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.

Public Health Relevance

Uncontrolled asthma, which disproportionately affects African American children and those living in low-income neighborhoods, is a significant public health problem. This study will examine the benefits of neighborhood greenspace (i.e., land with grass, trees, and other vegetation), which has been shown to reduce air pollution and promote physical activity, on level of asthma control in African American children living in low-income neighborhoods. Results have the potential to inform public health policies designed to improve children?s health by modifying neighborhood environments.

National Institute of Health (NIH)
National Institute of Nursing Research (NINR)
Predoctoral Individual National Research Service Award (F31)
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National Institute of Nursing Research Initial Review Group (NRRC)
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Banks, David
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Johns Hopkins University
Other Health Professions
Schools of Nursing
United States
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