Addressing Barriers to Physical Activity in Inner-City Schoolchildren with Asthma

DESCRIPTION (provided by applicant): The candidate, Marina Reznik, MD, MS is an Assistant Professor of Pediatrics at the Albert Einstein College of Medicine (Einstein), Children's Hospital at Montefiore (CHAM). Her long-term goal is to become a productive, independently funded clinical investigator with expertise in developing community-based interventions to improve the health care services and outcomes for medically underserved minority children with chronic diseases such as asthma and obesity. To achieve her goal, Dr. Reznik seeks to augment her prior basic training in clinical research methods and gain skills through combination of advanced didactic courses in behavioral methodology, qualitative research, advanced experimental designs and Community-Based Participatory Research (CBPR) and conducting proposed research. Her research is aimed at developing an intervention that will address barriers and facilitators to physical activity in inner-city minority elementary school students with asthma, more than half of whom are also overweight. Her research agenda is to generate rigorous evidence to improve physical activity in this vulnerable population through an intervention targeted to the needs of the community and developed in partnership with the community. Dr. Reznik proposes a two- phase project to develop and then evaluate a pilot intervention. In phase I, she will identify barriers and facilitators to physical activity using qualitative methods and inform intervention development (Specific Aims 1 and 2). Semi-structured interviews will be conducted with students, parents, school personnel and representatives from the community to identify barriers and facilitators to physical activity in children with asthma. Guided by the results of the qualitative analysis and CBPR principles, a Collaborative Board with representatives from the New York City Departments of Education and Health, South Bronx Asthma Partnership, schools, and parents will be established to provide feedback on intervention development. In phase II, the intervention will be tested via a pilot randomized controlled trial (RCT) for scientific and practical feasibility while assessing the proximal goal of improved physical activity levels, measured objectively with an accelerometer (Specific Aim 3). This pilot study will take place at four resource-poor elementary schools in the Bronx, New York. This study will inform a future large-scale cluster RCT to test the effectiveness of the developed intervention on improving physical activity and fitness levels, motivating behavior change, achieving healthier weight trajectories, and reducing asthma-related morbidity in inner-city minority students with asthma. In the rich research environment of Einstein and CHAM, Dr. Reznik will be guided by a team of three local experts in community-based clinical trials of obesity prevention (Dr. Wylie-Rosett);qualitative research, behavioral intervention trials and CBPR (Dr. Bauman);and clinical trials of school-based exercise intervention (Dr. Ozuah). Advisory committee includes strong foundation in clinical trials of asthma interventions (Drs. Crain and Cabana), design and analysis of clinical trials (Dr. Kim) and exercise physiology (Dr. Rowlands). PUBLIC HEALTH RELEVANCE: Physical activity has been shown to improve pediatric asthma outcomes. However, physical activity levels are low in the United States'children and may even be lower in children with asthma due to disease-related barriers to participation in physical activity. This proposal will address the existent gaps in the literature by identifying barriers and facilitators to participation in physical activity in inner-city minority elementary schoolchildren with asthma, more that half of whom are also overweight;developing and refining a school- based intervention in partnership with the community to improve physical activity;and conducting a pilot randomized controlled trial of the intervention to determine feasibility and obtain preliminary data for a future large-scale trial.