A Comparison of knowledge about asthma between Asians and non-Asians at two pediatric clinics

Asthma-Related Emergency Department Visits Among Low-Income Families With Young Children by Race/Ethnicity and Primary Language

OBJECTIVE

The aim of this study was to examine the existence of racial/ethnic and language disparities in asthma-related emergency department (ED) initial and return visits among young children in low-income families in California.

METHODS

Children younger than 6 years with at least 1 asthma-related ED visit recorded in the California Office of Statewide Health Planning and Development data set between January 1, 2009, and December 31, 2013, and on Medicaid (Medi-Cal) were assessed. Primary outcomes were hospitalization at the first asthma-related ED visit and a return asthma-related ED visit within 12 months. Data were analyzed using multivariate logistic regression.

RESULTS

Among 47,657 children, approximately 55% were Hispanic, 20% were black, and 2.7% were Asian/Pacific Islander. For non-English-speaking families, 82% were Hispanic. Among English-speaking families, blacks were less likely to be hospitalized at the first ED visit (odds ratio [OR], 0.787; 95% confidence interval [CI], 0.715-0.866) but more likely to return to the ED (OR, 1.291; 95% CI, 1.205-1.383) compared with whites. Conversely, Asian/Pacific Islanders whose primary language was English were more likely to be hospitalized (OR, 2.150; 95% CI, 1.827-2.530) compared with whites. Among families whose primary language was not English, Hispanic and Asian/Pacific Islanders are more likely to be hospitalized at the first ED visit and all groups are less likely to return to the ED compared with English-speaking whites.

CONCLUSIONS

The findings suggest that racial/ethnic and language disparities exist in eventual asthma-related hospitalizations and repeat ED visits. Continued research is needed to understand the existence of these differences and to inform future comprehensive and linguistically appropriate asthma interventions for children in low-income families.

Assessing Patient Knowledge of Asthma Using a Newly Validated Tool

OBJECTIVES

To develop and validate a measure of asthma knowledge and to translate and culturally adapt the measure into the Arabic language and context.

METHODS

Medically diagnosed individuals 18 years and older were recruited in primary care and specialty asthma clinics in the United Arab Emirates. The National Asthma Education and Prevention Program recommendations for education on asthma were used as a framework to develop the Asthma Knowledge Test (AKT). A measurement scale of "Yes," "No," and "I don't know" was selected. Descriptive statistics were calculated for participant demographics and other healthcare information. Cronbach α ≥ 0.7 was used to measure reliability. Principal component analysis was used to determine the distinct areas of asthma knowledge covered by the AKT. Differences in asthma knowledge depending on sex, age, marital status, and education were tested using multivariate analyses of variance.

RESULTS

Cronbach α = .70. Four components were retained and included: asthma as a common disease, triggers and control issues, inhalers, and beliefs and myths. The average AKT score = 13.95 ± 2.77 (range = 5.0-18.0). There was a significant effect of participant level of education on the AKT scores.

CONCLUSIONS

The availability of the AKT in Arabic is a valuable addition to the limited available tools related to asthma. As a simple and short tool, it could be used in clinical practice and research to identify specific areas of patient asthma knowledge needing improvements; hence, targeted interventions are sought.

Pediatric Asthma Among Small Racial/Ethnic Minority Groups: An Analysis of the 2006-2015 National Health Interview Survey

Few studies have examined the asthma burden among small racial/ethnic minority groups such as Asian children. We examined asthma disparities among children aged 4-17 in 6 small non-Hispanic racial/ethnic minority groups (American Indian/Alaska Native [AI/AN], Asian Indian, Chinese, Filipino, other Asian, and multiple race) by using the 2006-2015 National Health Interview Survey. These small minority groups represented a weighted 6.1% of the study population (6770 of 88 049). The prevalence of current asthma ranged from 5.5% (95% confidence interval [CI], 3.5%-7.5%) among Chinese children to 13.8% (95% CI, 10.4%-17.2%) among multiple-race children and 14.6% (95% CI, 10.8%-18.4%) among AI/AN children. Compared with non-Hispanic white children, AI/AN (adjusted odds ratio [aOR] = 1.6; 95% CI, 1.2-2.2) and multiple-race (aOR = 1.4; 95% CI, 1.0-2.0) children had higher odds for current asthma. Several small racial/ethnic minority groups are at heightened risk of asthma-associated outcomes, highlighting the need for further research on these populations.

