title: Difficult Family Relationships, Residential Greenspace, and Childhood Asthma.
abstract: OBJECTIVE
  Both the social environment and the physical environment are increasingly recognized as important to childhood diseases such as asthma. This study tested a novel hypothesis: that living in areas high in greenspace may help buffer the effects of difficult family relationships for children with asthma.
  
  
  METHODS
  A total of 150 children (ages 9-17), physician-diagnosed with asthma, participated in this study. To assess difficulties in parent-child relationships, parents and children completed measures of harsh/inconsistent parenting and parental hostility. Residential greenspace was calculated by using satellite-derived Normalized Difference Vegetation Index with a buffer of 250 m around the residential address. Outcomes included both clinical and biological measures: asthma control and functional limitations, as well as airway inflammation (fractional concentration of exhaled nitric oxide) and glucocorticoid receptor expression in T-helper cells.
  
  
  RESULTS
  After controlling for potential confounding variables, including family income, child demographics, and child medical variables, few main effects were found. However, interactions between residential greenspace and difficult family relationships were found for asthma control (P= .02), asthma functional limitations (P= .04), airway inflammation (P= .007), and the abundance of glucocorticoid receptor in T-helper cells (P= .05). These interactions were all in a direction such that as the quality of parent-child relationships improved, greenspace became more strongly associated with better asthma outcomes.
  
  
  CONCLUSIONS
  These findings suggest synergistic effects of positive environments across the physical and social domains. Children with asthma appear to benefit the most when they both live in high greenspace areas and have positive family relationships.
authors.affiliation: Institute for Policy Research and Department of Psychology, Northwestern University, Evanston, Illinois; edith.chen@northwestern.edu.
authors.forename: Edith
authors.initials: E
authors.lastname: Chen
authors.affiliation: Institute for Policy Research and Department of Psychology, Northwestern University, Evanston, Illinois.
authors.forename: Gregory E
authors.initials: GE
authors.lastname: Miller
authors.affiliation: Center for Clinical Research Informatics, and.
authors.forename: Madeleine U
authors.initials: MU
authors.lastname: Shalowitz
authors.affiliation: Department of Medicine, NorthShore University HealthSystem, Evanston, Illinois; and.
authors.forename: Rachel E
authors.initials: RE
authors.lastname: Story
authors.affiliation: Institute for Policy Research and Department of Psychology, Northwestern University, Evanston, Illinois.
authors.forename: Cynthia S
authors.initials: CS
authors.lastname: Levine
authors.affiliation: Institute for Policy Research and Department of Psychology, Northwestern University, Evanston, Illinois.
authors.forename: Robin
authors.initials: R
authors.lastname: Hayen
authors.affiliation: University of British Columbia, School of Population and Public Health, Vancouver, British Columbia, Canada.
authors.forename: Hind
authors.initials: H
authors.lastname: Sbihi
authors.affiliation: University of British Columbia, School of Population and Public Health, Vancouver, British Columbia, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Brauer
mesh_terms: D000293:Adolescent; D001249:Asthma / Q000209:etiology* / Q000503:physiopathology / Q000523:psychology; D002648:Child; D004781:Environmental Exposure; D005195:Family Relations / Q000523:psychology*; D005260:Female; D006798:Housing; D006801:Humans; D008297:Male; D010287:Parent-Child Relations; D016487:Parenting / Q000523:psychology*; D011795:Surveys and Questionnaires