Targeting Corrosive Couple Conflict and Parent-Child Coercion to Impact Health Behaviors and Regimen Adherence

 描述(申请人提供)：腐蚀性夫妻冲突(CCC)和强制性亲子冲突是一种无处不在的、强有力的、破坏性的(但可改变的)人际毒药，对成人和儿童的各种健康后果。这种模式还与不良的亲子关系和更严厉的惩罚有关，这与对环境压力的反应紊乱(例如，交感神经系统和下丘脑-垂体-肾上腺皮质反应中断)、儿童时期各种不利的健康后果有关，包括龋齿、肥胖和糖尿病相关的代谢标记物。这一阶段的NIH行为改变科学计划强调“行为改变的实验医学方法”，有必要确定中心的人际/社会目标，以最大限度地影响深远的健康结果。该项目将重点关注与糖尿病和口腔健康相关的因素(尽管这一过程会影响许多其他疾病的结果)。两者都与疼痛、痛苦、费用、生产力丧失，甚至死亡有关。他们共享重叠的医疗方案，由重叠的近端健康行为驱动，并影响从儿童早期到成年后期的广泛发育跨度。根据RFA的要求，我们将隔离三种近端健康行为：(A)坚持医疗方案；(B)吃和喝高糖/卡路里的食物；以及(C)自我护理行为。CCC/强制性亲子冲突由一组相互关联的情感、行为和生理信号来标记。在UH2阶段，我们将确定/开发/验证分析。我们还将确定/制定和测试减少CCC/胁迫目标的干预措施。在UH3阶段，我们预计将进行至少2项研究，以测试减少目标是否会导致依从性和其他感兴趣的健康行为的改善。一项研究将关注父母和孩子，另一项研究将关注处于亲密关系中的成年人。与糖尿病和口腔健康问题相关的健康行为将成为因变量，糖尿病和口腔健康中的自我保健行为也是如此。为了将这些健康行为放在疾病状况和坚持医疗方案的背景下，我们希望将一项研究集中在患有幼儿龋齿的儿童样本上，另一项研究集中在患有糖尿病的成人样本上。

 DESCRIPTION (provided by applicant): Corrosive couple conflict (CCC) and coercive parent-child conflict constitute a ubiquitous, potent, and destructive (but modifiable) interpersonal poison to a wide range of adult and children's health outcomes. Such patterns are also linked with poor parent-child relationships and with more harsh punishment, which is associated with disturbed responses to environmental stresses (e.g., disruption in sympathetic nervous system and hypothalamic-pituitary-adrenocortical responses), a wide variety of adverse health outcomes in childhood, including dental caries, obesity, and diabetes related metabolic markers. This phase of NIH's Science of Behavior Change program emphasizes an "experimental medicine approach to behavior change" necessitating identification of central interpersonal/social targets for maximal impact on far-reaching panoply of health outcomes. This project will focus on factors associated diabetes and oral health (though the processes affect many other disease outcomes). Both are associated with pain, distress, expense, loss of productivity, and even mortality. They share overlapping medical regimens, are driven by overlapping proximal health behaviors, and affect a wide developmental span, from early childhood to late adulthood. As requested by the RFA, we will isolate three proximal health behaviors: (a) medical regimen adherence; (b) eating and drinking high sugar/calorie items; and (c) self-care behaviors. CCC/coercive parent-child conflicts are marked by an interrelated set of affective, behavioral, and physiological signatures. In the UH2 phase, we will identify/develop/validate assays. We will also identify/develop, and test interventions to reduce CCC/coercion targets. In the UH3 phase, we expect to conduct at least 2 studies to test whether reduction in targets results in improvement in adherence and other health behaviors of interest. One study will focus on parents and children, the other on adults in intimate relationships. Health behaviors related to diabetes and oral health problems will serve as dependent variables as will self-care behaviors in both diabetes and oral health. To place these health behaviors in the context of disease conditions and medical regimen adherence, we expect to focus one study on a sample of children with early childhood caries and the other study on an adult sample with diabetes.