Department of Psychology and Institute for Policy Research, Northwestern University, Evanston, Illinois; and
Department of Psychology and Institute for Policy Research, Northwestern University, Evanston, Illinois; and.
Pediatrics. 2019 Aug;144(2). doi: 10.1542/peds.2018-3300. Epub 2019 Jul 18.
Poor neighborhood conditions have established associations with poorer child health, but little is known about protective factors that mitigate the effects of difficult neighborhood conditions. In this study, we tested if positive family relationships can buffer youth who live in dangerous and/or disorderly neighborhoods from poor asthma outcomes.
A total of 308 youths (aged 9-17) who were physician-diagnosed with asthma and referred from community pediatricians and/or family practitioners participated in this cross-sectional study. Neighborhood conditions around families' home addresses were coded by using Google Street View images. Family relationship quality was determined via youth interviews. Clinical asthma outcomes (asthma symptoms, activity limitations, and forced expiratory volume in 1 second percentile), asthma management behaviors (family response to asthma symptoms and integration of asthma into daily life), and asthma-relevant immunologic processes (lymphocyte T helper 1 and T helper 2 cytokine production and sensitivity to glucocorticoid inhibition) were assessed via questionnaires, interviews, spirometry, and blood draws.
Significant interactions were found between neighborhood conditions and family relationship quality (β = |.11-.15|; < .05). When neighborhood danger and/or disorder was low, family relationships were not associated with asthma. When neighborhood danger and/or disorder was high, better family relationship quality was associated with fewer asthma symptoms, fewer activity limitations, and higher forced expiratory volume in 1 second percentile. Similar patterns emerged for asthma management behaviors. With immunologic measures, greater neighborhood danger and/or disorder was associated with greater T helper 1 and T helper 2 cytokine production and reduced glucocorticoid sensitivity.
When youth live in dangerous and/or disorderly neighborhoods, high family relationship quality can buffer youth from poor asthma outcomes. Although families may not be able to change their neighborhoods, they may nonetheless be able to facilitate better asthma outcomes in their children through strong family relationships.
较差的邻里环境与较差的儿童健康状况有关，但对于减轻困难邻里环境影响的保护因素知之甚少。在这项研究中，我们测试了积极的家庭关系是否可以缓冲生活在危险和/或混乱社区的年轻人的不良哮喘结局。
共有 308 名（年龄为 9-17 岁）被医生诊断为哮喘并从社区儿科医生和/或家庭医生转诊的年轻人参加了这项横断面研究。使用 Google 街景图像对家庭住址周围的邻里环境条件进行编码。家庭关系质量通过青少年访谈确定。通过问卷调查、访谈、肺活量测定和血液采集评估临床哮喘结局（哮喘症状、活动受限和 1 秒用力呼气量百分比）、哮喘管理行为（家庭对哮喘症状的反应和将哮喘融入日常生活）和哮喘相关免疫过程（淋巴细胞 T 辅助 1 和 T 辅助 2 细胞因子产生和对糖皮质激素抑制的敏感性）。
发现邻里环境条件与家庭关系质量之间存在显著交互作用（β=|.11-.15|；<.05）。当邻里环境危险和/或无序程度较低时，家庭关系与哮喘无关。当邻里环境危险和/或无序程度较高时，更好的家庭关系质量与较少的哮喘症状、较少的活动受限和较高的 1 秒用力呼气量百分比有关。在哮喘管理行为中也出现了类似的模式。在免疫测量方面，更大的邻里危险和/或无序与更大的 T 辅助 1 和 T 辅助 2 细胞因子产生和糖皮质激素敏感性降低有关。
当年轻人生活在危险和/或混乱的社区中时，良好的家庭关系质量可以缓冲年轻人的不良哮喘结局。尽管家庭可能无法改变他们的社区，但他们仍然可以通过强大的家庭关系为孩子提供更好的哮喘结局。
