Asthma prevalence in Hispanic and Asian American ethnic subgroups: results from the California Healthy Kids Survey

Asthma heterogeneity among Asian American children: The California Health Interview Survey

BACKGROUND

The Asian American (AsA) population is heterogenous and rapidly growing; however, little is known regarding childhood asthma burden among AsA ethnic groups. The relation between obesity and asthma in AsA ethnic groups also remains unclear.

OBJECTIVE

To evaluate asthma prevalence and the relation of obesity to asthma risk among children in 7 AsA ethnic groups.

METHODS

We analyzed data from the California Health Interview Survey from 2011 to 2020. AsA ethnicities were self-reported. Body mass index z-scores, calculated from self-reported height/weight, were used to categorize children by obesity status, based on body mass index-for-age growth charts. Prevalence of self-reported lifetime doctor-diagnosed asthma and asthma attack in the last 12 months was calculated. We performed multivariable logistic regressions adjusting for age and sex.

RESULTS

Of 34,146 survey respondents, 12.2% non-Hispanic White and 12.5% AsA children reported lifetime asthma. Among AsA ethnic groups, however, lifetime asthma ranged from 5.1% (Korean American) to 21.5% (Filipino American). Non-Hispanic White children and AsA children had a similar lifetime asthma prevalence (adjusted odds ratio [aOR], 1.05; 95% CI, 0.71-1.55; P = .81), but prevalence was lower in Korean American children (aOR, 0.37; 95% CI, 0.19-0.73; P = .004) and higher in Filipino American children (aOR, 1.97; 95% CI, 1.22-3.17; P = .006). The lifetime asthma prevalence of different AsA ethnic groups persisted even when stratified by obesity status.

CONCLUSION

Childhood lifetime asthma prevalence varied among AsA ethnic groups, with lowest prevalence in Korean American children and highest prevalence in Filipino American. Further characterization of asthma burden among AsA ethnic groups may help guide asthma screening and prevention measures and offer new insights into asthma pathogenesis.

Risk of Incident Asthma Among Young Asian American, Native Hawaiian, and Pacific Islander Children from Age 3 to 7 Years in a Northern California Healthcare System

Incident childhood asthma risk has not been examined among diverse Asian American, Native Hawaiian, and Pacific Islander subgroups. In a large California healthcare system, incident asthma was higher among young Filipino/a, Native Hawaiian/Pacific Islander, and South Asian children compared with non-Hispanic White children, whereas Chinese and Japanese children were similar.

Trends in asthma among adults in the United States, National Health and Nutrition Examination Survey 2005 to 2018

BACKGROUND

Asthma is a common chronic disease in American adults. The prevalence of asthma has varied over time, but there are few studies on the long-term trend of asthma in American adults.

OBJECTIVE

To describe the prevalence and trend of asthma in American adults from 2005 to 2018 and analyze the risk factors for asthma.

METHODS

Data collection was performed from National Health and Nutrition Examination Survey 2005 to 2018. The unweighted number and weighted percentages of normal participants and patients with asthma and the trends of asthma were calculated. Weighted univariate logistic regression was used to analyze the risk factors for asthma.

RESULTS

A total of 39,601 adults were included in this study. From 2005 to 2018, the overall prevalence of asthma in American adults was 8.41%, whereas that in young, middle-aged, and elderly adults was 8.30%, 8.70%, and 7.92%, respectively. The estimated prevalence of asthma in the overall adults and young adults increased with time (P for trend = .03, difference = 0.023 and P for trend = .007, difference = 0.060, respectively), and the estimated prevalence of middle-aged and elderly adults remained stable with time (P for trend = .33, difference = 0.015 and P for trend = .80, difference = -0.024, respectively).

CONCLUSION

Asthma in American adults was on the rise. Female sex, non-Hispanic Blacks, individuals with low annual household income, active smokers, obese patients, patients with hypertension, patients with diabetes, and individuals with positive asthma family history were associated with a higher risk for developing asthma.

Knowledge Gaps, Challenges, and Opportunities in Health and Prevention Research for Asian Americans, Native Hawaiians, and Pacific Islanders: A Report From the 2021 National Institutes of Health Workshop

Asian Americans (AsA), Native Hawaiians, and Pacific Islanders (NHPI) comprise 7.7% of the U.S. population, and AsA have had the fastest growth rate since 2010. Yet the National Institutes of Health (NIH) has invested only 0.17% of its budget on AsA and NHPI research between 1992 and 2018. More than 40 ethnic subgroups are included within AsA and NHPI (with no majority subpopulation), which are highly diverse culturally, demographically, linguistically, and socioeconomically. However, data for these groups are often aggregated, masking critical health disparities and their drivers. To address these issues, in March 2021, the National Heart, Lung, and Blood Institute, in partnership with 8 other NIH institutes, convened a multidisciplinary workshop to review current research, knowledge gaps, opportunities, barriers, and approaches for prevention research for AsA and NHPI populations. The workshop covered 5 domains: 1) sociocultural, environmental, psychological health, and lifestyle dimensions; 2) metabolic disorders; 3) cardiovascular and lung diseases; 4) cancer; and 5) cognitive function and healthy aging. Two recurring themes emerged: Very limited data on the epidemiology, risk factors, and outcomes for most conditions are available, and most existing data are not disaggregated by subgroup, masking variation in risk factors, disease occurrence, and trajectories. Leveraging the vast phenotypic differences among AsA and NHPI groups was identified as a key opportunity to yield novel clues into etiologic and prognostic factors to inform prevention efforts and intervention strategies. Promising approaches for future research include developing collaborations with community partners, investing in infrastructure support for cohort studies, enhancing existing data sources to enable data disaggregation, and incorporating novel technology for objective measurement. Research on AsA and NHPI subgroups is urgently needed to eliminate disparities and promote health equity in these populations.

Prevalence of and risk factors for asthma among people aged 45 and older in China: a cross-sectional study

Background

Asthma is one of the most prevalent chronic respiratory diseases worldwide. This study aimed to determine the updated prevalence of and risk factors for asthma among individuals aged 45 and older in mainland China.

Methods

The data for this study came from the fourth wave of the China Health and Retirement Longitudinal Study (CHARLS) conducted by the National School of Development of Peking University in 2018. The CHARLS is a nationally representative survey targeting populations aged 45 and over from 28 provinces/cities in mainland China. A representative sample of 19,816 participants was recruited for the study using a multistage stratified sampling method. The prevalence of asthma was determined across different characteristics. The potential risk factors were examined by multivariable logistic regressions.

