Inflammation and worse asthma symptoms

Brain, Behavior, and Immunity Volume 96, August 2021, Pages 92-99

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Socioeconomic status, financial stress, and glucocorticoid resistance among youth with asthma: Testing the moderation effects of maternal involvement and warmth

Yanping Jiang , Allison K. Farrell , Erin T. Tobin , Henriette E. Mair-Meijers , Derek E. Wildman , Francesca Luca , Richard B. Slatcher , Samuele Zilioli

Abstract

Objectives

Children who grow up in more socioeconomically disadvantaged homes experience greater levels of inflammation and worse asthma symptoms than children from more advantaged families. However, recent evidence suggests that certain family-level factors can mitigate health disparities associated with socioeconomic status (SES). In a sample of youth with asthma, we investigated the potential buffering effects of maternal involvement and warmth on SES disparities in asthma- related immune responses, assessed via glucocorticoid resistance (GR) of immune cells.

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this hypothesis, and no clear evidence has emerged supporting the mediating role of stress exposure in the SES-health link from the few studies that explicitly tested this hypothesis (Cundiff et al., 2020). Cundiff and colleagues (2020) suggest that adopting measures of psychological stress that are theoretically specific to SES (vs. broad measures of stress) may increase the theoretical value and predictive utility of stress when testing the SES-health association. Thus, we examined the mediating role of perceived financial stress in the association between family SES and health in this study.

Chronic stress has been shown to exacerbate airway inflammation and, ultimately, to worsen clinical symptoms of asthma (Chen and Miller, 2007, Haczku and Panettieri, 2010, Landeo- Gutierrez and Celedn, 2020, Rosenberg et al., 2014). Airway inflammation involves a variety of immune cell types and (Th) cells, such as Th-1 and Th-2 cells (Busse et al., 1993, Umetsu et al., 2002). Th-1 cells perpetuate cellular immune responses through the production of interferon- (IFN-) and interleukin-2 (IL-2), while Th-2 cells promote humoral responses through releasing cytokines such as IL-5 and IL-13 (Berger, 2000, Chen and Miller, 2007). One way chronic stress amplifies airway inflammation in asthma is by altering the glucocorticoid sensitivity of immune cells (Chen and Miller, 2007, Haczku and Panettieri, 2010). In the context of asthma, glucocorticoids are a class of steroid hormones that decrease the production of Th-1 (e.g., IFN-) and Th-2 (e.g., IL-5, IL-13) cytokines, thereby lowering the magnitude of airway inflammation (Banuelos and Lu, 2016). In humans, cortisol is the major glucocorticoid, and its release is regulated by the activation of the hypothalamicpituitaryadrenal axis. Persistent secretion of cortisol associated with repeated or chronic exposure to stressors may lead to reduced expression and functioning of glucocorticoid receptors (Miller et al., 2009). Dysfunctional glucocorticoid receptors are, thus, less sensitive to the immunosuppressive action of glucocorticoids (i.e., glucocorticoid resistance [GR]), contributing to the amplification of airway inflammation (Chen and Miller, 2007).

A few studies have linked low SES, as well as other chronic psychosocial stressors, to increased Th-1 and Th-2 cell resistance to glucocorticoids, which has been indexed by the capacity of cortisol to suppress Th-1 and Th-2 cytokine production by stimulated peripheral blood mononuclear cells (PBMCs) in vitro (Chen et al., 2016, Miller et al., 2009). For example, in a sample of children with asthma, Chen et al. (2016) found that lower family SES was associated with higher GR of Th-1 cytokines (e.g., IFN-) and Th-2 (e.g., IL-5, IL-13) cytokines in vitro. GR related to chronic stress may be particularly problematic for children with asthma, who, as a result, can exhibit resistance to corticosteroid medications, the most common therapy for asthma control (Barnes and Adcock, 2009). Identifying protective factors against the pernicious health consequences of stress-related GR is thus critical.

A promising factor that may exert protective effects is positive parenting, which has been linked to multiple beneficial behavioral and psychological outcomes (Hoeve et al., 2009, McLeod et al., 2007) and more favorable health-related biological processes (Chen et al., 2011). Positive parenting

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is theorized to buffer the effects of SES primarily through its stress-buffering role that mitigates the toxic consequences of stress on health (Cohen and Wills, 1985). We investigated two forms of positive parenting, maternal involvement and warmth. Maternal involvement is a multifaceted construct that includes a broad range of behavioral, cognitive, and affective practices (e.g., monitoring, affective support) that mothers adopt to engage with childrens daily lives (Finzi- Dottan et al., 2016, Pleck, 2010). Maternal warmth refers to the acceptance, love, affection, comfort, nurturance, and care that mothers display towards their children (Khaleque and Rohner, 2012). Empirical evidence suggests that maternal involvement and warmth can act as stress- buffering factors in health outcomes (Chen et al., 2011, Cohen et al., 2020, Farrell et al., 2017, Figge et al., 2020). For example, maternal involvement reduced the risk of parent cultural stress on depressive and anxiety symptoms among children from low SES families (Figge et al., 2020). Similarly, maternal warmth was reported to buffer the risk of early socioeconomic disadvantage on adult health via reduced proinflammatory signaling (Chen et al., 2011). These converging reports provide support for the hypothesis that positive parenting may buffer the detrimental effects of growing up in low SES families on health.

