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

描述（由申请人提供）：拉丁裔儿童哮喘健康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，了解这种情况发生的原因。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、卫生保健系统或提供者因素来解释。很少有研究在一个解释模型中整合导致差异的众多因素。疾病表征（人们对影响健康问题管理的健康和疾病的解释方式）可能在父母决定使用辅助辅助治疗和控制药物来控制孩子哮喘方面发挥作用，这一点也许很重要，但尚未得到充分研究。父母是孩子医疗保健的看门人，并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体、文化、经验和卫生保健系统因素与社会环境背景之间的相互作用。拟议的研究将研究从描述性研究转移到社会、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相互作用的多层次检查。本研究的目的是：1)探讨这些拉丁裔亚组之间由于社会和环境因素导致的疾病表征差异；2)检验一种生长模型，该模型检验了哮喘控制差异作为父母治疗决策（CAM和控制者药物使用）差异的函数以及一年内疾病表征变化。这将是一项为期一年的纵向、多地点研究，涉及300名患有哮喘的拉丁裔（主要是墨西哥和波多黎各）父母和5-12岁儿童的父母疾病陈述、CAM和对照药物使用情况。在入学时，以及入学后3、6、9和12个月，将与家长和孩子进行面谈和儿童评估。该评估时间表使我们能够捕捉儿童哮喘症状的季节性变化，并符合建议，即每天服用控制药物的儿童每3个月进行一次随访。我们将获得儿童的肺活量测量数据，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化代表性，样本将从亚利桑那州凤凰城的两个社区学校卫生诊所和一个临床实践点以及纽约州布朗克斯的两个内城医院哮喘诊所招募。有必要进行多地点研究，因为单独一个地点都没有足够数量的墨西哥和波多黎各家庭独立进行这项研究。最好在这两个人群中同时进行访谈和评估，以尽量减少哮喘症状控制的季节性变化，并最大限度地实现跨时间和样本调查管理的标准化。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，了解这种情况发生的原因。导致墨西哥和波多黎各儿童之间哮喘健康差异的因素很复杂，但很少有研究将导致这些差异的众多因素整合到一个解释模型中。提出的研究将研究从个人结构和背景的描述性研究转移到测试一个综合的多因素模型。这个项目的创新之处在于对共变影响（社会人口、文化、经验、环境和卫生保健系统）在一年多的时间里对300名墨西哥和波多黎各儿童及其父母的哮喘控制差异进行了多层次的检查。

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.