Study on Inner-City Children Coping with Asthma Published

Newswise — A new study published by a Washington and Lee University professor of clinical psychology finds that children in urban neighborhoods who suffer from asthma may not benefit from using problem-solving coping strategies that are typically helpful for children.

"This study examined families of color living in low income urban environments because this population is disproportionately affected by pediatric asthma. Many children in the study were attempting to manage high levels of environmental stress in addition to their asthma symptoms," said Karla Klein Murdock, associate professor of psychology at W&L and the lead investigator on the study. “The empirical literature on coping has generally found that, in kids and adults, an active coping style works best. If you have a problem, you figure out what the problem is, and you try to do something about it. For instance, you do something constructive to fix the problem or change your approach to it."

In the case of the children in this study, however, they were apt to be dealing with stressors outside of their control. Children endorsed a range of life stressors, from relational (e.g., family arguments) or developmental (e.g., changing to a new school) strains to traumatic events (e.g., witnessing crime and violence). "Children in this situation who consistently attempt to cope through problem-solving may end up spinning their wheels. Their efforts to cope don’t work, which makes them feel anxious," she said. "Trying to solve unsolvable problems can give them a feeling of less control, which is anxiety-provoking."

According to Murdock, the research shows that a single coping method that emphasizes problem-solving will be not helpful for children who are faced with severe asthma and/or high levels of life stressors. "This is not the kind of finding that turns on its head everything psychologists might do with kids, but it does say that how children approach their symptoms and stressors has implications for their anxiety level," she said. "The coping skills that we would, by default, teach them probably wouldn’t be ideal in this case."

The study was published in the July 2010 issue of Anxiety, Stress and Coping. Three of the article's co-authors are 2008 Washington and Lee alumni: Will Hartmann, Sally Bittinger and Kelly Will.

Murdock began the NIH-funded research at the University of Massachusetts-Boston in 2001, when she and graduate and undergraduate students there spent two years conducting a longitudinal study of families in the Dorchester and Roxbury neighborhoods of Boston. She finished collecting the data just prior to joining the W&L faculty in 2005.

A specialist in developmental psychopathology, Murdock became interested in asthma as a childhood illness that had become prominent in urban environments and was having a major impact on urban, low-income and minority families.

"The research has made clear that the medical management of asthma depends upon providing support for the whole family system instead of just giving the children medication and sending them on their way," Murdock said. "Not surprisingly, the children's psychological well-being stems from how well their asthma is being managed.

"Kids with poorly controlled asthma are doing worse psychosocially. They're missing more school, so their academic functioning suffers. They have more activity limitations, which impacts their friendships and their self-competence. If their asthma is well managed, the degree to which it impacts other areas of their lives is minimized."

Murdock calls asthma a very socio-culturally driven disease. Low-income children in urban environments experience greater asthma prevalence, morbidity, and mortality than their peers with other demographic profiles. The children in this environment are, she added, exposed to triggers more regularly. "They have more stress, which is a trigger," she said. "Their parents face more barriers to effective asthma management — their family demands, work schedules, transportation logistics, and other stressors can make it difficult or impossible to access routine preventive care."

Although there has been a significant push for asthma education in these locales, Murdock says the issue is much bigger than education.

"For instance, most families in these areas rent their homes, and they can't simply pull their carpets up, eradicate insects and rodents, or demand that neighbors stop smoking in order to diminish asthma triggers. Parents may know what it would take to improve their child’s asthma management but cannot make it happen because of systems outside of their control. "

The research that Murdock conducted in Boston led to an earlier article on family-school communication, co-authored by 2007 W&L alumna Elizabeth Robinson. Three current Robert E. Lee Scholars, Brendon Ellis, Elizabeth Pears, and Alex Shabo, are currently analyzing home-health care provider relationships in this data.

"Washington and Lee offers a fabulous model for research training," said Murdock. "The most intensive time for mentored research is during the summer, but there isn’t time to design a study, collect data, analyze it and then disseminate it in three months. This summer my students are learning about the research development process by helping to orchestrate a new study concerning the psychosocial development of adolescent girls. They are analyzing and writing about the pediatric asthma data in order to learn about the final stages of the research process.

"One of the big draws for me to come to Washington and Lee was that students can engage in research in meaningful and sophisticated ways."

All four W&L co-authors are currently in graduate programs. Robinson (Virginia Commonwealth University), Hartmann (University of Michigan), and Will University of North Carolina) are in Ph.D. programs and Bittinger (Boston University) is in a Master’s program.