Electronic Thesis and Dissertation Repository

Thesis Format

Integrated Article

Degree

Master of Science

Program

Nursing

Supervisor

Dr. Richard Booth

2nd Supervisor

Penny Tryphonopoulos

Joint Supervisor

3rd Supervisor

None

Abstract

Introduction: Preterm birth (PTB) and socioeconomic status (SES) have both been associated previously with the onset of childhood asthma in high income countries. Yet, these factors have been studied minimally outside of an exposure or confounded relationship, and amongst the Canadian population.

Materials and Methods: Merging household interview data from Cycles 2 to 5 of the Canadian Health Measures Survey, this study analyzed data from weighted respondents in early (3-5 years, n = 1,096,609) and middle (6-11 years, n = 2,112,059) childhood. Bivariate, stepwise logistic regression, and logit decomposition were performed using STATA software. Intersectionality guided the study’s methodology.

Results: PTB and measures of SES (p < 0.05) were significantly associated with childhood asthma until entered into a multivariable regression. Instead, male sex, low household income, absence of siblings, and middle childhood were found to be the major predictors of childhood asthma in Canada. The relationship of PTB with childhood asthma was found to also be partially mediated by SES during logit decomposition, but this indirect effect was relatively small.

Discussion and Conclusions: These findings acknowledge the interaction between biological and social influences of childhood asthma, and are meaningful to forthcoming studies of asthma within the Canadian context. Implications of results direct healthcare systems to adopt multi-pronged approaches that reach beyond the confines of healthcare to diminish the onset of childhood asthma. Study strengths include a large sample size, robust analysis, and use of the theoretical lens of intersectionality to locate findings within society.

Summary for Lay Audience

Childhood asthma and asthma-like symptoms have been strongly associated with both preterm birth (PTB) and socioeconomic status (SES), but these three factors have been infrequently studied together. Being concepts within different healthcare models, biological and social, PTB and SES are often recognized in the literature as having separate causal pathways. This study sought to address the literature divide between PTB and SES using the theoretical lens of intersectionality, and by statistically testing each variable’s relationship to asthma, and one another within the Canadian population.

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