interactions. In a report by the Institute of Medicine (IOM), titled "Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare," the authors present evidence drawn from the literature indicating that persistent racial and ethnic discrimination as well as provider’s uncertainty working with culturally diverse patients contribute to unequal treatment.¹³ Additional contributing factors include patient/provider communications, patient preferences, treatment refusal, and the financial, legal, regulatory, and policy environment in which health systems operate.¹³ Other researchers^614151617 have found strong evidence to support the need to further examine genetic and environmental factors.

A multifaceted approach to reduce asthma disparities must also examine and address family, social, and behavioral factors. While the literature repeatedly demonstrates racial and ethnic disparities across a range of illnesses and health-care services, numerous studies find these disparities remain even after adjusting for socioeconomic differences and access to care.¹³ There are several mechanisms through which family, social, and behavioral factors may contribute to the disparities seen in asthma morbidity and mortality. For example, when quality of life is examined, disparities exist although race is less often a factor.¹⁸¹⁹²⁰ Why? Measures of quality of life allow the patient’s perspective of their asthma to be considered as an important outcome. Because this outcome is dependent on the patient’s perspective, it can be strongly influenced by family, social, and behavioral factors. At the same time, quality of life measures are only weakly associated with traditional measures of physiologic impairment such as spirometry.²¹ Behavioral factors and family social support also influence levels of treatment adherence, decisions to engage in risk reduction (eg, allergen reduction), and care-seeking. These factors, in turn, impact expression of asthma morbidity.

In 2002, the National Heart, Lung, and Blood Institute published a workshop summary²² describing approaches for reducing disparities in asthma and recommended research priorities. A large component of the summary addressed the social, cultural, and behavioral aspects of disparities. Emphasis was given to the diversity in beliefs and practices that are based on culture, social class, education, and minority status. These in turn, contribute to the health behaviors (eg, level of adherence), approaches to self-management, and health-care utilization that can lead to asthma disparities. Table 1 provides an overview of this summary.

In February of 2005, the National Workshop to Reduce Asthma Disparities was held in Chicago, IL. Workshop participants examined many factors related to asthma disparities and discussed the next steps for the research, clinical, policy, and consumer communities to use in reducing asthma disparities. Attention was given to the importance of discerning family, social, and behavioral factors that facilitate or impede the use of health-care services suitable to the medical status of an individual. Specifically the structures (eg, socioeconomic group, family, social networks, culture, knowledge) and processes (eg, social support, stress, coping, attitudes, beliefs and practices) that create and maintain differences among members of a population and contribute to asthma disparities were examined. Highlighted below are select factors that contribute to the disparities, the manner in which they may contribute or protect persons affected by asthma, and recommended future directions (Table 2 ).

	Social, Economic, and Environmental Interactions

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Equally important is the notion that individual behavior and lifestyle choices contribute to disparate health outcomes in lower SES strata.³³³⁴ There have been recent data that indicate when individual behavior and lifestyle choices such as smoking, alcohol consumption, diet, and exercise are corrected for, disparate health outcomes are still observed in lower SES groups. Such findings suggest that access to health care and individual behavior and lifestyle choices are not the major determinants of SES-related disparate health outcomes. Indeed, these results shift research emphasis toward an examination of mechanisms by which social and physical environments may interact with SES to produce health disparities.

In the United States, race is closely linked with SES, making the effects of the two factors difficult to separate. Race and ethnicity have often been used as surrogate variables for poverty and material deprivation.²² However, this is not always valid and adds to the difficulties in examining underlying causes for disparities. Additionally, while racial groups share certain genetic attributes, it is important to note that there are limitations to using "race" as more than a social construct. The definitions of racial groups vary across time and location. Also, how a person might classify their race often differs from how others may classify that person.²² Instead, the social and cultural attributes of race appear more likely to significantly affect health status.

Moreover, research indicates that race does not appear to affect illness behavior once other social and behavioral factors are taken into account.³⁵ This suggests that race affects health outcomes and disparities through its relation to other behavioral and social factors. For instance, culture affects health through its influence on risk and protective behaviors, the nature of the family and social relations, and the meanings and expectations associated with group memberships (eg, shared beliefs that disease symptoms are part of normal life and should be "toughed out," causing delays in accessing medical services and increase risk of harm in some minority populations³⁶). Collectively, this evidence provides the basis for the belief that there are multiple social forces that shape and support behavior in different groups of people. In addition, social and physical environments vary for different social groups. Within these environments, certain racial, ethnic, and socioeconomic groups are more severely affected by asthma than others. These same groups encounter multiple barriers (eg, financial constraints, logistical and cultural barriers, and environmental stressors) when attempting to follow health and treatment recommendations. The relationships and mechanisms by which family, social, and behavioral factors contribute to disparities and affect health-related quality of life either directly or indirectly are complex.

