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Buffering Effects of Supportive Caregiving

Shakira Franco Suglia, MS, ScD; Michelle Bosquet Enlow, PhD; Antje Kullowatz, PhD; Rosalind J. Wright, MD, MPH

Arch Pediatr Adolesc Med. 2009;163(3):244-250.

Objectives  To examine the relationship between maternal intimate partner violence (IPV) and asthma onset in children and the role of supportive caregiving factors in modifying this relationship.

Design  Prospective birth cohort.

Setting  In-person interview at enrollment as well as in-home interviews during study follow-up.

Participants  Children (N = 3116) enrolled in the Fragile Families and Child Wellbeing Study.

Main Exposures  Maternal report of IPV assessed after the child's birth and at 12 and 36 months. In addition, mothers indicated how many days a week they participated in activities with the child and the amount and type of educational/recreational toys available for the child.

Main Outcome Measure  Maternal report of physician-diagnosed asthma by age 36 months.

Results  Asthma was diagnosed in 19% of children. In adjusted analysis, children of mothers experiencing IPV chronically, compared with those not exposed, had a 2-fold increased risk of developing asthma. In stratified analysis, children of mothers experiencing IPV and low levels of mother-child activities (relative risk, 2.7; 95% confidence interval, 1.6-4.7) had a significant increased risk for asthma. Those exposed to IPV and high levels of mother-child activities had a lower risk for asthma (relative risk, 1.6; 95% confidence interval, 0.9-3.2). A similar buffering effect was noted among children with high numbers of educational/recreational toys.

Conclusions  Intimate partner violence is associated with increased early childhood asthma risk. Maternal ability to maintain positive caregiving processes in this context may buffer the effects of violence on child asthma risk. The best way to promote positive health in toddlers may be to help their mothers.

Author Affiliations: Department of Environmental Health, Harvard School of Public Health (Drs Franco Suglia, Kullowatz, and Wright), Department of Psychiatry, Children's Hospital Boston (Dr Bosquet Enlow), and Channing Laboratory, Department of Medicine, Brigham and Women's Hospital (Dr Wright), Harvard Medical School (Dr Bosquet Enlow), Boston, Massachusetts.

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