Biopsychosociocultural lifecourse determinants of inflammatory respiratory disease in offspring in ethnically diverse lower income families

A prospective longitudinal study tested an integrative biopsychosociocultural lifecourse model of asthma in 4,898 African American, European American, and Latino children born largely to unwed and lower income parents. Direct effects of sociodemographic factors, perinatal risk factors, child medical risk factors, and environmental risk factors were examined conjointly in predicting asthma expression at age three. This was the first study to also examine cultural resources within the family and other aspects of positive family functioning as a moderator of the effects of sociodemographic, perinatal, child medical, and environmental risk factors. It was hypothesized that child socioemotional functioning would partially mediate the links of sociodemographic factors, perinatal risk factors, child medical risk factors, and environmental risk factors to asthma expression. Moderated mediation was also hypothesized, such that positive family functioning was expected to function as a moderator via the mediational effect of child socioemotional functioning on independent variable-asthma expression links. Finally, ethnic differences in the predictive utility of the full model, and in the magnitude of particular paths within the model, were expected. Child medical risk had the strongest association to asthma expression in children at age three. Environmental risk also emerged as a reliable and robust predictor of asthma expression. Greater availability of cultural resources within the family and other aspects of positive family functioning attenuated the negative effects of greater child medical and environmental risks on asthma expression as hypothesized. Child socioemotional functioning partially mediated the effects of family socioeconomic position and child medical and environmental risks on asthma. Family functioning moderated this mediational pathway, such that the mediational effect of child socioemotional functioning was pronounced within the higher family functioning subsample. The magnitude of the effect of specific paths differed slightly by ethnicity, and ethnicity predicted variance in asthma expression beyond that predicted by the full model, suggesting that factors not included in the model contribute to ethnic disparities asthma. Future research is needed to develop and validate health-relevant measures of cultural resources and to determine whether and how cultural resources should be cultivated in service of reducing ethnic and socioeconomic disparities in asthma and other health outcomes.