Asthma and Physical Activity in Urban Children: Cultural and Contextual Factors

描述（由申请人提供）：在哮喘、肥胖和心血管健康方面的儿科健康差异仍然存在。具体而言，哮喘和肥胖是非常普遍的共病状况，不成比例地影响少数民族和城市儿童。这些病症具有共同的病理生理学（例如，炎症介质）和环境（生活在城市社区）相关，这可能会增加这两种情况的风险。与哮喘发病率和肥胖风险相关的一个关键生活方式行为是身体活动。一些哮喘儿童在症状控制不佳时，倾向于限制整体活动，包括体力活动。虽然与城市生活有关的压力也可能成为这一群体进行体育活动的障碍，但我们对有助于解释少数民族儿童哮喘和体育活动之间关系的潜在文化和背景机制知之甚少。这项辅助研究提供了一个独特的机会，以检查哮喘，体育活动和文化和环境因素之间的关联，在一组城市儿童谁是作为他们参与项目NAPS（夜间哮喘和学校表现（R 01 HD 057220; Koinis Mitchell，PI）的一部分。 项目NAPS包括三个，为期4周的评估期（第1节，S2和S3）在一个学年的过程中。在这项辅助研究中，我们将客观测量的身体活动，以及对哮喘，身体活动和环境的看法纳入第三个评估期（S3），并在下一学年开始时增加第四个评估期（S4）。这个额外的时间点将提供：1）检查哮喘和过敏性鼻炎症状、体力活动和久坐行为的同时发生的机会，以及2）在150例超重/肥胖或健康体重的持续性哮喘儿童样本中深入检查（在S3和S4）对体力活动的潜在文化和背景影响。 我们假设，有更多哮喘和过敏性鼻炎症状的儿童将参加较少的中度到剧烈的体力活动（MVPA）和更多的久坐活动。这些协会将更明显的儿童从拉丁美洲和AA背景比非拉丁美洲白色儿童。我们进一步假设，与哮喘相关的恐惧和对邻里安全的感知将分别是MVPA的独立预测因子，并将预测实际哮喘症状水平和测量的邻里特征之外的活动水平。我们还预计，这些协会将更加明显的照顾者从拉丁美洲和AA背景。最后，我们假设照顾者对运动的感知是哮喘的触发因素，这与MVPA减少和久坐行为增加有关。即使考虑到儿童实际的运动诱发支气管痉挛状态（EIB），这种关联也是显而易见的。儿童的感知也有类似的模式。这种关联在拉丁裔和AA背景的照顾者和儿童中更为明显。 这一系列的研究对开发文化定制的干预措施具有重要意义：增加持续性哮喘的城市儿童的体力活动;提高护理人员对哮喘症状和运动诱发的支气管痉挛的理解。最终，研究结果可能会对改善城市和少数民族持续性哮喘儿童的护理标准产生影响。

DESCRIPTION (provided by applicant): Pediatric health disparities in the area of asthma, obesity and cardiovascular fitness continue to exist. Specifically, asthma and obesity are highly prevalent co-morbid conditions that disproportionately affect ethnic minority and urban children. These conditions share pathophysiological (e.g., inflammatory mediators) and contextual (living in an urban neighborhood) correlates, which may increase the risk for both conditions. A key lifestyle behavior implicated in both asthma morbidity and obesity risk is physical activity. Some children with asthma tend to restrict overall activities, including physical activity, when symptoms are in poor control. Although stressors related to urban living may also serve as barriers to physical activity among this group, we know little about the potential cultural and contextual mechanisms that help explain the association between asthma and physical activity in ethnic minority children. This ancillary study offers a unique opportunity to examine the association between asthma, physical activity and cultural and contextual factors in a group of urban children who are followed as part of their participation in Project NAPS (Nocturnal Asthma and Performance in School (R01 HD057220; Koinis Mitchell, PI). Project NAPS includes three, 4-week assessment periods (Session 1, S2, & S3) over the course of one academic year. In this ancillary study, we will incorporate objectively measured physical activity, and perceptions of asthma, physical activity and context to the third assessment period (S3), and add a fourth assessment period (S4) to occur at the start of the following academic year. This additional time point will provide: 1) an opportunity to examine the co-occurrence of asthma and allergic rhinitis symptoms, physical activity, and sedentary behavior, and 2) an in depth examination (at S3 and S4) of potential cultural and contextual influences on physical activity in a sample of 150 children with persistent asthma who are overweight/obese or healthy weight. We hypothesize that children with more asthma and allergic rhinitis symptoms will participate in less moderate to vigorous physical activity (MVPA) and more sedentary activities. These associations will be more pronounced in children from Latino and AA backgrounds than in Non-Latino White children. We further hypothesize that fear related to asthma and perceptions of neighborhood safety will each be independent predictors of MVPA, and will predict activity levels beyond actual asthma symptom level and measured neighborhood characteristics. We also expect these associations will be more pronounced in caregivers from Latino and AA backgrounds. Finally, we hypothesize that caregivers' perception of exercise as a trigger for asthma will be related to less MVPA and more sedentary behavior. This association will be apparent even when accounting for children's actual exercise-induced brochospasm status (EIB). A similar pattern will be found for children's perceptions. This association will be more pronounced in caregivers and children of Latino and AA backgrounds. This line of research has significant implications for the development of cultural tailored interventions to: increase physical activity n urban children with persistent asthma; and improve caregiver understanding of asthma symptoms and exercise induced-bronchospasm. Ultimately, study findings could have implications for improving the standard of care for urban and ethnic minority children with persistent asthma.