Strong family ties may help teens cope with asthma in face of difficult neighbourhoods
Having supportive family relationships may help youth maintain good asthma management behaviours despite difficult neighbourhood conditions--thus serving as a buffer against poor asthma outcomes associated with living in disorderly neighbourhoods, a recent study finds.
The researchers found that children/teens who lived in dangerous/disorderly neighbourhoods had worse asthma outcomes as indicated by greater asthma-related activity limitations (p=0.004), poorer asthma management behaviours (p=0.027), and greater immunological responses in terms of Th-1 (p=0.049) and Th-2 (p=0.025) cytokine production as well as reduced sensitivity to glucocorticoids (p<0.05), compared with those whose neighbourhood conditions were less challenging. [Pediatrics 2019;doi:10.1542/peds.2018-3300]
“These patterns suggest that neighbourhood social characteristics may function as another level of stressor linked to biological processes in asthma, similar to stressors at the individual and family level,” said the researchers.
“While families may not be able to change their neighbourhoods, they may nonetheless be able to facilitate better asthma outcomes in their children through strong family relationships,” they pointed out.
Among children/teens living in dangerous/disorderly neighbourhoods, those with better family relationship quality had fewer parent-reported asthma symptoms (p=0.046), fewer activity limitations (p=0.008), and higher lung function on spirometry testing (FEV1*; p=0.07).
A stronger family tie was also associated with better responses from the family (p<0.001) and the children/teens themselves (p=0.02) to asthma symptoms of those living in challenging neighbourhoods, indicating that positive family relationships can override the adverse health effects associated with such neighbourhoods through better asthma management behaviours.
In contrast, there was no association between family relationships and asthma outcomes in neighbourhoods rated as having low levels of danger or disorder. In such neighbourhoods, the researchers observed that asthma symptoms, activity limitations, and lung function of children/teens living there were generally good and hence, the influence of family relationships did not really matter.
“Youth exposed to high neighbourhood danger/disorder but with high quality family relationships had asthma profiles similar to youth in low danger/disorder neighbourhoods … perhaps because high quality relationships help youth figure out how to manage their asthma in spite of neighbourhood stressors,” the researcher noted.
Participants in the cross-sectional study were 308 youths aged 9–17 years (mean age 13 years, 55 percent male) with physician-diagnosed asthma. The participants were interviewed on their family relationship quality. Clinical outcomes and management behaviours of asthma were assessed using spirometry, questionnaires, and interviews; while asthma-related immunological responses were evaluated using blood samples. Neighbourhood conditions were rated based on Google Street View images.
“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 neighbourhood stressors in order to minimize the disruption to asthma routines,” said lead author Professor Edith Chen from the Department of Psychology at Northwestern University in Evanston, Illinois, US.
“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 neighbourhoods and examining their effects on childhood asthma outcomes,” she added. "These types of interventions also have the strongest effects on those who are at highest risk at programme entry, so might be particularly useful if targeted at youth living in difficult neighbourhoods.”
“If paediatricians 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 neighbourhood difficulties that many of these families face, this might help families,” said Chen.