	Social Networks and Social Support

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Social networks and social support are interpersonal processes that influence health. Social support is the commitment, caring, advice, and aid provided through relationships or networks of people. These networks can have direct effects on health through emotional and instrumental support.³⁷ They also provide social ties with meanings and obligations that influence health behaviors, thereby influencing morbidity and mortality.³⁷

Research has indicated that social relationships have a significant effect on health,^3839404142 and that parental social networks are related to their children’s health.⁴³ Strong social networks often have a positive effect on health and well-being^384445464748; however, some networks can actually create stress or impede positive health behaviors.⁴⁹⁵⁰ Social networks are particularly important in chronic diseases such as asthma where persons must learn to self-manage their condition in the home. Strong social networks can enhance a person’s sense of self-efficacy, mastery, self-esteem, and facilitate self-management behaviors.⁵¹⁵² Conversely, nonsupportive networks can impede healthy behaviors and influence quality of life.⁵³ Furthermore, social networks can affect one’s ability to access care, and provide instrumental social support (such as assistance with transportation and child care, and information) as well as expressive social support through caring, concerned relationships. The differences that exist among social networks need to be examined further, characteristics of positive networks quantified, and mechanisms identified to intervene with stressful networks that may negatively impact health.

The exact mechanisms by which social relationships affect health also remain unclear.⁴¹⁵⁴ However, studies have indicated that social support can impact the development of disease and the severity of symptoms,⁵⁵ and can function as a shield between stress and asthma exacerbations.⁵⁶⁵⁷ The extent of social support has also been shown to be a significant predictor of emergency department (ED) visits and symptoms in asthma patients.^58596061 There is inconsistency in the literature regarding what type of support is more important, family or nonfamily. Some studies⁶²⁶³ have indicated that family support may be more important that other forms of social support, particularly in children; such research has shown that parental influence has a stronger effect on adolescent health behaviors than does peer influence. Others⁶⁴ have indicated that nonfamilial support from a health-care professional has the strongest effect.

	Family

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Although the relationship between family functioning and asthma management and morbidity has received little attention in the literature, family support and functioning play a role in health outcomes. There is evidence that the family may serve as a protective factor for health,³⁷⁶⁵⁶⁶ and act as a buffer from negative life events in patients with asthma.⁶⁷ Research has indicated that functional families may facilitate adherence and reduce morbidity in children with chronic illnesses,⁶⁸⁶⁹ and even promote recovery from illness.⁷⁰ Alternatively, dysfunctional families may influence the course of illness by reducing coping mechanisms and problem-solving capacities. Interestingly, while social support seems to be an important factor in asthma outcomes, interventions that attempt to increase social support for families of children with chronic disease have found only modest effects on improving children’s adjustment and maternal symptoms of anxiety, and have had no effects on the activity limitations of the child.⁷¹

Family cohesiveness has also been found to have a positive impact on health outcomes,⁴³⁷²⁷³ and can be more influential than other forms of social support in improving patient health.⁷² The extent or degree of family cohesiveness is also positively associated with better health outcomes.⁷³ Even in the case of a small family, such as a single-parent family, health is better when family cohesiveness is high.⁴³ One measure of cohesiveness is the family ritual. Such rituals serve as a protective function for children with asthma even under situations of high stress.⁷⁴

A patient’s family has a substantial impact on their asthma outcomes throughout their life course. Early family environments shape one’s health beliefs and behaviors, which impacts the way one manages his or her asthma as an adult. Research has demonstrated that the health behaviors of adults are related to those of their parents.^7576777879 Moreover, people adopt the practices/behaviors of their families, often without conscious awareness, and research reveals that a patient’s family serves as a significant source of health information. Peterson and colleagues⁸⁰ found that African-American caregivers acquire much of their information on childhood asthma from other family members and from their personal experiences.

For children, both their caregivers’ functioning as well as the child’s interactions with a caregiver can affect their asthma heath outcomes.⁸¹ Studies^82838485 have found the mental health of a mother is predictive of asthma morbidity, including ED use, hospitalizations, and asthma symptoms of their children. Parental psychological well-being and personal outlook also influence reporting of symptoms and quality of life,⁸⁶⁸⁷ perceptions of asthma outcomes, and may contribute to increased asthma morbidity through impaired problem solving skills, inappropriate utilization of health-care services, and reduced adherence.⁸³⁸⁸⁸⁹ Moreover, family responses to the demands of caring for a chronic pediatric illness can cause detrimental changes to the family as a whole. The stress of inharmonious family dynamics affects immune functioning, which in turn can affect health.⁹⁰ Family conflict may place children at greater risk for mental and physical health problems including more morbidity from asthma.⁹¹⁹²⁹³ For example, increased asthma attacks among children have been shown to be associated with critical attitudes of their mothers.⁹⁴⁹⁵⁹⁶ Noncompliance is also related to parental criticism.⁹⁷ Families with dysfunctional members, such as mothers who are depressed, may have limited social networks and coping skills that affect adherence and health-seeking behaviors. Within other families, a child’s illnesses can organize and strengthen the family,⁹⁸⁹⁹ and secure parent-child attachments have been related to fewer problems.¹⁰⁰

Families also have more indirect effects on health. In a review of the impact of family on health, Ross et al⁶⁵ outline several aspects of family that influence health and well-being: marriage, parenthood, and the family’s social and economic status. Being married is consistently and strongly associated with better physical health, psychological well-being, and low mortality. The primary mechanisms through which marriage protects health and well-being seem to include social support and economic well-being. As described above, social support provides one with both emotional and instrumental support. Support from one’s spouse may improve health in several ways such as by improving emotional health, reducing risky behavior, aiding early detection and treatment, and helping recovery. However, some marriages, particularly those characterized by an unequal division of decision-making power, lead to higher levels of distress. The quality of the marriage is the best indicator of whether or not the marriage leads to increased or decreased health and well-being. Married people also have higher household incomes than nonmarried people, and economic well-being is strongly related to health and well-being.

