Neighborhood Social Conditions, Family Relationships, and Childhood Asthma

To determine if positive family relationships mitigate the negative impact that residing in a dangerous neighborhood can have on asthma.

In total, 308 children (age 9–17 years) with physician-diagnosed asthma living in the Chicago area were studied. The majority (70%) had mild-moderate persistent asthma, and 14% had severe asthma. Exclusion criteria included other chronic diseases and acute respiratory illness.

This was a cross-sectional, observational study. Neighborhood danger was assessed by two raters who observed subjects’ neighborhoods on Google Earth Pro and Google Street View Imagery. Signs of physical disorder (litter, graffiti, defaced property, dilapidated cars) were coded and a separate global assessment of danger was made, both of which demonstrated high interrater reliability (0.77–0.90). Children were queried using the University of California Los Angeles Life Stress Interview to assess family relationship quality over the past 6 months. The Family Asthma Management System Scale quantified how well families responded to acute respiratory symptoms and integrated asthma management into their daily lives. Hierarchical multiple-regression analyses were used to predict asthma outcomes (activity impairment, forced expiratory volume in 1s [FEV₁], T helper type 1 [Th1] and type 2 [Th2] cytokine levels, and glucocorticoid sensitivity) based on scores rating neighborhood disorder and/or danger, family relationship quality, and the interaction between these two covariates.

When neighborhood disorder and/or danger were high, enhanced family relationship quality was associated with improved control of asthma symptoms, reduced activity impairment, higher FEV1, and better family asthma management. This relationship was not observed when neighborhood disorder and/or danger were low. Greater neighborhood danger was associated with increased production of Th1 and Th2 cytokines following mitogenic stimulation and reduced glucocorticoid sensitivity, neither of which were modified by the quality of family relationships.

High-quality family relationships were associated with improved asthma control in children living in dangerous neighborhoods. Pediatricians may encourage families to develop positive relationships to modify the detrimental effect of neighborhood danger on asthma.

This is the first study to demonstrate the protective impact of good family relationships on asthma outcomes. Limitations include the cross-sectional nature of the study, absent data regarding medication adherence and asthma exacerbations, and lack of stratification of outcomes based on asthma severity, to see if the protective advantage was maintained in patients with severe asthma. Use of objective assessments of asthma activity and high interrelater reliability on subjective scales are strengths. We know that disparities in asthma outcomes exist, and families living in the harshest conditions suffer the most. Although it would be tone-deaf for physicians to simply tell families living in these conditions to “be more supportive of one another,” authors of this study offers interesting insight into how we can foster these connections and help families in need understand how to control what they can control.