Addressing Barriers to Physical Activity in Inner-City Schoolchildren with Asthma

解决内城区哮喘学童体育活动的障碍

• 批准号: 8298578
• 负责人: Marina Reznik
• 金额: $ 13.38万
• 依托单位: ALBERT EINSTEIN COLLEGE OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-08-16 至 2015-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8298578
• 关键词: Absenteeism; Accident and Emergency department; Acute; Address; Adoption; Advisory Committees; African American; Age; Area; Asthma; Attitude; Behavior Therapy; Behavioral; Body mass index; Breathing; Caring; Child; Childhood Asthma; Chronic Disease; Clinical Investigator; Clinical Research; Clinical Trials; Collaborations; Communities; Comorbidity; Competence; Cross-Sectional Studies; Data; Disease; Education; Effectiveness; Effectiveness of Interventions; Environment; Exercise; Exercise Physiology; Experimental Designs; Feedback; Foundations; Funding; Future; Goals; Health; Health Services; Health education; Hispanics; Hospitalization; Human Resources; Intervention; Intervention Trial; Interview; Knowledge; Link; Literature; Low income; Measures; Medicine; Methodology; Minority; Morbidity - disease rate; New York; New York City; Nursing Schools; Obesity; Outcome; Outcome Measure; Overweight; Parents; Participant; Patient Self-Report; Pediatric Hospitals; Pediatrics; Phase; Physical Education; Physical Fitness; Physical activity; Pilot Projects; Prevalence; Primary Health Care; Protocols documentation; Provider; Qualitative Methods; Qualitative Research; Quality of life; Randomized Controlled Trials; Recruitment Activity; Reporting; Research; Research Methodology; Resources; Sample Size; School Nursing; School-Age Population; Schools; Self Efficacy; Severities; Site; Social support; Structure; Students; Symptoms; Target Populations; Testing; Time; Training; Underrepresented Minority; United States; Visit; Vulnerable Populations; Weight; Youth; base; behavior change; college; community based participatory research; design; elementary school; fitness; improved; inner city; medically underserved; motivated behavior; obesity prevention; professor; public health relevance; sex; skills; teacher; theories; therapy development

DESCRIPTION (provided by applicant): The candidate, Marina Reznik, MD, MS is an Assistant Professor of Pediatrics at the Albert Einstein College of Medicine (Einstein), Children's Hospital at Montefiore (CHAM). Her long-term goal is to become a productive, independently funded clinical investigator with expertise in developing community-based interventions to improve the health care services and outcomes for medically underserved minority children with chronic diseases such as asthma and obesity. To achieve her goal, Dr. Reznik seeks to augment her prior basic training in clinical research methods and gain skills through combination of advanced didactic courses in behavioral methodology, qualitative research, advanced experimental designs and Community-Based Participatory Research (CBPR) and conducting proposed research. Her research is aimed at developing an intervention that will address barriers and facilitators to physical activity in inner-city minority elementary school students with asthma, more than half of whom are also overweight. Her research agenda is to generate rigorous evidence to improve physical activity in this vulnerable population through an intervention targeted to the needs of the community and developed in partnership with the community. Dr. Reznik proposes a two- phase project to develop and then evaluate a pilot intervention. In phase I, she will identify barriers and facilitators to physical activity using qualitative methods and inform intervention development (Specific Aims 1 and 2). Semi-structured interviews will be conducted with students, parents, school personnel and representatives from the community to identify barriers and facilitators to physical activity in children with asthma. Guided by the results of the qualitative analysis and CBPR principles, a Collaborative Board with representatives from the New York City Departments of Education and Health, South Bronx Asthma Partnership, schools, and parents will be established to provide feedback on intervention development. In phase II, the intervention will be tested via a pilot randomized controlled trial (RCT) for scientific and practical feasibility while assessing the proximal goal of improved physical activity levels, measured objectively with an accelerometer (Specific Aim 3). This pilot study will take place at four resource-poor elementary schools in the Bronx, New York. This study will inform a future large-scale cluster RCT to test the effectiveness of the developed intervention on improving physical activity and fitness levels, motivating behavior change, achieving healthier weight trajectories, and reducing asthma-related morbidity in inner-city minority students with asthma. In the rich research environment of Einstein and CHAM, Dr. Reznik will be guided by a team of three local experts in community-based clinical trials of obesity prevention (Dr. Wylie-Rosett); qualitative research, behavioral intervention trials and CBPR (Dr. Bauman); and clinical trials of school-based exercise intervention (Dr. Ozuah). Advisory committee includes strong foundation in clinical trials of asthma interventions (Drs. Crain and Cabana), design and analysis of clinical trials (Dr. Kim) and exercise physiology (Dr. Rowlands). PUBLIC HEALTH RELEVANCE: Physical activity has been shown to improve pediatric asthma outcomes. However, physical activity levels are low in the United States' children and may even be lower in children with asthma due to disease-related barriers to participation in physical activity. This proposal will address the existent gaps in the literature by identifying barriers and facilitators to participation in physical activity in inner-city minority elementary schoolchildren with asthma, more that half of whom are also overweight; developing and refining a school- based intervention in partnership with the community to improve physical activity; and conducting a pilot randomized controlled trial of the intervention to determine feasibility and obtain preliminary data for a future large-scale trial.

