Conundrums in childhood asthma severity, control, and health care use: Puerto Rico versus Rhode Island

Esteban, Cynthia A.; Klein, Robert B.; McQuaid, Elizabeth L.; Fritz, Gregory K.; Seifer, Ronald; Kopel, Sheryl J.; Santana, J R Rodríguez; Colón, Angel; Alvarez, María; Koinis-Mitchell, Daphne; Ortega, Alexander N.; Martínez‐Nieves, Brenda; Canino, Glorisa

doi:10.1016/j.jaci.2009.05.014

Cited by 39 publications

(60 citation statements)

References 28 publications

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“…Asthma control of both the island Puerto Ricans and RI Latino groups was significantly worse than that of the Rhode Island non-Latino white subjects. (These findings relating to severity are presented in detail elsewhere [22]). …”

Section: Sample Characteristicsmentioning

confidence: 81%

“…The conceptual model and the study methods have been described in detail elsewhere (21,22). Institutional review boards at Rhode Island Hospital (Providence, RI) and the University of Puerto Rico (San Juan, Puerto Rico) approved the study.…”

Section: Methodsmentioning

confidence: 99%

“…As described in a previous publication (22), subjects were a convenience sample recruited from a variety of sources in San Juan, Puerto Rico and the metropolitan area of Providence, Rhode Island. Of the 787 subjects who began the perceptual accuracy component, 512 returned the AM2 device with a sufficient number of valid data points (minimum of 20; details of the data-cleaning process are available on request) to be included in subsequent analyses.…”

Section: Sample Characteristicsmentioning

confidence: 99%

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Ethnic Differences in Perception of Lung Function

Fritz

McQuaid²,

Kopel³

et al. 2010

Am J Respir Crit Care Med

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Rationale: Disparities in pediatric asthma exist in that Latino children have higher prevalence and greater morbidity from asthma than non-Latino white children. The factors behind these disparities are poorly understood, but ethnic-related variations in children's ability to accurately recognize and report their pulmonary functioning may be a contributing process. Objectives: To determine (1) if differences exist between Latino and non-Latino white children's perceptual accuracy and (2) whether these differences are related to asthma outcomes. Methods: Five hundred and twelve children, aged 7-16 years (290 island Puerto Ricans, 115 Rhode Island Latinos, and 107 Rhode Island non-Latino white children) participated in a 5-week home-based protocol in which twice daily they entered subjective estimates of their peak expiratory flow rate into a hand-held, programmable spirometer and then performed spirometry. Their accuracy was summarized as three perceptual accuracy scores. Demographic data, asthma severity, intelligence, emotional expression, and general symptom-reporting tendencies were assessed and covaried in analyses of the relationship of perceptual accuracy to asthma morbidity and health care use. Measurements and Main Results: Younger age, female sex, lower intelligence, and poverty were associated with lower pulmonary function perception scores. Island Puerto Rican children had the lowest accuracy and highest magnification scores, followed by Rhode Island Latinos; both differed significantly from non-Latino white children. Perceptual accuracy scores were associated with most indices of asthma morbidity. Conclusions: Controlling for other predictive variables, ethnicity was related to pulmonary function perception ability, as Latino children were less accurate than non-Latino white children. This difference in perceptual ability may contribute to recognized asthma disparities.

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Section: Sample Characteristicsmentioning

confidence: 81%

Section: Methodsmentioning

confidence: 99%

Section: Sample Characteristicsmentioning

confidence: 99%

See 1 more Smart Citation

Ethnic Differences in Perception of Lung Function

Fritz

McQuaid²,

Kopel³

et al. 2010

Am J Respir Crit Care Med

Self Cite

View full text Add to dashboard Cite

show abstract

“…Participants for this report were a subset from a larger study (n = 805) 22,23 investigating pediatric asthma disparities between Latino and NLW families. Previous work from this sample has evaluated asthma severity across demographic groups, 23 differences in lung function perception between Latino and NLW children, 24 and medication beliefs among Latino parents 11 ; however, data regarding medication adherence have not been reported.…”

Section: Methodsmentioning

confidence: 99%

“…Previous work from this sample has evaluated asthma severity across demographic groups, 23 differences in lung function perception between Latino and NLW children, 24 and medication beliefs among Latino parents 11 ; however, data regarding medication adherence have not been reported.…”

