INTERGENERATIONAL TRANSMISSION OF ILLNESS BEHAVIOR

到2000年，美国的医疗费用可能会达到2万亿美元。过了- 使用率是医疗保健增加的主要原因之一 成本。疾病行为模式，包括卫生保健利用和 残疾人日，在家庭中运行，以及父母模特和 强化被认为是解释家庭的可能机制 聚合模式。然而，亲本强化的研究 疾病行为受到来自成年人的回顾报告的限制 关于他们童年的经历。这项研究的第一个目的是 评估父母对孩子躯体疾病的反应方式 并评估父母的强化和模式化与 他们的孩子的患病行为的各种测量。从长远来看 目标是开发一种干预模式，用于预防或 减少不适当的疾病行为。第二个目标是确定 建模和钢筋的效果是否独立于 家庭压力、能力和父母的心理社会变量 儿童心理症状在确定儿童患病行为中的作用。这个 拟议的研究将侧重于老年人的胃肠道疾病行为 患有肠易激综合征(IBS)的成年人的孩子。研究对象将 由8-16岁的儿童组成，他们的母亲曾寻求照顾 来自确定的管理性保健(HMO)人群的IBS，控制其儿童 母亲们一直在寻求哮喘的治疗。所有家庭都将随机 从同一群体中挑选出来的。对于IBS和非IBS控制， 问卷、访谈和日记数据将从家长那里获得 以及对儿童患病行为、强化、心理症状、 压力应对，对疾病的信念，以及出勤率数据 将从学校获得。对于所有受试者，数据将是 从HMO数据库收集的有关数量、成本、类型和诊断的信息 所有家长和儿童保健探视。来自HMO和学校的数据 将在进入研究后的两年内预期获得 并对进入研究前的两年进行了回顾。

U.S. health care costs may reach $2 trillion by the year 2000. Over- utilization is one of the major reasons given for rising health care costs. Illness behavior patterns, including health care utilization and disability days, run in families, and parental modeling and reinforcement have been proposed as likely mechanisms to explain family aggregation patterns. However, studies of parental reinforcement of illness behavior have been limited by retrospective reports from adults about their childhood experiences. The first aim of this study is to assess the way parents respond to their children's somatic complaints and to assess the relationship of parental reinforcement and modeling to various measures of illness behavior in their children. The long term goal is the development of an intervention model for prevention or reducing inappropriate illness behavior. A second aim is to determine whether the effects of modeling and reinforcement are independent of the psychosocial variables of family stress, competence, and parent and child psychological symptoms in determining child illness behavior. The proposed study will focus on gastrointestinal illness behavior in the children of adults with irritable bowel syndrome (IBS). Subjects will consist of children aged 8-16 years whose mothers have sought care for IBS from a defined managed care (HMO) population, control children whose mothers have sought care for asthma. All families will be randomly selected from the same population. For the IBS and non-IBS controls, questionnaire, interview and diary data will be obtained from parents and children on illness behavior, reinforcement, psychological symptoms, stress coping, and beliefs about illness, and school attendance data will be obtained from the schools. For all subjects, data will be collected from the HMO database on number, cost, type, and diagnosis for all parent and child health care visits. Data from the HMO and schools will be obtained prospectively for two years after entering the study and retrospectively for the two years prior to entering the study.