Closing the gap: Understanding African American asthma knowledge and beliefs

BACKGROUND

African American children are disproportionately affected by asthma (13% vs 8% non-Hispanic white Americans) and experience 30% higher asthma-related deaths than whites. Knowledge regarding asthma and asthma treatment among African Americans has been postulated as a potential contributor to this observed health disparity. Compared with the amount of studies on asthma, few investigations provide insight into the baseline knowledge and beliefs of African Americans regarding asthma.

OBJECTIVE

Assess knowledge and beliefs regarding asthma symptoms, diagnosis, treatment, prognosis, and stigmas in a general community sample of African Americans.

METHODS

Using community-based participatory research techniques, we developed and implemented a cross-sectional survey to explore asthma knowledge and beliefs among African American adults in a Midwestern city.

RESULTS

Among the 158 African American adults who completed the survey, general asthma knowledge was good, with awareness of the genetic contribution to asthma and general asthma symptomatology (eg, 92% aware of nighttime cough as a symptom). However, asthma-related misconceptions were also revealed. Thirty-three percent of respondents were concerned about addiction to asthma medication, and 60% of respondents believed that inhaled corticosteroids were dangerous or did not know.

CONCLUSION

This study reveals important insights into asthma knowledge and beliefs among African Americans that may be used to address disparities in asthma outcomes in this population.

Community-based Participatory Research Is Needed to Address Pulmonary Health Disparities

Socioeconomic and racial disparities in the outcomes of medical management remain common across pulmonary diseases in the United States and worldwide. Acknowledging this, the American Thoracic Society recently put forth recommendations to advance respiratory health equity. Through engagement of vulnerable communities in search of collaborative solutions to improve health disparities, community-based participatory research embodies concepts essential to the American Thoracic Society mission for respiratory health equity. The purpose of this commentary is to provide an overview of the principles of community-based participatory research and the application of this approach to addressing inequity in the outcomes of treatment for lung disease. Community-based participatory research aims to decrease health disparities by recognizing the social and ecological paradigms of health care and by partnering community members with academic researchers in all aspects of the research process. Community partners are uniquely poised to offer insight into local culture, circumstances that guide health behaviors, and other challenges to improve their own community's health. Sustainable interventions, either through strengthening existing community assets or through community empowerment and local capacity building throughout the research process, are essential to the success of community-based participatory research. The National Institutes of Health and other funding agencies offer funding opportunities to support specific interventions aimed at engaging community members in the research process. In pulmonary medicine, community-based initiatives have focused primarily on improving pediatric asthma outcomes. Using a community-based approach in adult asthma and other pulmonary diseases could be an ideal manner in which to decrease pulmonary health disparities.

Disparities in Mortality and Morbidity in Pediatric Asthma Hospitalizations, 2007 to 2011

OBJECTIVE

Asthma is a leading cause of pediatric admissions. Although several factors including race have been linked to increased overall asthma morbidity and mortality, few studies have explored factors associated with inpatient asthma outcomes. We examined factors associated with mortality and morbidity in children admitted for asthma.

METHODS

Data were obtained from the US Nationwide Inpatient Sample for 2007 to 2011. Patients 2 to 18 years old with a primary diagnosis of asthma were included. Predictor variables were sociodemographic and hospital factors and acute/chronic secondary diagnoses. Outcomes were mortality, intubation, length of stay (LOS), and costs. Weighted national estimates were calculated. Multivariable analyses were performed.

RESULTS

There were 97,379 (478,546 weighted) asthma admissions. Most patients were male (60.6%); 30% were white, 28% black, and 18% Hispanic. Mortality rate was 0.03%, and 0.3% were intubated. Median LOS was 2 (interquartile range, 1-3) days. Median costs were $2,950 (interquartile range, $1990-$4610). Native American race, older age (13-18 years), and West region were significant independent predictors of mortality. Intubation rate was lower in Hispanic compared with white children (P = .028). LOS was shorter in Asian compared with white children (P = .022) but longer in children with public insurance and from low income areas (P < .001). Average costs were higher in black, Hispanic, and Asian compared with white children (P < .05).

