Risky Family Environments and Childhood Asthma

项目总结/摘要 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担忧。所谓的“风险”家庭-特征 冲突，忽视，缺乏情感温暖和支持，使儿童处于哮喘的危险之中， 为一生中的各种慢性疾病打下基础。然而，人们对这些途径知之甚少， 危险的家庭环境通过这种方式“深入皮肤”，对健康产生有害影响。 明确描述日常危险家庭行为及其对儿童哮喘的影响 发病率和生物介质（例如，表观遗传变化和基因表达）对于发育至关重要 采取有效干预措施，改善风险家庭儿童的健康状况。 这项研究将采用多方法的生物心理社会学方法来研究儿童 通过调查180名样本中日常家庭行为与哮喘发病率之间的联系， 底特律，密歇根州，10-15岁的年轻人，在三波数据收集超过2年的时间。这项研究将 采用了一种新的自然主义观察技术，称为电子激活记录器（Electronically Activated Recorder，缩写为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。 该项目将测试风险评估（衡量冲突，忽视， 缺乏情感温暖和支持）-超出了家庭功能的传统衡量标准-是 与更高的哮喘发病率纵向相关（例如，症状严重程度、ER访视和肺部 功能）和哮喘发病率的增加（例如，进展为更严重的哮喘诊断） 三波，2年随访期。我们将测试这些影响的生物介质，包括更大的 日常生活中的皮质醇分泌、糖皮质激素受体（GCR）基因表达和GCR CpG甲基化 启动子位点。最后，我们将测试日常生活中的危险家庭行为与哮喘之间的联系是否 发病率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）。 在家庭中隔离特定的生物和心理过程，可能有助于，或 缓冲区，哮喘发病率将促进未来的“板凳到床边”翻译的关键发现，从这个项目， 新的和发展敏感的干预措施，以减少哮喘发病率，也将告知和 改善家庭干预措施，目前正在测试我们的团队与NHLBI资金。最后 这项研究的结果将用于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.