Risky Family Environments and Childhood Asthma

描述（由申请人提供）：哮喘是美国儿童住院治疗的最常见原因，而不是感染，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，并为一生中各种慢性疾病奠定基础。然而，人们对危险的家庭环境“深入皮肤”对健康产生有害影响的途径知之甚少。制定一个清晰的日常危险的家庭行为及其对儿童哮喘发病率和生物介质（例如，表观遗传变化和基因表达）对于制定有效的干预措施，改善风险家庭儿童的健康结果至关重要。 这项研究将采用多方法生物心理社会方法来研究儿童哮喘，通过调查底特律180名10-15岁青少年样本中日常家庭行为与哮喘发病率之间的联系，在两年期间进行三波数据收集。该研究将采用一种名为电子激活记录器（Electronically Activated Recorder，EAR）的新型自然观察技术，以及经过充分验证的家庭功能、临床访谈、生物学测量和临床哮喘评估的父母和儿童报告。 该项目将测试由家庭功能评估（测量冲突，忽视，缺乏情感温暖和支持）评估的危险家庭行为-超越传统的家庭功能测量-是否与更高的哮喘发病率纵向相关（例如，症状严重程度、ER就诊和肺功能）和哮喘发病率增加（例如，进展为更严重的哮喘诊断）。我们将测试这些影响的生物介质，包括日常生活中更大的皮质醇输出，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和哮喘发病率之间的联系是否是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）。 在可能导致或缓冲哮喘发病率的家庭中分离特定的生物和心理过程将促进未来将该项目的关键发现转化为新颖的和发育敏感的干预措施，以减少哮喘发病率，并将告知和改善我们的团队目前正在测试的家庭干预措施。最后，本研究的结果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变化的潜在机制。 公共卫生相关性：哮喘是美国儿童住院治疗的最常见原因，而不是感染。所谓的“危险”家庭--以冲突、忽视、缺乏情感温暖和支持为特征--使儿童处于哮喘和其他健康问题的危险之中。该项目使用一种名为电子激活记录器（Electronically Activated Recorder，简称EAR）的创新技术，在密歇根州底特律市的180名10-15岁青少年样本中，调查日常危险家庭行为、哮喘发病率以及行为和生物介质（包括昼夜皮质醇、基因表达和表观遗传标记）之间的联系，我们将在两年的时间内对他们进行三波数据收集。

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.