Caregivers Mitigate Asthma Risk by Identifying Triggers Across Different Places

Asthma-related risk is tied to the physical characteristics, power dynamics, institutional policies, relationships, and social norms that shape a place, according to a new study published online ahead of print in Health and Place.

Not only is it known that that asthma disproportionately affects Black children in low-income and racially segregated communities, but structural factors also contribute to the unequal distribution of asthma. Researchers examined how caregivers to children with asthma utilize emplaced caregiving tactics to understand and respond to asthma-related risks. Emplacement is “the theory that embodied experiences and the material world are mutually informed,” the authors explained.

They interviewed 41 caregivers of children in asthma in two locations: Gainesville, FL, and St. Louis, MO. Through the research, they examined the caregivers’ emplaced knowledge, or how they identified asthma-related risk in different place, and their emplaced caregiving tactics, or how they managed the child’s risk across places.

The cities of Gainesville and St. Louis were chosen because they have high rates of pediatric asthma in low-income Black communities, as well as “patterns of racialized residential segregation” that have resulted in the Black communities in East Gainesville and North St. Louis having lower incomes. In addition, these neighborhoods have higher rates of air pollution.

The majority of caregivers were women (83%) and Black (67%) with a low socioeconomic status (78%). In addition, the majority were on Medicaid (70%). The children with asthma were mostly between the ages of 5 and 11 years (59%), followed by 12 to 17 years (44%) and finally 4 years and younger (22%).

The interviews focused on asthma-related risks in three locations:

• Houses: in the places where they lived, triggers for the children’s asthma were identified as temperature (heat and cold), pet dander, dust, mold, pests, chemicals, and second-hand smoke. In the houses, caregivers reported being able to manage the risks through emplaced caregiving tactics, such as enforcing rules on who could enter the home, conducting intense cleaning, and even home renovation projects. However, the authors noted that the more economically and socially disadvantaged caregivers struggled to manage triggers “amidst poverty and structural neglect from landlords and local policy.”
• Neighborhoods: in the public and private places outside of the households, triggers could be from outdoor and indoor places. For outdoor places, exposure to nature, such as trees, and open spaces to run in could be triggers for asthma. In indoor places, bacteria or chemicals could be triggers. Most commonly, caregivers utilized avoidance, such as keeping children inside, to reduce the asthma-related risks; however, the biggest barrier was that avoidance of places was at times unavoidable.
• Schools and childhood institutions: in addition to elementary, middle, and high school, these locations included school buses, day care centers, camp, and sports facilities. Among the asthma-related risks were other adults who may misunderstand the child’s asthma attacks. Other risks were related to the child’s actions, such as overexertion, forgetting medication, and experiencing emotion distress. Several emplaced caregiving tactics were used to manage the risks in these locations, and they varied by income level. Caregivers with higher incomes avoided certain institutions or, in some cases, “changed elements of the institution to better meet their child’s needs.” However, low-income caregivers reported a “lack of structural support for accommodating children with asthma” as a major barrier.

Overall, while caregivers displayed a range of emplaced caregiving tactics, they cannot control all physical and social features that put children at risk of asthma incidents. As a result, caregivers relied on the children to manage their own asthma when they were in places, such as schools, where the caregivers could not also be present.

“Emplaced understandings of risk and caregiving can help stakeholders target both individual and structural factors when developing asthma interventions that are more consistent with families’ everyday lived experiences,” the authors wrote.