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

描述（由申请人提供）：拉丁美洲儿童哮喘健康结果的种族差异是如此惊人，以至于研究人员和公共卫生官员已经发出行动呼吁，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。很少有研究将导致差异的众多因素整合到一个解释模型中。也许重要的是，但没有得到很好的研究，是疾病表征（一个人解释健康和疾病的方式，影响健康问题的管理）可能在父母的决定，使用CAM和控制药物来管理他们的孩子的哮喘。父母是孩子医疗保健的守门人，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，需要更深入地了解个人，文化，经验和医疗保健系统因素以及社会环境背景的相互作用。拟议的研究将研究从描述性研究转移到对墨西哥和波多黎各儿童哮喘控制差异的社会，文化，经验，环境和医疗保健系统因素相互作用的多层次检查。本研究的目的是：1）探索这些拉丁裔亚组之间由于社会和背景因素导致的疾病表征差异，2）测试一个增长模型，该模型检查哮喘控制差异作为父母治疗决策（CAM和控制药物使用）差异的函数，以及一年内疾病表征的变化。这将是一项为期一年的纵向、多中心研究，在300名拉丁裔（主要是墨西哥人和波多黎各人）父母和5-12岁哮喘儿童的样本中研究父母疾病陈述和CAM和控制药物的使用。将在入组时以及入组后3个月、6个月、9个月和12个月与家长和儿童进行访谈和儿童评估。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，并符合每日控制药物的儿童每3个月随访一次的建议。我们将从孩子们那里获得肺量测定法，并审查孩子们的医疗记录。为了确保拉丁裔家庭和医疗机构的多样性，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场所以及纽约州布朗克斯的两个内城医院哮喘诊所招募。多地点研究是必要的，因为没有一个地点单独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，并最大限度地提高调查管理的标准化。公共卫生相关性：墨西哥和波多黎各儿童哮喘结果之间的种族差异是如此惊人，以至于研究人员和公共卫生官员呼吁采取行动，以了解为什么会发生这种情况。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在一个解释性模型中。拟议的研究移动的研究从描述性研究的个别结构和上下文测试一个综合的，多因素的模型。该项目的创新之处在于对300名墨西哥和波多黎各儿童及其父母在一年内哮喘控制差异的共同变化影响（社会人口统计学，文化，经验，环境和医疗保健系统）进行多层次检查。

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.