Southwest and New Mexico Asthma Triggers

New Mexico/Southwest Hispanic Native American Rural Poverty

New Mexico/Southwest

Author(s): Stephen GA ; McRill C ; Mack MD ; O'Rourke MK ; Flood TJ ; Lebowitz MD
Affiliation: Southern Arizona VA Health Care System, University of Arizona, Tucson, Arizona 85723, USA. stephen@med.va.gov Title: Assessment of respiratory symptoms and asthma prevalence in a U.S.-Mexico border region. Source: Arch Environ Health (Archives of environmental health.) 2003 Mar; 58(3): 156-62

Abstract: The authors studied children who were 10-12 yr of age and who resided in sister cities in a U.S.-Mexico border region to determine the prevalence of asthma and respiratory symptoms. The relationship of symptoms to ambient levels of particulate matter less than 10 microm in diameter (PM10), and to several indoor environmental conditions, was assessed. The study was conducted in the border cities of Ambos Nogales (Nogales, Arizona [United States], and Nogales, Sonora [Mexico]). At the beginning of the 11-wk study, during the autumn of 1996, 631 students and their parents completed baseline questionnaires. While in school, the children completed daily symptom diaries and daily peak expiratory flow maneuvers. PM10 values and daily temperatures were also measured. The authors found that the prevalence of self-reported asthma among 5th-grade students was comparable on both sides of the border (i.e., 7.6% on the Arizona side and 6.9% on the Sonora side). Wheezing was a frequent complaint (29.5-35.6%), as was cough (16.8-29.6%). Smoking in the home was common on both sides of the border, and it was associated with a greater occurrence of self-reported asthma and respiratory complaints. Increased respiratory symptoms were also associated with increased ambient PM10 levels. The prevalence of respiratory symptoms such as wheezing and frequent cough among all children in this study, combined with the limitations inherent in self-reporting, suggest that asthma may actually be more prevalent than has been previously reported.

Main Author: López, Elizabeth, 1976-

Title: Implementation and evaluation of a home-based asthma

health education program : results from a pilot study in

three selected rural communities in southern New Mexico

/ by Elizabeth López.

Variant Title: Home-based asthma health education program

Thesis (M.P.H.)--Health Science, New Mexico State

University, 2003.

Primary Material: Archival/Manuscript Material

Subject(s): Asthma--Treatment--New Mexico.

Medical care surveys--New Mexico.

Health education--New Mexico.

Publisher: 2003.

Description: xv, 132 leaves : ill. ; 29 cm.

Notes: Includes vita.

Thesis (M.P.H.)--New Mexico State University, 2003.

Includes bibliographical references (leaves 124-132).

Questionnaire and consent form in English and Spanish.

Call Number: RA 9999 .L66 2003

Location: Branson Library

______________________________

Author(s): Klinnert MD ; Price MR ; Liu AH ; Robinson JL
Affiliation: National Jewish Medical and Research Center, Denver, Colo 80206, USA. klinnertm@njc.org

Title: Unraveling the ecology of risks for early childhood asthma among ethnically diverse families in the southwest. Source: Am J Public Health (American journal of public health.) 2002 May; 92(5): 792-8

Abstract: OBJECTIVES: We describe the prevalence of asthma risk factors within racial/ethnic and language groups of infants participating in an intervention study for reducing chronic asthma. METHODS: Low-income children aged 9 to 24 months with 3 or more episodes of wheezing illness were enrolled. Baseline information included family and medical histories, allergic status, environmental exposures, emotional environment, and caregiver psychosocial resources. RESULTS: Racial/ethnic and language groups-European Americans, African Americans, high-acculturated Hispanics, and low-acculturated Hispanics-showed different patterns of risk factors for childhood asthma, with low-acculturated Hispanics showing the most distinctive pattern. CONCLUSIONS: Patterns of covariation of biological and psychosocial risk factors for childhood asthma were associated with racial/ethnic and language status among urban, low-income children.

