Addressing asthma health disparities: A multilevel challenge

Behavioral Sciences Research Institute and the Department of Pediatrics, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico.
The Journal of allergy and clinical immunology (Impact Factor: 11.48). 06/2009; 123(6):1209-17; quiz 1218-9. DOI: 10.1016/j.jaci.2009.02.043
Source: PubMed


Substantial research has documented pervasive disparities in the prevalence, severity, and morbidity of asthma among minority populations compared with non-Latino white subjects. The underlying causes of these disparities are not well understood, and as a result, the leverage points to address them remain unclear. A multilevel framework for integrating research in asthma health disparities is proposed to advance both future research and clinical practice. The components of the proposed model include health care policies and regulations, operation of the health care system, provider/clinician-level factors, social/environmental factors, and individual/family attitudes and behaviors. The body of research suggests that asthma disparities have multiple, complex, and interrelated sources. Disparities occur when individual, environmental, health system, and provider factors interact with one another over time. Given that the causes of asthma disparities are complex and multilevel, clinical strategies to address these disparities must therefore be comparably multilevel and target many aspects of asthma care. Several strategies that could be applied in clinical settings to reduce asthma disparities are described, including the need for routine assessment of the patient's beliefs, financial barriers to disease management, and health literacy and the provision of cultural competence training and communication skills to health care provider groups.

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    • "These results also revealed that, all other things being equal, participants with lower levels of health self-efficacy were more likely to be diagnosed with asthma, as were Medicaid beneficiaries receiving publicly funded health services. Patients who feel unable to care for their health as well as those who are affected by poverty and lack material resources to do so require additional support to successfully manage their respiratory health (Canino et al., 2009). "
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    • "This methodological approach directs attention toward the contexts in which people reside and how social settings may impact different types of people in different ways (Wright and Subramanian, 2007). A multilevel framework is needed to understand and successfully reduce asthma disparities (Wright and Subramanian, 2007; Canino et al., 2009). Multilevel models permit examination of how immigrant density at the neighborhood level relates to children's health; multilevel models with cross-level interactions also enable us to determine if effects of neighborhood immigrant density vary for different types of children at the individual level. "
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