Parenthood also has an impact. Generally, children at home decrease adult health and well-being. However, under circumstances when the family is having no economic hardships and the parents have sufficient emotional and instrumental support, children may not decrease well-being. For some parents, children may provide them with a sense of enduring responsibility that reduces the likelihood of participating in risky behaviors and may increase adherence with medical regimens. The impact of children varies widely by families because children often erode the very things necessary to successfully cope with children: economic well-being and supportive relationships.⁶⁵

Families are dynamic groups that change over time. A family that may have initially been a positive impact on health behaviors may develop into one that has a negative impact and vice versa. Life stressors that impact the family (such as deaths and job loss) are also likely to be important in the health behaviors of persons with asthma. Therefore, it is important for researchers and clinicians to examine family structure, activities, work/home patterns, living arrangements, and the impact of life events on asthma management and outcomes.

	Stress

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The physiologic impact of stress on psychological functioning, behavior, and the endocrine, immune, and central nervous systems has led researchers to identify stress as a precipitating factor for cardiovascular diseases, endocrine dysfunctions, autoimmune disorders, and cancer. Similarly, high levels of stress have been empirically found to predispose people to asthma, precipitate its development, and predict both asthma morbidity and poorer quality of life.^{101102103104105106107}

While researchers¹⁰⁸ in the field of psychonueroimmunology (which examines the connections between psychosocial stress, the CNS, and immune and endocrine function) have made inroads toward elucidating how stress and emotions may trigger asthma exacerbations, specific associations between the type of stressor and resulting disease remains perplexing. Plausible explanations for this are within individual differences in psychobiological reactivity, as well as the duration and frequency of stressors.¹⁰⁹ In a prospective study of the role of acute and chronic stress in asthma attacks in children, Sandberg and colleagues¹¹⁰¹¹¹ reported that children who experienced a severely negative life event in conjunction with chronic adversity have a significantly increased risk for an immediate asthma exacerbation. In addition, children who experienced a severe event in the absence of high chronic stress were at increased risk for an asthma exacerbation in the weeks after the event, following a minor time delay.¹¹⁰¹¹¹ Likewise, adults with asthma have been found to experience rapid and significant increases in respiratory symptoms and airway resistance during situations that generate negative emotions.¹¹² Consequently, it is important to explain chronological relationships between the duration and frequency of stress, asthma exacerbations, and changes in underlying neuroendocrine and immune markers.

Relaxation therapies and psychological interventions aimed at helping patients to reduce stress or inhibit emotional expression in order to prevent stress-induced asthma episodes have produced mixed results with indeterminate clinical significance. These interventions have also been criticized for their lack of appropriate control groups, small sample sizes and selection of study participants.^{107113114115116117} Yet, data presented in the literature indicate that strong methodologic studies of psychological interventions, guided by explicit theoretical frameworks, to improve lung function and symptom relief for persons with asthma is warranted.¹¹⁸¹¹⁹

	Coping

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While stress is the physiologic response to perceived (both real and imagined) threats to a person’s mental, physical, emotional, and spiritual well being, coping is the manner in which a person responds and adapts behaviorally, cognitively, and emotionally to environmental or internal circumstances.⁹³¹²⁰ Therefore, when an individual judges their coping to be inadequate, the result is psychological stress.¹²¹ Adequate coping can facilitate the acceptance of an asthma diagnosis, adherence to medications and self-management regimens, prevent asthma exacerbations or aggravation of an exacerbation, and promote convalescence.

Numerous coping strategies have been identified by researchers. Two main conceptual approaches are used to classify coping responses. The first is the orientation or focus of coping, which may be problem focused or emotion focused. Problem-focused coping reflects cognitive and behavioral efforts to master or resolve stressors. Examples of problem-focused coping include planning, information seeking, and active coping; emotional coping includes such responses as venting anger, avoidance, and denial. The second conceptual approach is the method of coping, which encompasses cognitive or behavioral responses.

Among persons with asthma, a more emotional coping style has been associated with lower perceptions of control over asthma, quick relief medication overuse and control medication underuse, and increased ED utilization and inpatient hospitalization following an asthma attack.¹²² Additionally, an emotional coping style has been independently associated with poor health-related quality of life.⁵¹

Coping styles used by parents and caregivers have also been investigated. Eisner and Havermans¹²³ found that the coping strategies employed by the parents of children with asthma varied according to the time since diagnosis, age, and gender of the child. In a study of family adaptation to childhood asthma, Brazil and Krueger¹²⁴ report differences in coping between mothers and fathers. Mothers reported greater efforts than fathers to engage support from relatives, friends, and neighbors. Moreover, mothers are more likely to develop relationships outside the family, engage in activities that enhance feelings of individual identify and self worth, and find ways to manage psychological tensions and pressures.¹²⁴ In an examination of coping styles among racial groups, Mailick and colleagues¹²⁵ found that the caretakers of low-income Hispanic or African-American children with asthma use active coping, planning, and religion most frequently, while the least often employed strategies included restraint coping, denial, and mental disengagement.

