Article Critique – Multiple Regression Moderation

Article Critique – Multiple Regression Moderation

Socioeconomic status, financial stress, and glucocorticoid resistance among youth with asthma: Testing the moderation effects of maternal involvement and warmth.

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Brain, Behavior, and Immunity Volume 96, August 2021, Pages 92-99

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Socioeconomic status, financial stress, and glucocorticoid resistance among youth with asthma: Testing the moderation effects of maternal involvement and warmth

Yanping Jiang , Allison K. Farrell , Erin T. Tobin , Henriette E. Mair-Meijers , Derek E. Wildman , Francesca Luca , Richard B. Slatcher , Samuele Zilioli

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https://doi.org/10.1016/j.bbi.2021.05.014

Abstract

Objectives

Children who grow up in more socioeconomically disadvantaged homes experience greater levels of inflammation and worse asthma symptoms than children from more advantaged families. However, recent evidence suggests that certain family-level factors can mitigate health disparities associated with socioeconomic status (SES). In a sample of youth with asthma, we investigated the potential buffering effects of maternal involvement and warmth on SES disparities in asthma- related immune responses, assessed via glucocorticoid resistance (GR) of immune cells.

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12/15/21, 5:09 PM Socioeconomic status, financial stress, and glucocorticoid resistance among youth with asthma: Testing the moderation effects o…

https://www.sciencedirect.com/science/article/abs/pii/S0889159121001951?via%3Dihub 2/8

Methods

One hundred and forty-three youth (10–16 years of age) with asthma completed measures of maternal involvement and warmth, and their primary caregivers reported their levels of education, income, and financial stress. Peripheral blood mononuclear cells from youth’s blood were isolated, cultured, and assayed to determine mitogen-stimulated (PMA/INO + Etho) and mitogen/hydrocortisone-stimulated (PMA/INO + Cort) levels of two Th-2 cytokines (i.e., interleukin-5, interleukin-13) and one Th-1 cytokine (i.e., interferon-γ). GR was calculated by subtracting log-transformed cytokine concentration in the PMA/INO + Etho samples from log- transformed cytokine concentration in the PMA/INO + Cort samples.

Results

Both maternal involvement and warmth moderated the indirect pathway from family SES to GR of Th-2 cytokines via financial stress. Specifically, we found that low family SES was associated with elevated GR of Th-2 cytokines via increased financial stress among youth reporting low levels of maternal involvement and warmth, but not among those reporting high levels of maternal involvement or warmth.

Conclusions

These results highlight the protective role of maternal involvement and warmth in health-related biological processes modulated by family SES among youth with asthma.

Introduction

Social stratification of wealth and prestige is a robust predictor of health disparities (Adler et al., 1994, Chen and Miller, 2013). Research suggests that the effect of family socioeconomic status (SES) on youth health is mediated by multiple ecological (e.g., family conflict) and psychological factors (e.g., stress), which cumulatively lead to dysregulated health-related biological processes (Gallo and Matthews, 2003, Miller and Chen, 2013). However, less often examined are the protective factors that may mitigate the adverse impact of growing up in a low SES environment. The present study tested whether two key aspects of parenting—maternal involvement and warmth—modulated the previously identified link between family SES and immune responses implicated in asthma pathogenesis in a sample of youth with asthma.

Psychological stress is often proposed as a key mediator linking SES to health (Baum et al., 1999, Gallo and Matthews, 2003, McEwen and Gianaros, 2010). For example, the reserved capacity model (Gallo and Matthews, 2003) proposes that individuals from lower SES backgrounds are more likely to experience stressors and less able to cope with these stressors than their higher SES counterparts, partially due to their limited resources. Although stress exposure and response are often invoked as critical mediators linking SES to health, very few studies have formally tested

 

 

12/15/21, 5:09 PM Socioeconomic status, financial stress, and glucocorticoid resistance among youth with asthma: Testing the moderation effects o…

https://www.sciencedirect.com/science/article/abs/pii/S0889159121001951?via%3Dihub 3/8

this hypothesis, and no clear evidence has emerged supporting the mediating role of stress exposure in the SES-health link from the few studies that explicitly tested this hypothesis (Cundiff et al., 2020). Cundiff and colleagues (2020) suggest that adopting measures of psychological stress that are theoretically specific to SES (vs. broad measures of stress) may increase the theoretical value and predictive utility of stress when testing the SES-health association. Thus, we examined the mediating role of perceived financial stress in the association between family SES and health in this study.

