This study would investigate childhood asthma longitudinally in the family context. It is likely that a child?s asthma condition and the family?s resources influence each other. These reciprocal relations are likely to operate, at least partly, through family-level asthma control activities. The proposed research seeks to investigate the components of the process that may result in an increase in asthma burden, leading to an increase in its economic and non-economic costs for the family. This study would be different from macro-level studies of the cost of asthma in that it would focus on the family-level processes that link asthma to its impact on family resources, and the way available family resources, in turn, impact asthma. An empirical study of the reciprocal relationship between the family resources and asthma does not exist to date, although this approach has been considered conceptually. This study would extend the previous research of the investigators by examining the impact of having a child with asthma and the burden of this condition (as evidenced by indicators of functional limitations and acute exacerbations) on the family resources, which are defined as family economic resources, parents? time availability for care, access and barriers to healthcare. This impact may partly operate through asthma control activities that are undertaken by the family. Asthma control activities include healthcare utilization, control of environmental irritants, and reduction of exposure to respiratory infections. The proposed research would also investigate the impact of a family?s resources on the asthma control activities that are undertaken by the family, ultimately impacting asthma status. Data from two sources, MEPS and NLSY, would be used. The 1996 and 1997 panels of the Medical Expenditure Panel Surveys (MEPS) provide detailed information on family resources, child health, health service utilization, and cost of healthcare for a period of two years for each panel. The National Longitudinal Survey of Youth (NLSY) for 1979-2000 provides long term information on a national cohort of mothers and their children. The proposed analyses would provide information regarding the nature of the linkage that results in families with limited resources who have children who have asthma that is more threatening to functional status and with more frequent acute exacerbations. By investigating the family-level processes, it would be possible to identify policy targets that may be keys to stopping the cycle that leads to an increase in a child?s asthma burden. The longitudinal approach and the focus on the process that links asthma and family resources may bring a better understanding to this issue than the cross-sectional and static framework that was used in much of prior research. Macro-level policies regarding health insurance availability, employee leave benefits, administration of medications in schools, and child care for children with asthma are a few examples that would also be informed by the proposed study.
| Kim, Hyoshin; Kieckhefer, Gail M; Greek, April A et al. (2009) Health care utilization by children with asthma. Prev Chronic Dis 6:A12 |
