Good Family Relationships Counterbalance Neighborhood Status in Childhood Asthma

Investigators sought to determine whether positive family relationships can safeguard youths who live in dangerous and/or disorderly neighborhoods from poor asthma outcomes.

Healthy family relationships are associated with better asthma outcomes among youths in disorderly or dangerous neighborhoods, according to study results recently published in Pediatrics

This cross-sectional study included 308 participants ages 9 to 17 years, all of whom had an asthma-related physician visit within the past 2 years. All youths were free of acute respiratory illness, were fluent English speakers, and lived in the greater Chicago area. Researchers used questionnaires, interviews, blood samples, and spirometry to assess participant characteristics. They evaluated the youths’ neighborhoods via interviews and virtually using Google Street View and rated neighborhood status according to the following observational parameters:

  • state of streets, sidewalks, buildings, and signs
  • litter and rundown cars
  • graffiti damage
  • abandoned homes, vacant lots, and security bars on windows
  • police cameras, and
  • mitigating factors of churches and schools

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Neighborhood danger and disorder correlated strongly (P <.001) and thus were combined to form a single scale. The quality of family relationships and asthma management practices were gauged through interviews. Investigators used hierarchical multiple regression analyses to examine the associations among asthma outcomes and neighborhood status, family life, neighborhood-family relationships, and participant characteristics.

Neighborhood conditions interacted significantly with the quality of family relationships (P <.05). Among youths living in neighborhoods with low danger and disorder, the association between asthma and family relationship quality was low. In dangerous and disorderly neighborhoods, healthy family relationships were associated with fewer symptoms of asthma (P =.046), better response to asthma symptoms (P =.002), better spirometric measures (P =.07), and fewer limitations to activity (P =.008). Greater danger and disorder in a neighborhood showed a correlation with lower glucocorticoid sensitivity (P =.026) and higher T helper 1 cytokine production (P =.08).

Limitations to this study included a lack of previous family residence addresses, an inability to draw causal conclusions from these data, and the inability to accurately gauge the status of a neighborhood over time using Google Street View.

Study researchers concluded that “when neighborhoods are characterized as dangerous and disorderly, better-quality family relationships are associated with better asthma management behaviors and better asthma outcomes. These patterns are apparent across multiple clinical indicators, including symptoms, activity limitations, and lung function. Together, the results suggest that although families may not be able to do much to change the neighborhoods in which they live, they may nonetheless be able to facilitate better asthma outcomes in their children through strong family relationships.”


Chen E, Hayen R, Le V, et al. Neighborhood social conditions, family relationships, and childhood asthmaPediatrics. 2019;144(2):e20183300.