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Journ. of Fam.Ther.
Family Process
perspekt. mediation
Psychoth. im Dialog
Soziale Systeme
System Familie
"Das erste Mal"
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Family Process Heft 1/2008
1/2008 - 2/2008 - 3/2008 - 4/2008 - Überblick

Fiese, Barbara H. (2008): Breathing Life into Family Processes: Introduction to the Special Issue on Families and Asthma. In: Family Process 47(1), S. 1-5

abstract: This introduction to the special issue dedicated to families and asthma proposes that the study of asthma highlights general systems topics such as integration of individual needs into the group, developmental trajectories of risk and resilience, supportive and destructive patterns of interaction, and the cultural adaptation of family therapy. It briefly introduces papers in the special issue and concludes that asthma can serve as an exemplar in the study of family health due to its comorbidity with mental health problems, potential to affect multiple members of the family, disproportionate influence on low-income and minority families, and multiple avenues for intervention.

Celano, Marianne, Roger Bakeman, Osvaldo Gaytan, Chaundrissa Oyeshiku Smith, Anne Koci & Sasschon Henderson (2008): Caregiver Depressive Symptoms and Observed Family Interaction in Low-Income Children with Persistent Asthma. In: Family Process 47(1), S. 7-20

abstract: This study examined the relationship between caregiver depressive symptoms and observed parenting behaviors and family processes during interactions among 101 urban, low-income Africtan American families with children with persistent asthma. Caregivers (primarily female) were assessed on four dimensions (i.e., warmth/involvement, hostility, consistent discipline, relationship quality) in three videotaped interaction tasks (loss, conflict, cohesion). The results indicated that increased depressive symptoms were significantly associated with lower warmth/involvement and synchrony scores and greater hostility scores during the loss and conflict tasks. In the total sample, the highest levels of hostility and the lowest levels of warmth/involvement were found for the conflict task; nevertheless, caregivers with moderate/severe depressive symptoms showed a significantly greater increase in hostility from the loss to the conflict task than caregivers with minimal/mild depressive symptoms. The findings highlight the salience of considering task content in family observational process research to expand our understanding of depressed and nondepressed caregivers' abilities to modulate appropriately their behaviors and affect across various family interactions. Implications for improving asthma management for low-income children with persistent asthma are discussed, including the utility of multidisciplinary interventions that combine asthma education with family therapy.

Wood, Beatrice L., Jungha Lim, Bruce D. Miller, Poann Cheah, Tressa Zwetsch, Sujatha Ramesh & Samuel Simmens (2008): Testing the Biobehavioral Family Model in Pediatric Asthma: Pathways of Effect. In: Family Process 47(1), S. 21-40

abstract: This study uses a laboratory-based multiinformant, multimethod approach to test the hypothesis that a negative family emotional climate (NFEC) contributes to asthma disease severity by way of child depressive symptoms, and that parent-child relational insecurity mediates the effect. Children with asthma (n=199; aged 7-17; 55% male) reported parental conflict, parent-child relational security, and depressive symptoms. Parent(s) reported demographics, asthma history, and symptoms. Asthma diagnosis was confirmed by clinical evaluation and pulmonary function tests, with disease severity rated by an asthma clinician according to NHLBI guidelines. Family interactions were evoked using the Family Process Assessment Protocol, and rated using the Iowa Family Interaction Rating Scales. Path analysis indicated a good fit of data to the hypothesized model (chi2[1]=.11, p=.74, NFI=.99, RMSEA=.00). Observed NFEC predicted child depression (beta=.19, p<.01), which predicted asthma disease severity (beta=.23, p<.01). Relational security inversely predicted depressive symptoms (beta=-.40, p<.001), and was not a mediator as predicted, but rather an independent contributor. The findings are consistent with the Biobehavioral Family Model, which suggests a psychobiologic influence of specific family relational processes on asthma disease severity by way of child depressive symptoms.

Klinnert, Mary D., Astrida S. Kaugars, Matthew Strand & Lori Silveira (2008): Family Psychological Factors in Relation to Children's Asthma Status and Behavioral Adjustment at Age 4. In: Family Process 47(1), S. 41-61

abstract: The objectives of this study were to determine whether family psychosocial factors influenced asthma development by age 4, and whether family factors and early wheezing illness were associated with behavioral adjustment at age 4. Participants were 98 children enrolled in an intervention study at 9-24 months and followed to age 4. Baseline evaluations assessed infants' respiratory illness severity, family psychosocial characteristics, and parental risk factors for asthma development. Active asthma categorization at age 4 utilized both parent report and objective data. Parents completed the Child Behavior Checklist (CBCL). Caregiver single-parent status, a composite of baseline family stresses, and early wheezing illness severity were associated with active asthma at age 4. The contribution of prenatal smoke exposure and early hospitalization to active asthma varied with racial/ethnic group membership. Maternal mental health and family stresses predicted CBCL scores at age 4, whereas early illness severity and hospitalization were unrelated to CBCL scores. CBCL scores were not elevated for children with active asthma at age 4. Family factors consistent with a negative emotional environment were associated with both active asthma and adjustment problems at age 4, suggesting that both outcomes may be influenced by a common factor.

