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

调查邻里因素与非裔美国儿童哮喘控制之间的关系

• 批准号: 9394314
• 负责人: Kelli N DePriest
• 金额: $ 4.4万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-08-01 至 2019-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9394314
• 关键词: Accident and Emergency department; Address; Affect; African American; Air Pollution; Area; Asthma; Baltimore; Child; Child health care; Childhood Asthma; Cities; Complex; Crime; Cross-Sectional Studies; Crowding; Data Analyses; Data Collection; Diagnosis; Economic Factors; Economically Deprived Population; Environment; Environmental Tobacco Smoke; Expenditure; Exposure to; Failure; Family; Foundations; Geographic Locations; Goals; Green space; Health; Health Benefit; Health Policy; Healthcare; Home environment; Housing; Impairment; Indoor pollutant; Link; Low income; Measures; Mission; National Institute of Nursing Research; Neighborhoods; Not Hispanic or Latino; Outcome; Parents; Perception; Pharmaceutical Preparations; Physical activity; Physical environment; Physiological; Play; Poaceae; Policies; Political Factor; Poverty; Prevalence; Public Health; Quality of life; Reporting; Research; Research Training; Resources; Role; Sampling; Seasons; Stress; Symptoms; Time; Trees; United States; Violence; base; contextual factors; cost; design; health disparity; high risk; improved; indexing; indoor allergen; informant; lower income families; neighborhood safety; programs; racial disparity; residence; segregation; skills; social; statistics; stressor; traffic-related air pollution; urban poverty; violent crime; willingness

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.

项目概要 美国有超过 230 万儿童患有未受控制的哮喘，定义为每周出现症状的天数≥2 天，>1 每月症状夜间、活动限制以及每周使用救援药物超过 2 天的非裔美国人。 儿童受到不受控制的哮喘的影响尤为严重；他们接受治疗的可能性是其他国家的 4.1 倍。 急诊科的儿童死于哮喘的可能性是非西班牙裔白人儿童的 7.6 倍。 儿童哮喘的种族差异部分归因于成长环境的差异 贫困、生活在不安全和有压力的社区以及不健康的物质环境（空气污染、贫困 住房质量、家中是否有害虫以及接触二手烟）。 社区层面的因素很难改变，这是一种可能改善哮喘的潜在可改变因素 控制是指绿地的可用性，绿地定义为有草地、树木或其他植被的土地。 与压力、热量和空气污染的减少有关，这些变量与哮喘控制更好有关 然而，很少有研究直接检验可用性之间的关系。 社区绿地和哮喘产生了不同的结果，造成这种结果的原因之一可能是： 没有一个研究考虑到可能影响儿童使用城市绿地的关键环境因素 居住在不安全社区的父母可能会留下他们的孩子。 在室内，从而增加了孩子接触室内哮喘诱因的机会，并限制了潜在的健康 这项研究将探讨社区绿地的好处，控制儿童家中的室内哮喘诱因。 检查社区绿地、社区安全和哮喘控制水平之间的关联 巴尔的摩市 222 名主要是低收入非裔美国儿童的现有样本。 这项描述性横断面研究的目的是检查：1）邻里之间的关联 绿地和哮​​喘控制水平；2) 两个邻里安全指标之间的关联 （社区暴力犯罪率和家长对社区安全的看法）以及哮喘控制水平； 3）邻里安全在多大程度上可以调节邻里之间的联系 我将使用多种措施和信息来源来捕获研究变量。 包括地理编码、社区犯罪统计、家长报告和生理测量。 研究培训计划是专注于发展社区技能的学习计划的基础 对影响城市贫困儿童的健康差异的研究 本研究与国家政策一致。 护理研究所的使命是通过研究之间的复杂关系来促进健康 环境和非传染性疾病的轨迹，重点是健康差异。