Asthma in the Lives of Families Today (ALOFT)

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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. The overarching goal of this longitudinal project—Asthma in the Lives of Families Today (ALOFT)—is to identify the behavioral and biological pathways through which family social environments “get under the skin” to exert their effects on youth asthma. This project uses naturalistic observation to identify everyday family behaviors that either exacerbate or ameliorate asthma pathogenesis, representing a substantial advance over other methods (e.g., questionnaires, interviews, and laboratory interactions) and provides a unique opportunity to understand the effects of family functioning on childhood disease over time in a large sample of urban youth. Our novel naturalistic observation approach incorporates the Electronically Activated Recorder (EAR), as well as surveys, daily diaries, biological measures (including diurnal cortisol, inflammatory markers and gene expression), and clinical asthma evaluations. This renewal project builds on the success of the original ALOFT study. In the renewal phase, we will first “refresh” (augment) the ALOFT sample with 100 new participants recruited from Detroit. The refresher sample will allow us to (a) compare the two groups (original sample and refresher sample) to see the effects of the changing economic environment in Detroit (the so-called “New Detroit” post-bankruptcy) on youth health and (b) augment the sample size of the ALOFT project, increasing statistical power for analyses. Second, we will initiate a new 4th wave of data collection on the existing ALOFT sample. This additional wave of data from the original ALOFT sample—4 years after the most recent wave— will allow us to: (a) test how family environments early in adolescence impact asthma morbidity and health- related biology later in adolescence and (b) test how changes in family relationships over time and non-family relationships (e.g., peers, friends, romantic partners)—which often become much more influential during this period—impact health. Finally, we will utilize next-generation genetic sequencing techniques to conduct genome-wide gene expression analyses on the original sample and the refresher sample. These new analyses will allow us to advance understanding of the molecular pathways through which family social environments impact the health of youth with asthma. 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. Finally, the findings from this project 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.