Preferred Language and Asthma among Asian Americans

Abstract

Little is known about childhood asthma rates and severity in the Asian American population in the U.S. We screened convenience samples of recent Chinese immigrants and longtime Asian Americans using the Brief Pediatric Asthma Screen (BPAS) in Boston Chinatown. Our goal was to conduct an exploratory study that helped develop methodology for researching asthma in Chinese immigrant populations. About 15 percent of the children surveyed were reported to have doctor-diagnosed asthma. Over 18 percent had possible undiagnosed asthma as scored via a modification to the BPAS that was likely to increase responses consistent with undiagnosed asthma. The CDC estimates that 8.7 percent of children have a lifetime diagnosis of asthma. Studies examining asthma in children have consistently found that asthma rates are higher among children living in urban communities of color, which is reflected in this study's findings. The only statistically significant predictor of asthma diagnosis in a logistic regression model was taking the survey in Chinese (p<0.001; R 2 =0.62) suggesting that acquisition of English is an important factor. We note that there are difficulties associated with translation of the word "wheeze" into Chinese and discuss the problems associated with this key term in the BPAS. Finally we report data from a separate survey of housing conditions in Boston Chinatown. Housing conditions known or suspected to aggravate asthma were reported by respondents to be infrequent. More research is needed to distinguish true difference in prevalence from differential diagnosis of asthma.

Screening for asthma in Cantonese-speaking immigrant children

“…With nine million children diagnosed with asthma in the United States, it is the leading cause of school absences, emergency room visits and hospitalizations among American youth [1,2]. Studies of asthma prevalence however, have tended to neglect the Asian-American population, leaving the burden of asthma faced by this population largely unknown [3,4]. …”

“…In the few studies that have included Asian-American children, lower prevalence of diagnosed asthma than in comparable populations has usually been found [1,3,4]. When included as part of "other races" in the Center for Disease Control report, Asian-American children, were found to have an asthma prevalence of 11.4% [1].…”

“…Recent studies suggest that lack of general asthma knowledge as well as a misunderstanding of the word "wheeze" may affect detection of asthma in Asian children [3,7]. A study of parents of asthmatic children in Nanjing, China found 54.7% of parents had "poor" knowledge of the disease.…”

“…The BPAS also relies heavily on the use of the word "wheeze," thereby being subject to the same limitation [8]. Two previous studies have used Chinese translations of the BPAS in attempts to determine the prevalence of asthma in Asian-American immigrant children, yielding conflicting results [3,4]. Both studies offered the survey in English and Chinese.…”

“…In the second study, the survey was administered orally, with surveyors physically demonstrating what they believed to be wheezing [3]. It should be noted that the demonstration more resembled labored breathing and therefore was not specific for asthma.…”