Results

A total of 18,395 participants (8744 men and 9651 women) were eligible for the final data analysis. The estimated prevalence of asthma among Chinese people aged ≥ 45 years in 2018 was 2.16% (95% CI 1.96–2.38). The prevalence of asthma significantly differed according to race (P = 0.002), with an overall rate of 2.07% (95% CI 1.86–2.29) in Han paticipants and 3.32% (95% CI 2.50–4.38) in minority participants. Furthermore, the minority ethnicities (OR = 1.55 [95% CI 1.12–2.14], P = 0.008), older age (60–69 years group: OR = 1.85 [95% CI 1.17–2.92], P = 0.008; ≥ 70 years group: OR = 2.63 [95% CI 1.66–4.17], P < 0.001), an education level of middle school or below (middle-school education: OR = 1.88 [95% CI 1.15–3.05], P = 0.011; primary education: OR = 2.48 [95% CI 1.55–3.98], P < 0.001; literate: OR = 2.53 [95% Cl 1.57–4.07], P < 0.001; illiterate: OR = 2.78 [95% CI 1.72–4.49, P < 0.001]), smoking (OR = 1.37 [95% CI 1.11–1.68], P = 0.003), and residence in North (OR = 1.52 [95% CI 1.11–2.09], P = 0.01) or Northwest China (OR = 1.71 [95% CI 1.18–2.49], P = 0.005) were associated with prevalent asthma.

Conclusions

Asthma is prevalent but underappreciated among middle-aged and elderly people in China. A number of risk factors were identified. These results can help to formulate correct prevention and treatment measures for asthma patients.

Residential Mobility Among Elementary School Students in Los Angeles County and Early School Experiences: Opportunities for Early Intervention to Prevent Absenteeism and Academic Failure

School connectedness is closely linked to academic success: students who are engaged at school have better attendance and academic performance, and are less likely to drop out. Residential mobility – having moved homes – can increase the risk of a negative academic trajectory (e.g., absenteeism and academic failure). Increasing housing instability in the United States due to rising housing costs, especially in urban areas, has made residential mobility a growing concern. While existing research has examined residential mobility among students and its connection to long-term consequences such as absenteeism and academic failure, less is known about how residential mobility relates to potential intermediate school experiences (e.g., school disconnectedness, low perceived academic ability, and experiences with school violence and harassment) that contribute to a negative academic trajectory. This study examines associations between residential mobility in elementary school and school experiences in a large urban jurisdiction. Data were collected from a sample of public elementary school students in Los Angeles County (5th grade, n = 5,620) via the California Healthy Kids Survey (2013–2014). Descriptive, Chi-square, multiple logistic regression analyses, and predicted probabilities were performed to examine the relationships between past-year residential mobility and indicators of school connectedness and school-based relationships, perceived academic performance, and exposure to violence and harassment. More than a third (36.6%) of students in the analysis sample moved at least once in the past year. After adjusting for neighborhood and family factors, a higher number of past-year moves was significantly associated with poorer school experiences, including lower odds of school connectedness for high-movers (2+ moves) [adjusted odds ratio (AOR) = 0.77; 95% confidence interval (CI) = 0.68–0.86], compared to non-movers. Movers had lower odds of perceived academic ability (1 move: AOR = 0.72; CI = 0.63–0.83; 2+ moves: AOR = 0.55; CI = 0.44–0.69), but higher odds of exposure to violence and harassment as a victim (1 move: AOR = 1.26, CI = 1.17–1.37; 2+ moves: AOR = 1.34, CI = 1.17–1.54), and as a perpetrator (1 move: AOR = 1.21, CI = 1.08–1.36; 2+ moves: AOR = 1.54, CI = 1.24–1.92). These results highlight the value of developing and implementing strategies that can identify and support students who move at young ages, to prevent student disengagement and promote attendance and academic success early in their life trajectory.

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.

Early life obesity increases the risk for asthma in San Francisco born Latina girls

BACKGROUND

Previous studies showed that youths who are obese are more likely to have asthma; however, some studies found important sex differences in the risk for asthma.

METHODS

We retrospectively assessed the asthma incidence in a Latino cohort of children recruited from birth and followed up until 9 years of age. We subsequently assessed risk factors for asthma and for an early asthma (defined as <4 years of age) diagnosis in relation to obesity. Asthma was assessed via maternal reports and medical records review of the children at 9 years of age. Each child's weight and height were collected annually. Independent and sex-specific risk factors for asthma diagnosis were assessed by using multivariable logistic regression models.

RESULTS

In our cohort, 24.6% (42/164) of the children were diagnosed with asthma by 9 years of age. The mean ± standard deviation age of asthma diagnosis was 29.5 ± 4.5 months; 79.5% had a diagnosis of asthma at <4 years of age. In girls, any breast-feeding at 6 months was associated with a reduced risk of asthma (odds ratio [OR] 0.21 [95% confidence interval {CI}, 0.05-0.86]) and obesity at 2 years of was associated with increased risk for asthma (OR 12.14 [95% CI 2.79-53.05]). Exposure to environmental toxins and consumption of sugar-sweetened beverages were associated with a risk for asthma diagnosis after 4 years of age.

CONCLUSION

In our high-risk Latino cohort, obesity was associated with asthma development in the girls. In addition, an asthma diagnosis after 4 years of age may be related to environmental toxin exposure and early consumption of sugar-sweetened beverages compared with an earlier diagnosis.

Revisiting the Hispanic health paradox: the relative contributions of nativity, country of origin, and race/ethnicity to childhood asthma

This study examined the relationship between race and Hispanic ethnicity, maternal and child nativity, country of origin and asthma among 2,558 non-Hispanic white and Hispanic children across 65 Los Angeles neighborhoods. A series of two-level multilevel models were estimated to examine the independent effects of race, ethnicity, and country of origin on childhood asthma. Lifetime asthma prevalence was reported among 9% of children, with no significant differences between Hispanics and non-Hispanic whites overall. However, in fully adjusted models, Hispanic children of non-Mexican origin reported higher odds of asthma compared to non-Hispanic white children. A protective nativity effect was also observed among children of foreign born mothers compared to US born mothers. Our study provides evidence in support of the heterogeneity of childhood asthma by Hispanic ethnicity and maternal nativity. These findings suggest moving beyond solely considering racial/ethnic classifications which could mask subgroups at increased risk of childhood asthma.

Persistent racial and ethnic disparities in flu vaccination coverage: Results from a population-based study

BACKGROUND

The Advisory Committee on Immunization Practices recommends annual flu vaccination for all adults. We aimed to identify predictors of receiving a flu vaccination, with an emphasis on the impact of race and ethnicity.

METHODS

We used data from the 2011-2012 California Health Interview Survey and included all individuals aged ≥18 years. We performed a survey-weighted logistic regression on receipt of flu vaccination within the last year, adjusted by demographic and socioeconomic variables, and calculated odds ratios (ORs) and 95% confidence intervals (CIs).

RESULTS

Our study included a population-weighted sample of 27,796,484 individuals. Overall, 35.8% received a flu vaccination within the last year. Blacks were 33% less likely (95% CI, 21%-43%) to have been vaccinated than whites. Conversely, Koreans (OR, 1.77; 95% CI, 1.35-2.33) and Vietnamese (OR, 1.57; 95% CI, 1.19-2.07) were more likely than whites to have been vaccinated. No differences were seen between whites and the remaining racial and ethnic groups (Latino, Japanese, Chinese, Filipino, South Asian, Asian other, and other).

CONCLUSIONS

Racial and ethnic disparities in flu vaccination uptake exist in California. Namely, blacks have lower vaccination rates than whites, and there are disparate vaccination rates among the Asian-American subgroups. Efforts to increase vaccination rates among these groups are needed.

