Latino children experience disparities in asthma control and have worse functional outcomes related to poorly controlled asthma compared to non-Latino White children, including more school absences, emergency department visits, and hospitalizations for asthma. These disparities persist despite the benefits of asthma self- management interventions. A significant and growing percentage of Latino children live in poverty, which further increases their risk for uncontrolled asthma. For low-SES Latino children, psychosocial stress is an unaddressed factor in asthma disparities. Existing interventions rarely target psychosocial processes to address the role of stress in asthma control. However, research on coping offers insight into potential intervention approaches that would buffer the effects of stress and reduce asthma disparities for low-SES Latino children. Coping is a key modifiable factor that lies ?midstream? between upstream social determinants of health and downstream disparities in health outcomes. In particular, secondary control coping (i.e., efforts to accommodate/adapt to stressors, such as acceptance and cognitive restructuring) has been linked to better asthma control for children in low-SES contexts. Therefore, the purpose of the current R01 proposal is to test the effectiveness and mediators of Adapt 2 Asthma (A2A), a bilingual family-based coping skills + asthma management intervention tailored to the stressors, strengths, and cultural beliefs of low-SES Latino families. 280 low-SES Latino families of children ages 9-13 years old with asthma will be identified and enrolled from community primary care clinics and randomly assigned to either A2A or a standard asthma self-management (AM) control arm. We will assess children?s asthma control, quality of life, lung function, school absences, and emergency department visits as the outcomes of the intervention. We will also examine child mediational pathways (child coping and mood and behavior symptoms) and parent mediational pathways (parent coping and depressive symptoms) of the intervention. Assessments will occur at pre- and post-intervention and at 6 and 12-month follow-up timepoints using child and parent report, spirometry, and school records. The successful completion of this R01 would provide evidence of the effectiveness and mediators of A2A for low-SES Latino children, a population underserved by current intervention approaches. Our results are expected to lead to a subsequent multi-site implementation trial of A2A in primary care. The long-term goal of this line of research is to reduce disparities in asthma control and its health consequences affecting low-SES Latino children and similar underserved youth populations. The knowledge gained would improve the health of low-SES Latino children and reduce the public health burden related to pediatric asthma, a condition with a significant cost to society.
Uncontrolled asthma in school-aged children is a significant public health problem. Low-SES Latino children are at increased risk for uncontrolled asthma compared to non-Latino white children, and psychosocial stress is an unaddressed factor in this disparity. Therefore, the proposed intervention targets coping with stress as a way to reduce risk for uncontrolled asthma in low-SES Latino children.
