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

描述（由申请人提供）：儿童在哮喘、肥胖和心血管健康方面的健康差距继续存在。具体来说，哮喘和肥胖是非常普遍的合并症，对少数民族和城市儿童的影响尤为严重。这些疾病具有病理生理（如炎症介质）和环境（生活在城市社区）相关因素，这可能会增加患这两种疾病的风险。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体育活动。一些患有哮喘的儿童在症状控制不佳时往往会限制整体活动，包括身体活动。尽管与城市生活相关的压力源也可能成为这一群体体育活动的障碍，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来检查一组城市儿童的哮喘、身体活动和文化和背景因素之间的关系，这些儿童作为参与nap项目（夜间哮喘和学校表现）的一部分进行了随访（R01 HD057220; Koinis Mitchell， PI）。项目nap包括三个，四个星期的评估期（会话1，S2和S3）在一个学年的过程中。在这项辅助研究中，我们将在第三个评估期（S3）中纳入客观测量的身体活动、哮喘感知、身体活动和环境，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)有机会检查哮喘和过敏性鼻炎症状、身体活动和久坐行为的共同发生；2)在150名超重/肥胖或健康体重的持续性哮喘儿童样本中，深入检查文化和环境对身体活动的潜在影响（S3和S4）。我们假设有更多哮喘和过敏性鼻炎症状的儿童将较少参加中度到剧烈的身体活动（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为明显。我们进一步假设，与哮喘相关的恐惧和对社区安全的感知将各自成为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拉丁裔和AA背景的护理人员中更加明显。最后，我们假设看护者对运动作为哮喘诱因的认知将与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），这种关联也很明显。儿童的认知也有类似的模式。这种关联在拉丁裔和AA背景的看护者和儿童中更为明显。这条研究路线对发展适合文化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身体活动；提高护理人员对哮喘症状和运动性支气管痉挛的认识。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.