Neighborhood Social Conditions, Family Relationships, and Childhood Asthma

Abstract

Background and objectives: 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.

Methods: 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.

Results: Significant interactions were found between neighborhood conditions and family relationship quality (β = |.11-.15|; P < .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.

Conclusions: 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.

FIGURE 1

Interaction between neighborhood conditions and family relationship quality predicting asthma activity limitations, with higher scores indicating more activity limitations. The figure depicts estimated regression lines at ±1 SD of neighborhood danger. Lower and higher family relationship quality also refer to ±1 SD.

FIGURE 2

Interaction between neighborhood conditions and family relationship quality predicting asthma management behaviors. A, How well families respond to their child’s asthma symptoms. B, How well families balance managing asthma within their daily lives. In both cases, higher scores indicate better asthma management. The figure depicts estimated regression lines at ±1 SD of neighborhood danger. Lower and higher family relationship quality also refer to ±1 SD.