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.

Montelukast Use and Patterns of Ambulatory Care among Asian versus Non-Asian Adult Patients with Asthma and/or Allergic Rhinitis in the United States

Background: Asthma and allergic rhinitis (AR) are inflammatory conditions that are similar in pathophysiology. Mild-to-moderate persistent asthma has been widely treated with inhaled corticosteroids, while allergic rhinitis is commonly treated with antihistamines, nasal corticosteroids, anticholinergics, and other allergy specific medications. The introduction of montelukast, a leukotriene receptor antagonist, has opened a treatment pathway that is common to both conditions. Previous real world studies of montelukast (Singulair®) relative to other medications have not investigated the role of race in the management of asthma and AR, specifically as relates to differences among Asian versus non-Asian patients. Objective: To contrast montelukast use and patterns of ambulatory care for adult Asian versus non-Asian patients in the United States with asthma and/or AR. Methods: Data for adult asthma and AR patients were extracted from a national electronic medical records database for the years 2006-2014. Patients were classified into condition cohort (Asthma-Only, AR-Only, Asthma & AR), and treatment condition (monotherapy or combination therapy, with or without montelukast for Asthma and Asthma & AR cohorts, usual care with or without montelukast for AR-Only) and stratified by race (Asian vs. non-Asian). Results: Overall patterns of use of montelukast were similar for Asian and non-Asian patients, but Asians were more likely to receive it as part of a combination therapy regimen. Changes in treatment regimen followed similar patterns for both groups. Asian patients with both asthma and AR were found to have lower service utilization rates if their therapy included montelukast, whereas for non-Asians there was no significant difference between regimens with or without montelukast. Conclusion: Differences in montelukast use and outcomes of care exist between Asian and non-Asian patients in the United States. Future research should explore the reasons for these differences and whether they can be replicated in non-US settings.

The prevalence of asthma risk and contributing factors in underserved Vietnamese children in Orange County, CA

OBJECTIVES

Vietnamese constitutes one of the fastest growing minority groups in America, with the largest concentration in Orange County (OC), CA. Yet, there are limited data on the prevalence of asthma in Vietnamese children. Our study evaluated the risk of asthma and key contributing factors among these children living in OC, CA.

METHOD

Five elementary schools in OC that were predominantly Vietnamese with low socioeconomic status were selected for participation. Validated surveys were sent to parents of all students ages 3-12 in these schools with materials available in English, Vietnamese and Spanish. Surveys included questions to identify the risk of asthma and related key factors. Surveys were completed by parents and returned to schools.

RESULTS

There were 1530 participants eligible for analysis. Asthma risk was 30.4%, and of these, 22.6% had no prior diagnosis. Contributing factors to identification of those at risk were male gender (p < 0.001), preferred use of the Vietnamese language (p = 0.004), longer duration in the United States (p = 0.019), and smoker in the household (p = 0.015).

CONCLUSIONS

The prevalence of asthma risk in our community of low socioeconomic status Vietnamese children was found to be higher than commonly appreciated. Furthermore, a considerable number of these children had not been previously diagnosed. Given the limited information in this population, our current findings of asthma risk and key contributing factors could affect health care policies that allow appropriate funding for programs dedicated to asthma care in this and other growing population.

Genetic Ancestry and Asthma and Rhinitis Occurrence in Hispanic Children: Findings from the Southern California Children's Health Study

Background

Asthma and rhinitis are common childhood health conditions. Being an understudied and rapidly growing population in the US, Hispanic children have a varying risk for these conditions that may result from sociocultural (including acculturative factors), exposure and genetic diversities. Hispanic populations have varying contributions from European, Amerindian and African ancestries. While previous literature separately reported associations between genetic ancestry and acculturation factors with asthma, whether Amerindian ancestry and acculturative factors have independent associations with development of early-life asthma and rhinitis in Hispanic children remains unknown. We hypothesized that genetic ancestry is an important determinant of early-life asthma and rhinitis occurrence in Hispanic children independent of sociodemographic, acculturation and environmental factors.

Methods

Subjects were Hispanic children (5–7 years) who participated in the southern California Children’s Health Study. Data from birth certificates and questionnaire provided information on acculturation, sociodemographic and environmental factors. Genetic ancestries (Amerindian, European, African and Asian) were estimated based on 233 ancestry informative markers. Asthma was defined by parental report of doctor-diagnosed asthma. Rhinitis was defined by parental report of a history of chronic sneezing or runny or blocked nose without a cold or flu. Sample sizes were 1,719 and 1,788 for investigating the role of genetic ancestry on asthma and rhinitis, respectively.

Results

Children had major contributions from Amerindian and European ancestries. After accounting for potential confounders, per 25% increase in Amerindian ancestry was associated with 17.6% (95% confidence interval [CI]: 0.74–0.99) and 13.6% (95% CI: 0.79–0.98) lower odds of asthma and rhinitis, respectively. Acculturation was not associated with either outcome.

Conclusions

Earlier work documented that Hispanic children with significant contribution from African ancestry are at increased asthma risk; however, in Hispanic children who have little contribution from African ancestry, Amerindian ancestry was independently associated with lower odds for development of early-childhood asthma and rhinitis.

Asthma in US Mexican-Origin Children in Early Childhood: Differences in Risk and Protective Factors by Parental Nativity

OBJECTIVE

Over 900,000 Mexican-origin children in the United States have asthma, but little is known about the extent to which development of this condition reflects early childhood exposure to social and environmental risks. The objectives of this research are to demonstrate the roles of risk and protective factors in the prevalence and severity of asthma in this population and provide comparisons with other racial/ethnic groups.

METHODS

Nationally representative data from the Early Childhood Longitudinal Study, Birth Cohort (n = 6900), with county-level ozone data appended to this file were analyzed using descriptive and multivariate regression methods.

RESULTS

The odds of asthma diagnosis by 60 months are approximately 50% higher among Mexican-origin children than for non-Hispanic whites (P < .05) in multivariate analyses. Compared to those with foreign-born parents, Mexican-origin children with native-born parents have a lower likelihood of being breast-fed and greater chances of having risks including a family history of asthma, having respiratory illnesses and allergies, living with a smoker, and attending center-based child care. Mexican-origin children live in counties with over 3 times more elevated ozone days annually than non-Hispanic whites.

CONCLUSIONS

Mexican-origin children experience a constellation of risk and protective factors, but those with US-born parents have elevated asthma risks compared to those with foreign-born parents. Asthma incidence and severity will likely increase as this population becomes increasingly integrated into US society.

Perceived discrimination and chronic health in adults from nine ethnic subgroups in the USA

OBJECTIVE

This comparative analysis examines the association between chronic cardiovascular, respiratory and pain conditions, race, ethnicity, nativity, length of residency, and perceived discrimination among three racial and nine ethnic subgroups of Asian Americans (Vietnamese, Filipino, and Chinese), Latino-American (Cuban, Portuguese, and Mexican), and Afro-Caribbean American (Haitian, Jamaican, and Trinidadian/Tobagonian) respondents.

