Chen Edith, Miller Gregory E, Shalowitz Madeleine U, Story Rachel E, Levine Cynthia S, Hayen Robin, Sbihi Hind, Brauer Michael
Institute for Policy Research and Department of Psychology, Northwestern University, Evanston, Illinois;
Institute for Policy Research and Department of Psychology, Northwestern University, Evanston, Illinois.
Pediatrics. 2017 Apr;139(4). doi: 10.1542/peds.2016-3056. Epub 2017 Mar 9.
Both the social environment and the physical environment are increasingly recognized as important to childhood diseases such as asthma. This study tested a novel hypothesis: that living in areas high in greenspace may help buffer the effects of difficult family relationships for children with asthma.
A total of 150 children (ages 9-17), physician-diagnosed with asthma, participated in this study. To assess difficulties in parent-child relationships, parents and children completed measures of harsh/inconsistent parenting and parental hostility. Residential greenspace was calculated by using satellite-derived Normalized Difference Vegetation Index with a buffer of 250 m around the residential address. Outcomes included both clinical and biological measures: asthma control and functional limitations, as well as airway inflammation (fractional concentration of exhaled nitric oxide) and glucocorticoid receptor expression in T-helper cells.
After controlling for potential confounding variables, including family income, child demographics, and child medical variables, few main effects were found. However, interactions between residential greenspace and difficult family relationships were found for asthma control ( = .02), asthma functional limitations ( = .04), airway inflammation ( = .007), and the abundance of glucocorticoid receptor in T-helper cells ( = .05). These interactions were all in a direction such that as the quality of parent-child relationships improved, greenspace became more strongly associated with better asthma outcomes.
These findings suggest synergistic effects of positive environments across the physical and social domains. Children with asthma appear to benefit the most when they both live in high greenspace areas and have positive family relationships.
社会环境和自然环境对诸如哮喘等儿童疾病的重要性日益得到认可。本研究检验了一个新假设：居住在绿地丰富的地区可能有助于缓冲哮喘儿童家庭关系紧张所带来的影响。
共有150名经医生诊断患有哮喘的儿童（年龄在9至17岁之间）参与了本研究。为评估亲子关系中的困难，父母和孩子完成了关于严厉/不一致养育方式及父母敌意的测量。利用卫星衍生的归一化植被指数计算居住绿地面积，以居住地址为中心，半径250米范围内为缓冲区。结果包括临床和生物学指标：哮喘控制情况和功能受限情况，以及气道炎症（呼出一氧化氮的分数浓度）和辅助性T细胞中糖皮质激素受体的表达。
在控制了包括家庭收入、儿童人口统计学特征和儿童医学变量等潜在混杂变量后，未发现明显的主效应。然而，在哮喘控制（P = 0.02）、哮喘功能受限（P = 0.04）、气道炎症（P = 0.007）以及辅助性T细胞中糖皮质激素受体丰度（P = 0.05）方面，发现了居住绿地面积与紧张家庭关系之间的相互作用。这些相互作用均表明，随着亲子关系质量的改善，绿地与更好的哮喘治疗效果之间的关联变得更强。
这些发现表明了自然和社会领域积极环境的协同效应。哮喘儿童似乎在居住于绿地丰富地区且拥有积极家庭关系时获益最大。
