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: 11.25). 06/2009; 123(6):1209-17; quiz 1218-9. DOI: 10.1016/j.jaci.2009.02.043
Source: PubMed

ABSTRACT 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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    Schizophrenia Research 12/2014; DOI:10.1016/j.schres.2014.11.021 · 4.43 Impact Factor
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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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    ABSTRACT: Prior research suggests that economic deprivation has a generally negative influence on residents' health. We employ hierarchical logistic regression modeling to test if economic deprivation presents respiratory health risks or benefits to Hispanic children living in the City of El Paso (Texas, USA) at neighborhood- and individual-levels, and whether individual-level health effects of economic deprivation vary based on neighborhood-level economic deprivation. Data come from the US Census Bureau and a population-based survey of El Paso schoolchildren. The dependent variable is children's current wheezing, an established respiratory morbidity measure, which is appropriate for use with economically-deprived children with an increased likelihood of not receiving a doctor's asthma diagnosis. Results reveal that economic deprivation (measured based on poverty status) at both neighborhood- and individual-levels is associated with reduced odds of wheezing for Hispanic children. A sensitivity analysis revealed similar significant effects of individual- and neighborhood-level poverty on the odds of doctor-diagnosed asthma. Neighborhood-level poverty did not significantly modify the observed association between individual-level poverty and Hispanic children's wheezing; however, greater neighborhood poverty tends to be more protective for poor (as opposed to non-poor) Hispanic children. These findings support a novel, multilevel understanding of seemingly paradoxical effects of economic deprivation on Hispanic health.
    International Journal of Environmental Research and Public Health 08/2014; 11(8):7856-7873. DOI:10.3390/ijerph110807856 · 2.06 Impact Factor
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    • "Some children have mild attacks and others have severe life threatening attacks. Asthma attacks are usually triggered by a wide variety of things, including allergens (e.g., cockroaches, dust mites, pollen, etc.), exercise, changes in weather, air pollutants (e.g., tobacco smoke), stress, infections, diet, and obesity [6] [7] [8]. In 2007, 13.1% of children (9.6 million) had, at some time during their lives, a diagnosis of asthma and 9.1% (6.7 million) currently had asthma [9]. "
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    ABSTRACT: Racial/ethnic minorities are 1.5 to 2.0 times more likely than whites to have most of the major chronic diseases. Chronic diseases are also more common in the poor than the nonpoor and this association is frequently mediated by race/ethnicity. Specifically, children are disproportionately affected by racial/ethnic health disparities. Between 1960 and 2005 the percentage of children with a chronic disease in the United States almost quadrupled with racial/ethnic minority youth having higher likelihood for these diseases. The most common major chronic diseases of youth in the United States are asthma, diabetes mellitus, obesity, hypertension, dental disease, attention-deficit/hyperactivity disorder, mental illness, cancers, sickle-cell anemia, cystic fibrosis, and a variety of genetic and other birth defects. This review will focus on the psychosocial rather than biological factors that play important roles in the etiology and subsequent solutions to these health disparities because they should be avoidable and they are inherently unjust. Finally, this review examines access to health services by focusing on health insurance and dental insurance coverage and access to school health services.
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