DESIGN

Analysis used weighted Collaborative Psychiatric Epidemiology Surveys-merged data from the National Latino and Asian American Study and the National Survey of American Life. Logistic regression analysis was conducted to determine which groups within the model were more likely to report perceived discrimination effects.

RESULTS

Afro-Caribbean subgroups were more likely to report perceived discrimination than Asian American and Latino-American subgroups were. Logistic regression revealed a significant positive association with perceived discrimination and chronic pain only for Latino-American respondents.

CONCLUSION

Significant differences in reports of perceived discrimination emerged by race and ethnicity. Caribbean respondents were more likely to report high levels of perceived discrimination; however, they showed fewer significant associations related to chronic health conditions compared to Asian Americans and Latino-Americans. Examination of perceived discrimination across ethnic subgroups reveals large variations in the relationship between chronic health and discrimination by race and ethnicity. Examining perceived discrimination by ethnicity may reveal more complex chronic health patterns masked by broader racial groupings.

Latinos in the United States on the HIV/AIDS care continuum by birth country/region: a systematic review of the literature

Twenty percent of Latinos with HIV in the US are unaware of their HIV status, 33% are linked to care late, and 74% do not reach viral suppression. Disparities along this HIV/AIDS care continuum may be present between various ethnic groups historically categorised as Latino. To identify differences along the HIV/AIDS care continuum between US Latinos of varying birth countries/regions a systematic review of articles published in English between 2002 and 2013 was conducted using MEDLINE, PsycINFO, and Web of Science. Studies that reported on one or more steps of the HIV/AIDS care continuum and reported results by birth country/region for Latinos were included. Latinos born in Mexico and Central America were found to be at increased risk of late diagnosis compared with US-born Latinos. No studies were found that reported on linkage to HIV care or viral load suppression by country/region of birth. Lower survival was found among Latinos born in Puerto Rico compared with Latinos born in mainland US. Inconsistent differences in survival were found among Latinos born in Mexico, Cuba, and Central America. Socio/cultural context, immigration factors, and documentation status are discussed as partial explanations for disparities along the HIV/AIDS care continuum.

Television viewing in low-income latino children: variation by ethnic subgroup and English proficiency

BACKGROUND

Television viewing is associated with an increased risk for obesity in children. Latino children are at high risk for obesity and yet little is known about differences in television viewing habits within this population. The purpose of this study is to determine if hours of television viewed by young children with low-income Latina mothers differs by maternal ethnic subgroup and English language proficiency.

METHODS

This was a cross-sectional analysis of data from the Welfare, Children, & Families: A Three City Study. Participants were 422 low-income Latina mothers of Mexican and Puerto Rican descent with children ages 0-4 years old. The dependent variable was hours of daily television viewed by the child. The independent variable was maternal ethnic subgroup and English language proficiency. Analyses involved the use of multiple negative binomial regression models, which were adjusted for demographic variables.

RESULTS

Multivariable regression analyses showed that compared to children with mothers of Mexican descent, children of mothers of Puerto Rican descent watch more daily television (<2 years old, incidence rate ratio (IRR)=4.18, 95% confidence interval (CI) 1.68, 10.42; 2-4 years, IRR=1.54, 95% CI 1.06, 2.26). For children with mothers of Mexican descent, higher maternal English language proficiency was associated with higher amounts of child television viewing (IRR=1.29, 95% CI 1.04, 1.61). No relationship was found for children of Puerto Rican descent.

CONCLUSIONS

Child television viewing varies in low-income Latino children by maternal ethnic subgroup and English language proficiency. Interventionists must consider the varying sociocultural contexts of Latino children and their influence on television viewing.

The challenge of asthma in minority populations

The burden and disparity of asthma in race/ethnic minorities present a significant challenge. In this review, we will evaluate data on asthma epidemiology in minorities, examine potential reasons for asthma disparities, and discuss strategies of intervention and culturally sensitive care.

Poquito a poquito: how Latino families with children who have asthma make changes in their home

INTRODUCTION

The purpose of this study was to assess the cultural and environmental barriers to making asthma-focused changes in the homes of Latino families with children who have asthma.

METHODS

A descriptive qualitative design guided data collection and analysis in this study. Participating families described their experiences in caring for their children with asthma and the barriers they encountered when trying to modify their home environments and manage their children's asthma symptoms.

RESULTS

Families discussed a spectrum of methods to manage their children's asthma symptoms, including barriers they experienced and successful changes they made in their homes. "Little by little" parents made minor adjustments, as they were able, to alleviate their children's asthma symptoms.

DISCUSSION

Nurses working with Latino families who experience similar barriers can use these findings to guide inquiries about families' successful changes in their home environment and use them as a starting place to work collaboratively with families to reduce their children's asthma exacerbations. This process will allow nurses to use culturally and family tailored interventions to fit their needs and goals.

Understanding sibilancias (wheezing) among Mexican American parents

BACKGROUND

Asthma is one of the most common pediatric chronic diseases in the United States; however, prevalence varies across Latino ethnicities, such as Mexican Americans (MAs). Linguistic and cultural issues may contribute to difficulties in diagnosis.

METHODS

We conducted a qualitative study to assess the comprehension of common words used in a validated asthma questionnaire. The study sample consisted of 40 MA Spanish-speaking parents of 2- to 18-year-old children, with and without asthma, at a community health clinic.

RESULTS

Regardless of their child's asthma status, the majority of parents (12 [80%] with non-asthmatic children; 16 [64%] with asthmatic children) did not understand common Spanish words used in clinical settings to identify asthma (e.g., wheezing and whistling). Instead, parents used physical symptoms and sounds to describe asthma.

CONCLUSION

This exploratory study demonstrates MA parents' limited comprehension of common words used in clinical settings to identify asthma. Future research should examine tools that incorporate visual and auditory descriptions of asthma.

Relationship between exercise-induced bronchospasm (EIB) and asthma control test (ACT) in asthmatic children

OBJECTIVE

Evaluate the relationship between Asthma Control Test™ (ACT) and exercise-induced bronchospasm (EIB) in 81 asthmatic children.

METHODS

EIB was assessed in every patient by Balke protocol and asthma control was evaluated by ACT. Patients were divided into three groups: Group A (30 patients) with complete asthma control (ACT score = 25), Group B (37 patients) with partial asthma control (ACT score = 21-24), and Group C (14 patients) with poor asthma control (ACT score < 20).

RESULTS

About 36% (11/30) of patients in Group A (with complete asthma control) tested positive for EIB, whereas 21% (8/37) in Group B (with partial asthma control) and 28% (4/14) in Group C (with poor asthma control) exhibited EIB. The percentage of positive EIB was very similar between the three groups with no differences between controlled, partially controlled, and uncontrolled asthma. Statistical evaluation by χ(2)-test between complete (ACT score = 25) and not complete asthma control (ACT score < 24) confirmed a statistically significant difference (p < .01) between the obtained data.

CONCLUSIONS

It must be stated that ACT alone is not sufficient to evaluate asthma control in children correctly because it fails to detect EIB in a significant percentage of subjects.

Association of house dust mite-specific IgE with asthma control, medications and household pets

Background

Evidence is conflicting regarding the effectiveness of creating a low-allergen environment or reducing allergen exposure to control asthma exacerbations.

