INTERGENERATIONAL TRANSMISSION OF ILLNESS BEHAVIOR

到2000年，美国的医疗保健费用可能达到2万亿美元。在- 利用率是医疗保健水平提高的主要原因之一 成本疾病行为模式，包括卫生保健利用和 残疾日，在家庭中运行，和父母建模， 强化被认为是解释家庭的可能机制 聚集模式。然而，关于父母强化的研究， 成年人的回顾性报告限制了患病行为 他们童年的经历本研究的第一个目的是 评估父母对孩子身体不适的反应 并评估父母的强化和建模与 他们的孩子的各种疾病行为的措施。长期 目标是制定一个预防或 减少不适当的疾病行为。第二个目标是确定 建模和强化的效果是否独立于 家庭压力、能力和父母的心理社会变量， 儿童心理症状决定儿童患病行为。的 拟议的研究将集中在胃肠道疾病的行为， 肠易激综合征（IBS）的儿童和成人。受试者将 由8-16岁的儿童组成，其母亲寻求照顾， IBS从一个定义的管理式护理（HMO）人群，对照儿童， 母亲们寻求哮喘治疗。所有家庭将随机 从同一个群体中选出。对于IBS和非IBS对照， 调查问卷、访谈和日记数据将从家长那里获得 和儿童的疾病行为，强化，心理症状， 压力应对、对疾病的信念和学校出勤率数据 将从学校获得。对于所有受试者，数据将 从HMO数据库中收集的数量，费用，类型和诊断， 所有的父母和儿童保健访问。来自HMO和学校的数据 将在入组研究后两年内前瞻性获取 并在进入研究前两年进行回顾性研究。

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.