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Doctor of Philosophy (PhD)




Asthma is a chronic lung disease of epidemic proportions affecting 24.6 million Americans, including 7.0 million children. In particular, 22% of high school students indicated a doctor or a nurse had told them that they had asthma, with 10.8% with current asthma. The disease disproportionately afflicts minority children from low-income areas. Adolescents with asthma, who live in such areas, are at particular risk for increased morbidity and mortality. The purpose of this study was to examine the degree to which the phenomenon of resilience, observed in other physical health and psycho-social contexts, may be found in adolescents with asthma exposed to risks that often accompany low-income environments. The Asthma-related Resilience Model was used to guide this study.The concept of resilience sheds light on the phenomenon where some individuals have thrived while faced with risks to psychosocial and physical health. A variety of protective factors are used by these individuals to moderate the risks. Asthma, which requires negotiation of physical and psychosocial challenges for successful management, fits well with the concept of resilience. It is important to know what resource and protective factors may help to alleviate certain risk factors associated with asthma in low-income adolescents. One hundred and two adolescents with a physician's diagnosis of asthma were recruited from four healthcare centers that accepted Medicaid in low-income areas in Chicago, IL (mean age, 16 years; 40% male; 61% Black). Participants completed a confidential paper-and-pencil survey booklet of risk factors, resource factors, and positive health outcomes. Hierarchical multiple regression analyses were performed to assess the benefits of self-esteem, social support, and internal locus of control as both moderators of risk and as main effects. Three general findings from this study were noted. One was the singular importance of depression as a risk factor for positive health outcomes in adolescents with asthma. Second was the absence of any interaction or significant moderation of risk factors by resource factors. The third general finding was lack of evidence supporting direct beneficial effects due to resource factors characteristic of social support or self-esteem. Internal locus of control was found to have a direct benefit on asthma-related quality of life and asthma control.

The complexity of asthma's underlying causes and the challenges of managing it as a chronic disease are impacted by many factors. The adolescent's asthma-related quality of life goes beyond simply managing the severity of the asthma itself. As such, it would seem natural that the concept of resilience would be suited to help explain positive health outcomes. However, this research does not support this assumption.

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