Barton and colleagues¹²² propose that the behavioral problems, anxiety, and depression frequently found among individuals with asthma may be predicted from the coping styles used by patients rather than the experience of asthma itself. Therefore, the coping style negatively influences treatment adherence and asthma control rather than the experience of asthma itself.¹²² Among patients with chronic illnesses other than asthma, measures of depression have been found to be unrelated to the disease itself but may be predicted from the coping strategies used.¹²⁶

Interventions to improve coping skills of parents or caregivers and persons with asthma have demonstrated improved symptoms, reduced asthma morbidity, and improvements in psychological functioning, especially anxiety.¹²⁷¹²⁸ Yet questions remain over whether coping styles remain stable or change over time, as well as how cognitive development and emotional and personality development impact coping.¹²⁹

	Knowledge, Attitudes, Beliefs, and Health Practices

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Self-management education for both caregivers and patients facilitates problem-focused coping. An expanding body of research indicates that patients who possess a better understanding of their diagnosis, treatment, and care are able to adopt skills to better manage their disease, experience less asthma morbidity, and reduce their utilization of health-care services and lost days of work.^130131132 Additionally, patient education has the capacity to modify patients’ attitudes, beliefs, and skills related to their disease state; recommended medical regimens; and treatment options.

Yet to be effective, educational interventions must expand beyond factual knowledge about asthma. Interventions that concentrate primarily on providing information about asthma are not sufficient to improve self-management ability or asthma morbidity.¹³³ While a baseline level of knowledge may be necessary to enable some actions to occur, after this threshold has been met additional information does not automatically bring about added behavioral change.¹³⁴

Effective self-management programs have been shown to share common characteristics or processes. Summarized by Creer,¹³⁵ these processes include the following: (1) goal selection, which entails acquisition of knowledge of asthma and its management and setting specific goals that will enable optimal health and well-being; (2) information collection through self-monitoring; (3) processing and evaluation of self-monitoring information; (4) appropriate decision making; (5) action; and (6) self-reaction.¹³⁵ Mastery of each of these processes enables patients and their caregivers to achieve an understanding of the nature of their disease as well as knowledge and skills necessary to make decisions in response to asthma symptoms and exacerbations. Therefore, it is imperative that health-care providers address with patients the types of decisions that must be made, provide information so that patients may make informed decisions, address the advantages and disadvantages of decision choices, and provide adequate information related to the probable outcomes of decision choices. Erroneous decisions not only affect quality of life for individuals but also may impede recovery or decrease their chances for survival.¹³⁶ Errors may also be linked to cultural prioritization of illness, differing perceptions of illness and perceptions of risk, or the use of alternative or complementary medicine; therefore, it is important for researchers and clinicians to consider the cultural aspects of education and behavior change.

Illness is a socially constructed phenomenon in that the patient’s experience of a disease is dependent on a multiplicity of social forces (such as culture, environment, support networks, and family) that combine to create and modify the experience. Therefore, the "illness experience" is unique to individuals. However, similarities of cultural, racial, and ethnic groups can assist us in determining the experience for differing groups of individuals. This illness experience is important in a patient’s perception of the attributions of the cause of disease, the severity and symptoms of the disease, and the health behaviors necessary to prevent or treat the disease. These patient perceptions also affect when and why a condition gets identified at a certain point in time and how the person experiences the social outcomes of the illness. It is important to remember that a patient’s experience of an illness is related to much more than just the symptoms experienced. The illness experience is often influenced by broader social perceptions and interactions such as interpersonal crises, perceived interference with social or personal relations, social support from family and friends, sanctioning from other family members, and/or perceived interference with work/physical activity.¹³⁷ This is, indeed, the reasoning behind measuring quality of life in addition to physiologic outcomes.

People feel and act on symptoms in many nonmedical ways and the perceived need to act on symptoms differs by social groups. Differing perceptions of health problems and attributions of causes of disease by race, class, sex, ethnic, and national differences effect compliance, health beliefs, and health-seeking behaviors.¹³⁸ People do not always experience disease as illness. For example, some people manage to avoid active symptoms, attribute their symptoms to other sources, or in some situations accommodate them. Additionally, what may seem like noncompliance to the clinician may actually be a well-thought-out plan by the patient to avoid medical and social side effects.

