DePriest Kelli, Butz Arlene, Gross Deborah
School of Nursing, The Johns Hopkins University, School of Medicine, Baltimore, Maryland.
General Pediatric and Adolescent Medicine, The Johns Hopkins University, School of Medicine, Baltimore, Maryland.
Res Nurs Health. 2018 Oct;41(5):428-439. doi: 10.1002/nur.21901. Epub 2018 Aug 31.
Over 2 million children in the US have uncontrolled asthma. African American children are disproportionately affected with a risk of dying from asthma that is 7.6 times higher than non-Hispanic White children. Racial disparities in childhood asthma are partially attributed to differential exposures to poverty; unsafe and stressful neighborhoods; and unhealthy physical environments. This paper describes the protocol for an ongoing National Institutes of Health/National Institute of Nursing Research-funded descriptive, cross-sectional study to investigate two neighborhood factors that may influence children's asthma. Building on an existing dataset, this study examines associations among neighborhood greenspace, neighborhood safety, and level of asthma control while controlling for indoor asthma triggers in an urban sample of predominantly low-income, African American children with persistent asthma. Two new variables are added to the dataset: availability of neighborhood greenspace and neighborhood violent crime rate. Greenspace is being accessed using geographic information systems and measured using the normalized difference vegetation index. Neighborhood violent crime rate is calculated using geocoded, point locations for crimes downloaded from the city police department. It is hypothesized that parents living in unsafe neighborhoods are likely to keep their children indoors, thereby increasing their children's exposure to indoor asthma triggers and limiting the potential benefits of neighborhood greenspace. The biggest challenges thus far are related to limited variability in greenspace and violent crime rates. Progress to date and strategies to address these challenges are discussed. Results have the potential to inform interventions to improve asthmatic children's health and influence public health policy.
美国有超过200万儿童患有未得到有效控制的哮喘。非裔美国儿童受哮喘影响的比例过高，死于哮喘的风险比非西班牙裔白人儿童高7.6倍。儿童哮喘方面的种族差异部分归因于不同程度地暴露于贫困、不安全且压力大的社区以及不健康的物理环境。本文描述了一项正在进行的由美国国立卫生研究院/国立护理研究所以资助的描述性横断面研究的方案，该研究旨在调查可能影响儿童哮喘的两个社区因素。基于现有数据集，本研究在控制室内哮喘诱发因素的情况下，对一个以低收入为主的非裔美国持续性哮喘儿童的城市样本中的社区绿地、社区安全和哮喘控制水平之间的关联进行研究。两个新变量被添加到数据集中：社区绿地的可及性和社区暴力犯罪率。使用地理信息系统获取绿地信息，并使用归一化植被指数进行测量。社区暴力犯罪率通过对从城市警察局下载的犯罪地理编码点位置进行计算得出。据推测，生活在不安全社区的父母可能会让孩子待在室内，从而增加孩子接触室内哮喘诱发因素的机会，并限制社区绿地的潜在益处。迄今为止最大的挑战与绿地和暴力犯罪率的有限变异性有关。本文讨论了迄今为止的进展以及应对这些挑战的策略。研究结果有可能为改善哮喘儿童健康的干预措施提供信息，并影响公共卫生政策。
