The Environmental Impact on Facility-Treated Pediatric Asthma Exacerbation: A Secondary Study

Abstract

Pediatric asthma is a leading chronic disease in America; however, it is best thought of as a syndrome of airway symptoms with various etiological origins. As a result, there are numerous combinations of "triggers" that can precipitate an exacerbation in individuals who have asthma. Categorically, these triggers can range from psychosocial, such as stress and anxiety, to physical, such as pollen and pet dander. Family geographic relocations are events that can expose a child with asthma to many of these triggers simultaneously. Ecological transition is a concept within Bronfenbrenner's ecological system theory of human development, where individuals and their environments interact to produce change. The ecological transition concept accounts for aspects of the individual and the broadening layers of the environmental interaction (microsystem, mesosystem, exosystem, macrosystem, and chronosystem) in a holistic approach that allows for seemingly indirect factors to be incorporated in the development process. Through the lens of ecological transition upon the foundation of ecological systems theory, two studies were devised to examine different environmental effects on facility-treated pediatric asthma exacerbations. First, a secondary cross-sectional multilevel binomial regression (n=10,401) suggested there was no significant correlation between children of veteran parents and the likelihood of facility-treated asthma exacerbation (OR 0.96, p= .452). Second, a secondary longitudinal multilevel binomial regression (n=1,055,742) identified a significant correlation between the month of relocation and the first several months following a geographic relocation and the increased likelihood of facility-treated asthma exacerbation. Month of relocation (OR 2.10, p <.001), which is consistent with predictions from ecological transition and ecological systems theory.