Author(s): Alexander J ; Divin-Cosgrove C ; Faner ML ; O'Connell M
Affiliation: Pediatric Pulmonary Services & Physicians Healthcare Association, University of Texas, El Paso College of Nursing & Health Sciences, TX, USA. jla@iname.com

Title: Increasing the knowledge base of asthmatics and their families through asthma clubs along the southwest border. Source: J Am Acad Nurse Pract (Journal of the American Academy of Nurse Practitioners.) 2000 Jul; 12(7): 260-6

Abstract: This study focused on behavior modification and enhancement of knowledge concerning home asthma management. The intervention focused on asthma awareness, severity assessment, medication use, and development of management plans while building a support group. The quasi-experimental design utilized various tools to evaluate knowledge, behavior modification, and self-care management. A 25% increase in knowledge and a 13% decrease in emergency department visits was identified over the 12-month period of the study.

Author(s): Romero LJ ; Lindeman RD ; Liang HC ; Koehler KM ; Baumgartner RN ; Garry PJ
Affiliation: Department of Family and Community Medicine, University of New Mexico Health Sciences Center, Albuquerque 87131, USA. ljromero@salud.unm.edu

Title: Prevalence of self-reported illnesses in elderly Hispanic and non-Hispanic Whites in New Mexico. Source: Ethn Dis (Ethnicity & disease.) 2001 Spring-Summer; 11(2): 263-72

Abstract: OBJECTIVE: To report on the prevalences of self-reported illnesses from the New Mexico Elder Health Survey. DESIGN: Randomized community-based cross-sectional survey of elderly (> or = 65 years of age) Hispanics and non-Hispanic Whites. METHOD: Analysis of data from the 883 participants in the New Mexico Elder Health Survey. RESULTS: Complete data on 848 subjects were available for this analysis: Hispanic males, 212; Hispanic females, 189; non-Hispanic White males, 236; non-Hispanic White females, 211. The mean age was 74 years (age range 65-98). Hispanics had fewer years of school and lower income. Hispanics reported a significantly (P<.05) higher prevalence of type 2 diabetes; leg ulcers/pressure sores; and Parkinson's Disease. Non-Hispanic Whites reported a significantly (P<.05) higher prevalence of asthma; circulatory problems; stomach (not ulcers), intestinal or gallbladder disease; urinary tract disorders (other than kidney disease); and cancer. Prevalence odds ratios and confidence intervals were calculated. Hispanic males reported a higher prevalence of type 2 diabetes (OR 1.88, CI 1.10-3.26, P = .02), and lower prevalences of asthma (OR 0.43, CI 0.18-0.93, P = .04); urinary tract disorders, other than kidney disease (OR 0.59, CI 0.38-0.91, P = .01); and cancer (OR 0.31, CI 0.13-0.68, P = .005). Hispanic females reported a higher prevalence of diabetes (OR 3.01, CI 1.48-6.50, P = .003), and a lower prevalence of glaucoma (OR 0.48, CI 0.22-1.00, P = .05). These differences remained significant after adjustment for age, education, income, and language. CONCLUSION: There are significant differences in the prevalences of self-reported illnesses between Hispanic and non-Hispanic White elderly.

Author(s): Hanson J
Affiliation: Student Health Center, University of New Mexico, Albuquerque, USA.

Title: Parental self-efficacy and asthma self-management skills. Source: J Soc Pediatr Nurs (Journal of the Society of Pediatric Nurses : JSPN.) 1998 Oct-Dec; 3(4): 146-54

Abstract: PURPOSE: To determine whether a formal asthma self-management program and social support using lay health advisors increases parent self-efficacy in the management of their child's asthma, and whether parent self-efficacy predicts asthma self-management skills. DESIGN: Quasi-experimental with four time points measured over 2 years. PARTICIPANTS: Low-income, primarily Hispanic parents (N = 303) of children with moderately severe to severe asthma. SETTING: A Southwestern university medical setting in a rural state. MAIN OUTCOME MEASURES: Parent self-efficacy and parent asthma self-management skill score scales. RESULTS: Parent self-efficacy increased significantly from baseline, but there were no significant differences between the control and treatment groups. The increase in self-efficacy was apparent at 6 months, then leveled off. Parent self-efficacy at either baseline or 12 months did not predict parents' asthma self-management skill score. CONCLUSIONS: Individual education was just as effective as group education in increasing parental self-efficacy. Parents felt more comfortable treating asthma episodes than preventing them, thus clinicians need to spend time teaching preventive strategies.