Objective

This study determined the association of house dust mite (HDM)-specific IgE levels with asthma symptom control, selected medications, family history of allergic disease, and exposure to second-hand smoke and household pets.

Methods

Serum samples from 102 doctor-diagnosed allergic asthma patients and 100 non-atopic controls were subjected to enzyme-linked immunosorbent assay using the HDM species Dermatophagoides pteronyssinus (Dp), Dermatophagoides farinae (Df), and Blomia tropicalis (Bt) allergens. Point-biserial correlation coefficient, Pearson R correlation, and logistic regression analyses were used to determine association of HDM-specific IgE levels with the abovementioned variables.

Results

Of the 102 cases, 38.24%, 47.06%, and 33.33% were sensitized to Bt, Df, and Dp, respectively. Sensitized patients showed greater probability [Bt (OR = 1.21), Df (OR = 1.14), and Dp (OR = 1.35)] to manifest symptoms than those who were not. Obtained p-values [Bt (p = 0.73), Df (p = 0.83), and Dp (p = 0.59)], however, proved that HDM-specific IgE levels had no significant contribution in predicting or explaining occurrence of asthma symptoms. Bt- and Df-specific IgEs showed moderately weak but significant relationship with bambuterol HCl and expectorant, respectively. Patients currently on said medications registered higher HDM-specific IgE levels than those who were not. No significant correlation between IgE levels and family history of allergic disease or with exposure to second-hand smoke was seen. Dp-specific IgE levels of patients exposed to household pets were significantly lower compared to those without exposure.

Conclusion

This study proves that sensitization to Bt, Df, and Dp allergens is not significantly associated with asthma symptoms and control. Although cases were shown to be sensitized to HDMs, their current medications were at least effective in controlling their asthma symptoms.

Prevalence of asthma and its association with glycemic control among youth with diabetes

OBJECTIVE

To estimate the prevalence of asthma among youth with types 1 and 2 diabetes and examine associations between asthma and glycemic control.

METHODS

This was a cross-sectional analysis of data from the SEARCH for Diabetes in Youth study, which included youth diagnosed with type 1 (n = 1683) and type 2 (n = 311) diabetes from 2002 through 2005. Asthma status and medications were ascertained from medical records and self-administered questionnaires, and glycemic control was assessed from hemoglobin A1c measured at the study visit.

RESULTS

Prevalence of asthma among all youth with diabetes was 10.9% (95% confidence interval [CI]: 9.6%-12.3%). The prevalence was 10.0% (95% CI: 8.6%-11.4%) among youth with type 1 and 16.1% (95% CI: 12.0%-20.2%) among youth with type 2 diabetes and differed according to race/ethnicity. Among youth with type 1 diabetes, those with asthma had higher mean A1c levels than those without asthma, after adjustment for age, gender, race/ethnicity, and BMI (7.77% vs 7.49%; P = .034). Youth with asthma were more likely to have poor glycemic control, particularly those with type 1 diabetes whose asthma was not treated with pharmacotherapy, although this association was attenuated by adjustment for race/ethnicity.

CONCLUSIONS

Prevalence of asthma may be elevated among youth with diabetes relative to the general US population. Among youth with type 1 diabetes, asthma is associated with poor glycemic control, especially if asthma is untreated. Specific asthma medications may decrease systemic inflammation, which underlies the complex relationship between pulmonary function, BMI, and glycemic control among youth with diabetes.

Prevalence, demographics, and health outcomes of comorbid asthma and overweight in urban children

BACKGROUND

Asthma and overweight are epidemic in urban children but the relationship between these conditions is not fully understood. This study presents demographic and risk profiles of comorbidity for overweight asthmatic children, characterizes morbidity by comparing health outcomes among overweight asthmatics and healthy weight asthmatics, and examines socioeconomic factors associated with comorbidity.

OBJECTIVE

To construct a demographic profile of overweight asthmatic children in an urban setting and identify factors that contribute to prevalence.

METHOD

Cross-sectional study of 5250 children in New York City public elementary schools using a parent-report questionnaire on body mass index, socioeconomic status, asthma, and asthma-related outcomes.

RESULTS

Prevalence of overweight (body mass index ≥ 85th percentile for age and gender) was 50.9%. The prevalence of overweight and ever being diagnosed with asthma was 10.9%. The prevalence of overweight with current asthma was 6.2%. Overweight current asthmatics had more night symptoms, missed school days, and asthma medication use than healthy weight asthmatics. Almost 50% of overweight current asthmatic children reported emergency department visits for asthma compared with 30% of healthy weight asthmatics. Comorbidity was most prevalent among males, Latinos, and children in low-income households, with the highest prevalence among Puerto Ricans. In multivariate analysis stratified by gender, the most significant factors associated with comorbidity among girls were low income and minority race/ethnicity, while among boys significant factors were parental education and parental history of asthma. Interestingly, there were few underweight children (7.8%) but they had high prevalence of asthma (13.8%).

CONCLUSIONS

The comorbidity of overweight and asthma has a large impact on urban populations, causing greater disease burden than asthma alone. Overweight asthmatics show more uncontrolled asthma, evidenced by emergency department visits, quick-relief medication use, and days with asthma symptoms. The relationship between socioeconomic factors and the asthma-obesity comorbidity may vary by gender and requires further study to identify successful interventions to reduce disease in children.

Self-reported asthma in Chaldeans, Arabs, and African Americans: factors associated with asthma

Although the prevalence of asthma is increasing worldwide, there are striking, and largely unexplained differences across various racial and ethnic groups. The current study looks at the prevalence of asthma and risk factors between Chaldeans, Arabs, and African Americans. We used Health Assessment Survey data representing 3,136 respondents. Prevalence across the three ethnic groups were compared using unadjusted and adjusted odds ratios, accounting for multiple risk factors. There were significant socio-demographic differences across all ethnic groups. Asthma prevalence was significantly lower in Arabs (9.4%) and Chaldeans (5.4%) than in Non-Middle Eastern Whites (14.4%). African American prevalence was 14.4%. The significantly lower prevalence of asthma among Chaldean and Arabs, as compared to African Americans, were not explained by traditional risk factors included in our models. We therefore, suggest that future studies should explore the possible role of ethnic-specific differences in gene × environmental interactions in the precipitation and/or exacerbation of asthma.

Race and asthma control in the pediatric population of Hawaii

OBJECTIVES

The racially unique population of Hawaii has one of the highest prevalences of childhood asthma in America. We estimate the prevalence of impaired asthma control among asthmatic children in Hawaii and determine which factors are associated with impaired control.

PATIENTS AND METHODS

We analyzed data from 477 asthmatic children living in Hawaii participating in the 2006-2008 Behavioral Risk Factor Surveillance System (BRFSS) Asthma Call-Back Surveys. Impaired asthma control was modeled after 2007 National Asthma Education and Prevention Program guidelines. Univariate and multivariate analyses were used to identify factors associated with impaired asthma control.

