Pediatric asthma, the most common chronic illness of childhood, is increasing in prevalence, morbidity and mortality : particularly in minority children. This application seeks to establish the Rhode Island : Puerto Rico Asthma Center (RIPRAC) for reducing disparities in asthma among Latino children. Brown University faculty involved with an extensive pediatric asthma research program will join with epidemiologists, clinicians, and health services researchers from the minority serving University of Puerto Rico to study potentially overlooked determinants of disparity. An ambitious training component (based on a successful T32 research training program) will involve individuals from both sites at both sites. The RIPRAC Research AIMS include four projects that seek to understand the causes of disparities at multiple levels : the biomedical, the individual/family, and the socioenvironmental level. The four projects, respectively, will 1) examine discrepancies between the diagnosis of asthma as assessed by parental report, the primary care medical record and our systematic diagnosis base on the NHLBI guidelines; 2) assess characteristics (prescription practices, shared decision making, continuity and access to care) of the health care system that may differentially affect asthma morbidity; 3) evaluate family beliefs, the burden of asthma management and medication adherence as they affect asthma morbidity and health care utilization in Latino and Anglo children; and 4) study the relation of symptom perception to pediatric asthma discrepancies. Subjects for all 4 projects will be the same 300 mainland Anglos, 200 mainland Latinos (of Puerto Rican and Dominican descent) and 400 island Puerto Rico children with asthma, aged 7-15, thereby promoting comparability and efficiency. Chi-square analyses and ANOVA's will be used to assess differences between groups; techniques of logistic regression and multiple regression will be used to model the effects of covariates. The RIPRAC Training component will provide clinical research education and supervision to Puerto Rican trainees and faculty, enhance cultural awareness of Brown personnel as it relates to asthma disparities, and launch at least three trainee-led pilot research projects in the area.
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