Racial/ethnic differences in symptom perception in childhood asthma

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DESCRIPTION (provided by applicant): The greatest racial/ethnic disparity in pediatric asthma exists between the two largest Latino ethnic groups in the United States. Puerto Rican children have the highest asthma prevalence, morbidity, and mortality rates, and Mexican-American children have the lowest rates. African-American children are also disproportionately affected by asthma and have high levels of morbidity. Identification of mechanisms that may contribute to these disparities is a critical goal for asthma research. At the present time, there is a surprising gap in the literature regarding children's asthma symptom perception accuracy among specific racial/ethnic groups. Additionally, little is known about how racial/ethnic differences in parental beliefs and mental health may affect children's symptom perception and asthma morbidity. The research plan will involve a cross-sectional comparison of 40 African-American, 40 Puerto Rican, and 40 Mexican-American children with asthma between ages 7-11 and their primary caregivers. Families will be recruited from two city hospitals that predominantly serve families of low SES in the Bronx, NY. The study will involve a baseline session followed by 5 weeks of monitoring of children's asthma symptom perception ability and use of asthma medications in naturalistic settings. A second testing session will occur at a 5-week follow- up. Parent measures will include asthma beliefs, family support, acculturation, and assessment of major depression and abridged somatization using the Composite International Diagnostic Interview. Child measures will include depression, somatization, emotions during asthma attacks, and acculturation. Dependent measures will include use of PRN medication, functional morbidity, and asthma-related emergency room visits. Groups will be matched on clinician-rated asthma severity documented in medical charts. The primary aims of this small grant are to: a) examine children's asthma symptom perception and PRN medication use among African-American, Puerto Rican, and Mexican-American children, and b) compare parents' mental health, health beliefs, and family support across racial/ethnic groups, and c) examine the relationship between parents' level of acculturation and children's asthma symptom perception and morbidity among Puerto Rican and Mexican-American families. An exploratory aim is to examine whether pathways involving children's psychological symptoms, children's asthma symptom perception, and parent factors mediate racial/ethnic differences on PRN medication use and asthma morbidity. This study is designed to identify parent and child factors that may contribute to asthma morbidity and symptom perception in a differential manner among African-American, Puerto Rican, and Mexican-American children. The long-term objective of this research program is the development of culturally sensitive family interventions designed to reduce asthma morbidity and hence, disparities among ethnic minority children. This research will help support the NIH mission to reduce health disparities by focusing on asthma among inner-city, ethnic minority children. Examining behavioral predictors of disparities among African-American, Puerto Rican, and Mexican-American families may help inform culturally sensitive guidelines for provider care and family management of asthma.