RESULTS

Children (53.8%) with asthma were either part or full Native Hawaiian/Pacific Islander. While 35.6% of asthmatic children met criteria for impaired asthma control, being part or full Native Hawaiian/Pacific Islander was not associated with impaired control. Only 31.1% of children with impaired control reported the use of inhaled corticosteroids despite >80% having had a routine checkup for asthma in the past year and receipt of asthma education from a healthcare provider.

CONCLUSION

A large proportion of asthmatic children in Hawaii have impaired asthma control that does not appear to be associated with race but may be associated with inadequate pharmacologic therapy. While a significant percentage reported receiving routine asthma care and asthma education, a minority reported using inhaled corticosteroids. Reasons for this discrepancy between asthma assessment and treatment are unclear. However, additional education on part of the physician, community, and healthcare system are likely to improve management and reduce morbidity in this population.

Recruitment of asthmatic ethnic minorities into a methacholine research study: factors influencing participation

BACKGROUND

How to recruit minority participants into research studies has been an issue since 1993, when NIH funding guidelines required minorities to be included as research participants.

OBJECTIVE

The purpose of this analysis was to determine what factors affected recruitment of asthmatic minorities into a large bronchoconstrictor study involving African-Americans, Hispanics/Mexican Americans, Asian/Pacific Islanders, and whites with mild asthma (forced expiratory volume in the first second of expiration > or = 70%).

METHODS

Ethnic minorities were recruited for 3 years. Recruitment strategies included physician and clinic referrals, newspaper ads, posters in health care settings, asthma databases, and electronic resources.

FINDINGS

After 3 years, the total number of referrals was 650, with 50 from medical doctor clinic settings and 600 from all of the other resources. The inclusion/exclusion criteria were clearly listed, but only 64.5% (419/650) of respondents met inclusion criteria. Of these, only 31.9% (134/419) [corrected] met pulmonary function testing criteria. Only 5, or 1% of the 50 medical doctor clinic referrals met inclusion criteria--1 participated. A total of 106, or 82.8%, completed all of the study procedures; for 87.7% of participants this was their first research experience. Hispanics/Mexican Americans accounted for only 14.8% of the total recruitment responses.

CONCLUSION

We believe our recruitment strategies did encourage ethnic minorities to participate, but the inclusion criteria of a positive methacholine response proved to be a study enrollment barrier.

Ethnicity and risk of hospitalization for asthma and chronic obstructive pulmonary disease

PURPOSE

To identify ethnic differences for risk of hospitalization for asthma and chronic obstructive pulmonary disease (COPD).

METHODS

We undertook a cohort study with 126,019 participants: 55% whites, 27% blacks, 11% Asians, and 4% Hispanics. To estimate asthma and COPD risk, we used Cox proportional hazards models adjusted for age, sex, body mass index, education, smoking, and alcohol intake. End points were hospitalizations for asthma or COPD.

RESULTS

Compared with whites, relative risks (RR) with 95% confidence intervals (95% CI) for asthma among other groups were: blacks, 1.7 (1.4-2.0); Hispanics, 0.9 (0.6-1.4); and Asians, 1.6 (1.2-2.1). Among Asians, increased risk was concentrated in Filipino men and women and South Asian men. For COPD, whites were at highest risk; RR of blacks was 0.9 (0.7-1.0); Hispanics, 0.6 (0.3- 0.9); and Asians, 0.4 (0.3-0.6). COPD risk among Asians was lowest in Chinese with RR of 0.3 (0.1-0.5).

CONCLUSIONS

Ethnic disparities in risk of asthma and COPD as well as between both diseases exist, especially for Asian Americans, who have high asthma risk and low COPD risk. While residual confounding for smoking or other environmental factors could be partially responsible, genetic factors in Asians may be involved in decreased COPD risk.

Association of environment and place of birth with asthma in Chinese immigrant children

Despite the advances in perinatal and neonatal care and use of newer potent antibiotics, the incidence of neonatal sepsis remains high and the outcome is still severe. For years, investigators have sought a test or panel of tests able to identify septic neonates accurately and rapidly in order to obtain an early diagnosis and develop a specific effective treatment for a successful outcome. In addition to the standard procedures (blood, CSF, and urine cultures, chest x-ray), such panels have included a combination of total and differential cell counts, total immature neutrophil counts, immature to total neutrophil ratio, platelet counts, and levels of acute-phase reactants and cytokines. Furthermore, the science of proteomics and genomics has been applied to the search for biomarkers, production of protein profiles and genetic polymorphisms that can rapidly help the prediction, early diagnosis, and treatment of human diseases, but, for now, data are as yet insufficient to confirm their validity.

Considerations and challenges for planning a public health approach to asthma

Addressing asthma from a public health perspective is a relatively new concept for which the literature provides little guidance. A public health approach seeks to decrease the burden of asthma and improve health outcomes at the population level, such as communities, cities, or states, by reaching large numbers of individuals with effective interventions and at reasonable cost. Projects designed to achieve a measureable impact at the population level are fundamentally different from projects or interventions designed to improve outcomes among individuals. This paper uses the experience of the Controlling Asthma in American Cities Project and a review of the relevant literature to explore some of the unique questions and considerations that are implicit when planning large-scale asthma projects intended to improve population outcomes. The paper is intended to inform decision making by local and state government agencies, managed care organizations, health systems, community coalitions, and funders. Analysis of asthma and other chronic disease projects aiming to achieve population-level impact is an area for continued public health research.

Knowledge and use of ethnomedical treatments for asthma among Puerto Ricans in an urban community

PURPOSE

Puerto Ricans have higher lifetime and current asthma prevalence than other racial and ethnic groups in the United States. A great many Hispanics use ethnomedical therapies for asthma. This study elicited participant knowledge of ethnomedical therapies, developed a typology of the therapies, and considered whether some types are used or deemed efficacious based, in part, on information source.

METHODS

Eligible participants were randomly selected from the medical records of an inner-city primary care clinic serving a predominantly Hispanic community in Buffalo, New York. Thirty adult Puerto Ricans who had asthma or were care-givers of children with asthma were interviewed in person using a semistructured instrument. Qualitative data analysis followed a content-driven immersion-crystallization approach. Outcome measures were ethnomedical treatments for asthma known to participants, whether these treatments were used or perceived effective, and the participant's information source about the treatment.

RESULTS

Participants identified 75 ethnomedical treatments for asthma. Behavioral strategies were significantly more likely to be used or perceived effective compared with ingested and topical remedies (P <.001). Among information sources for ingested and topical remedies, those recommended by community members were significantly less likely to be used or perceived effective (P <.001) compared with other sources.

CONCLUSIONS

This sample of Puerto Ricans with a regular source of medical care was significantly more likely to use or perceive as effective behavioral strategies compared with ingested and topical remedies. Allopathic clinicians should ask Puerto Rican patients about their use of ethnomedical therapies for asthma to better understand their health beliefs and to integrate ethnomedical therapies with allopathic medicine.

