Risky Family Environments and Childhood Asthma

描述（由申请人提供）：在美国，除感染外，哮喘是儿童住院的最常见原因，底特律等城市的哮喘死亡率高得令人不安。所谓的“危险”家庭——以冲突、忽视、缺乏情感温暖和支持为特征——使儿童处于患哮喘的危险之中，并为一生中患上各种慢性疾病奠定了基础。然而，人们对危险的家庭环境是如何“深入人心”并对健康产生有害影响的知之甚少。明确了解日常危险家庭行为及其对儿童哮喘发病率和生物介质（如表观遗传变化和基因表达）的影响，对于制定旨在改善危险家庭儿童健康结果的有效干预措施至关重要。拟议的研究将采用多方法的生物心理社会方法来研究儿童哮喘，通过调查密歇根州底特律市180名10-15岁青少年的日常家庭行为与哮喘发病率之间的联系，在2年的时间内收集三波数据。这项研究将采用一种新颖的自然观察技术，称为电子激活记录仪（EAR），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。本项目将测试EAR评估的危险家庭行为（测量冲突、忽视、缺乏情感温暖和支持）——超越传统的家庭功能测量——是否与更高的哮喘发病率（例如，症状严重程度、急诊室就诊和肺功能）以及哮喘发病率的增加（例如，进展到更严重的哮喘诊断）在三次为期两年的随访期间具有纵向相关性。我们将测试这些影响的生物介质，包括日常生活中更多的皮质醇分泌、糖皮质激素受体（GCR）基因表达和GCR CpG启动子位点的甲基化。最后，我们将检验日常生活中的危险家庭行为与哮喘发病率之间的联系是否由回避应对行为和不良哮喘管理行为（例如，较差的哮喘控制药物依从性和较差的哮喘触发避免）介导。在家庭中分离出可能导致或缓冲哮喘发病率的特定生物和心理过程，将促进本项目的关键发现在未来“从实验室到病床”的转化，转化为新颖的、对发展敏感的干预措施，以降低哮喘发病率，也将为我们的团队目前在NHLBI资助下测试的家庭干预措施提供信息和改进。最后，本研究的发现将用于指导如何使用新技术和生物标志物更准确地评估家庭互动和压力，以更好地捕捉家庭干预研究中行为改变的潜在机制。

DESCRIPTION (provided by applicant): 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. PUBLIC HEALTH RELEVANCE: Asthma is the most common cause of hospitalization in children in the U.S. other than infections. So- called "risky" families-characterized by conflict, neglect, and lacking in emotional warmth and support- place children in jeopardy for asthma and other health problems. This project uses an innovative technology called the Electronically Activated Recorder (EAR) to investigate the links between everyday risky family behaviors, asthma morbidity and behavioral and biological mediators (including diurnal cortisol, gene expression, and epigenetic markers) in a sample of 180 youth aged 10-15 in Detroit, MI, whom we will follow for three waves of data collection over a two-year period.