Perceptions about asthma may differ by cultural/ethnic group and the words used to describe asthma may vary among different cultures leading to differences in expression of symptoms. Research has indicated that many of these factors, in turn, are related to adherence or health seeking behaviors. For example, the degree of distress during an asthma episode and perceived danger from asthma have been shown to be significant predictors of ED visits.⁵⁸ Health distress has also been shown to decrease adherence.¹³⁹

In addition to differing patient perceptions of the disease and need for treatment, clinician characteristics, such as job satisfaction and specialty, can also effect patient health-seeking behaviors.¹³⁹ Experiences with physicians can influence health-care utilization.¹⁴⁰ Physician characteristics such as incongruent values with patient, insensitivity to patient’s complaints, and hurried interactions decrease utilization of health-care services, as does a negative experience with past care. Interestingly, research has indicated that SES has no direct effect on revisiting the doctor; however, it does have indirect effects by way of health, type of practice attended, and experiences with care.¹⁴⁰

	Future Directions

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Many family, social, and behavioral factors contribute to asthma disparities both directly and indirectly. The relationships between these factors and the mechanisms by which they contribute to disparities are complex. Family, social, and behavioral factors indirectly affect disparities by affecting the resources (physical, economic, psychological, and social) to which persons have access and the health behaviors they perceive to be important vs those which they neglect. The challenge for researchers is to answer the following questions, "to what extent do these factors drive disparities in asthma prevalence, incidence, and outcomes" and "what are the most effective approaches to counteract the influence of these factors on disparities"?

	Footnotes

 
Abbreviations: ED = emergency department; IOM = Institute of Medicine; SES = socioeconomic status

The authors have no conflicts of interest to disclose.

Received for publication December 20, 2006. Accepted for publication August 2, 2007.

