Risky Family Environments and Childhood Asthma

描述(申请人提供)：哮喘是美国儿童除感染外最常见的住院原因，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、忽视和缺乏情感温暖和支持为特征--使儿童处于哮喘的危险之中，并为一生中各种慢性病奠定了基础。然而，关于危险的家庭环境如何“深入”对健康产生有害影响的途径，人们知之甚少。对每天的危险家庭行为及其对儿童哮喘发病率和生物媒介(如表观遗传变化和基因表达)的影响进行清晰的描述，对于制定有效的干预措施以改善危险家庭儿童的健康结果至关重要。这项拟议的研究将采用多方法生物心理社会方法来研究儿童哮喘，通过在两年内的三次数据收集中调查密歇根州底特律180名10-15岁青年的日常家庭行为与哮喘发病率之间的联系。这项研究将纳入一种名为电子激活记录仪(EAR)的新型自然观察技术，以及经过充分验证的家庭功能报告、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)-超出传统的家庭功能测量-是否纵向上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)有关，以及与哮喘发病率(例如，进展到更严重的哮喘诊断)在三波、两年的随访期内是否存在纵向关联。我们将测试这些效应的生物介体，包括日常生活中更多的皮质醇输出，糖皮质激素受体(GCR)基因表达，以及GCR CpG启动子位置的甲基化。最后，我们将测试日常生活中危险的家庭行为与哮喘发病率之间的联系是否通过回避性应对行为和糟糕的哮喘管理行为(例如，较差的哮喘控制服药依从性和较差的哮喘触发回避)来中介。在可能导致或缓冲哮喘发病率的家庭中隔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的、对发展敏感的干预措施，以减少哮喘发病率，并将告知和改进目前由我们的团队利用NHLBI资金进行测试的家庭干预措施。最后，这项研究的结果将被用来告知如何利用新技术和生物标记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。 与公共卫生相关：哮喘是导致美国儿童住院的最常见原因，仅次于感染。所谓的“危险”家庭--以冲突、忽视和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(EAR)的创新技术，在密歇根州底特律的180名年龄在10-15岁的年轻人中调查日常危险家庭行为、哮喘发病率和行为和生物介质(包括昼夜皮质醇、基因表达和表观遗传标记物)之间的联系，我们将在两年内跟踪他们进行三次数据收集。

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.