Ethnic disparities in asthma health outcomes among Latino children are so striking that researchers and public health officials have issued a call for action to understand why this is occurring. Recent descriptive asthma research confirmed that these disparities are not totally explained by genetic, environmental, healthcare system or provider factors. Little research has been conducted integrating, in one explanatory model, the multitude of factors that lead to disparities. Perhaps of importance, but not well examined, is the role that illness representations (the way one interprets health and illness that influences management of health problems) may play in parents'decisions to use CAM and controller medications to manage their children's asthma. Parents are the gatekeepers for their children's healthcare and ultimately make the final treatment decisions. Before developing interventions targeting asthma health disparities, a more thorough understanding of the interaction of individual, cultural, experiential, and healthcare system factors and the social-environmental context is needed. The proposed study moves the research from descriptive studies to a multi-level examination of the interaction of social, cultural, experiential, environmental, and healthcare system factors on disparities in asthma control among Mexican and Puerto Rican children.
The aims of this study are 1) to explore differences in illness representations between these Latino subgroups due to social and contextual factors, and 2) to test a growth model examining disparities in asthma control as a function of differences in parents'treatment decisions (CAM and controller medication use) and changes in illness representations over one year. This will be a one-year longitudinal, multi-site study of parental illness representations and CAM and controller medication use among a sample of 300 Latino (primarily Mexican and Puerto Rican) parents and children aged 5-12 who have asthma. Interviews and child assessments will be conducted with parents and children at enrollment, and 3, 6, 9, and 12 months after enrollment. This assessment schedule allows us to capture seasonal variations in the children's asthma symptoms as well as conform to the recommendation that children on daily controller medications have follow-up visits every 3 months. We will obtain spirometry measures from the children, and review children's medical records. To ensure diverse representation of Latino families and healthcare settings, the sample will be recruited from two community school-based health clinics and one clinical practice site in Phoenix, AZ, and two inner-city hospital asthma clinics in Bronx, NY. A multisite study is warranted because neither site alone has sufficient numbers of both Mexican and Puerto Rican families to conduct this research independently. It is preferable that interviews and assessments be conducted simultaneously among these two populations to minimize seasonal variations in asthma symptom control and to maximize standardization of administration of the surveys across time and samples.
Ethnic disparities in childhood asthma outcomes between Mexican and Puerto Rican children asthma outcomes are so striking that researchers and public health officials have issued a call for action to understand why this is occurring. The factors leading to asthma health disparities between Mexican and Puerto Rican children are complex, yet little research has been conducted integrating, in one explanatory model, the multitude of factors that can lead to these disparities. The proposed study moves the research from descriptive studies of individual constructs and contexts to testing an integrated, multi-factorial model. The innovation of this project lies in the multi-level examination of co-varying influences (socio-demographic, cultural, experiential, environmental, and healthcare system) on disparities in asthma control among a sample of 300 Mexican and Puerto Rican children and their parents over a one year period.