Stifling racism raises stress, increases asthma suffering for Black children

By Starla Muhammad -Managing Editor- | Last updated: Sep 19, 2019 - 2:01:55 PM

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Members of the medical community say traumatic childhood experiences can contribute to a number of mental and physical health issues in Black children.
The distinct, unmistakable sound of wheezing while struggling desperately for air, uncontrolled coughing and extreme tightness in the chest. It is a sound and feeling all too familiar to many of the more than 25 million Americans suffering from asthma.

Of 6.2 million young people under 18 with this chronic condition, Black children not only have the highest rates but are more likely to be hospitalized and die. And while environmental factors like poor air quality, pollutants and lack of access to quality health care and other factors linked to race and economics contribute to this disparity in Black children, a new study reveals another likely factor—racism.

A new study published in Annals of Allergy, Asthma and Immunology shows an association between Black parents and guardians who experienced chronic stress associated with exposure to racism and poor asthma control in their young children. Asthma is a long-term disease of the lungs that causes airways to get inflamed and narrow and makes breathing difficult. Coughing, wheezing, shortness of breath, and chest tightness are classic asthma symptoms. Severe asthma can make it hard to talk or be active. Treatments include rescue inhalers to treat symptoms or controller inhalers that prevent symptoms. Severe cases may require longer-acting inhalers that keep the airways open as well as oral steroids.

Asthma costs the U.S. economy more than $80 billion annually in medical expenses, missed work and school days and deaths.

According to the Center for Disease Control and Prevention, about 13.4 percent of non-Hispanic Black children have asthma, compared to about 7.4 percent of White children.

“An important environmental thing to consider beyond the typical environmental issues that we focus on like pollution and allergens, is racism as an environmental exposure that children of color particularly are exposed to, which has not only personal impact—there are studies that have shown that when people experience racism, are exposed to racism, that there are actual biological changes that occur in the body that could certainly impact asthma,” explained Dr. Bridgette L. Jones, lead author of the new study, “Chronic Stress Exposure Among Young African American Children With Asthma: Racism is a Factor.” Dr. Jones is a pediatric allergist and immunologist and has conducted research over the past several years focusing on asthma and asthma therapeutics.

Race itself as a social construct and genetic risk related to race cannot solely explain differences in disease prevalence and outcomes, notes the study. In other words, Black children are not just disproportionately afflicted with asthma because of bad air, dust or allergies. Factors called Adverse Childhood Experiences (ACEs) and toxic, chronic stressors like emotional, physical and sexual abuse, housing instability, financial stress and experiencing racial discrimination are psychosocial factors associated with asthma in children and adults, the study explained.

Dr. Bridgette L. Jones
“One of the things that happens with stressors like racism is that the pathway that controls your internal steroid pathway, those change. And so when you think about asthma as an inflammatory disease and steroids is how we treat that disease, if it’s already perturbed because of stressful situations that we’re experiencing on a daily basis such as racism, then potentially the treatments we use may not work as well, or may not work at all or we really need to address this factor,” Dr. Jones explained.

The study took a small sample size of 31 parents and guardians of Black children ages one through six in Kansas City, Mo., who had been diagnosed by a doctor to determine the association between what parents reported as chronic exposure to stress and control of their child’s asthma. Dr. Jones wanted to look at this young age group to potentially identify factors which could subsequently lead to policy changes or develop interventions to address chronic stressors Black parents experience that impact the health of their children.

“For example, the questionnaires that we use asked about experiences of racism and discrimination relative to things like you have difficulty with a boss on your job related to racism and you know that could either directly or indirectly affect that child. If a parent has a job where they don’t have a good relationship with their boss; their boss is not sympathetic to their child that has asthma and doesn’t understand that the parent has to leave work and go pick-up their child that’s having an asthma attack at school. Or the parent has to go and take their child for regular follow-up visits for their asthma.

