Investigating the Relationships among Neighborhood Factors and Asthma Control in African American Children

项目摘要 在美国，超过230万儿童患有不受控制的哮喘，定义为每周≥ 2个症状日，> 1 每月症状夜、活动受限和每周使用急救药物> 2天。非裔美国人 儿童不成比例地受到不受控制的哮喘的影响;他们接受治疗的可能性是儿童的4.1倍。 急诊室和7.6倍的可能性死于哮喘比非西班牙裔白色儿童。 儿童哮喘的种族差异部分归因于在不同环境中成长的不同暴露。 贫困，生活在不安全和压力大的社区，以及不健康的物理环境（空气污染，贫困 住房质量、家中是否有害虫以及是否接触二手烟）。虽然许多这些 邻里水平的因素很难改变，这是一个可能改善哮喘的潜在可改变因素 控制是绿地的可用性。绿地被定义为有草、树或其他植被的土地， 与压力，热量和空气污染的减少有关，这些变量与更好的哮喘控制有关， 孩子然而，很少有研究直接研究了 社区绿地和哮喘产生了好坏参半的结果。结果好坏参半的一个原因可能是， 没有人考虑到可能影响儿童使用城市绿地的关键环境因素 比如邻里安全。生活在不安全社区的父母很可能会让他们的孩子 室内，从而增加他们的孩子暴露于室内哮喘触发因素，并限制潜在的健康 邻里绿地的好处控制儿童家中的室内哮喘诱因，这项研究将 检查邻里绿地、邻里安全和哮喘控制水平之间的关系 在现有的222个样本中，主要是巴尔的摩市的低收入非洲裔美国儿童。具体 这项描述性的横断面研究的目的是检验：1）邻里之间的关联 绿地和哮喘控制水平; 2）邻里安全两个指标之间的关联 （邻里暴力犯罪率和父母对邻里安全的看法）和哮喘控制水平; 邻里安全在多大程度上可以调节邻里之间的关联 绿色空间和哮喘控制水平。我将使用多种测量方法和知情人来捕捉研究变量 包括地理编码、邻里犯罪统计、家长报告和生理测量。拟议 研究培训计划是一个以发展邻里水平技能为重点的学习计划的基础 研究影响城市贫困儿童的健康差距。这项研究符合国家 护理研究所的使命是通过调查 报告还强调了环境和非传染性疾病的发展轨迹，重点是健康方面的差距。

PROJECT SUMMARY Over 2.3 million children in the US have uncontrolled asthma, defined by ≥2 symptom days per week, >1 symptom night per month, activity limitation, and use of rescue medications >2 days per week. African American children are disproportionately affected by uncontrolled asthma; they are 4.1 times more likely to be treated in emergency departments and 7.6 times more likely to die from asthma than are non-Hispanic White children. Racial disparities in childhood asthma have been partially attributed to differential exposures to growing up in poverty, living in unsafe and stressful neighborhoods, and unhealthy physical environments (air pollution, poor quality of housing, presence of pests in the home, and exposure to secondhand smoke). Although many of these neighborhood level factors are difficult to change, one potentially modifiable factor that may improve asthma control is the availability of greenspace. Defined as land with grass, trees, or other vegetation, greenspace has been linked to decreases in stress, heat, and air-pollution, variables associated with better asthma control in children. However, the few studies that have directly examined the relationship between the availability of neighborhood greenspace and asthma have yielded mixed results. One reason for the mixed results may be that none have accounted for critical contextual factors that could influence children’s use of the greenspace in urban cities such as neighborhood safety. Parents living in unsafe neighborhoods are likely to keep their children indoors, thereby increasing their children’s exposures to indoor asthma triggers and limiting the potential health benefits of neighborhood greenspace. Controlling for indoor asthma triggers in children’s homes, this study will examine the associations among neighborhood greenspace, neighborhood safety, and level of asthma control in an existing sample of 222 predominantly low-income, African American children in Baltimore City. The specific aims of this descriptive, cross-sectional study are to examine: 1) the association between neighborhood greenspace and level of asthma control; 2) the associations among two indicators of neighborhood safety (neighborhood violent crime rate and parent perceptions of neighborhood safety), and level of asthma control; and 3) the extent to which neighborhood safety may moderate the association between neighborhood greenspace and level of asthma control. I will use multiple measures and informants to capture study variables including geocoding, neighborhood crime statistics, parent reports, and physiologic measures. The proposed research training plan is foundational to a program of study focused on developing skills in neighborhood level research of health disparities affecting children living in urban poverty. This research aligns with the National Institute of Nursing Research’s mission to promote wellness by investigating the complex relationships between environment and the trajectory of non-communicable disease with an emphasis on health disparities.