Fiese, Barbara, Marcia Winter, Ran Anbar, Kimberly Howell & Scott Poltrock (2008): Family Climate of Routine Asthma Care: Associating Perceived Burden and Mother-Child Interaction Patterns to Child Well-being. In: Family Process 47(1), S. 63-79

abstract: This preliminary report links the literatures on family asthma management practices and on the characteristics of family interaction patterns thought to influence children's adjustment to a chronic physical illness. Specifically, this study of 60 families with a child with asthma examined the extent to which perceived burden of routine asthma care affected child mental health via its influence on parent-child interaction patterns. Mothers completed a measure of asthma management routine burden, mother and child were observed in a 15-minute interaction task, and children completed measures of child anxiety and asthma quality of life (QOL). Perceived routine burden significantly predicted child anxiety and QOL through its effect on mother-child rejection/criticism. The same pattern did not hold for mother intrusiveness/control. The results are discussed in terms of how overall family climate and regulation of routines affects child well-being. Implications for clinical practice and limitations of the study are provided.

Wamboldt, Frederick S., Ronald C. Balkissoon, Allison E. Rankin, Stanley J. Szefler, S. Katharine Hammond, Russell E. Glasgow & W. Perry Dickinson (2008): Correlates of Household Smoking Bans in Low-Income Families of Children With and Without Asthma. In: Family Process 47(1), S. 81-94

abstract: Exposure to secondhand smoke (SHS) harms all children's health, especially children with asthma. Yet, children with asthma are as likely to live with smokers as healthy children. Household smoking bans are being advocated to reduce children's harm from SHS. To measure the effect of household smoking bans on child SHS exposure and to examine correlates of strict smoking bans in a low-income, diverse sample, 91 children with asthma were matched to 91 healthy children. All had at least one smoker living in their homes. Nicotine dosimeters, child cotinine assays, and maternal reports quantified child SHS exposures. Maternal reports of household smoking rules, behaviors, and beliefs, and other family characteristics were also gathered. The presence of a strict household smoking ban vastly reduced children's SHS exposures and was associated with fewer cigarettes smoked by the mother and by other family members, the belief that SHS was a personal health risk, having children with asthma, and living in a single-family home. Many children are exposed to high levels of SHS at home. Strict household smoking bans greatly decrease, but do not eliminate children's SHS exposure. Even in disadvantaged families, mutable factors were associated with strict smoking bans. Increased dissemination and use of established public health strategies are needed to reduce children's SHS exposures.

Bruzzese, Jean-Marie, Lynne Unikel, Richard Gallagher, David Evans & Vivian Colland (2008): Feasibility and Impact of a School-Based Intervention for Families of Urban Adolescents with Asthma: Results from a Randomized Pilot Trial. In: Family Process 47(1), S. 95-113

abstract: The purpose of this study was to test the feasibility and short-term outcomes of Asthma: It's a Family Affair!, a school-based intervention for adolescents with asthma and their caregivers. Twenty-four ethnic minority families with a middle school student with asthma were randomized to immediate intervention or no-treatment control. Intervention students received six group sessions on prevention and management of asthma. Caregivers received five group sessions teaching child-rearing skills to support the youth's autonomy and asthma self-management. All students attended all sessions; caregivers attended an average of three. Two months post-intervention, relative to controls, intervention caregivers reported better problem-solving with children. Intervention students were more responsible for carrying medication, took more prevention steps, and woke fewer nights from asthma. The intervention resulted in positive short-term changes in family relations, asthma management by students, and health status.

Ng, S.M., Albert M. Li, Vivian W.Q. Lou, Ivy F. Tso, Pauline Y.P. Wan & Dorothy F.Y. Chan (2008): Incorporating Family Therapy into Asthma Group Intervention: A Randomized Waitlist-Controlled Trial. In: Family Process 47(1), S. 115-130

abstract: Asthma psychoeducational programs have been found to be effective in terms of symptom-related outcome. They are mostly illness-focused, and pay minimal attention to systemic/familial factors. This study evaluated a novel asthma psychoeducation program that adopted a parallel group design and incorporated family therapy. A randomized waitlist-controlled crossover clinical trial design was adopted. Children with stable asthma and their parents were recruited from a pediatric chest clinic. Outcome measures included, for the patients: exhaled nitric oxide (eNO), spirometry, and adjustment to asthma; and for the parents: perceived efficacy in asthma management, Hospital Anxiety and Depression Scale anxiety subscale, Body Mind Spirit Well-being Inventory emotion subscale, and Short Form 12 health-related quality of life scale. Forty-six patients participated in the study. Attrition rates were 13.0% and 26.0% for the active and control groups, respectively. Repeated-measures ANOVA revealed a significant decrease in airway inflammation, as indicated by eNO levels, and an increase in patient's adjustment to asthma and parents' perceived efficacy in asthma management. Serial trend analysis revealed that most psychosocial measures continued to progress steadily after intervention. Significant improvements in both symptom-related measures and mental health and relationship measures were observed. The findings supported the value of incorporating family therapy into asthma psychoeducation programs.

Wamboldt, Frederick S. (2008): Asthma Theory and Practice: It's Not too Simple. In: Family Process 47(1), S. 131-136

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