Date of Award


Document Type

Open Access Dissertation

Degree Name

Doctor of Philosophy (PhD)



First Advisor

Laura L. Hayman

Second Advisor

Jerry Cromwell

Third Advisor

Wanda Phipatanakul


Background. Asthma is a prevalent chronic condition with excess disease burden in school-aged, minority children from low income inner-city communities. Conceptualized within a nursing and socio-ecological framework, the purpose of this secondary analysis of a prospective study of inner-city school-aged children with asthma (School Inner-City Asthma Study [SICAS]) was to examine associations between characteristics of children and parents, parents stress, parent asthma management behaviors (AMB) and child asthma outcomes, including emergency (ED) visits for asthma, missed school and asthma control.

Methods. The sample included 351 school-aged children (7.9 years old, SD= 1.9 years; 53.0% male; 95.7% minority). Parents reported their own perceived stress (Perceived Stress Scale) and AMBs (national guidelines) at baseline; child asthma outcomes were measured quarterly at follow-up. Generalized estimation equations were used due to the repeated quarterly wave nature of the data.

Results. The majority of parents (63.5%) reported moderate to high stress. Controlling for other participant characteristics, income and education were directly related to parent stress in this inner-city population. Parent stress also had a direct positive effect on child ED visits for asthma (OR=1.68, p=.014), which persisted when potential mediators were added to the model. Poor parent AMB of missing routine appointments (OR=2.32, p=.025) and pests in the home (OR=1.51, p=.001) also raised the likelihood of ED visits. Parents who missed their child’s healthcare appointments and have pests in their home were both more likely to live in an unmaintained neighborhood (OR=7.6, p=.001; OR=1.8, p=.002) and have more family members in their home (OR=5.0, p=.01; OR=2.0, p=.000).

Conclusions. Parents with high stress and who reside with large families in unmaintained neighborhoods are at higher risk for not performing AMBs that support the best outcomes for their child with asthma. Low income and educational attainment raise parental stress that leads to costly ED visits for inner city children. Clinical interventions to facilitate increased routine visits and policy change for inner-city household pest control will help reduce ED visits related to asthma. Research on the implementation science of these interventions and role of parent stress on the effectiveness of these interventions in the inner-city population is necessary.

Included in

Nursing Commons