Protective Factors in Urban Children with Asthma

描述（由申请人提供）：在美国，低收入、城市和少数民族背景的儿童中，儿童哮喘的比例过高。NIH正在积极推动研究，以确定减少少数民族、低收入儿童与健康的白色儿童之间健康差距的因素。与患有哮喘和面临社会压力源（贫困，文化适应压力）相关的综合风险可能会增加功能障碍（例如，增加紧急访问）。然而，尽管面临这些风险，但仍有城市儿童和家庭有效地控制了哮喘。 该项目的主要目标是确定儿童特定的，文化的，疾病特定的保护过程，尽量减少哮喘发病率，尽管暴露在逆境中的城市，低收入的儿童。在基线（初始访视）和随访（一年后）检查的哮喘发病率指标包括：哮喘相关急诊室访视次数、住院次数和功能受限程度。风险和弹性理论模型将应用于本研究。累积风险指数（CRI）将提供一个分数，表明家庭可能面临的几种城市风险的数量和严重程度。参与者将包括来自非洲裔美国人，拉丁美洲人和盎格鲁背景的低收入和城市8-11岁儿童（N= 150，每个民族50个家庭）。哮喘儿童及其主要照顾者将参与家庭观察和基于访谈的风险，保护过程和发病率评估。基线访谈后三个月，家庭将参加纵向随访部分（为期一年）。间隔三个月的四次电话访谈将收集发病率信息。 建议较高水平的儿童，文化和哮喘特异性因素将缓和的累积风险水平和最低哮喘发病率之间的关系，在基线和后续的城市儿童。较高水平的儿童特异性和哮喘特异性因素将最大限度地减少非裔美国人、西班牙裔和盎格鲁儿童的发病率。与最低发病率有关的文化因素（家庭价值观和信仰）因族裔亚组而异。研究结果将用于设计一种文化敏感的哮喘干预措施，以加强少数民族、城市和贫困家庭的哮喘管理行为。

DESCRIPTION (provided by applicant): Pediatric asthma is over-represented in children from low income, urban, and ethnic minority backgrounds in the U.S. The NIH is actively promoting research that identifies factors that decrease the health disparities between ethnic minority, low-income children and their healthier, white counterparts. The combined risks related to having asthma and facing social stressors (poverty, acculturative stress) may increase functional impairment (e.g., increased emergency visits). However, there are urban children and families who are managing asthma effectively, despite facing such risks. The primary objectives of this project are to identify child-specific, cultural, and disease-specific protective processes that minimize asthma morbidity despite exposure to adversity in urban, low-income children. Indices of asthma morbidity to be examined at baseline (initial visit) and follow-up (one year later) include: the number of asthma-related emergency room visits, hospitalizations, and degree of functional limitation. A risk and resilience theoretical model will be applied to this study. A Cumulative Risk Index (CRI) will provide a score that indicates the number and severity of several urban risks that families may face. Participants will include low-income and urban, 8-11 year old children from African-American, Latino, and Anglo backgrounds (N= 150, 50 families in each ethnic group). Children with asthma and their primary caregivers will participate in a home observation and interview-based assessments on risk, protective processes, and morbidity. Three months after the baseline interview, families will participate in a longitudinal, follow-up component (for one year). Four phone interviews that occur three months apart will collect information on morbidity. It is proposed that higher levels of child, cultural, and asthma-specific factors will moderate the relation between the cumulative level of risks and minimal asthma morbidity for urban children at baseline and follow-up. Higher levels of child-specific and asthma-specific factors will minimize morbidity for African- American, Hispanic, and Anglo children. Cultural factors (family values and beliefs) related to minimal morbidity will differ by ethnic subgroup. Results will be used to design a culturally sensitive asthma intervention to enhance asthma management behaviors of ethnic minority, urban and poor families.