Chronic stress has been shown to exacerbate airway inflammation and, ultimately, to worsen clinical symptoms of asthma (Chen and Miller, 2007, Haczku and Panettieri, 2010, Landeo- Gutierrez and Celedón, 2020, Rosenberg et al., 2014). Airway inflammation involves a variety of immune cell types and mediators including T-helper (Th) cells, such as Th-1 and Th-2 cells (Busse et al., 1993, Umetsu et al., 2002). Th-1 cells perpetuate cellular immune responses through the production of interferon-γ (IFN-γ) and interleukin-2 (IL-2), while Th-2 cells promote humoral responses through releasing cytokines such as IL-5 and IL-13 (Berger, 2000, Chen and Miller, 2007). One way chronic stress amplifies airway inflammation in asthma is by altering the glucocorticoid sensitivity of immune cells (Chen and Miller, 2007, Haczku and Panettieri, 2010). In the context of asthma, glucocorticoids are a class of steroid hormones that decrease the production of Th-1 (e.g., IFN-γ) and Th-2 (e.g., IL-5, IL-13) cytokines, thereby lowering the magnitude of airway inflammation (Banuelos and Lu, 2016). In humans, cortisol is the major glucocorticoid, and its release is regulated by the activation of the hypothalamic–pituitaryadrenal axis. Persistent secretion of cortisol associated with repeated or chronic exposure to stressors may lead to reduced expression and functioning of glucocorticoid receptors (Miller et al., 2009). Dysfunctional glucocorticoid receptors are, thus, less sensitive to the immunosuppressive action of glucocorticoids (i.e., glucocorticoid resistance [GR]), contributing to the amplification of airway inflammation (Chen and Miller, 2007).

A few studies have linked low SES, as well as other chronic psychosocial stressors, to increased Th-1 and Th-2 cell resistance to glucocorticoids, which has been indexed by the capacity of cortisol to suppress Th-1 and Th-2 cytokine production by stimulated peripheral blood mononuclear cells (PBMCs) in vitro (Chen et al., 2016, Miller et al., 2009). For example, in a sample of children with asthma, Chen et al. (2016) found that lower family SES was associated with higher GR of Th-1 cytokines (e.g., IFN-γ) and Th-2 (e.g., IL-5, IL-13) cytokines in vitro. GR related to chronic stress may be particularly problematic for children with asthma, who, as a result, can exhibit resistance to corticosteroid medications, the most common therapy for asthma control (Barnes and Adcock, 2009). Identifying protective factors against the pernicious health consequences of stress-related GR is thus critical.

A promising factor that may exert protective effects is positive parenting, which has been linked to multiple beneficial behavioral and psychological outcomes (Hoeve et al., 2009, McLeod et al., 2007) and more favorable health-related biological processes (Chen et al., 2011). Positive parenting

 

 

12/15/21, 5:09 PM Socioeconomic status, financial stress, and glucocorticoid resistance among youth with asthma: Testing the moderation effects o…

https://www.sciencedirect.com/science/article/abs/pii/S0889159121001951?via%3Dihub 4/8

is theorized to buffer the effects of SES primarily through its stress-buffering role that mitigates the toxic consequences of stress on health (Cohen and Wills, 1985). We investigated two forms of positive parenting, maternal involvement and warmth. Maternal involvement is a multifaceted construct that includes a broad range of behavioral, cognitive, and affective practices (e.g., monitoring, affective support) that mothers adopt to engage with children’s daily lives (Finzi- Dottan et al., 2016, Pleck, 2010). Maternal warmth refers to the acceptance, love, affection, comfort, nurturance, and care that mothers display towards their children (Khaleque and Rohner, 2012). Empirical evidence suggests that maternal involvement and warmth can act as stress- buffering factors in health outcomes (Chen et al., 2011, Cohen et al., 2020, Farrell et al., 2017, Figge et al., 2020). For example, maternal involvement reduced the risk of parent cultural stress on depressive and anxiety symptoms among children from low SES families (Figge et al., 2020). Similarly, maternal warmth was reported to buffer the risk of early socioeconomic disadvantage on adult health via reduced proinflammatory signaling (Chen et al., 2011). These converging reports provide support for the hypothesis that positive parenting may buffer the detrimental effects of growing up in low SES families on health.