应聘者：Marina Reznik，医学博士，医学硕士，蒙特菲奥尔儿童医院阿尔伯特·爱因斯坦医学院儿科学助理教授。她的长期目标是成为一名富有成效、独立资助的临床调查员，拥有开发基于社区的干预措施的专业知识，以改善患有哮喘和肥胖症等慢性病、医疗服务不足的少数族裔儿童的医疗服务和结果。为了实现她的目标，Reznik博士试图通过结合行为方法论、定性研究、高级实验设计和基于社区的参与性研究(CBPR)的高级教学课程以及进行拟议的研究，来加强她先前的临床研究方法基础培训，并获得技能。她的研究旨在开发一种干预措施，解决市中心患有哮喘的少数民族小学生在体育活动方面的障碍和促进者，其中超过一半的人也超重。她的研究议程是产生严格的证据，通过针对社区需求并与社区合作制定的干预措施，改善这一弱势群体的身体活动。雷兹尼克博士提出了一个分两个阶段的项目，以开发并评估试点干预措施。在第一阶段，她将使用定性方法确定身体活动的障碍和促进者，并告知干预发展(具体目标1和2)。将与学生、家长、学校工作人员和社区代表进行半结构化访谈，以确定哮喘儿童体力活动的障碍和促进者。在定性分析结果和CBPR原则的指导下，将成立一个合作委员会，由纽约市教育和卫生部门、南布朗克斯哮喘伙伴关系、学校和家长的代表组成，就干预措施的制定提供反馈。在第二阶段，将通过试点随机对照试验(RCT)测试干预措施的科学和实际可行性，同时评估用加速度计客观测量的改善体力活动水平的近期目标(特定目标3)。这项试点研究将在纽约布朗克斯区的四所资源匮乏的小学进行。这项研究将为未来的大规模群集式随机对照试验提供信息，以测试所开发的干预措施在改善市中心少数民族哮喘学生的身体活动和健康水平、激励行为改变、实现更健康的体重轨迹以及降低哮喘相关发病率方面的有效性。在爱因斯坦和查姆丰富的研究环境中，雷兹尼克博士将由一个由三名当地专家组成的团队指导，他们从事以社区为基础的肥胖预防临床试验(怀利-罗斯特博士)；定性研究、行为干预试验和CBPR(鲍曼博士)；以及学校运动干预临床试验(奥祖阿博士)。咨询委员会在哮喘干预的临床试验(克雷恩博士和卡巴纳博士)、临床试验的设计和分析(金博士)和运动生理学(罗兰兹博士)方面拥有坚实的基础。 公共卫生相关性：体力活动已被证明可以改善儿童哮喘的预后。然而，美国儿童的体力活动水平很低，由于与疾病有关的参与体力活动的障碍，哮喘儿童的体力活动水平甚至可能更低。这项建议将解决现有文献中存在的空白，办法是确定市中心患有哮喘的少数民族小学生参与体力活动的障碍和促进者，其中一半以上也超重；与社区合作开发和完善基于学校的干预措施，以改善体力活动；对干预措施进行试点随机对照试验，以确定可行性并为未来的大规模试验获得初步数据。