The aim of the current study was to investigate the buffering effects of maternal involvement and warmth on the associations among family SES, financial stress, and GR in immune cells in a sample of children with asthma. Given the reported moderation effects of positive parenting on the associations between SES and health and between psychological stress and health in previous studies (Chen et al., 2011, Cohen et al., 2020, Farrell et al., 2017, Figge et al., 2020), we proposed a moderated mediation model (see Fig. 1), in which low family SES would be associated with elevated GR via increased financial stress, and maternal involvement and warmth would moderate the associations between SES and GR and between financial stress and GR. We hypothesized that there would be stronger relationships between SES and GR and between financial stress and GR in youth who reported lower levels of maternal involvement and warmth.

Section snippets

Participants and procedure

One hundred and ninety-four youth with asthma and their caregivers took part in the Asthma in the Lives of Families Today (ALOFT) project. Data on GR was available for 145 children (10 16years of age). Among the 145 children, two of them reported using oral steroid medications to manage their asthma. These two individuals were excluded from the analyses, resulting in a final sample of 143 children (M =12.651.66years, 39.2% female, 76.2% African Americans). Participants who were

age

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Descriptive results

Table 1 displays the means, standard deviations, and correlation coefficients between study variables. Family SES and financial stress were negatively correlated with each other (r=-0.52, p<0.001); however, neither of them was significantly correlated with GR of Th-2 cytokines or IFN- (ps>0.10). Maternal involvement was positively correlated with SES (r=0.19, p=0.030) and negatively correlated with financial stress (r=-0.27, p=0.002), but not with GR of Th-2 cytokines or IFN- (p

Discussion

This study tested the associations among family SES, financial stress, maternal involvement and warmth, and GR in a sample of youth with asthma. We found that family SES was associated with financial stress. Family SES and financial stress were not associated with GR of Th-2 cytokines or IFN-. However, financial stressbut not family SES interacted with both maternal involvement and warmth in influencing GR of Th-2 cytokines. Specifically, greater financial stress was associated with higher

Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

References (53)

S.L. Rosenberg et al. Stress and asthma: novel insights on genetic, epigenetic, and immunologic mechanisms Journal of Allergy and Clinical Immunology (2014)

G.E. Miller et al. Parental support and cytokine activity in childhood asthma: the role of glucocorticoid sensitivity Journal of Allergy and Clinical Immunology (2009)

B.D. McLeod et al. Examining the association between parenting and childhood depression: A meta-analysis Clinical psychology review (2007)

Landeo-Gutierrez et al. Chronic stress and asthma in adolescents Ann. Allergy Asthma Immunol. (2020)

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Haczku et al. Social stress and asthma: the role of corticosteroid insensitivity Journal of Allergy and Clinical Immunology (2010)

A.K. Farrell et al. Socioeconomic status, family negative emotional climate, and anti-inflammatory gene expression among youth with asthma Psychoneuroendocrinology (2018)

M.M. Farmer et al. Are racial disparities in health conditional on socioeconomic status? Soc. Sci. Med. (2005)

Chen et al. Stress and inflammation in exacerbations of asthma Brain Behav. Immun. (2007)

P.J. Barnes et al. Glucocorticoid resistance in inflammatory diseases The Lancet (2009)

Banuelos et al. A gradient of glucocorticoid sensitivity among helper T cell cytokines Cytokine Growth Factor Rev. (2016)

View more references

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Case Analysis Integrating Theoretical Orientations

Prior to beginning this assignment, read thePSY650 Week Two Treatment Plan ,

Download PSY650 Week Two Treatment Plan ,

Case 16: in Gorenstein and Comer (2014), and in Hamblin and Gross (2012).

Assess the evidence-based practices implemented in this case study by addressing the following issues:

Explain the connection between each theoretical orientation used by Dr. Remoc and the four interventions utilized in the case.
Consider Dr. Remocs utilization of two theoretical frameworks to guide her treatment plan. Assess the efficacy of integrating two orientations based on the information presented in the case study. Describe some potential problems with prescribing medication as the only treatment option for children with ADHD.
Identify tasks and positive reinforcements that might be included in Billys token economy chart given the behavior issues described in the case. (There are articles in the recommended resources that may assist you in this portion of the assignment.)
Evaluate the effectiveness of the four treatment interventions implemented by Dr. Remoc and support your statements with information from the case and two to three peer-reviewed articles from the University of Arizona Global Campus Library.
Recommend three additional treatment interventions that would be appropriate in this case. Use information from the Hamblin and Gross Attention-Deficit/Hyperactivity Disorders chapter to help support your recommendations. Justify your selections with information from the case.