The aim of the current study was to investigate the buffering effects of maternal involvement and warmth on the associations among family SES, financial stress, and GR in immune cells in a sample of children with asthma. Given the reported moderation effects of positive parenting on the associations between SES and health and between psychological stress and health in previous studies (Chen et al., 2011, Cohen et al., 2020, Farrell et al., 2017, Figge et al., 2020), we proposed a moderated mediation model (see Fig. 1), in which low family SES would be associated with elevated GR via increased financial stress, and maternal involvement and warmth would moderate the associations between SES and GR and between financial stress and GR. We hypothesized that there would be stronger relationships between SES and GR and between financial stress and GR in youth who reported lower levels of maternal involvement and warmth.

Section snippets

Participants and procedure

One hundred and ninety-four youth with asthma and their caregivers took part in the Asthma in the Lives of Families Today (ALOFT) project. Data on GR was available for 145 children (10– 16 years of age). Among the 145 children, two of them reported using oral steroid medications to manage their asthma. These two individuals were excluded from the analyses, resulting in a final sample of 143 children (M  = 12.65 ± 1.66 years, 39.2% female, 76.2% African Americans). Participants who were…

age

 

 

12/15/21, 5:09 PM Socioeconomic status, financial stress, and glucocorticoid resistance among youth with asthma: Testing the moderation effects o…

https://www.sciencedirect.com/science/article/abs/pii/S0889159121001951?via%3Dihub 5/8

Descriptive results

Table 1 displays the means, standard deviations, and correlation coefficients between study variables. Family SES and financial stress were negatively correlated with each other (r = -0.52, p < 0.001); however, neither of them was significantly correlated with GR of Th-2 cytokines or IFN-γ (ps > 0.10). Maternal involvement was positively correlated with SES (r = 0.19, p = 0.030) and negatively correlated with financial stress (r = -0.27, p = 0.002), but not with GR of Th-2 cytokines or IFN-γ (p…

Discussion

This study tested the associations among family SES, financial stress, maternal involvement and warmth, and GR in a sample of youth with asthma. We found that family SES was associated with financial stress. Family SES and financial stress were not associated with GR of Th-2 cytokines or IFN-γ. However, financial stress–but not family SES– interacted with both maternal involvement and warmth in influencing GR of Th-2 cytokines. Specifically, greater financial stress was associated with higher…

Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.…

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S.L. Rosenberg et al. Stress and asthma: novel insights on genetic, epigenetic, and immunologic mechanisms Journal of Allergy and Clinical Immunology (2014)

G.E. Miller et al. Parental support and cytokine activity in childhood asthma: the role of glucocorticoid sensitivity Journal of Allergy and Clinical Immunology (2009)

B.D. McLeod et al. Examining the association between parenting and childhood depression: A meta-analysis Clinical psychology review (2007)

J. Landeo-Gutierrez et al. Chronic stress and asthma in adolescents Ann. Allergy Asthma Immunol. (2020)

 

 

12/15/21, 5:09 PM Socioeconomic status, financial stress, and glucocorticoid resistance among youth with asthma: Testing the moderation effects o…

https://www.sciencedirect.com/science/article/abs/pii/S0889159121001951?via%3Dihub 6/8

A. Haczku et al. Social stress and asthma: the role of corticosteroid insensitivity Journal of Allergy and Clinical Immunology (2010)

A.K. Farrell et al. Socioeconomic status, family negative emotional climate, and anti-inflammatory gene expression among youth with asthma Psychoneuroendocrinology (2018)

M.M. Farmer et al. Are racial disparities in health conditional on socioeconomic status? Soc. Sci. Med. (2005)

E. Chen et al. Stress and inflammation in exacerbations of asthma Brain Behav. Immun. (2007)

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J. Banuelos et al. A gradient of glucocorticoid sensitivity among helper T cell cytokines Cytokine Growth Factor Rev. (2016)

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12/15/21, 5:09 PM Socioeconomic status, financial stress, and glucocorticoid resistance among youth with asthma: Testing the moderation effects o…

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