	References

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1. Blackwell, DL, Vickerie, JL, Wondimu, EA (2003) Summary health statistics for U.S. children: National Health Interview Survey, 2000. Vital Health Stat 10 213,1-48
2. Centers for Disease Control and Prevention.. Self reported asthma prevalence among adults, United States, 2000. MMWR Morb Mortal Wkly Rep 2001;50,682-686[Medline]
3. Carr, W, Zeitel, L, Weiss, K Variations in asthma hospitalizations and deaths in New York City. Am J Public Health 1992;82,59-65[Abstract/Free Full Text]
4. Pendergraft, TB, Stanford, RH, Beasley, R, et al Rates and characteristics of intensive care unit admissions and intubations among asthma-related hospitalizations. Ann Allergy Asthma Immunol 2004;93,29-35[ISI][Medline]
5. Mannino, DM, Homa, DM, Akinbami, LJ, et al Surveillance for asthma–United States, 1980–1999. MMWR Morb Mortal Wkly Rep 2002;51,1-13[Medline]
6. Redd, SC Asthma in the United States: burden and current theories. Environ Health Perspect 2002;110(suppl),557-560[ISI][Medline]
7. Evans, R, Mullally, DI, Wilson, RW, et al National trends in the morbidity and mortality of asthma in the US: prevalence, hospitalization and death from asthma over two decades: 1965–1984. Chest 1987;91,65S-74S
8. Mannino, DM, Homa, DM, Pertowski, CA, et al Surveillance for asthma–United States 1960–1995. MMWR Morb Mortal Wkly Rep 1998;47,1-27[Medline]
9. Taylor, WR, Newacheck, PW Impact of childhood asthma on health. Pediatrics 1992;90,657-662[Abstract/Free Full Text]
10. Weiss, KB, Wagener, DK Changing patterns of asthma mortality: identifying target populations at high risk. JAMA 1990;264,1683-1687[Abstract]
11. Centers for Disease Control and Prevention.. Current trends: asthma–United States. MMWR Morb Mortal Wkly Rep 1995;43,952-955[Medline]
12. Homa, DM, Mannino, DM, Lara, M Asthma mortality in U.S: Hispanics of Mexican, Puerto Rican, and Cuban heritage, 1990–1995. Am J Respir Crit Care Med 2000;161,504-509[Abstract/Free Full Text]
13. Institute of Medicine Board on Health Sciences Policies.. Unequal treatment: confronting racial and ethnic disparities in healthcare. 2003 National Academy Press. Washington, DC:
14. Institute of Medicine Committee on the Assessment of Asthma and Indoor Air.. Clearing the air: asthma and indoor air exposures. 2000 National Academy Press. Washington, DC:
15. Linn, WS, Gong, H, Jr The 21st century environment and air quality influences on asthma. Curr Opin Pulm Med 1999;5,21-26[Medline]
16. Nieminen, MM, Kaprio, J, Koskenvuo, M A population-based study of bronchial asthma in adult twin pairs. Chest 1991;100,70-75[CrossRef][ISI][Medline]
17. Jenkins, MA, Hopper, JL, Giles, GG Regressive logistic modeling of familial aggregation for asthma in 7,394 population-based nuclear families. Genet Epidemiol 1997;14,317-332[CrossRef][ISI][Medline]
18. Apter, A, Reisine, ST, Affleck, G, et al The influence of demographic and socioeconomic factors of health related quality of life in asthma. J Allergy Clin Immunol 1999;193,72-78
19. Erickson, SR, Christian, RD, Kirking, DM, et al Relationship between patient and disease characteristics, and health-related quality of life in adults with asthma. Respir Med 2002;96,450-460[CrossRef][ISI][Medline]
20. Leidy, N, Couchlin, C Psychometric performance of the Asthma Quality of Life Questionnaire in a US sample. Qual Life Res 1997;7,127-134[CrossRef][ISI]
21. Juniper, E, Guyatt, G, Ferrie, PJ, et al Measuring quality of life in asthma. Am J Respir Crit Care Med 1993;147,832-838
22. Strunk, RC, Ford, JG, Taggart, VS Reducing disparities in asthma care: priorities for research; National Heart, Lung, and Blood Institute Workshop Report. J Allergy Clin Immunol 2002;109,229-237[CrossRef][Medline]
23. Marmot, M, Rose, G, Shipley, M, et al Employment grade and coronary heart disease in British civil servants. J Epidemiol Commun Health 1978;32,244-249[Abstract]
24. Marmot, M, Shipley, MJ, Rose, G Inequalities in death: specific explanations of a general pattern? Lancet 1984;1,1003-1006[CrossRef][ISI][Medline]
25. Marmot, M, Smith, GD, Stansfeld, S, et al Health inequalities among British civil servants: the Whitehall II study. Lancet 1991;337,1387-1392[CrossRef][ISI][Medline]
26. Kawachi, I, Kennedy, B, Wilkinson, R The society and population health reader: income inequality and health. 1999 New York Press. New York, NY:
27. Marmot, M, Wilkinson, R Social determinants of health. 1999 Oxford University Press. Oxford, UK:
28. Williams, DR Race, socioeconomic status, and health: the added effects of racism and discrimination. Ann N Y Acad Sci 1999;896,173-188[Abstract/Free Full Text]
29. Baum, A, Garofalo, JP, Yali, AM Socioeconomic status and chronic stress: does stress account for SES effects on health? Ann N Y Acad Sci 1999;896,131-144[Abstract/Free Full Text]
30. Kosteniuk, JG, Dickinson, HD Tracing the social gradient in the health of Canadians: primary and secondary determinants. Soc Sci Med 2003;57,263-276[CrossRef][ISI][Medline]
31. Kristenson, M, Eriksen, HR, Sluiter, JK, et al Psychobiological mechanisms of socioeconomic differences in health. Soc Sci Med 2004;58,1511-1522[CrossRef][ISI][Medline]
32. Link, B, Phelan, J Understanding sociodemographic differences in health: the role of fundamental social causes. Am J Public Health 1996;86,471-473[Free Full Text]
33. Lantz, PM, House, JS, Lepkowski, JM, et al Socioeconomic factors, health behaviors, and mortality: results from a nationally representative prospective study of US adults. JAMA 1998;279,1703-1708[Abstract/Free Full Text]
34. Lantz, PM, Lynch, JW, House, JS, et al Socioeconomic disparities in health change in a longitudinal study of US adults: the role of health-risk behaviors. Soc Sci Med 2001;53,29-40[CrossRef][ISI][Medline]