The Case Analysis

Must be 4 to 5 double-spaced pages in length (not including title and references pages) and formatted according to APA style as outlined in theWriting Center
(Links to an external site.)
.
Must include a separate title page with the following:
Title of paper
Students name
Course name and number

Instructors name
Date submitted
Must use at least two peer-reviewed sources from the University of Arizona Global Campus Library.
Must document all sources in APA style as outlined in theWriting Center.
(Links to an external site.)
Must include a separate references page that is formatted according to APA style as outlined in the Writing Center.

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Trauma and Stressor Related Disorders

Trauma and Stressor Related Disorders Additional Content Attribution

[MUSIC PLAYING]

FEMALE SPEAKER: Well, I just keep thinking what if something happens? I mean I’ve always had trouble concentrating. But this time, it’s different.

FEMALE SPEAKER: Different, how?

FEMALE SPEAKER: Well, you know how like you were talking on your cell phone or something and it cuts out. You lose the connection. It’s kind of like that. My mind just goes blank.

And when I’m at the hospital and it happens, I flip out. I could give the patient the wrong medication or something.

What if it’s early dementia? I mean I’ve read about that happening. I read an article just the other day about people in their 30s and 40s getting that. That’s horrible.

FEMALE SPEAKER: It sounds like you’re constantly nervous that you’ll go blank and that something bad will happen. You mentioned having other symptoms. Like what?

FEMALE SPEAKER: Well, at work, my temper. I flip out on patients sometimes and on other nurses. I just freak out. I even started snapping at my daughter. And that has never happened before.

FEMALE SPEAKER: Well, I understand. You’re feeling anxious. And you’re having some temper issues, which are sort of out of character for you. How are things going at home?

FEMALE SPEAKER: Well, I’m not sleeping very well at all. One of my favorite things used to be to curl up at night with a book. But I can’t concentrate. I have this whole stack of books by my bedside table. I mean they’re history books. And I love reading about history. But I haven’t even touched them.

And my husband got so upset the other day because he brought me this kit for scrap-booking, which is something I used to really enjoy doing. But I just took them back to the store. I could not deal with that either.

FEMALE SPEAKER: Well, it seems like you’re not finding relaxation in the things that used to enjoy doing. Now, when you returned your husband’s gift, you said that you couldn’t deal with that. What exactly couldn’t you deal with?

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Trauma and Stressor Related Disorders

FEMALE SPEAKER: The expense. You have no idea what these scrap-making materials cost. I could spend that much in groceries in a week. And I thought– So that I lie in bed at night at 3:00 AM worrying about, just money, money, money, money, money.

And my husband and I both work. We work really long hours. But it’s just not enough.

We really should have started saving for college. I mean my eldest is going to start college in a few years. And I don’t know what we’re going to do. We don’t have the money.

FEMALE SPEAKER: Did you talk to your husband about your concerns?

FEMALE SPEAKER: Yeah. Yeah. We talk. Alex, my husband, he’s 12 years older than me. I mean we get along fine.

But I worry about him. I mean at work for example, he’s been up for this really big promotion. But now it looks like he’s not going to get it.

And his health, he’s got a whole history of early heart attacks in his family. And I just worry about that. I mean he hasn’t shown any symptoms or anything. But I really, really, worry that one day something might happen to him.

I mean the whole thing just feels like a crap shoot. With care reform now, what if they cut back on my hours at work? And what if I lose my job? Doctor, I cannot afford to lose this job.

FEMALE SPEAKER: Any idea how long you’ve been having these symptoms, the lack of concentration, trouble sleeping, problems relaxing?

FEMALE SPEAKER: A while. Off and on, I guess. I went to see a counselor when I was in nursing school. I was Ms. Overachiever. I was making straight A’s, but I couldn’t help but worry that it was never enough.

FEMALE SPEAKER:It sounds like you were feeling the pressure of trying to achieve your career goals. Did the counseling help you?

FEMALE SPEAKER: Yeah. Yeah. I guess it did. I mean I went for a couple of months. And the counselor had me do this body scan exercise. And he suggested I should start meditating. But who had time to meditate. I was too busy making straight A’s.

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Trauma and Stressor Related Disorders

Trauma and Stressor Related Disorders Additional Content Attribution

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Special Thanks:

Fairland Center/Region One Mental Health

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