The National Center of Complementary and Alternative Medicine (NCCAM), a center of the National Institutes of Health (NIH), has awarded a $2.5 million grant for research of asthma disparities among Latino children to the College of Nursing and Health Innovation at Arizona State University. The grant, titled “Asthma Disparities in Latino Children: Acculturation, Illness Representation & Contemporary Alternative Medicine” (CAM), is the largest in the history of the college.

Racial and ethnic disparities in asthma health outcomes have been increasing in the United States, resulting in researchers and public health officials calling for studies to determine the causes. Compared with majority-population children, minority children use controller medication less often, have less continuity of care, and visit emergency departments more frequently.

Especially noteworthy has been the increasing prevalence of asthma among Latino, primarily Puerto Rican, children. Individuals of Mexican and Puerto Rican origin constitute 73 percent of the Latino population in the United States. Although these two groups share similar historical origins and cultural values, significant differences exist. Puerto Rican children exhibit the highest rates of asthma prevalence and mortality among all ethnic groups while Mexican children have the lowest rates. Asthma disproportionately affects Puerto Rican children with a 2.33 adjusted odds ratio for lifetime diagnosis compared to non-Latino white children.

Perhaps of critical importance, but not extensively researched, is the role that culture, acculturation and illness representations – such as the way the parent interprets health and illness which influences how he/she manages the child’s asthma – may play in parents’ asthma treatment decisions.

The factors leading to asthma health disparities between Mexican and Puerto Rican children are complex, yet little research has been conducted that integrates, in one explanatory model, the multitude of factors that can lead to these disparities among Latino children. Illness representations and the associated treatment decisions (CAM and controller medication use) are two factors that need additional study.

Kimberly Sidora-Arcoleo, an assistant professor in the Center for Children, Teens & Families at the College of Nursing and Health Innovation and a fellow of the Center of Evaluation of Health Disparities Research & Training, is the principal investigator of the grant.

Flavio Marsiglia and Susanne Cook are co-investigators. Marsiglia is a faculty member in ASU’s School of Social Work where he is the Distinguished Foundation Professor of Cultural Diversity and Health. He also is the director of the Southwest Interdisciplinary Research Center (SIRC), a national exploratory center of excellence funded by the National Center on Minority Health and Health Disparities (NCMHD) of the National Institutes of Health (NIH).

Cook is an assistant professor at ASU Nursing and Health, and research consultant for the Arizona Asthma Coalition and the Phoenix Children’s Hospital Breathmobile program. She is a recognized expert in childhood asthma and has spent the past decade working with parents, school nurses, community leaders and legislators on the effects of asthma on children.

 According to Sidora-Arcoleo, the study is innovative because the proposed project moves the research from descriptive studies of individual constructs and contexts to testing an integrated, multifactorial model.

“Targeted interventions, aimed at reshaping illness representations, can be developed and implemented to integrate the family’s ethnomedical belief system – a medical system based on the cultural beliefs of specific ethnic groups – into the biomedical model,” Sidora-Arcoleo says. “The proposed interdisciplinary multilevel study will address gaps in the evidence base and expand the framework for assessing disparities in asthma health outcomes among Latino children.”

Longitudinal design

The research will take the form of a longitudinal study of parental illness representations, CAM and controller medication use among a diverse sample of 300 Latino families, primarily Mexican and Puerto Rican, of children with asthma ages five to 12. This age range was selected because children in this age group typically have not assumed daily control for managing their asthma.

Interviews and child assessments will be conducted at five time periods: initial enrollment, then three, six, nine and 12 months after enrollment, for a total data collection period of 12 months.

As data-gathering instruments are being finalized, hiring and training of staff will begin this month at two study locations: the Bronx borough of New York City and Phoenix, Ariz. Recruiting and enrollment of the 300 mother/child dyads is scheduled to begin next April. Study results will be reported in late 2013.

Contact:
Terry.Olbrysh@asu.edu
602-496-0877