[Regional inequalities in the prevalence of asthma diagnosis in children: an analysis of the Brazilian National Household Sample Survey, 2003]

The aim of this study was to estimate the prevalence of asthma diagnosis in Brazilian children and to analyze socio-demographic inequalities between the South and Northeast regions of the country. Data for children under 10 years of age were analyzed from the 2003 National Household Sample Survey, or PNAD (n = 69,796). Socioeconomic characteristics, the child's gender and age, and the parent or guardian's skin color were the independent variables investigated through unconditional multiple logistic regression. Prevalence of asthma diagnosis was 8.5% in Brazil as a whole (95%CI: 7.7-8.5) and 12.6% (95%CI: 11.6-13.5) and 4.4% (95%CI: 4.0-4.8) in the South and Northeast, respectively. After adjustment, children from 3 to 7 years of age and those from the poorest families were more likely to have an asthma diagnosis in both regions. Black skin color, crowding, and substandard housing were associated with asthma in the South. In the Northeast, children of parents with low schooling were less likely to present asthma. The inequalities were more evident in the South, suggesting variation in asthma determinants across the country.

Ethnic differences in methacholine responsiveness and word descriptors in African Americans, Hispanic-Mexican Americans, Asian-Pacific Islanders, and Whites with mild asthma

OBJECTIVE

There is little asthma research that compares ethnic differences in airway responsiveness and word descriptors among African Americans, Hispanic-Mexican Americans, Asian-Pacific Islanders, and Whites. Thus, identifying ethnic differences in symptom descriptors and airway responsiveness may improve health outcomes by educating health professionals about treatment decisions that are culturally and ethnically sensitive.

METHODS

Specific Inclusion criteria-forced expiratory volume in one second (FEV(1)) >or= 70% predicted normal; provocative concentration causing a 30% fall in FEV(1) (PC(30)) <or= 8 mg/ml for methacholine (MCh), using only a beta(2)- inhaler, and self-reported ethnicity of African American, Hispanic-Mexican American, Asian-Pacific Islander, or White. Serial pulmonary function test (PFT) and Borg, Visual Analogue Scale (VAS), and Ethnic Word Descriptors (EWDs) were collected.

RESULTS

One hundred eighteen consented, 106 completed procedures, and 90 had a positive PC(30) and were enrolled. Asian-Pacific Islanders had significantly greater airway responsiveness (p <.02). Baseline FEV(1), MCh dose, and PC(30) correlated with race (p <.001); baseline FEV(1) and ethnicity predicted airway responsiveness (p <.001). EWDs differed significantly by ethnicity. Upper airway EWDs for Asian-Pacific Islanders: itchy throat (p < .04), itchy (p <.02), itchy back throat (p <.04), voice tight, tight throat (p <.001), and cough (p <.04). Upper airway EWDs for African Americans: add itchy throat (p <.002), itchy neck (p <.001), tight throat (p <.003), voice tight (p <.02), and cough (p <.04). Hispanic-Mexican Americans used both upper and lower airway EWDs; Whites used only lower airway EWDs.

CONCLUSION

This study provides new insights about ethnic differences in airway responsiveness and EWDs. Asian-Pacific Islanders required a significantly smaller dose of MCh to achieve a PC(30) compared to the other three ethnic groups. The upper airway EWDs used by African Americans, Asian-Pacific Islanders, and Hispanic-Mexican Americans indicate a shared language of symptoms. A new language of breathlessness that incorporates both cultural and ethnic differences is needed to address the present disparity in the management of asthma symptoms.

Health status and health services access and utilization among Chinese, Filipino, Japanese, Korean, South Asian, and Vietnamese children in California

OBJECTIVES

We examined health status and health services access and utilization of Chinese, Filipino, Japanese, Korean, South Asian, Vietnamese, and non-Hispanic White children in California.

METHODS

We analyzed aggregated data from the 2003 and 2005 California Health Interview Survey (648 Chinese, 523 Filipino, 235 Japanese, 308 Korean, 314 South Asian, 264 Vietnamese, and 8468 non-Hispanic White children aged younger than 12 years), examining the relationship between Asian ethnicities and outcomes.

RESULTS

Compared with non-Hispanic White children, Korean children were 4 times more likely to lack health insurance; Filipino children were twice as likely to not have had recent contact with a doctor; Chinese, Korean, and Vietnamese children were less likely to have visited an emergency room in the past year; and Chinese, Korean, and Vietnamese children were more likely to be in fair or poor health. Age, gender, poverty, citizenship-nativity status, health insurance, and parental marital and child health statuses were related to most outcomes.

CONCLUSIONS

Asian ethnicities have heterogeneous health care access and utilization patterns, suggesting the need for targeted outreach to different Asian ethnic groups.

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.

Variability in childhood allergy and asthma across ethnicity, language, and residency duration in El Paso, Texas: a cross-sectional study

BACKGROUND

We evaluated the impact of migration to the USA-Mexico border city of El Paso, Texas (USA), parental language preference, and Hispanic ethnicity on childhood asthma to differentiate between its social and environmental determinants.

METHODS

Allergy and asthma prevalence was surveyed among 9797 fourth and fifth grade children enrolled in the El Paso Independent School District. Parents completed a respiratory health questionnaire, in either English or Spanish, and a sub-sample of children received spirometry testing at their school. Here we report asthma and allergy outcomes across ethnicity and El Paso residency duration.

RESULTS

Asthma and allergy prevalence increased with longer duration of El Paso residency independent of ethnicity and preferred language. Compared with immigrants who arrived in El Paso after entering first grade (18%), lifelong El Paso residents (68%) had more prevalent allergy (OR, 1.72; 95% CI, 1.32 - 2.24), prevalent asthma (OR, 1.75; 95% CI, 1.24 - 2.46), and current asthma (OR, 2.01; 95% CI, 1.37 - 2.95). Spirometric measurements (FEV1/FVC and FEF25-75) also declined with increasing duration of El Paso residency (0.16% and 0.35% annual reduction, respectively).

CONCLUSION

These findings suggest that a community-wide environmental exposure in El Paso, delayed pulmonary development, or increased health of immigrants may be associated with allergy and asthma development in children raised there.

An analysis of the association between parental acculturation and children's medication use

OBJECTIVES

We examined how Hispanic children, with stratification according to language to approximate acculturation, differed with respect to sociodemographic characteristics and medication use. We also examined how different factors were associated with the use of different classes of prescription medications.

METHODS

We used data from the 2004 Medical Expenditure Panel Survey linked to the National Health Interview Survey. Independent variables were grouped as predisposing characteristics, enabling factors, perceived need, and evaluated need. Multivariate logistic regression was used to assess the impact of independent variables on the outcomes of overall and specific types of medication use.

RESULTS

Hispanic, Spanish-interviewed children were less likely to have a usual source of care than were Hispanic, English-interviewed subjects. Both groups had lower odds of using any prescription medication, compared with white children, which was explained largely by having a usual source of care. The lower use of psychiatric medications in the Spanish-interviewed group was not explained by the independent variables, whereas the difference in the use of antibiotics was.

CONCLUSIONS

There are differences between Hispanic children according to acculturation, and acculturation affects prescription medication use. These findings may be used to address more specifically the needs of Hispanic children, particularly mental health needs.