Author(s): Sporik R ; Squillace SP ; Ingram JM ; Rakes G ; Honsinger RW ; Platts-Mills TA
Affiliation: Institute of Respiratory Medicine, Sydney, Australia.

Title: Mite, cat, and cockroach exposure, allergen sensitisation, and asthma in children: a case-control study of three schools. Source: Thorax (Thorax.) 1999 Aug; 54(8): 675-80

Abstract: BACKGROUND: The amount of allergen necessary to sensitise genetically "at risk" children is unclear. The relation between allergen exposure and asthma is also uncertain. METHODS: To ensure a wide range of allergen exposures the data from case-control studies of asthma in children aged 12-14 years attending three schools in Los Alamos, New Mexico and Central Virginia were combined. Skin prick tests to indoor and outdoor allergens and bronchial hyperreactivity to histamine were assessed in children with and without symptoms of asthma. The concentration of mite, cat, and cockroach allergens in dust from the children's homes was used as a marker of exposure. RESULTS: Three hundred and thirty two children (157 with asthmatic symptoms and 175 controls) were investigated. One hundred and eighty three were classified as atopic on the basis of allergen skin prick tests and 68 as asthmatic (symptoms plus bronchial responsiveness). The prevalence and degree of sensitisation to mite and cockroach, but not cat, was strongly associated in atopic children with increasing domestic concentrations of these allergens. Asthma was strongly associated with sensitisation to indoor allergens (p<10(-6)) and weakly to outdoor allergens (p = 0.026). There was an association between current asthma and the concentration of mite allergen amongst atopic children (p = 0.008) but not amongst those who were specifically mite sensitised (p = 0.16). CONCLUSIONS: The domestic reservoir concentration of mite and cockroach, but not cat, allergen was closely related to the prevalence of sensitisation in atopic children. However, the prevalence of current asthma had a limited relationship to these allergen measurements, suggesting that other factors play a major part in determining which allergic individuals develop asthma.

Author(s): Holberg CJ ; Elston RC ; Halonen M ; Wright AL ; Taussig LM ; Morgan WJ ; Martinez FD
Affiliation: Respiratory Sciences Center, University of Arizona Health Sciences Center, Tucson 85724, USA.

Title: Segregation analysis of physician-diagnosed asthma in Hispanic and non-Hispanic white families. A recessive component? Source: Am J Respir Crit Care Med (American journal of respiratory and critical care medicine.) 1996 Jul; 154(1): 144-50

Abstract: The inheritance of asthma, evident from its high family concordance, is not well understood. To investigate whether asthma may be inherited through a major gene with two alleles, segregation analyses were conducted in 3,369 individuals from 906 nuclear families enrolled, without selection, in a longitudinal study of respiratory health in Tucson, Arizona. Physician-diagnosed asthma and its age of onset were ascertained for each family member when children were at a mean age of 7 yr. Age of asthma diagnosis was allowed for in analyses, and the impact of the covariate total serum IgE level on age of onset was examined. Segregation analyses were conducted with and without residual family effects, with and without the covariate IgE. The hypothesis of a single two-allele locus for asthma was rejected. However, depending on the method of assessment of the residual familial effects, either a polygenic/multifactorial mode of inheritance alone, or an oligogenic model with some evidence of a recessive component present in the population with the high frequency of 0.67, were compatible with the data. Results were unchanged with the addition of the covariate IgE.

Author(s): Halonen M ; Stern DA ; Wright AL ; Taussig LM ; Martinez FD
Affiliation: Department of Pharmacology, University of Arizona Health Sciences Center, Tucson 85724, USA.

