Rural Asthma: Current Understanding of Prevalence, Patterns, and Interventions for Children and Adolescents

Abstract

Rural children experience factors unique to location that impact asthma development and outcomes, including housing quality, cigarette smoke exposure, and small/large-scale farming. Additionally, there are challenging barriers to appropriate asthma care that frequently are more severe for those living in rural areas, including insurance status, lack of primary care providers and pulmonary specialists, knowledge deficits (both patient and provider), and a lack of culturally tailored asthma interventions. Interventions designed to address rural pediatric asthma disparities are more likely to be successful when targeted to specific challenges, such as the use of school-based services or telemedicine to mitigate asthma care access issues. Continued research on understanding the complex interaction of specific rural environmental factors with host factors can inform future interventions designed to mitigate asthma disparities.

What do asthmatic patients think about telemedicine visits?

“…Telemedicine is capable to overcome the distance and safety barriers in this context and might be as effective as in-person visits for outpatient management of asthma (2), enabling mild to moderate-severe patients to get the supportive care they need. Several authors documented that virtual visits (VV), that could be either video or phone calls, for asthma patients allow positive outcomes, such as more symptom-free days and fewer emergency department visits or hospitalizations, improving asthma control (3,4). Moreover, it was demonstrated that VV are comparable to in-person visits, enabling its occasional replacement with same outcomes in asthma control (5).…”

A geographic identifier assignment algorithm with Bayesian variable selection to identify neighborhood factors associated with emergency department visit disparities for asthma

“…Past research has highlighted the disproportionate asthma burden among urban children. However, recent research has shown a similar asthmarelated health burden in rural areas, especially among rural African American communities [37][38][39][40][41][42][43][44]. Risk factors for asthma ED visits include factors at an individual level, in addition to socioenvironmental factors at family, neighborhood, and even regional or administrative levels, making them difficult to disentangle.…”

Exploring a broader context of the home environment and its relationship with asthma control in American Indian children

“…In North Carolina (NC), racial disparities in asthma morbidity reflect national trends: for example, among children ages 0–14, the number of asthma‐related hospital discharges in American Indian children is greater than 3.4 times the number in White children (245 vs. 71.8 per 100,000, respectively; Bell, Foglia, & Ries, 2017). Concentrated largely in the least resourced counties in rural Southeastern NC, American Indian children are at particular risk based on geographic disparities in asthma and asthma morbidities burdening rural and impoverished counties disproportionately (Dieu, Kearney, Bian, Jones, & Mohan, 2018; Estrada & Ownby, 2017). Achieving better asthma control in high‐risk groups such as American Indians is a practical step toward narrowing the racial disparities gap in childhood asthma.…”

“…Social, economic, and physical environmental factors unique to rural minority communities can create additional challenges in the management of asthma in rural minority children. Beyond disproportionate exposures to poor quality housing, tobacco smoke, and agriculture, rural families experience additional barriers that include lack of insurance, less access to healthcare services, and adverse socioeconomic conditions (Estrada & Ownby, 2017). Focusing on common, yet avoidable, asthma triggers in the child's physical environment within parents' control (e.g., environmental tobacco smoke) may improve asthma control in children (Abreo, Gebretsadik, Stone, & Hartert, 2018).…”