Multiple risk factors for lead poisoning in Hispanic sub-populations: a review

As a result of recent media attention to lead (Pb) in consumer products, Pb exposure and toxicity to children has been placed back on the national agenda. This review presents the current literature on sources of Pb in Hispanic sub-populations in the broader context of national lead poisoning trends, sources, and exposure pathways. Pb poisoning among Hispanics is a multi-dimensional issue that is far more complex than for the general population in terms of environmental, cultural, and social dimensions. As a result, a higher percentage of Hispanic children have elevated blood lead levels compared to the general population. Given the additional risks that Hispanics face, all Hispanic children should be defined as "at risk" for lead exposure and included in targeted screening programs. This review concludes with specific public policy recommendations that directly address the increased risk of Pb poisoning to Hispanic children so that Pb will poison fewer children in the future.

Burden of COPD, asthma, and concomitant COPD and asthma among adults: racial disparities in a medicaid population

BACKGROUND

Asthma and COPD are characterized by substantial racial disparities in morbidity and mortality. We hypothesized that because African-American patients with these conditions experience greater mortality and morbidity than their white counterparts, they would use more health-care resources when no difference in health insurance exists.

METHODS

A retrospective, population-based cohort study was conducted using Maryland Medicaid Managed Care patient encounter data. We compared health services utilization and cost outcomes in both African-American and white patients with COPD, asthma, or coexisting COPD and asthma.

RESULTS

The study population consisted of 9,131 patients with COPD, asthma, or both conditions. Of the total population, 52% were African American (n = 4,723), and 44% were white (n = 4,021); all other races were combined into the "unknown race" category to account for the remaining 4% (n = 387). After controlling for age, gender, cohort allocation, and comorbidities, we found that African-American adults with COPD, asthma, or coexisting COPD and asthma actually used fewer medical services and accounted for lower medical costs than white adults.

CONCLUSIONS

Lower health services utilization and medical costs among African-American patients with COPD and asthma may provide a possible explanation for the racial disparities in outcomes of patients with these conditions.

Prevalence of asthma among Chinese adolescents living in Canada and in China

BACKGROUND

Studies of the prevalence of asthma among migrating populations may help in identifying environmental risk factors.

METHODS

We analyzed data from Vancouver, Canada, and from Guangzhou, Beijing and Hong Kong, China, collected during phase 3 of the International Study of Asthma and Allergies in Childhood. We subdivided the Vancouver adolescents according to whether they were Chinese immigrants to Canada, Canadian-born Chinese or Canadian-born non-Chinese. We compared the prevalence of asthma and wheezing among Chinese adolescents born in Canada, Chinese adolescents who had immigrated to Canada and Chinese adolescents living in China.

RESULTS

Of 7794 Chinese adolescents who met the inclusion criteria, 3058 were from Guangzhou, 2824 were from Beijing, and 1912 were from Hong Kong. Of 2235 adolescents in Vancouver, Canada, 475 were Chinese immigrants, 617 were Canadian-born Chinese, and 1143 were Canadian-born non-Chinese. The prevalence of current wheezing among boys ranged from 5.9% in Guangzhou to 11.2% in Canadian-born Chinese adolescents. For girls, the range was 4.3% in Guangzhou to 9.8% in Canadian-born Chinese adolescents. The prevalence of ever having had asthma ranged from 6.6% to 16.6% for boys and from 2.9% to 15.0% for girls. Prevalence gradients persisted after adjustment for other environmental variables (odds ratios for ever having had asthma among Canadian-born Chinese compared with native Chinese in Guangzhou: 2.72 [95% confidence interval 1.75-4.23] for boys and 5.50 [95% confidence interval 3.21-9.44] for girls; p < 0.001 for both). Among Chinese adolescents living in Vancouver, the prevalence of ever wheezing increased with duration of residence, from 14.5% among those living in Canada for less than 7 years to 20.9% among those living their entire life in Canada. The same pattern was observed for the prevalence of ever having had asthma, from 7.7% to 15.9%.

INTERPRETATION

Asthma symptoms in Chinese adolescents were lowest among residents of mainland China, were greater for those in Hong Kong and those who had immigrated to Canada, and were highest among those born in Canada. These findings suggest that environmental factors and duration of exposure influence asthma prevalence.

Respiratory and other health effects reported in children exposed to the World Trade Center disaster of 11 September 2001

BACKGROUND

Effects of the World Trade Center (WTC) disaster on children's respiratory health have not been definitively established.

OBJECTIVE

This report describes respiratory health findings among children who were < 18 years of age on 11 September 2001 (9/11) and examine associations between disaster-related exposures and respiratory health.

METHODS

Children recruited for the WTC Health Registry (WTCHR) included child residents and students (kindergarten through 12th grade) in Manhattan south of Canal Street, children who were south of Chambers Street on 9/11, and adolescent disaster-related workers or volunteers. We collected data via computer-assisted telephone interviews in 2003-2004, with interview by adult proxy for children still < 18 years of age at that time. We compared age-specific asthma prevalence with National Health Interview Survey estimates.

RESULTS

Among 3,184 children enrolled, 28% were < 5 years of age on 9/11; 34%, 5-11 years; and 39%, 12-17 years. Forty-five percent had a report of dust cloud exposure on 9/11. Half (53%) reported at least one new or worsened respiratory symptom, and 5.7% reported new asthma diagnoses. Before 9/11, age-specific asthma prevalence in enrolled children was similar to national estimates, but prevalence at interview was elevated among enrollees < 5 years of age. Dust cloud exposure was associated with new asthma diagnosis (adjusted odds ratio = 2.3; 95% confidence interval, 1.5-3.5).

CONCLUSIONS

Asthma prevalence after 9/11 among WTCHR enrollees < 5 years of age was higher than national estimates, and new asthma diagnosis was associated with dust cloud exposure in all age groups. We will determine severity of asthma and persistence of other respiratory symptoms on follow-up surveys.

Asthma prevalence among US children in underrepresented minority populations: American Indian/Alaska Native, Chinese, Filipino, and Asian Indian

OBJECTIVES

The purpose of this work was to estimate asthma prevalence among US children in racial minority subgroups who have been historically underrepresented in the pediatric asthma literature. These subgroups include American Indian/Alaska Native, Chinese, Filipino, and Asian Indian children. We also explored the association between these race categories and asthma after adjusting for demographic and sociodemographic characteristics and explored the effect of place of birth as it relates to current asthma.

PATIENTS AND METHODS

Data on all 51944 children aged 2 to 17 years from the 2001-2005 National Health Interview Survey were aggregated and analyzed to estimate the prevalence of current asthma, lifetime asthma, and asthma attacks according to race and place of birth. Logistic regression was used to determine adjusted odds ratios for current asthma according to race and place of birth while controlling for other demographic and sociodemographic variables.

RESULTS

National estimates of current asthma prevalence among the children in the selected minority subgroups ranged from 4.4% in Asian Indian children to 13.0% in American Indian/Alaska Native children. Overall, children born in the United States had greater adjusted odds of reporting current asthma than did children born outside of the United States.

CONCLUSIONS

Smaller racial and ethnic minority groups are often excluded from asthma studies. This study reveals that, among children from different Asian American subgroups, wide variation may occur in asthma prevalence. We also found that children born in the United States were more likely than children born outside of the United States to have current asthma.