CONCLUSIONS

With the exception of Native Americans, race/ethnicity is not associated with inpatient asthma mortality and has varied effects on morbidity. Recognition of factors associated with increased asthma mortality and morbidity might allow for earlier, more effective treatment and avoidance of complications.

Association between asthma and obesity among immigrant Asian Americans, California Health Interview Survey, 2001-2011

Our objective was to study the comorbidity of asthma and obesity among foreign-born Asian Americans, by subgroups. Public data from the California Health Interview Survey, 2001-2011, were analyzed by using independent logistic regressions, yielding the association between asthma and obesity (Asian and standard cutoffs for body mass index [BMIs]) of 19,841 Asian American immigrant respondents. Chinese, Filipino, South Asian, and Japanese immigrants had a positive association between lifetime asthma and obesity, whereas among Korean immigrants, a positive association was found between lifetime asthma and overweight status (standard BMI cutoffs). Routine screening for this comorbidity is warranted among immigrant Asian Americans.

Asthma disease management-Australian pharmacists' interventions improve patients' asthma knowledge and this is sustained

OBJECTIVE

To assess any improvements in knowledge of asthma patients after a tailored education program delivered by pharmacists and measure the sustainability of any improvements. To ascertain patients' perceptions about any changes in their knowledge.

METHODS

Ninety-six specially trained pharmacists recruited patients based on their risk of poor asthma control. A tailored intervention was delivered to patients based on individual needs and goals, and was conducted at three or four time points over six months. Asthma knowledge was assessed at the beginning and end of the service, and six and 12 months after it had ended. Patients' perceptions of the impact of the service on their knowledge were explored qualitatively in interviews.

RESULTS

The 96 pharmacists recruited 570 patients, 398 (70%) finished. Asthma knowledge significantly improved as a result of the service (7.65 ± 2.36, n=561, to 8.78 ± 2.14, n=393). This improvement was retained for at least 12 months after the service. Patients reported how the knowledge and skills gained had led to a change in the way they managed their asthma.

CONCLUSION

Improvements in knowledge are achievable and sustainable if pharmacists used targeted educational interventions.

PRACTICE IMPLICATIONS

Pharmacist educational interventions are an efficient way to improve asthma knowledge in the community.

Development and validation of an asthma knowledge questionnaire for use in Brazil

OBJECTIVE

To develop and validate an asthma knowledge questionnaire for use in adult asthma patients in Brazil.

METHODS

A 34-item self-report questionnaire was constructed and administered to adult asthma patients and adult controls. The maximum total score was 34.

RESULTS

The questionnaire was shown to be discriminatory, with good reliability and reproducibility. The mean score for asthma patients and controls was, respectively, 21.47 +/- 4.11 (range: 9-31) and 17.27 +/- 5.11 (range: 7-28; p < 0.001). The Kaiser-Meyer-Olkin measure of sampling adequacy was 0.53, and the Bartlett's test of sphericity demonstrated a satisfactory suitability of the data to factor analysis (p < 0.001). There was no significant difference between the total scores obtained in the first and in the second application of the questionnaire within a two-week interval (p = 0.43). The internal consistency reliability (KR-20 coefficient) was 0.69.

CONCLUSIONS

This study has validated an asthma knowledge questionnaire for use in Brazil.

Community-based participatory research in Boston's neighborhoods: A review of asthma case examples

Three case examples of asthma studies that differ in terms of community and involvement are considered. The Boston Chinatown studies faced limited funding that restricted the level of community involvement, but resulted in some of the first published evidence about asthma in Asian American children. These studies led to an asthma education program grant to a local Asian clinic and elementary school. The public housing study was a well-funded multi-year study of asthma and pest management with city, university and community partners. Residents were trained to collect data and participated throughout the study. Follow up pest management and pesticide buy-back programs headed by the city and community partners have been funded. The Dorchester case had more limited funding, but had the greatest level of involvement of parents of asthmatic children in all phases of the research. This survey led to an interesting novel finding of lower asthma prevalence in foreign born black residents.