Title: Alternaria as a major allergen for asthma in children raised in a desert environment. Source: Am J Respir Crit Care Med (American journal of respiratory and critical care medicine.) 1997 Apr; 155(4): 1356-61

Abstract: The relationships of asthma and allergic rhinitis with individual immediate skin test responses were examined for preferential associations and for changes with age in children raised in a semiarid environment. Prevalence of physician-diagnosed asthma was 9.8% at age 6 (n = 948) and 15.5% at age 11 (n = 895). Immediate skin test responses to Bermuda grass were the most prevalent among children with allergic rhinitis and control subjects, whereas responses to the mold, Altenaria alternata, were the most prevalent among asthmatics. Skin test responses for crude house dust, Dermatophagoides farinae, and cat had low prevalences in all groups. By logistic regression, Alternaria was the only allergen independently associated with increased risk for asthma at both ages 6 and 11. Allergic rhinitis showed independent association with sensitization to Bermuda grass and mulberry tree pollen at age 11 but did not show an independent relation to any single allergen at age 6. Logistic regression further revealed that persistent asthma (diagnosed before age 6) was independently associated with Alternaria skin tests at both ages 6 and 11, whereas new asthma (diagnosed after age 6) was associated with Alternaria skin tests at age 6 but not at age 11. We conclude that Alternaria is the major allergen associated with the development of asthma in children raised in a semiarid environment and that skin test responses at age 6 are more closely linked to asthma than those at age 11.

Author(s): Halonen M ; Stern DA ; Lohman C ; Wright AL ; Brown MA ; Martinez FD
Affiliation: Respiratory Sciences Center and Departments of Pharmacology and Pediatrics, University of Arizona Health Sciences Center, Tucson, Arizona, USA. mhalonen@resp-sci.arizona.edu

Title: Two subphenotypes of childhood asthma that differ in maternal and paternal influences on asthma risk. Source: Am J Respir Crit Care Med (American journal of respiratory and critical care medicine.) 1999 Aug; 160(2): 564-70

Abstract: Asthma is a phenotypically heterogeneous disease. Two subgroups are defined here based initially on skin test reactivity to the allergen Alternaria at age 6 from among a large population of children born and raised in the Southwestern desert environment of Tucson, Arizona. When compared with asthma among Alternaria-positive subjects, asthma among Alternaria-negative subjects was associated with lower levels of total serum IgE, no relation to local aeroallergen skin tests, a younger age at diagnosis, greater remittance by age 11, and more frequent wheezing lower respiratory illnesses (LRIs) in the first year of life. Despite the difference in total serum IgE, however, IgE concentrations were significantly higher in each asthma group compared with its respective control group. Asthma in each parent contributed approximately equivalent risk for Alternaria-positive asthma in the child. However, neither parental skin test sensitization nor total serum IgE levels provided risk for asthma in the child. Inheritance patterns for Alternaria-negative asthma revealed a contribution from maternal but not paternal asthma. Thus, dividing asthma in children at age 6 into Alternaria-positive and Alternaria-negative groups identifies subphenotypes that are further distinguished by differences in phenotypic markers and parental influences.

Author(s): Hanson J
Affiliation: Student Health Center, University of New Mexico, Albuquerque, USA.

Title: Parental self-efficacy and asthma self-management skills. Source: J Soc Pediatr Nurs (Journal of the Society of Pediatric Nurses : JSPN.) 1998 Oct-Dec; 3(4): 146-54

Author(s): Samet JM ; Coultas DB ; Howard CA ; Skipper BJ
Affiliation: Department of Medicine, University of New Mexico Medical Center, Albuquerque.

Title: Respiratory diseases and cigarette smoking in a Hispanic population in New Mexico. Source: Am Rev Respir Dis (The American review of respiratory disease.) 1988 Apr; 137(4): 815-9

Abstract: We have conducted a cross-sectional study of Hispanic residents of a community in New Mexico. A total of 2,111 subjects were recruited from 733 households; the overall participation rates were 68.1% for males and 78.9% for females. For all subjects, a standardized respiratory symptoms questionnaire was completed, spirometric testing was performed, and saliva and end-tidal breath samples were obtained. As in other populations, chronic respiratory symptoms were uncommon in children, and asthma was more prevalent in boys than in girls. In adults, physician-diagnosed chronic bronchitis and emphysema were less prevalent in this population than in a previously studied sample of non-Hispanic whites in New Mexico. Spirometric testing was confirmatory; less than 1% of the Hispanic males and females had chronic air-flow obstruction. The prevalence of cigarette usage in the Hispanics was comparable to data from non-Hispanic whites in New Mexico and from nationwide surveys. However, daily cigarette consumption by the Hispanics in this sample tended to be low, as found in previous studies in New Mexico and elsewhere. MESH Subject(s) below:

Author(s): Crago S ; Coors L ; Lapidus JA ; Sapien R ; Murphy SJ
Affiliation: Department of Pediatrics, University of New Mexico, School of Medicine, Albuquerque 87131, USA.

