Daily Peer Problems among Adolescents: Investigating Associations with Asthma Symptoms via Sleep

• In Event: Pathways to Adolescent Physical Health Outcomes: Unpacking the Power of Peers

Abstract

Background

Asthma is the most common chronic pediatric illness in the United States, affecting approximately 5 million children and adolescents every year (Zahran et al., 2018). In addition to posing a significant public health burden (United States Environmental Protection Agency, 2013), asthma elevates adolescents’ risks for long-term health impairments (Sears, 2015). Therefore, identifying malleable factors that contribute to asthma morbidity is critical for improving quality of life among youth with asthma.

Biopsychosocial models of asthma suggest that chronic and acute interpersonal stress worsen youth asthma morbidity (Miller et al., 2011). Although past research suggests that stressors in the home environment (e.g., family conflict) place children with asthma at risk for greater health problems (Suglia et al., 2008; Tobin et al., 2015), little is known about whether or how peer stressors contribute to health problems in youth with asthma. Additionally, while some evidence implicates sleep as a mechanism linking peer stress to impaired health among youth without chronic conditions, it is unknown whether sleep problems underly pathways from peer problems to health symptoms in the daily lives of youth with asthma. In the current study, we hypothesized that youth facing more daily peer problems would experience worse asthma symptoms and that these associations would be partially explained by sleep disruptions. Because past studies show elevated stress reactivity among adolescents with pre-existing mental health difficulties (e.g., Stone et al., 2016), the possible moderating role of adolescent mental health was also explored.

Methods

Two hundred and ninety-six adolescents with asthma, aged ten to seventeen (M = 12.72, SD = 1.72), were recruited along with their primary caregiver from Detroit area hospitals, asthma centers, and schools. The youth (43% female; 81.1% African American/Black, 15.8% White, 1% Latino/a, 1% multiracial, 0.3% Asian, 0.7% not responding), provided daily reports on peer problems, nighttime awakenings, sleep quality, and asthma symptoms over four days. Youth also self-administered daily peak expiratory flow rate (PEFR) assessments to measure respiratory blockage, and parents reported on their children’s anxious-depressive symptoms.

Results

Multiple linear regression models indicated that adolescents encountering greater daily peer problems experienced more severe daytime (b=.40, p<.001) and nighttime (b=.38, p<.001) asthma symptoms, but not lower PEFR, after controlling for relevant demographic factors (gender, race, age, height). Additionally, as seen in Figures 1 and 2, bootstrapped indirect effect models indicated that associations between daily peer problems and subjective asthma symptoms were partially explained by more nighttime awakenings and lower sleep quality (daytime symptoms: ab=0.16; 95% bootstrapped confidence interval: [.06, .31]; nighttime symptoms: ab=0.16, 95% bootstrapped confidence interval: [.05, .31]). The indirect pathways did not vary depending on youth mental health (i.e., anxious-depressive symptoms).

Conclusions

The findings provide novel evidence for everyday peer stress as a developmentally relevant health risk factor among adolescents with asthma. Insofar as daily peer problems were associated with elevated asthma symptoms via impaired sleep, psychosocial interventions focusing on the peer context may help mitigate maladaptive health behaviors and asthma morbidity.

Authors

• Hannah Schacter, Wayne State University
  Presenting Author

• Richard B. Slatcher, University of Georgia
  Non-Presenting Author

• Jacqueline Rodriguez-Stanley, Wayne State University
  Non-Presenting Author

• Russell Houpt, Arizona State University
  Non-Presenting Author

• Samuele Zilioli, Wayne State University
  Non-Presenting Author