title: The role of the social environment in children and adolescents with asthma.
abstract: BACKGROUND
  Biopsychosocial models of asthma have been proposed in the literature, but few empirical tests of social factors at various levels of influence have been conducted.
  
  
  OBJECTIVE
  To test associations of neighborhood, peer, and family factors with asthma outcomes in youth, and to determine the pathways through which these social factors operate.
  
  
  METHODS
  Observational study of youths with asthma (n = 78).
  
  
  RESULTS
  Youths completed questionnaires about neighborhood problems, peer support, and family support. Biological (IgE, eosinophil count, production of IL-4) and behavioral (youth smoking, exposure to smoke, adherence to medications) pathways were measured. Asthma symptoms and pulmonary function were assessed in the laboratory and at home for 2 weeks. Lower levels of family support were associated with greater symptoms (beta coefficients: -0.26 to -0.33, P < 0.05) and poorer pulmonary function (beta: 0.30, P < 0.05) via biological pathways (Z statistics from 1.19 to 1.51, P < 0.05). Higher levels of neighborhood problems were associated with greater symptoms (beta coefficients: 0.27-0.33, P < 0.05) via behavioral pathways related to smoking (Z statistics = 1.40, P < 0.05). Peer support was not associated with symptoms or pulmonary function.
  
  
  CONCLUSIONS
  This study indicates that family factors may affect youths' asthma via physiologic changes, whereas community factors may help shape the health behaviors of youths with asthma.
authors.affiliation: Department of Psychology, University of British Columbia, Vancouver, BC, Canada. echen@psych.ubc.ca
authors.forename: Edith
authors.initials: E
authors.lastname: Chen
authors.forename: Louise S
authors.initials: LS
authors.lastname: Chim
authors.forename: Robert C
authors.initials: RC
authors.lastname: Strunk
authors.forename: Gregory E
authors.initials: GE
authors.lastname: Miller
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D001249:Asthma / Q000503:physiopathology / Q000523:psychology*; D002648:Child; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D010287:Parent-Child Relations; D010366:Peak Expiratory Flow Rate; D010379:Peer Group; D012111:Residence Characteristics; D012931:Social Environment; D012944:Social Support