Title: Prehospital treatment of acute asthma in a rural state. Source: Ann Allergy Asthma Immunol (Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology.) 1998 Oct; 81(4): 322-5

Abstract: BACKGROUND: Acute asthma exacerbations can be life threatening and are recognizable to emergency medical service (EMS) personnel; however, the therapies and medications which these emergency service personnel can use to treat exacerbations are limited. Several studies have demonstrated the effective use of beta2-agonist therapy in the treatment of patients complaining of wheezing or dyspnea, yet few EMS personnel can administer them. OBJECTIVE: The purpose of this study was to determine what therapeutic interventions emergency personnel around the state of New Mexico could use when responding to a call for a severe asthma exacerbation. METHODS: Questionnaires were distributed over a period of three years, 1992-1994, to all Emergency Service Agencies in New Mexico. RESULTS: Eighty percent of the emergency medical personnel administer oxygen to patients experiencing acute asthma exacerbations. Seventeen percent of EMS personnel administer epinephrine, 4% administer steroids, and only 23% administer beta2 agonists. Only in more populated areas were EMS personnel allowed to administer beta2 agonists, and those personnel had to have at least intermediate-level training. Most emergency response teams in the state consisted of EMT Basics and provided only basic life support services. In rural New Mexico, transport to a hospital can often take over one hour, which left EMS crews feeling helpless. CONCLUSIONS: We conclude that due to the rural nature of New Mexico, EMS personnel should be trained in the use of beta2 agonists and allowed to administer them to patients with acute asthma exacerbations. In addition, standard protocols for the pre-hospital management of acute asthma exacerbations should be instituted.

Author(s): Rivera JO ; Hughes HW ; Stuart AG
Affiliation: University of Texas at El Paso/University of Texas (UTEP/UT)-Austin Cooperative Pharmacy Program, El Paso, TX 79902-4153, USA. jrivera@utep.edu

Title: Herbals and asthma: usage patterns among a border population. Source: Ann Pharmacother (The Annals of pharmacotherapy.) 2004 Feb; 38(2): 220-5

Abstract: BACKGROUND: The use of herbal products (HP) is rising in the US. Higher rates of HP use have been documented in the US/Mexico border population, as well as increasing concerns about herbal-related adverse events. OBJECTIVE: To evaluate the prevalence of HP use in adult asthmatic patients requiring hospitalization and the frequency of HP documentation in medical records. METHODS: We conducted a retrospective chart review of admissions for asthma to determine the frequency of HP documentation. Additionally, during a 12-month period, a bilingual interviewer conducted prospective, semistructured interviews with patients with asthma exacerbations to record data on HPs used specifically for the treatment of asthma. RESULTS: A total of 67 cases were chart-reviewed retrospectively; 60 patients were interviewed prospectively. We found no documentation of HP use by chart review, while prospective interviews showed that 42% of patients reported using HPs for the treatment of asthma. The most common HPs used were oregano 28%, chamomile 20%, garlic 16%, eucalyptus 12%, and lime 12%. Ten patients reported taking an HP that could potentially exacerbate their asthma and 18 patients reported using an HP that could interact with other medications or cause other types of adverse events. CONCLUSIONS: An obvious lack of documentation for HP use was observed in the medical records reviewed. Because a number of HPs that are commonly used by residents along the border can interact with antiasthmatic agents and/or result in compromised asthma control, questions about HP use should be included in routine history taking.

