Kirsten Rudestam '01 - Thesis Abstract

The Importance of Place: Asthmatic Children's Perception
of Inside and Outside Environments

Kirsten Rudestam
Bachelor's of Arts in Environmental Studies
May 2001

Asthma is dramatically increasing among impoverished, inner-city child populations. Because asthma is an environmentally induced disease, it has the potential to influence children's understandings of and perceptions of place. I interviewed fourteen asthmatic and twelve non-asthmatic children in Providence between January and March 2001 to shed light on asthmatic children's understandings of illness and how the asthma experience influences and shapes their "sense of place."

For this qualitative study, I asked several questions: In what ways do children with asthma understand their illness? What is the influence of the asthma experience on environmental attitudes and perceptions? In what ways do these perceptions influence activities and daily life?

The interview was comprised of asthma related and place related questions, including a picture response activity and a Children's Health Locus of Control Scale, used to evaluate how much perceived control exists over ones health. The interview for the asthmatic children was about twenty minutes long and the interview for the non-asthmatic children did not include asthma-related questions and was about ten minutes long. I also interviewed parents, school nurses and teachers, and observed the children in their school environments.

Findings

My findings consist of two parts: ways in which children understand their asthma and ways in which children understand place.
Children with asthma expressed different attributes of and responses to the disease:

Asthmatic children reported three negative impacts of asthma on daily life:

They spend less time outside

They are restricted in their physical activity

They spend less time with friends.

Children appeared to have adapted to their asthma and exhibited no awareness of negative stigmatization.
Asthmatic and non-asthmatic children valued similar places and similar aspects of places. All children appreciated places that were:

Children rarely mentioned aesthetic aspects of place.
While asthmatic and non-asthmatic children valued similar places and similar aspects of places, there were fundamental differences between their reasons for valuing these places:

While both groups referred to social aspects of places, asthmatic children emphasized family members while non-asthmatic children emphasized friends.

Asthmatic children rather than non-asthmatic children negatively referred to places they regarded as isolating.

Asthmatic children more consistently valued familiar places, while non-asthmatic children valued places that offered exploration.

While all children valued "safe" places, asthmatic children referred to places as unsafe because they contained asthma triggers while non-asthmatic children referred to places as unsafe because they harbored violence.

The Children's Health Locus of Control scale revealed similar scores for both populations; however, specific questions within the scale illuminated a tension between relegating control to figures of authority and taking personal responsibility over illness.

Recommendations

My findings lead me to conclude that asthma education programs are valuable in providing children with an understanding of their illness. I recommend that:

Asthma education programs incorporate and validate "lived experiences" in their classes, as well as skills that foster self-empowerment and responsibility, important for impoverished children with and without asthma.

Medical advocates and environmental activists narrow the gap between their respective projects and work together to combat asthma

Reinvigorating inner city neighborhoods to provide community infrastructure and public open spaces can help to foster positive perceptions of outdoor environments

Subsequent researchers may want to interview parents of children with asthma, interview children of different socio-economic backgrounds, and evaluate the impact of intervention programs on children's "sense of place."