title: Resilience in low-socioeconomic-status children with asthma: adaptations to stress.
abstract: BACKGROUND
  Low socioeconomic status (SES) is a strong predictor of many health problems, including asthma impairment; however, little is understood about why some patients defy this trend by exhibiting good asthma control despite living in adverse environments.
  
  
  OBJECTIVE
  This study sought to test whether a psychological characteristic, the shift-and-persist strategy (dealing with stressors by reframing them more positively while at the same time persisting in optimistic thoughts about the future), protects low-SES children with asthma.
  
  
  METHODS
  One hundred twenty-one children aged 9 to 18 years with a physician's diagnosis of asthma were recruited from medical practices and community advertisements (mean age, 12.6 years; 67% male; 61% white). Shift-and-persist scores and asthma inflammation (eosinophil counts and stimulated IL-4 cytokine production) were assessed at baseline, and asthma impairment (daily diary measures of rescue inhaler use and school absences) and daily peak flow were monitored at baseline and at a 6-month follow-up.
  
  
  RESULTS
  Children who came from low-SES backgrounds but who engaged in shift-and-persist strategies displayed less asthma inflammation at baseline (β = 0.19, P < .05), as well as less asthma impairment (reduced rescue inhaler use and fewer school absences; β = 0.32, P < .01) prospectively at the 6-month follow-up period. In contrast, shift-and-persist strategies were not beneficial among high-SES children with asthma.
  
  
  CONCLUSIONS
  An approach that focuses on the psychological qualities that low-SES children develop to adapt to stressors might represent a practical and effective starting point for reducing health disparities. Moreover, the approaches that are effective in low-SES communities might be different from those that are optimal in a high-SES context.
authors.affiliation: Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada. echen@psych.ubc.ca
authors.forename: Edith
authors.initials: E
authors.lastname: Chen
authors.forename: Robert C
authors.initials: RC
authors.lastname: Strunk
authors.forename: Alexandra
authors.initials: A
authors.lastname: Trethewey
authors.forename: Hannah M C
authors.initials: HM
authors.lastname: Schreier
authors.forename: Nandini
authors.initials: N
authors.lastname: Maharaj
authors.forename: Gregory E
authors.initials: GE
authors.lastname: Miller
mesh_terms: D000293:Adolescent; D001249:Asthma / Q000276:immunology / Q000473:pathology / Q000523:psychology*; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D055500:Resilience, Psychological; D012923:Social Class