The central aim of this multi-measure, multi-informant, longitudinal study is to clarify the extent to which and the mechanisms whereby specific family processes may be protective or deleterious in the adherence behaviors and treatment outcome in 3 groups of children with asthma of mild-moderate severity: 80 children participating in the Denver site of the Childhood Asthma Management Program (CAMP), 80 children receiving asthma-related care in a large, state-of-the-art, nationally recognized health maintenance organization, and 60 children recruited by using school records to identify children with asthma receiving their care in a variety of different health care systems across the Denver metro area. The CAMP study is an NHLBI-sponsored, longitudinal, multicenter, randomized trial of differing asthma treatments in children designed to determine the influence of the treatments on such asthma outcome measures as lung function, bronchial hyper-responsiveness, and asthma morbidity. Additionally, another NHLBI- funded ancillary study will gather detailed data concerning the treatment adherence of children participating in CAMP. The study proposed in this application adds measurements of family processes that dovetail into other data collection efforts underway at the Denver CAMP site. This greatly increases the important scientific aims evaluated by CAMP for a quite modest cost. Furthermore, the parallel study of the two comparison samples not only increases the power of this study to clarify the relationships among family process, adherence, and asthma outcome, but also allows us to evaluate the extent to which participation in a major clinical trial like CAMP alters the relationships observed across these factors. This study has three specific aims: 1) to examine the extent to which family process variables are cross-sectionally associated with and longitudinally influence adherence to asthma treatment, as well as the consistency of this relationship across the three sites; 2) to examine the extent to which family process variables are cross-sectionally associated with and Iongitudinally influence asthma treatment outcome, as well as the consistency of this relationship across the three sites: 3) to determine whether adherence with treatment mediates the relationship between specific family processes and asthma treatment outcome, as well as the consistency of this relationship across the three sites. This study represents a logical next step for The investigator s ongoing research program examining the relationships among specific family processes, health care practices, medical outcomes, and psychosocial adjustment of children with chronic medical illnesses, and has important treatment implications.
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