35. Wolinsky, FD Racial differences in illness behavior. J Community Health 1982;8,87-101[CrossRef][Medline]
36. Wright, R, Fisher, EB Putting asthma into context: community influences on risk, behavior, and intervention. Kawachi, I Berkman, L eds. Neighborhoods and health 2003,233-264 Oxford University Press. New York, NY:
37. Umberson, D Family status and health behaviors: social control as a dimension of social integration. J Health Soc Behav 1987;28,306-319[CrossRef][ISI][Medline]
38. Berkman, L, Syme, L Social networks, host resistance, and mortality: a nine-year follow-up study of Alameda county residents. Am J Epidemiol 1979;109,186-204[Abstract/Free Full Text]
39. Berkman, L, Breslow, L Health and ways of living: the Alameda county study. 1983 Oxford University Press. New York, NY:
40. Rogers, R The effects of family composition, health, and social support linkages on mortality. J Health Soc Behav 1996;37,326-338[CrossRef][ISI][Medline]
41. House, J, Landis, K, Umberson, D Social relationships and health. Conrad, P eds. The sociology of health and illness 2001,76-84 Worth Publishers. New York, NY:
42. Link, B, Phelan, J Evaluating the fundamental cause explanation for social disparities in health. Bird, C Conrad, P Fremont, A eds. Handbook of medical sociology 2000,33-46 Prentice Hall. Upper Saddle River, NJ: New Jersey:
43. Hanson, S Health single parent families. Fam Relat 1986;35,125-132[CrossRef][ISI]
44. Cohen, S, Wills, T Stress, social support, and the buffering hypothesis. Psychol Bull 1985;98,310-357[CrossRef][ISI][Medline]
45. Sherbourne, C, Hays, R Marital status, social support, and health transitions in chronic disease patients. J Health Soc Behav 1990;31,328-343[CrossRef][ISI][Medline]
46. Gallant, MP The influence of social support on chronic illness self-management: a review and directions for research. Health Educ Behav 2003;30,170-195[Abstract]
47. Dysvik, E, Lindstrom, TC, Eikeland, OJ, et al Health-related quality of life and pain beliefs among people suffering from chronic pain. Pain Manage Nurs 2004;5,66-74[CrossRef]
48. Ethgen, O, Vanparijs, P, Delhalle, S, et al Social support and health-related quality of life in hip and knee osteoarthritis. Qual Life Res 2004;13,321-330[CrossRef][ISI][Medline]
49. Stansfeld, SA, Fuhrer, R, Shipley, MJ Types of social support as predictors of psychiatric morbidity in a cohort of British Civil Servants (Whitehall II Study). Psychol Med 1998;28,881-892[CrossRef][ISI][Medline]
50. Kawachi, I, Berkman, L Social ties and mental health. J Urban Health 2001;78,458-467[ISI][Medline]
51. Hesselink, A, Penninx, B, Schlosser, M, et al The role of coping resources and coping style in quality of life of patients with asthma or COPD. Quality Life Res 2004;13,509-518[CrossRef]
52. Boyd, KJ, Murray, SA, Worth, A, et al Living with advanced heart failure: a prospective, community based study of patients and their carers. Eur J Heart Fail 2004;6,585-591[ISI][Medline]
53. Biggs, AM, Aziz, Q, Tomenson, B, et al Effect of childhood adversity on health related quality of life in patients with upper abdominal or chest pain. Gut 2004;53,180-186[Abstract/Free Full Text]
54. Syme, S, Yen, IH Social epidemiology and medical sociology: different approaches to the same problem. Bird, C Conrad, P Fremont, A eds. Handbook of medical sociology 2000,365-376 Prentice Hall. Upper Saddle River, NJ:
55. Cohen, S, Doyle, W, Skoner, D, et al Social ties and susceptibility to the common cold. JAMA 1997;277,24
56. Smith, A, Nicholson, K Psychosocial factors, respiratory viruses and exacerbation of asthma. Psychoneuroendocrinology 2001;26,411-420[CrossRef][ISI][Medline]
57. Klinnert, M, Mrazek, P, Mrazek, D Early asthma onset: the interaction between family stressors and adaptive parenting. Psychiatry 1994;57,51-61[ISI][Medline]
58. Janson-Bjerklie, S, Ferketich, S, Benner, P Predicting the outcomes of living with asthma. Res Nurs Health 1993;16,241-250[ISI][Medline]
59. Kolbe, J, Garrett, J, Vamos, M, et al Influences on trends in asthma morbidity and mortality: the New Zealand experience. Chest 1994;106,211s-215S[Medline]
60. Andren, K, Rosenquist, U Heavy users of an emergency department: a two year follow-up study. Soc Sci Med 1987;25,825-831[CrossRef][ISI][Medline]
61. Smyth, J, Soefer, M, Hurewitz, A, et al Daily psychosocial factors predict levels and diurnal cycles of asthma symptomatology and peak flow. J Behav Med 1999;22,179-193[CrossRef][ISI][Medline]
62. Lau, R, Quardrel, M, Hartman, K Development and change of young adults’ preventive health beliefs and behavior: influence from parents and peers. J Health Soc Behav 1990;31,240-259[CrossRef][ISI][Medline]
63. Donovan, J, Blake, D Patient non-compliance: deviance or reasoned decision-making? Soc Science Med 1992;34,507-513[CrossRef][ISI]
64. Kyngas, H, Rissanen, M Support as a crucial predictor of good compliance of adolescents with a chronic disease. J Clin Nurs 2001;10,767-774[CrossRef][ISI][Medline]
65. Ross, CE, Mirowsky, J, Goldsteen, K The impact of the family on health: the decade in review. J Marriage Fam 1990;52,1059-1078[CrossRef][ISI]
66. Waite, L, Gallagher, M The case for marriage. 2000 Doubleday. New York, NY:
67. Araujo, G, Arsdel, P, Holmes, T, et al Life change, coping ability, and chronic intrinsic asthma. J Psychosom Res 1973;17,359-363[CrossRef][ISI][Medline]
68. Anderson, B, Miller, J, Auslander, W Family characteristics of diabetic adolescents: relationship to metabolic control. Diabetes Care 1981;4,586-594[Abstract]
69. Hanson, C, Henggeler, S, Burghen, G Social competence and parental support as mediators of the link between stress and metabolic control. J Consult Clin Psychol 1989;55,529-533