Section: Methodsmentioning

confidence: 99%

Medication Adherence Among Latino and Non-Latino White Children With Asthma

2012

PEDIATRICS

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WHAT'S KNOWN ON THIS SUBJECT: Asthma disparities exist, with Latino children of Caribbean descent at risk for poor disease control. Controller medications reduce symptoms; however, medication adherence remains suboptimal. Identifying what factors predict poor medication adherence in at-risk groups could identify important treatment targets. WHAT THIS STUDY ADDS:This study is the first to assess objective rates of medication use among children with asthma in Puerto Rico. Findings suggest that interventions incorporating family resources and addressing parental beliefs about medications may be of benefit across cultural groups. abstract OBJECTIVE: Latino children of Caribbean descent remain at high risk for poorly controlled asthma. Controller medications improve asthma control; however, medication adherence remains suboptimal, particularly among minorities. This study assessed socioeconomic, familybased, and parent factors in medication adherence among children with asthma from Rhode Island (RI; Latino and non-Latino white [NLW]) and Puerto Rico. METHODS:Data collection occurred as part of a multicenter study of asthma disparities. Our sample included children (ages 7-16) prescribed objectively monitored controller medications (n = 277; 80 island Puerto Rico, 114 RI Latino, 83 RI NLW). Parents completed questionnaires regarding family background and beliefs about medications. Families participated in an interview regarding asthma management. Multilevel analyses (maximum likelihood estimates) accounting for children being nested within site and ethnic group assessed the contribution of social context, family, and parent variables to medication adherence. RESULTS:Medication adherence differed by ethnic group (F 2, 271 = 7.46, P , .01), with NLW families demonstrating the highest levels of adherence. Multilevel models indicated that parental beliefs about medication necessity and family organization regarding medication use were significant predictors of adherence, even for families below the poverty threshold. With family factors in the model, a substantial improvement in model fit occurred (Akaike Information Criterion change of 103.45).CONCLUSIONS: Adherence to controller medications was lower among Latino children in our sample. Targeted interventions that capitalize on existing family resources, emphasize structure, and address parental beliefs about the importance of medications may be of benefit to families from different cultural backgrounds.

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Beliefs and barriers to medication use in parents of Latino children with asthma

McQuaid

Vásquez

Canino

et al. 2009

Pediatric Pulmonology

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Summary Objective Disparities in asthma outcomes exist between Latino and non-Latino white (NLW) children. We examined rates of medication use, medication beliefs, and perceived barriers to obtaining medication in US and island Puerto Rican parents of children with asthma Hypotheses Island PR parents would report the lowest rates of controller medication use, followed by RI Latino and RI NLW parents; Latino parents would report more medication concerns than NLW parents; and Island PR parents would report the most barriers to medication use. Study Design Five hundred thirty families of children with persistent asthma participated, including 231 Island PR, 111 RI NLW, and 188 RI Latino. Parents completed survey measures. Results Group differences were found on reported use of ICS (X2 = 50.96, P <0.001), any controller medication (X2 = 56.49, P <0.001), and oral steroids (X2 = 10.87, P <0.01). Island PR parents reported a greater frequency of barriers to medication use than the other two groups (X2 = 61.13, P <0.001). Latino parents in both sites expressed more medication concerns than NLW parents (F = 20.18, P <0.001). Medication necessity was associated with ICS use in all three groups (all P’s <0.01). Medication concerns were positively associated with ICS use in PR only (OR = 1.64, P <0.05). Conclusions Differences in medication beliefs and the ability to obtain medications may explain the reported disparity in controller medication use. Further studies are needed to evaluate these obstacles to medication use.

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Conundrums in childhood asthma severity, control, and health care use: Puerto Rico versus Rhode Island

Abstract: Background-The lifetime prevalence of self-reported asthma among Puerto Ricans is very high, with increased asthma hospitalizations, emergency department visits, and mortality rates. Differences in asthma severity between the mainland and island, however, remain largely unknown.

Cited by 39 publications

References 28 publications

Ethnic Differences in Perception of Lung Function

Ethnic Differences in Perception of Lung Function

Medication Adherence Among Latino and Non-Latino White Children With Asthma

Beliefs and barriers to medication use in parents of Latino children with asthma

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