Division of General Pediatrics and Adolescent Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA.
Child Abuse Negl. 2012 Jul-Aug;36(7-8):596-601. doi: 10.1016/j.chiabu.2011.12.002. Epub 2012 Jul 31.
Neuroendocrine alterations may help explain health differences between intimate partner violence (IPV) exposed children and non-exposed children. We sought to determine the feasibility of having families, recruited at a child asthma visit, collect at home and return via mail child salivary samples, and whether socio-demographic variables were associated with sample return. For those returning samples, we examined whether past-year IPV exposure was associated with total cortisol output (AUC) and the magnitude of the cortisol awakening response (CAR), and whether these cortisol values were associated with asthma control.
Fifty-five families with an asthmatic child of any age were recruited from 2 pediatric asthma clinics. At the time of the visit, parents completed a survey packet which included a modified version of the Conflict Tactics Scale to assess IPV. Parents were given supplies to collect 3 child salivary cortisol samples (awakening, 30-min after awakening, bedtime) at home on a typical day, and return them via mail. Medical records also were abstracted.
Fifty-three percent (n=29) returned child salivary samples. Families who returned samples typically returned them within 2 weeks, most commonly before we made a reminder call. Parental male sex was associated (p=.06) with increased rate of return at the trend level. In multivariable models, a 1-unit increase in IPV was significantly associated with a .93 SD increase in root-transformed total cortisol output (AUC) (un-standardized beta=2.5; SE .59; p=.001). The odds of uncontrolled asthma were marginally higher for every nmol/l increase in CAR (OR 1.04; 95% CI 1.0, 1.1; p=.06).
This study provides support for the feasibility of obtaining a moderate return of salivary specimens from a convenience sample. Findings that IPV was associated with elevated total cortisol output and uncontrolled asthma was marginally associated with cortisol awakening response suggest that future studies should investigate whether cortisol mediates the IPV-child asthma relationship.
神经内分泌的改变可能有助于解释亲密伴侣暴力（IPV）暴露儿童和未暴露儿童之间的健康差异。我们试图确定这样一种可行性，即让在儿童哮喘就诊时招募的家庭在家中采集并通过邮件返还儿童唾液样本，以及社会人口统计学变量是否与样本返还相关。对于那些返还样本的家庭，我们研究了过去一年的 IPV 暴露是否与总皮质醇输出（AUC）和皮质醇觉醒反应（CAR）的幅度相关，以及这些皮质醇值是否与哮喘控制相关。
从 2 家儿科哮喘诊所招募了 55 个有任何年龄哮喘儿童的家庭。在就诊时，父母完成了一份调查包，其中包括修改后的冲突策略量表，以评估 IPV。父母收到了在家中采集 3 个儿童唾液皮质醇样本（觉醒时、觉醒后 30 分钟、睡前）的用品，并通过邮件返还。还从医疗记录中提取了信息。
53%（n=29）的家庭返还了儿童唾液样本。返还样本的家庭通常在我们打电话提醒之前的 2 周内返还样本，大多数情况下都是这样。父母的男性性别与返还率呈正相关（p=.06），呈趋势性增加。在多变量模型中，IPV 增加 1 个单位与根转换后的总皮质醇输出（AUC）增加 0.93 个标准差显著相关（未标准化的β=2.5；SE.59；p=.001）。CAR 每增加 1 nmol/L，哮喘未控制的可能性就会略有增加（OR 1.04；95%CI 1.0，1.1；p=.06）。
这项研究支持从便利样本中获得中等数量唾液标本的可行性。发现 IPV 与总皮质醇输出增加有关，而皮质醇觉醒反应与哮喘未控制有关，这表明未来的研究应该调查皮质醇是否介导了 IPV 与儿童哮喘之间的关系。