Author(s): English PB ; Von Behren J ; Harnly M ; Neutra RR
Affiliation: Impact Assessment, Inc., Emeryville, CA 94608, USA. Title: Childhood asthma along the United States/Mexico border: hospitalizations and air quality in two California counties. Source: Rev Panam Salud Publica (Revista panamericana de salud publica = Pan American journal of public health.) 1998 Jun; 3(6): 392-9

Abstract: Since the passage of the North American Free Trade Agreement in 1993, there has been an increasing need to monitor environmental health trends that may be related to the rapid industrialization of the United States/Mexico border. We studied two counties on the California/Baja California border to obtain baseline data on trends in childhood asthma hospitalizations and two pollutants that aggravate asthma, ozone and particulate matter (less than 10 microns in diameter), from 1983 to 1994. Hospital discharge records of children 14 years and younger were analyzed, and rates by county, race, and sex were age-adjusted to the 1990 California population. Data on five ozone and particulate matter indices obtained from the California Environmental Protection Agency were used. Imperial County had the highest childhood asthma hospitalization rates in California for non-Hispanic whites and African-Americans, and the second highest for Hispanics. San Diego County had rates below the state average. Over the time period examined, rates in Imperial County increased 59%, while those in San Diego County decreased 9%. Maximum ozone levels increased 64% in Imperial County but decreased 46% in San Diego County. Particulate matter levels were four times higher in Imperial than in San Diego County. High rates of childhood asthma hospitalizations in Imperial County may be partially related to high levels of poverty and worsening air quality conditions produced by increased burdens on the local airshed. Asthma prevalence surveys and binational time-series analyses examining asthma-pollutant relationships are needed.

Author(s): Sporik R ; Ingram JM ; Price W ; Sussman JH ; Honsinger RW ; Platts-Mills TA
Affiliation: Los Alamos Medical Center, New Mexico, USA.

Title: Association of asthma with serum IgE and skin test reactivity to allergens among children living at high altitude. Tickling the dragon's breath. Source: Am J Respir Crit Care Med (American journal of respiratory and critical care medicine.) 1995 May; 151(5): 1388-92

Abstract: Asthma in children and young adults is strongly associated with immediate hypersensitivity to indoor allergens, notably those derived from the house dust mite. In addition, outdoor air pollution is considered to aggravate existing asthma. We investigated the prevalence of asthma and the pattern of allergen sensitization in a mite-free environment with low levels of outdoor air pollution. A total of 567 children aged between 12 and 14 attending Los Alamos Middle School, NM (altitude 7,200 feet) were screened using a respiratory questionnaire; 120 children (53 control children) underwent allergen skin testing and serum IgE measurement, and their bronchial reactivity to histamine was measured. Dust was collected from 111 homes and the level of indoor mite and cat allergen measured. The prevalence of respiratory symptoms was high (13%), and from the detailed testing it was estimated that 6.3% of the children had asthma (defined as symptomatic bronchial reactivity). Children with asthma had elevated IgE, 367 (179 to 755) versus 38 (23 to 61), and predominant sensitization to cat, 68 versus 20% (p < 0.001). A high number of households (77%) had a pet cat or dog. The concentration of mite allergen was very low (mean 0.18 micrograms Der p milligrams sieved house dust), whereas that of cat allergen was high in homes with a cat (80.8 micrograms Fel d milligrams) but also in homes with no cat (3.2 micrograms Fel d milligrams). The results show that in a mite-free environment with low levels of outdoor air pollution, asthma was still a major cause of morbidity among schoolchildren.(ABSTRACT TRUNCATED AT 250 WORDS)

Author(s): VanderJagt TJ ; Ghattas R ; VanderJagt DJ ; Crossey M ; Glew RH
Affiliation: Department of Biochemistry and Molecular Biology, University of New Mexico School of Medicine, Albuquerque 87131-5221, USA.

Title: Comparison of the total antioxidant content of 30 widely used medicinal plants of New Mexico. Source: Life Sci (Life sciences.) 2002 Jan 18; 70(9): 1035-40

