Asthma Disparities in Latino Children:Acculturation,Illness Representations & CAM

拉丁裔儿童的哮喘差异：文化适应、疾病表征

• 批准号: 8325454
• 负责人: Kimberly Joan Arcoleo
• 金额: $ 46.72万
• 依托单位: OHIO STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-01 至 2014-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8325454
• 关键词: Accident and Emergency department; Accounting; Acculturation; Address; Adrenal Cortex Hormones; Affect; Age; Asthma; Belief; Belief System; Breathing; Child; Childhood Asthma; Clinic; Communities; Complementary and alternative medicine; Complex; Continuity of Patient Care; Cultural Characteristics; Diagnosis; Disease; Education; Employee Strikes; Enrollment; Ensure; Ethnic group; Exhibits; Family; Gatekeeping; Genetic; Growth; Health; Health Personnel; Health behavior; Healthcare; Healthcare Systems; Heterogeneity; Hispanics; Household; Individual; Interdisciplinary Study; Intervention; Interview; Latino; Lead; Leukotriene Antagonists; Measures; Medical; Medical Records; Mexican; Minority; Modeling; Morbidity - disease rate; Odds Ratio; Oral; Outcome; Parental Ages; Parents; Patients; Pharmaceutical Preparations; Play; Population; Poverty; Prevalence; Provider; Public Health; Puerto Rican; Race; Recommendation; Recording of previous events; Recruitment Activity; Regimen; Research; Research Personnel; Risk; Risk Factors; Role; Sampling; Schedule; Schools; Seasonal Variations; Sick Role; Site; Social Interaction; Spirometry; Standardization; Subgroup; Surveys; Symptoms; System; Testing; Time; United States; Urban Hospitals; Visit; Wheezing; age group; aged; base; child poverty; clinical practice; contextual factors; cultural values; evidence base; experience; follow-up; health disparity; inner city; innovation; medication compliance; member; mortality; parental influence; racial and ethnic disparities; social; social model; theories

DESCRIPTION (provided by applicant): 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. PUBLIC HEALTH RELEVANCE: 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.

描述(由申请者提供)：拉美裔儿童哮喘健康结果的种族差异是如此显著，以至于研究人员和公共卫生官员发出了行动呼吁，以了解为什么会发生这种情况。最近的描述性哮喘研究证实，这些差异不能完全由遗传、环境、医疗保健系统或提供者因素解释。在一个解释模型中，很少有研究将导致差异的多种因素整合在一起。也许重要的，但没有得到很好检验的是，疾病表征(一个人解释健康和影响健康问题管理的疾病的方式)可能在父母使用CAM和控制器药物来控制他们孩子的哮喘的决定中发挥作用。父母是孩子医疗保健的守门人，最终做出最终的治疗决定。在制定针对哮喘健康差异的干预措施之前，需要更彻底地了解个人、文化、经验和医疗保健系统因素以及社会环境背景之间的相互作用。这项拟议的研究将研究从描述性研究转移到多层次检查，即社会、文化、经验、环境和医疗保健系统因素对墨西哥和波多黎各儿童哮喘控制差异的交互作用。这项研究的目的是1)探索这些拉丁裔亚群之间由于社会和背景因素而在疾病表现上的差异，以及2)测试一个增长模型，该模型检验哮喘控制方面的差异作为父母治疗决策(CAM和控制者药物使用)的不同以及一年来疾病表现的变化的函数。这将是一项为期一年的纵向多点研究，研究对象是300名拉丁裔(主要是墨西哥人和波多黎各人)父母和5-12岁患有哮喘的儿童的父母疾病陈述、CAM和控制者药物使用情况。在入学时、入学后3个月、6个月、9个月和12个月将对家长和孩子进行访谈和儿童评估。这一评估时间表使我们能够捕捉到儿童哮喘症状的季节性变化，并符合每天服用控制器药物的儿童每3个月进行一次随访的建议。我们将从儿童那里获得肺活量测量，并审查儿童的医疗记录。为了确保拉丁裔家庭和医疗保健环境的多样性，样本将从亚利桑那州凤凰城的两家社区学校医疗诊所和一个临床诊所以及纽约布朗克斯的两家市中心医院哮喘诊所招募。多地点研究是有必要的，因为两个地点都没有足够数量的墨西哥和波多黎各家庭来独立进行这项研究。最好同时在这两个人群中进行访谈和评估，以最大限度地减少哮喘症状控制的季节性变化，并最大限度地标准化跨时间和跨样本的调查管理。公共卫生相关性：墨西哥和波多黎各儿童哮喘结果的种族差异如此显著，以至于研究人员和公共卫生官员呼吁采取行动，了解为什么会发生这种情况。导致墨西哥和波多黎各儿童哮喘健康差异的因素很复杂，但很少进行研究，在一个解释性模型中综合了可能导致这些差异的多种因素。这项拟议的研究将研究从对个体结构和背景的描述性研究转移到测试一个综合的、多因素的模型。这个项目的创新之处在于，在一年的时间里，对300名墨西哥和波多黎各儿童及其父母的样本进行了多层次的影响(社会人口、文化、经验、环境和医疗保健系统)对哮喘控制差异的影响。