70. Gustafsson, P, Kjellman, N, Björkstén, B Family interaction and a supportive social network as salutogenic factors in childhood atopic illness. Pediatr Allergy Immunol 2002;13,51-57[CrossRef][ISI][Medline]
71. Chernoff, R, Ireys, H, DeVet, K, et al A randomized, controlled trial of a community-based support program for families of children with chronic illness: pediatric outcomes. Arch Pediatr Adolesc Med 2002;156,533-539[Abstract/Free Full Text]
72. Barbarin, O, Tirado, M Enmeshment, family processes and successful treatment of obesity. Fam Relat 1985;34,115-121[CrossRef][ISI]
73. Farrell, M, Barnes, G, Banerjee, S Family cohesion as a buffer against the effects of problem-drinking fathers on psychological distress, deviant behavior, and heavy drinking in adolescents. J Health Soc Behav 1995;36,377-385[CrossRef][ISI][Medline]
74. Markson, S, Fiese, BH Family rituals as a protective factor for children with asthma. J Pediatr Psychol 2000;25,471-480[Abstract/Free Full Text]
75. Lasky, P, Eichelberger, K Health related view and self-care behaviors of young children. Fam Relat 1985;34,13-18[CrossRef][ISI]
76. Blecke, J Exploration of children’s health and self-care behavior within a family context through qualitative research. Fam Relat 1990;39,284-291[CrossRef][ISI]
77. Lynch, J, Kaplan, G, Salonen, J Why do poor people behave poorly? Variation in adult health behaviours and psychosocial characteristics by stages of the socioeconomic life course. Soc Sci Med 1997;44,809-819[CrossRef][ISI][Medline]
78. Foshee, V, Bauman, K Parental and peer characteristics as modifiers of the bond-behavior relationship: an elaboration of control theory. J Health Soc Behav 1992;33,66-76[CrossRef][ISI][Medline]
79. Wiecha, J, Lee, V, Hodgkins, J Patterns of smoking, risk factors for smoking, and smoking cessation among Vietnamese men in Massachusetts. Tob Control 1998;7,27-34[Abstract/Free Full Text]
80. Peterson, JW, Sterling, YM, Stout, JW Explanatory models of asthma from African-American caregivers of children with asthma. J Asthma 2002;39,577-590[CrossRef][ISI][Medline]
81. Kaugars, A, Klinnert, M, Bender, B Family influences on pediatric asthma. J Pediatr Psychol 2004;29,475-491[Abstract/Free Full Text]
82. Bartlett, S, Kolodner, K, Butz, A, et al Maternal depressive symptoms and emergency department use among inner-city children with asthma. Arch Pediatr Adolesc Med 2001;155,347-353[Abstract/Free Full Text]
83. Weil, C, Wade, S, Bauman, L, et al The relationship between psychosocial factors and asthma morbidity in inner-city children with asthma. Pediatrics 1999;104,1274-1280[Abstract/Free Full Text]
84. Wood, P, Smith, L, Romero, D, et al Relationship between welfare status, health insurance status, and health and medical care among children with asthma. Am J Public Health 2002;92,1446-1452[Abstract/Free Full Text]
85. Shalowitz, M, Berry, C, Quinn, K, et al The relationship of life stressors and maternal depression to pediatric asthma morbidity in a subspecialty practice. Ambul Pediatr 2001;1,185-193[CrossRef][ISI][Medline]
86. Annett, R, Bender, B, DuHamel, T, et al Factors influencing parent reports on quality of life for children with asthma. J Asthma 2003;40,577-587[CrossRef][ISI][Medline]
87. Christiaanse, M, Lavigne, J, Lerner, C Psychosocial aspects of compliance in children and adolescents with asthma. J Dev Behav Pediatr 1989;10,75-80[ISI][Medline]
88. Fehrenbach, A, Peterson, L Parental problem solving skills and dietary compliance in phenylketonuria. J Consult Clin Psychol 1989;57,238-241
89. Riley, A, Finney, J, Mellins, E Determinants of children’s health care use: an investigation of psychosocial factors. Med Care 1993;31,767-783[ISI][Medline]
90. Kiecolt-Glaser, J, Malarkey, W, Chee, M, et al Negative behavior during marital conflict is associated with immunological down-regulation. Psychosom Med 1993;55,395-409[Abstract/Free Full Text]
91. Chen, E, Bloomberg, G, Fisher, E, et al Predictors of repeat hospitalizations in children with asthma: the role of psychosocial and socioenvironmental factors. Health Psychol 2003;22,12-18[CrossRef][ISI][Medline]
92. Strunk, R Identification of the fatality prone subject with asthma. J Allergy Clin Immunol 1989;83,477-485[CrossRef][ISI][Medline]
93. Strunk, R, Mrazek, D, Wolfson Fuhrmann, G, et al Physiologic and psychological characteristics associated with deaths due to asthma in childhood: a case-controlled study. JAMA 1985;254,1193-1198[Abstract]
94. Hermanns, J, Florin, I, Dietrich, M, et al Maternal criticism, mother-child interaction, and bronchial asthma. J Psychosom Res 1989;33,498-502
95. Schobinger, R, Florin, I, Zimmer, C Childhood asthma: paternal critical attitude and father-child interaction. J Psychosom Res 1992;36,743-750[CrossRef][ISI][Medline]
96. Schoebinger, R, Florin, I, Reichbauer, M Childhood asthma: mother’s affective attitude, mother-child interaction and children’s compliance with medical requirements. J Psychosom Res 1993;37,697-670[CrossRef][ISI][Medline]
97. Wamboldt, MZ, Wamboldt, FS Psychosocial aspects of severe asthma in children. Szefler, S Leung, D eds. Severe asthma: pathogenesis and clinical managements 1995,465-495 Marcel Dekker. New York, NY:
98. Wamboldt, MZ, Wamboldt, FS Role of the family in the onset and outcome of childhood disorders: selected research findings. J Am Acad Child Adolesc Psychiatry 2000;39,1212-1219[CrossRef][ISI][Medline]
99. Fiese, B, Wamboldt, FS Coherent accounts of coping with a chronic illness: convergences and divergences in family measurement using a narrative analysis. Fam Process 2003;42,439-451[CrossRef][ISI][Medline]
100. Mrazek, D, Casey, B, Anderson, I Insecure attachment in severely asthmatic preschool children: is it a risk factor? J Am Acad Child Adolesc Psychiatry 1987;26,516-520[ISI]