Strong family relationships may help with asthma outcomes for children

EVANSTON, Ill. — Positive family relationships might help youth to maintain good asthma management behaviors even in the face of difficult neighborhood conditions, according to a new Northwestern University study.

For children with asthma, neighborhood environmental conditions — the role of allergens and pollutants, for example — have long been known to play an important role, but less is known about how social conditions in the neighborhood might affect children’s asthma.

In the study, researchers sought to test whether there are social factors that can buffer children from the negative effects of difficult neighborhood conditions, focusing on one particular factor they thought would be important in the lives of children — whether they had positive and supportive family relationships.

“We found significant interactions between neighborhood conditions and family relationship quality predicting clinical asthma outcomes,” said Edith Chen, professor of psychology in the Weinberg College of Arts and Sciences, faculty fellow at the Institute for Policy Research at Northwestern and lead author of the study. “When children lived in neighborhoods that were high in danger and disorder, the better their family relationships, the fewer symptoms and activity limitations they had, and the better their pulmonary function.”

In contrast, Chen said, when children lived in neighborhoods that were lower in danger and disorder, their symptoms, activity limitations and pulmonary function were generally good, and the nature of their family relationships didn’t really matter.

Using Google Street View, the researchers were able to take a virtual walk through each of the research participant’s Chicago neighborhoods, and code for indicators of neighborhood danger or disorder, including evidence of graffiti, rundown or abandoned cars, bars or grates on windows and doors, and abandoned or boarded-up homes. That gave them a more objective indicator of the level of neighborhood danger and disorder that a participant is likely experiencing on a daily basis as they walk to places from their home.

They then interviewed children about their family relationships and coded the amount of support, trust and conflict that was present, and measured a variety of asthma outcomes — clinical, behavioral and biological — in these children.

Chen said the research is important to the field of pediatrics because families often don’t have options for moving out of neighborhoods that are challenging.

“If pediatricians can provide suggestions to families about how supportive relationships can help with managing their child’s asthma, while at the same time still acknowledging the realities of the ongoing neighborhood difficulties that many of these families face, this might help families,” Chen said.

“It’s possible that when children have high-quality relationships with their family, family members are able to help their children prioritize asthma management, for example, perhaps by shielding them from neighborhood stressors in order to minimize the disruption to asthma routines,” Chen said. “But this is speculative at this point, and future research could test this idea by implementing family or parenting interventions in youth with asthma who live in high-danger neighborhoods and examining their effects on childhood asthma outcomes.”

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“Neighborhood Social Conditions, Family Relationships, and Childhood Asthma” published in the journal Pediatrics on July 18. In addition to Chen, co-authors include Robin Hayen, Van Le, and Makeda Austin of Northwestern University; Madeleine Shalowitz and Rachel Story, NorthShore University HealthSystem; and Gregory Miller, Northwestern University.

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