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（由申请人提供）：拉丁裔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呼吁采取行动，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来解释。很少有研究将导致差异的多种因素整合到一个解释模型中。也许很重要，但尚未得到充分研究的是，疾病表征（人们解释健康和影响健康问题管理的疾病的方式）可能在父母决定使用 CAM 和控制药物来治疗孩子的哮喘时发挥作用。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，需要更全面地了解个人、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。拟议的研究将研究从描述性研究转向对社会、文化、经验、环境和医疗保健系统因素之间的相互作用对墨西哥和波多黎各儿童哮喘控制差异的多层次研究。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而导致的疾病表征的差异，2) 测试增长模型，检查哮喘控制差异作为父母治疗决策差异的函数 (CAM和控制药物的使用）以及一年内疾病表现的变化。这将是一项为期一年的纵向、多地点研究，以 300 名患有哮喘的拉丁裔（主要是墨西哥和波多黎各人）父母和 5-12 岁儿童为样本，研究父母疾病表征以及 CAM 和控制药物的使用情况。我们将在入学时以及入学后 3、6、9 和 12 个月对家长和儿童进行面试和儿童评估。该评估计划使我们能够捕捉儿童哮喘症状的季节性变化，并符合每日服用控制药物的儿童每 3 个月进行一次随访的建议。我们将从儿童那里获取肺活量测定结果，并审查儿童的医疗记录。为了确保拉丁裔家庭和医疗机构的多元化代表性，样本将从亚利桑那州凤凰城的两个社区学校健康诊所和一个临床实践中心以及纽约州布朗克斯的两个市中心医院哮喘诊所招募。需要进行多地点研究，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，并最大限度地提高跨时间和样本的调查管理的标准化。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非常惊人，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之间哮喘健康差异的因素很复杂，但很少有研究将可能导致这些差异的多种因素整合到一个解释模型中。拟议的研究将研究从个体结构和背景的描述性研究转移到测试集成的多因素模型。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样本中哮喘控制差异的共同影响（社会人口、文化、体验、环境和医疗保健系统）进行多层次检查一年多的时间里。