Trajectories of pediatric asthma control: Examining sleep's influence in adolescence

Project Summary/Abstract Pediatric asthma remains a significant public health challenge, affecting 8.1% of U.S. children. Disparities are particularly evident, with asthma prevalence reaching 10.5% among low-income children and 19.5% in minoritized communities. Effective pediatric asthma control involves individual, caregiver, community, and healthcare factors. The role of these factors in asthma management is well-documented, but gaps remain in understanding how their influence changes from childhood to adolescence. Poor sleep is also prevalent among adolescents with asthma, in part due to nocturnal symptoms. Sleep research in adolescents with asthma often overlooks caregiver factors, such as attitudes and beliefs about youth sleep hygiene, and knowledge of youth’s sleep environment. Caregivers often have inaccurate perceptions of their adolescent’s sleep practices, indicating a lack of congruence. Given the importance of sleep in adolescent development, examining its impact on asthma control and the alignment between adolescent and caregiver sleep perceptions is crucial for effective asthma management. This project uses data from RVA Breathes, a study that included 250 families of children with asthma, many of whom are from low-income and/or other minoritized communities (U01HL138682, PI: Everhart). In Aim 1, we will use extant data from 250 5-11-year-olds from the RVA Breathes study to examine childhood asthma control trajectories and to identify predictors of poor asthma control using latent growth curve modeling (LGCM). We hypothesize that higher child quality of life, less caregiver stress, fewer caregiver depressive symptoms, and less neighborhood deprivation will be associated with better child asthma control trajectories over time. In Aim 2, we will conduct a six-month study with 100 adolescents aged 12-15 recruited from the same community as RVA Breathes to evaluate whether asthma control predictors from Aim 1 remain significant in this age group; we will also examine new factors relevant to adolescence (e.g., peer influence, asthma responsibility, and sleep quality). We hypothesize that childhood predictors from Aim 1 will continue to influence asthma control in adolescence and that less peer influence, greater asthma responsibility, and better sleep quality will more strongly influence positive asthma control trajectories in adolescence. In Aim 3, we will use data from the adolescent cohort to explore the association between sleep behaviors and asthma control, and examine how congruence between caregiver and adolescent sleep beliefs influences this link. We hypothesize that greater sleep quality (Model 1) and sleep efficiency (Model 2) will predict better asthma control and that higher congruence will strengthen this association. Findings from this study will lay the foundation for developing interventions that optimize asthma control trajectories during the transition from childhood to adolescence. The research and training plan will equip the applicant with the skills to become an independent researcher specializing in pediatric health disparities through training in advanced statistics, adolescent health management, and sleep research methodologies.