Risky Family Environments and Childhood Asthma

项目摘要/摘要 哮喘是美国儿童除感染外最常见的住院原因，以及 底特律等城市的哮喘死亡率高得令人不安。所谓的“高风险”家庭-- 由于冲突、忽视和缺乏情感温暖和支持--使儿童处于哮喘的危险之中，以及 在一生中为各种慢性病奠定基础。然而，人们对这些途径知之甚少。 通过这种方式，危险的家庭环境“深入”，对健康产生有害影响。 清晰地描述日常危险的家庭行为及其对儿童哮喘的影响 发病率和生物媒介(例如，表观遗传变化和基因表达)是发育所必需的 旨在改善高危家庭儿童健康状况的有效干预措施。 建议的研究将采用多方法生物心理社会方法来研究儿童。 180例哮喘患者日常家庭行为与哮喘发病关系的研究 密歇根州底特律10-15岁的年轻人，在两年的时间里进行了三次数据收集。这项研究将 融合了一种新的自然主义观察技术，称为电子激活记录器(EAR)，如 以及经过充分验证的父母和孩子的家庭功能报告、临床访谈、生物测量 和临床哮喘评估。 该项目将测试EAR评估的危险家庭行为(衡量冲突、忽视、 缺乏情感温暖和支持)--除了传统的家庭功能衡量标准之外-- 纵向上与更高的哮喘发病率相关(例如，症状严重程度、急诊室就诊和肺部疾病 功能)和哮喘发病率的增加(例如，进展到更严重的哮喘诊断) 三波两年的随访期。我们将测试这些影响的生物介体，包括更多 日常生活中皮质醇排出量、糖皮质激素受体(GCR)基因表达及GCR CpG甲基化 启动子站点。最后，我们将测试日常生活中危险的家庭行为与哮喘之间的联系 发病率通过回避性应对行为和糟糕的哮喘管理行为(例如， 较差的哮喘控制服药依从性和较差的哮喘触发回避)。 在家庭中隔离特定的生物和心理过程，这些过程可能有助于或 缓冲，哮喘发病率将促进未来将该项目的关键发现转化为 新的和对发展敏感的干预措施，以减少哮喘发病率，并将告知和 改善目前由我们的团队利用NHLBI资金进行测试的家庭干预措施。最后， 这项研究的结果将被用来指导如何更准确地评估家庭互动和压力 利用新技术和生物标志物更好地捕捉家庭行为变化的潜在机制 干预研究。

Project Summary / Abstract Asthma is the most common cause of hospitalization in children in the U.S. other than infections, and cities such as Detroit have troublingly high asthma mortality rates. So-called "risky" families-characterized by conflict, neglect, and lacking in emotional warmth and support-place children in jeopardy for asthma, and lay the groundwork for various chronic illnesses throughout life. However, little is known about the pathways through which risky family environments "get under the skin" to exert their deleterious effects on health. Formulating a clear picture of everyday risky family behaviors and their effects on childhood asthma morbidity and biological mediators (e.g., epigenetic changes and gene expression) is essential for developing effective interventions targeted at improving health outcomes of children from risky families. The proposed research will take a multi-method biopsychosocial approach to the study of childhood asthma by investigating the links between everyday family behaviors and asthma morbidity in a sample of 180 youth aged 10-15 in Detroit, MI, in three waves of data collection over a 2-year period. The study will incorporate a novel naturalistic observation technology called the Electronically Activated Recorder (EAR), as well as well-validated parent- and child-reports of family functioning, clinical interviews, biological measures and clinical asthma evaluations. This project will test whether risky family behaviors assessed by the EAR (measuring conflict, neglect, lack of emotional warmth and support)-above and beyond traditional measures of family functioning-are longitudinally associated with greater asthma morbidity (e.g., symptom severity, ER visits, and pulmonary function) and with an increase in asthma morbidity (e.g., progression to more severe asthma diagnosis) over the three-wave, 2-year follow-up period. We will test biological mediators of these effects, including greater cortisol output in daily life, glucocorticoid receptor (GCR) gene expression, and methylation of GCR CpG promoter sites. Finally, we will test whether the links between risky family behaviors in daily life and asthma morbidity are mediated by avoidant coping behaviors and by poor asthma management behaviors (e.g., poorer asthma control medication adherence and poorer asthma trigger avoidance). Isolating specific biological and psychological processes in families that potentially contribute to, or buffer, asthma morbidity will foster future "bench to bedside" translation of key findings from this project into novel and developmentally sensitive interventions to reduce asthma morbidity, and will also inform and improve family interventions that are currently being tested by our team with NHLBI funding. Finally, the findings from this study will be used to inform how to more accurately assess family interactions and stress with new technology and biomarkers to better capture potential mechanisms of behavior change in family intervention research.