What happens to asthma over time among sexual and/or racial/ethnic minority youth?
Published online: September 1, 2021
Stigma is a fundamental social determinant of health. Stigmatization of marginalized populations can contribute to higher levels of stress among minoritized individuals. Such “minority stress” may be experienced differently based on an individual’s intersecting identities. Individuals with multiple minoritized identities may experience overlapping forms of stigma and discrimination. For example, individuals with both a minoritized sexual identity (e.g., lesbian, gay, or bisexual) and race/ethnicity (e.g., Black or Hispanic/Latinx) can experience both homophobia or biphobia and racism, as well as distinct experiences of, for example, racialized homophobia. Minority stress is associated with poor health behaviors and physical stress that may explain the increased presence of asthma among sexual minority and/or racial/ethnic minority (SM/REM) youth. This study aimed to assess disparities in asthma remission among SM/REM youth and its association with traditional risk factors such as obesity and smoking, as well as with stress-inducing experiences such as bullying, cyberbullying, and forced sex. Asthma remission was defined as the self-reported absence of asthma among participants with a previous history of asthma.
In an original article in The Journal of Allergy and Clinical Immunology: In Practice, Curry et al. utilized data from the state and local administrations of the 2009-2017 Youth Risk Behavior Survey (YRBS)—a population-level assessment of health outcomes and risk behaviors from the Centers for Disease Control and Prevention (CDC). They examined the prevalence of asthma remission in a sample of high-school aged youth in the United States by sexual identity, race/ethnicity, and the intersections of these characteristics. The authors then analyzed associations between traditional risk factors and stress-inducing experiences with asthma remission disparities.
Approximately one-third of high-school aged youth with a history of asthma will enter asthma remission. In line with previous studies, non-remitting asthma (asthma that has not entered remission) was more common among female compared to male youth. Black youth across sex and additional-race (American Indian or Alaska Native; Asian; Native Hawaiian or Other Pacific Islander; or those selecting multiple races) male youth had a higher prevalence of non-remitting asthma than white sex-matched youth. Hispanic females, however, had a lower prevalence of non-remitting asthma compared to white females. By sexual identity, gay male youth had more non-remitting asthma than heterosexual male youth. All Black female sexual minority youth had significantly higher odds of non-remitting asthma than white heterosexual female youth. Being forced to have sex and being bulled were associated with non-remitting asthma among female youth. Among male youth, Black heterosexual, additional-race heterosexual, white gay, and additional-race gay youth had significantly higher odds of non-remitting asthma than white male heterosexual youth. Obesity was associated with non-remitting asthma among male youth.
Clinical asthma guidelines should be updated to include population-level asthma disparities by sexual identity and race/ethnicity. Providers should implement National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care in practice. Providers should also consider adopting approaches for identifying and reducing the effects of minority stress among their patients, such as by advocating for structural level policy changes to promote health equity for SM/REM youth.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.