Naturalistically observed conflict and youth asthma symptoms.

Multiple factors in family environment have been known to exacerbate childhood asthma morbidity, such as psychological stress (Marin, Chen, Munch, & Miller, 2009), marital conflict (Northey, Griffin, & Krainz, 1998), parental stress (Shalowitz, Berry, Quinn, & Wolf, 2001), and family conflict (Anda et al., 2006). Additional family characteristics, such as poor caregiver or youth mental health (Ortega, Goodwin, McQuaid, & Canino, 2004; Wood et al., 2007), family disorganization (Kaugars, Klinnert, & Bender, 2004), and minority ethnicity (Bauman et al., 2002) all are contributing components through which the family environment and stress can negatively impact the asthma symptom profile. Research also has demonstrated that increased exposure to stress in adolescents with asthma is associated with greater eosinophil counts, increased lymphocyte proliferation, and increased production of pro-inflammatory cytokines, which may contribute to increased asthma symptom expression (Chen et al., 2006; Kang et al., 1997). Given the accumulating evidence for a biopsychosocial model of asthma, it is important for researchers to identify aspects of relationships that can contribute to the exacerbation and persistence of asthma symptoms. Furthermore, the research to date has largely focused on the extent to which very general family characteristics, such as family-related stress, impact asthma morbidity during youth using parent and youth accounts of the family environment. No investigations to our knowledge have examined the direct effect of daily conflict in everyday life on youth health. Frequent conflict in the home has been theorized to create vulnerabilities in youth by disrupting biological and psychological processes through interactions with genetic and environmental factors (Repetti, Taylor, & Seeman, 2002). Family conflict has been associated with a variety of poor health outcomes, including lower weight attainment in infancy (Stein, Woolley, Cooper, & Fairburn, 1994), slower growth in childhood (Montgomery, Bartley, & Wilkinson, 1997), and greater psychological distress during adolescence (Gunnlaugsson , Kristjansson, Einarsdottir, & Sigfusdottir, 2011). Research also has demonstrated that youth growing up in environments with increased conflict and anger have amplified emotional responses to stressors and more often use maladaptive coping strategies, which negatively impact physical health (Cummings, Zahn-Waxler, & Radke-Yarrow, 1981; Repetti, Robles, & Reynolds, 2011; Valiente, Fabes, Eisenberg, & Spinrad, 2004). Surprisingly, very little is known about the direct impact of conflict at home on serious physical health problems, such as asthma during childhood and adolescence. Moreover, there has been a recent call for research focusing on the adversities youth face on a routine basis, such as family conflict, to clarify links between stress during development and chronic illness (Miller, Chen, & Parker, 2011). Family conflict is a construct that typically is measured via brief questionnaire reports or laboratory interactions. However, questionnaire reports of family conflict include potential sources of bias, aspects of social desirability, and shared method variance (Campbell & Fiske, 1959; Mehl, Robbins, & Deters, 2012). Additionally, assessing family conflict from short laboratory interactions can raise questions regarding generalizability of these interactions, as research has long documented variations in parental behaviors due to changes in the context in which they are measured (Belsky, 1980). Research suggests that data should be collected from multiple informants (e.g., from both parents and children) due to contextual elements and situational determinants that may influence an individual's perceptions (Achenbach, McConaughy, & Howell, 1987; Kerr, Lunkenheimer, & Olson, 2007). Collecting questionnaire data from multiple informants can sometimes pose a challenge in family research. Alternatively, naturalistic observation can provide reasonably objective and detailed accounts of daily interactions in the home. The Electronically Activated Recorder (EAR; Mehl, Pennebaker, Crow, Dabbs, & Price, 2001) is a relatively new naturalistic observation method used to capture participant behaviors and interactions as they occur in daily life. The EAR unobtrusively takes brief recordings of ambient sounds and interactions as they occur in a participant's environment. By taking an observational approach, the EAR helps to address the potential issues of bias, shared method variance, and generalizability that can sometimes hinder questionnaire and laboratory measures of conflict. Previous studies of families have documented the usefulness of the EAR in assessing everyday behaviors in the home. For example, parental negative emotionality (Slatcher & Trentacosta, 2012) and parental depressive symptoms (Slatcher & Trentacosta, 2011) have been linked with increased problem behaviors in young children. Increased observed-conflict in the home of young children (aged 3-5) was associated with an altered diurnal cortisol profile, including flatter (less “healthy”) cortisol slopes and lowered waking cortisol levels, whereas maternal questionnaire reports of daily parent-child conflict were unrelated to cortisol patterns (Slatcher & Robles, 2012). To our knowledge, no studies to date have addressed how naturalistically-observed everyday family interactions are associated with youth asthma symptoms. This study addresses that gap by using the EAR to assess the links between observed conflict in the home and the health of youth with asthma.