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The Potential for Reducing Asthma Disparities Through Improved Family and Social Function and Modified Health Behaviors
Section snippets
Social, Economic, and Environmental Interactions
Disparities are most apparent among populations with varying levels of socioeconomic status (SES). Significant evidence has demonstrated that a gradient exists between SES and health status, with individuals of high SES having better overall health that those of low SES.23, 24, 25, 26, 27 Many hypothesize that the health disparities seen across SES levels are due to health-care access. Yet in industrialized nations with universal health-care systems, an SES gradient exists in all causes of
Social Networks and Social Support
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
Family
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,37, 65, 66 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,68, 69
Stress
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.101, 102, 103, 104, 105, 106, 107
Coping
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.93, 120 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
Knowledge, Attitudes, Beliefs, and Health Practices
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.130, 131, 132 Additionally, patient education has the capacity to modify patients' attitudes, beliefs, and
Future Directions
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
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