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

描述(申请人提供)：儿童在哮喘、肥胖和心血管健康方面的健康差距仍然存在。具体地说，哮喘和肥胖是高度普遍的并存疾病，对少数民族和城市儿童的影响不成比例。这些疾病具有共同的病理生理(例如，炎症介质)和背景(居住在城市社区)的相关性，这可能会增加这两种疾病的风险。与哮喘发病率和肥胖风险有关的一个关键生活方式行为是体力活动。当症状控制不佳时，一些哮喘儿童倾向于限制整体活动，包括体力活动。尽管与城市生活相关的压力源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与体育活动之间联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，在一组城市儿童中检查哮喘、体育活动与文化和背景因素之间的联系，作为他们参与午睡项目(夜间哮喘与在校表现)的一部分(R01HD057220；Koinis Mitchell，PI)。项目国家行动方案包括三个为期4周的评估期(第1节、第2节和第3节)，为期一学年。在这项辅助研究中，我们会把客观量度的体力活动，以及对哮喘、体力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加入第四个评估期(S4)。这一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共存的机会，以及2)深入检查(在中三和中四)对150名超重/肥胖或正常体重的持续性哮喘儿童的潜在文化和背景影响对体力活动的影响。我们假设，有更多哮喘和过敏性鼻炎症状的儿童将参与较少的中等到剧烈的体力活动(MVPA)和更多的久坐活动。这些关联在拉丁裔和AA背景的儿童中比在非拉丁裔白人儿童中更加明显。我们进一步假设，与哮喘相关的恐惧和对社区安全的看法都将是MVPA的独立预测因子，并将预测超出实际哮喘症状水平和测量的社区特征的活动水平。我们还预计，这些关联将在来自拉丁裔和AA背景的照顾者中更加明显。最后，我们假设护理者认为运动是哮喘的诱因，这将与较少的MVPA和更多的久坐行为有关。即使考虑到儿童实际的运动性布鲁斯痉挛状态(EIB)，这种联系也是显而易见的。在儿童的感知上也会发现类似的模式。这种关联在照顾者和具有拉丁裔和AA背景的儿童中将更加明显。这一系列研究对制定有文化针对性的干预措施具有重要意义：增加患有持续性哮喘的城市儿童的体力活动；提高照顾者对哮喘症状和运动性支气管痉挛的了解。最终，研究结果可能对改善患有持续性哮喘的城市和少数民族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.