Asthma could serve as the poster child of multifactorial medical conditions. The pathogenetic mechanisms are complex and the interactions with environmental and psychosocial factors are numerous. Minority and disadvantaged groups often show increased prevalence of asthma and increased morbidity and mortality, which is not fully understood. This proposal will recruit a population-based sample of American Indians from the Cheyenne River Sioux Tribe at Eagle Butte, SD, 120 well-defined cases and 240 matched controls for a cross sectional investigation of a broad range of factors running from genetics, immunity, environmental exposures, educational ability, economic resources, access and utilization of medical care, to perceived quality of life. In addition, 1/2 ofthe cases will be recruited into a randomized trial of intensive education related to understanding, self-directed care and empowerment compared with usual care. The intervention will last for 2 years and a follow-up exam will be conducted at 3 years. Analysis will be on an "intention to treat" basis and the primary end point will be clinic and emergency room visits for respiratory complaints. It is anticipated that capture of endpoints will be very complete, as nearly all clinical care in this community is provided by the Indian Health Service or tribal clinics, both of which will cooperate with this study. An important component ofthis proposal is the enhancement of community human resources related to biomedical research and clinical care. Tribal college students will be engaged as part-time (but active) members ofthe research team, recruiting and educating participants, collecting and analyzing data, translating findings to community members and leaders, and hopefully becoming more interested and aware of health issues as they impact minority populations. Although this community has been accepting and involved in genetic research in the past, this component ofthe project will expand this experience, both for local tribal college students;but also for those at Turtle Mountain college, where genotyping is conducted. Another exciting aspect is the involvement of a young American Indian investigator and clinician from South Dakota in a prominent role.
Most medical conditions involve a complicated interaction between biology, a person's psychological makeup and the social and cultural environment that they live in. This study will shed new light on the many factors that influence asthma, ranging from genetics to environmental respiratory exposure to access to and quality of medical care. A major component of the study will increase community-wide understanding of asthma, as well as medical research in general.