1. In this cross sectional study, children with asthma living in dangerous neighborhoods were less likely to have asthma symptoms if they had strong family relationships.
2. Greater neighborhood danger was associated with increased asthma-related activity limitations, larger Th2 cytokine response, and less sensitivity to glucocorticoids.
Evidence Rating Level: 3 (Average)
Study Rundown: Though previous studies have demonstrated that negative health outcomes are associated with living in poor or dangerous neighborhoods, fewer studies have focused on factors that can protect against these deleterious outcomes. In this cross sectional study, researchers explored whether or not strong family support improved asthma outcomes among children living in poor neighborhoods. Surveying children and their families from the greater Chicago area, researchers discovered that children with higher quality family relationships were less likely to report activity limitations related to their asthma. Stronger family relationships were also correlated with better responses to asthma symptoms. Greater neighborhood danger was associated with less sensitivity to glucocorticoids, increased Th2 cytokine response, poorer family response to asthma symptoms, and greater asthma-related activity limitations. Overall, though this study is limited by its cross-sectional design and subsequent inability to determine causation, the association between strong family relationships and fewer asthma-related symptoms offers pediatricians an area of targeted intervention that may help patients who live in higher-risk environments.
Relevant Reading: Community Violence and Asthma Morbidity: The Inner-City Asthma Study
In-Depth [cross-sectional study]: In this study, researchers completed a cross-sectional analysis from 2013 to 2016 of 308 youths ages 9 to 17 years (55% male, 50% white, 26% African American). Participants lived in the greater Chicago area and had been diagnosed with asthma by a physician. Both parents and children completed surveys and interviews, and children were asked to perform spirometry and provide venous blood. Higher-quality family relationships were associated with better responses to asthma symptoms (P = .002) and more balanced integration of asthma into day to day life (P < .001). In more dangerous neighborhoods, higher quality family relationships were associated with fewer reported asthma-related activity limitations (P = .008). In contrast, higher danger neighborhoods were associated with more asthma-related activity limitations (P = .004), poorer family responses to asthma symptoms (P = .027), increased Th2 cytokine responses (P = .025), and less sensitivity to glucocorticoids (P = .026).
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