Racial/ethnic differences in symptom perception in childhood asthma

描述（由申请人提供）：儿童哮喘的最大种族/民族差异存在于美国两个最大的拉丁裔族群之间。波多黎各儿童的哮喘患病率、发病率和死亡率最高，墨西哥裔美国儿童的发病率最低。非裔美国儿童也不成比例地受到哮喘的影响，发病率很高。确定可能导致这些差异的机制是哮喘研究的关键目标。目前，关于特定种族/民族儿童哮喘症状感知准确性的文献存在令人惊讶的差距。此外，关于父母信仰和心理健康的种族/民族差异如何影响儿童的症状感知和哮喘发病率，我们知之甚少。该研究计划将对40名7-11岁的非裔美国人、40名波多黎各人和40名墨西哥裔美国人哮喘儿童及其主要照顾者进行横断面比较。这些家庭将从纽约布朗克斯区的两家主要服务低收入家庭的城市医院招募。该研究将包括一个基线阶段，随后是5周的儿童哮喘症状感知能力监测和在自然环境中使用哮喘药物。第二次测试将在5周的随访中进行。家长措施将包括哮喘信念，家庭支持，文化适应，以及使用复合国际诊断访谈评估重度抑郁症和缩短躯体化。儿童措施包括抑郁、躯体化、哮喘发作时的情绪和文化适应。依赖性措施包括PRN药物的使用、功能性发病率和哮喘相关的急诊室就诊。各组将根据医学图表中记录的临床医生评估的哮喘严重程度进行匹配。这项小额赠款的主要目的是：a)检查非裔美国人、波多黎各人和墨西哥裔美国儿童的哮喘症状感知和PRN药物使用情况；b)比较不同种族/族裔群体中父母的心理健康、健康信念和家庭支持；c)检查波多黎各人和墨西哥裔美国家庭中父母的文化适应水平与儿童哮喘症状感知和发病率之间的关系。探索性目的是探讨儿童心理症状、儿童哮喘症状感知和父母因素是否介导PRN药物使用和哮喘发病率的种族/民族差异。本研究旨在确定非裔美国人、波多黎各人和墨西哥裔美国儿童中可能导致哮喘发病率和症状感知差异的父母和儿童因素。本研究项目的长期目标是开发具有文化敏感性的家庭干预措施，旨在减少哮喘发病率，从而减少少数民族儿童之间的差异。这项研究将有助于支持美国国立卫生研究院的使命，即通过关注市中心少数民族儿童的哮喘来减少健康差距。研究非裔美国人、波多黎各人和墨西哥裔美国人家庭差异的行为预测因素，可能有助于为哮喘的提供者护理和家庭管理提供具有文化敏感性的指导方针。

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.