“So I think that those are things by looking at the parent, and what the parents are experiencing, we are also able to see maybe some of those systemic impacts of racism that are not only affecting the parents and the parents’ quality of life but it’s also causing a negative impact on the child’s health outcome,” said Dr. Jones. This new study is critical in helping policymakers and communities identify the actual root cause of health patterns and problems, she explained.

Brandi Muhammad of Columbus, Ohio, is acquainted with navigating day to day life as a Black woman in America and having two of her three children diagnosed with asthma. Her son, 18, and youngest daughter, 14, were both diagnosed at age two. Trips to the doctor and the ER for treatment when they were younger was a part of their lives over the years. She agrees emotional and mental challenges her children directly experience, or experience indirectly through her struggles against racism or other stressors, influenced their asthmatic conditions. “All of it plays a part,” said Ms. Muhammad.

Dr. Hasan Abdullah-Pratt is an emergency medicine physician at the University of Chicago Medical Center. There is usually not a shift that goes by that a Black child with asthma is not brought through the doors, he said.

“As an ER physician on Chicago’s South Side asthma is a significant percentage of what we see in our pediatric population and that ranges from mild asthma attacks all the way to the very severe,” said Dr. Abdullah-Pratt.

Different racial factors lead to certain health outcomes in Black communities and trying to manage asthma in children on a day to day basis can be challenging and stressful, he explained.

“In our communities because health care access is poor, because the different racial factors that end up leading to work-health outcomes in the Black communities … we don’t have a primary care physician or a pediatrician for our children; and so that leads to not properly managing asthma on a day-to-day basis so that the only time you seek help is when it gets too far and it gets to be severe asthma exacerbation. I think that does come from a lot of the stressors and socio-economic factors that lead to poor outcomes for African American families,” said Dr. Abdullah-Pratt.

A child can go from having “controlled” asthma to a much more severe case with lack of consistent treatment and follow up, he said. But if a Black parent is just struggling to survive and function in a racist or discriminatory environment, it can affect that parent’s decisions on their child’s treatment or can distract from a parent’s ability to be more attentive to their child’s treatment, he added.

Dr. Jones said there was something that surprised her during the study.

“We looked at those stressors in relationship to asthma control and we included racism not as an afterthought, but we included racism as a known stressor,” she said.

“I really wasn’t expecting for racism to be the one that was associated with asthma outcomes in these children. I thought it would be some of the other stressors that we looked at. Some of the ones like physical abuse or sexual abuse experiences. I was kind of shocked that racism was one of the stronger factors that was associated with asthma control.”

There are plans to present outcomes of the study to parents that participated and develop materials they can use to help themselves and their children, she said.

“I will say during the study, families felt like this was important. The questions that we were asking, they felt like it was important. They felt like these were questions that people should be asking but aren’t really asking a lot. A lot of them talked about ‘these are the kind of day-to-day things that are impacting me that are really making it hard for me.’ I think that they were very pleased that we were asking those types of questions,” said Dr. Jones.

In health care there needs to be a recognition that racism has an impact on health, a fact that was recently revealed in a policy statement released by the American Academy of Pediatrics. In August, the group said racism should be defined as a social determinant of health. “The Impact of Racism on Child and Adolescent Health” found racism is a health factor that should be addressed by pediatricians in a clinical assessment.

“Once it’s defined as a social determinant, just like poverty or socioeconomic status or other social determinants, I think we can really start looking at it as a more objective factor rather than something that maybe makes people feel bad every once in a while but really doesn’t impact their health,” said Dr. Jones.

This latest study is an important step in delving deeper into how racism affects health, she added. It is important for health care organizations, hospitals and academic institutions to really start looking at how racism impacts patients on a daily basis, she continued.

“This was a small study. This was 31 kids. So, this study needs to be done in much larger groups of kids of other age groups as well as older children that maybe can tell us about their own experiences of racism. I think that within research, especially now that it’s been defined as a social determinant, it has to be included in the research,” Dr. Jones argued.