A COMMUNITY UNITED TO REDUCE DISPARITIES IN COMORBID PEDIATRIC ASTHMA AND OBESITY

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The associations in prevalence and morbidity between asthma and obesity suggest that interventions targeting comorbid asthma and obesity may lead to greater success in controlling both conditions. The team of investigators for this proposal has developed strong partnerships with local organizations in a low-income minority community in Chicago where asthma and obesity rates are significantly higher than the national rates. Community prevalence of asthma and obesity has been determined, qualitative pilot work has been conducted, and the community is now prepared for action on these diseases. This proposal aims to develop an intervention for comorbid asthma and obesity. The first phase of this study is to define the intervention. Specific Aim 1 is to conduct a qualitative exploration of comorbid asthma and obesity. The results will inform the design of the subsequent interventions. Phase 2 is to conduct several pilot studies to determine the feasibility and efficacy of an individual-level intervention and a community-level intervention to improve asthma control and obesity in overweight/obese minority children with asthma ages 5-12. Specific Aim 2 will begin with a pilot behavioral randomized controlled trial to test the feasibility and efficacy of a home intervention that provides self-management skills education to families. Outcomes measured in the one-year trial of 100 participants include asthma control, body mass index, physical activity, and stress/distress. The following year, a school-wide intervention that targets teachers, parents, and children in the school environment will be pilot tested. Outcomes for this pilot include schoollevel measures of absenteeism from asthma, physical activity, and school meal content. A 50 participant cohort of overweight/obese children with asthma in the target school will also be followed to assess individual changes in asthma control and body mass index. Because of the epidemic levels of community violence in Chicago and the high levels of sexual abuse and violence for inner-city children in general, an Exploratory Aim is to assess the relationships between reported caregiver major and traumatic stressors, biomarkers of stress in caregivers, child reported major and traumatic stressors, and biomarkers of stress in children with comorbid asthma and obesity. After completion of these interventions. Phase 3 will evaluate the outcomes and possibly conduct further small qualitative studies to determine which elements should be included in future intervention efforts. The intervention design that results will be the focus of future NIH grant proposals emanating from the Rush Centerfor Urban Health Equity.