Abstract: Teas made from medicinal plants are commonly used by a majority of the inhabitants of New Mexico and Mexico to treat various ailments including infections, arthritis, heart disorders, headaches, fever, asthma and menstrual pain. However, little is known about the identity or chemical nature of the bioactive substances and compounds responsible for the therapeutic effects of the teas made from the leaves, seeds, flowers stems, and roots of these medicinal plants. Some of the beneficial effects of these teas may be attributable to antioxidants contained in the medicinal plants from which they are brewed. In the present study we collected 30 medicinal plants that are widely used in the Rio Grande Valley and, using a two-stage Trolox based assay, analyzed the total antioxidant capacity of aqueous extracts prepared from these plants. The antioxidant content of the aqueous extracts was substantial, ranging from 27 to 972 micromol Trolox equivalent per gram dry weight. An extract of the leaves of the plant Ilex paraguensis (Mate leaf) contained the highest amount of antioxidant, followed by the flowers of the Rosa sp. (Rosa de Castillo, 804 micromol/g), the bark of Chinchona sp. (Copalquin, 692 micromol/g), Rumex hymenosepalus stems (Cana Agria, 672 micromol/g) and the leaves of Marrubium vulgare (Mastranzo, 560 micromol/g). The plants that had the lowest antioxidant capacity were the seeds of Linum lewissii (Linasa, 29 micromol/g) and Yucca sp. plant root (Amole, 27 micromol/g). It will be useful to further analyze those plants that contain the most antioxidant activity in order to identify the active principles.

Title: Prevalence of self-reported illnesses in elderly Hispanic and non-Hispanic Whites in New Mexico. Source: Ethn Dis (Ethnicity & disease.) 2001 Spring-Summer; 11(2): 263-72

Author(s): Loera JA ; Black SA ; Markides KS ; Espino DV ; Goodwin JS
Affiliation: Department of Internal Medicine, Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas 77555-0460, USA. jloera@utmb.edu

Title: The use of herbal medicine by older Mexican Americans. Source: J Gerontol A Biol Sci Med Sci (The journals of gerontology. Series A, Biological sciences and medical sciences.) 2001 Nov; 56(11): M714-8

Abstract: BACKGROUND: Little is known about use of herbal medicines by older Mexican Americans. The objective of this study was to determine the characteristics among older Mexican Americans that correlate with use of herbal medicines. METHODS: We administered a cross-sectional regional sample survey, the 1993-1994 Hispanic Established Populations for the Epidemiologic Study of the Elderly of Mexican Americans, by in-home interviews of noninstitutionalized older Mexican Americans age 65 and over living in Texas, New Mexico, Colorado, Arizona, and California. RESULTS: The use of herbal medicine in the 2 weeks prior to the interview was reported by 9.8% of the sample. Chamomile and mint were the two most commonly used herbs. Users of herbal medicines were more likely to be women, born in Mexico, over age 75, living alone, and experiencing some financial strain. Having arthritis, urinary incontinence, asthma, and hip fracture were also associated with an elevated use of herbal medicines, whereas heart attacks were not. We found that herbal medicine use was substantially higher among individuals reporting any disability in activities of daily living, poor self-reported health, and depressive symptoms. Herbal medicine use was associated with the use of over-the-counter medications but not with prescription medications. Herbal medicine use was particularly high among respondents who had over 24 physician visits during the year prior to interview. CONCLUSIONS: Herbal medication use is common among older Mexican Americans, particularly among those with chronic medical conditions, those who experience financial strain, and those who are very frequent users of formal health care services.

Hispanic

New Mexico/Southwest Hispanic Native American Rural Poverty

Author(s): Delfino RJ ; Gong H Jr ; Linn WS ; Pellizzari ED ; Hu Y
Affiliation: Epidemiology Division, Department of Medicine, College of Medicine, University of California, Irvine, California 92697-7550, USA. rdelfino@uci.edu

Title: Asthma symptoms in Hispanic children and daily ambient exposures to toxic and criteria air pollutants. Source: Environ Health Perspect (Environmental health perspectives.) 2003 Apr; 111(4): 647-56

Abstract: Although acute adverse effects on asthma have been frequently found for the U.S. Environmental Protection Agency's principal criteria air pollutants, there is little epidemiologic information on specific hydrocarbons from toxic emission sources. We conducted a panel study of 22 Hispanic children with asthma who were 10-16 years old and living in a Los Angeles community with high traffic density. Subjects filled out symptom diaries daily for up to 3 months (November 1999 through January 2000). Pollutants included ambient hourly values of ozone, nitrogen dioxide, sulfur dioxide, and carbon monoxide and 24-hr values of volatile organic compounds (VOCs), particulate matter with aerodynamic diameter < 10 microm (PM10, and elemental carbon (EC) and organic carbon (OC) PM10 fractions. Asthma symptom severity was regressed on pollutants using generalized estimating equations, and peak expiratory flow (PEF) was regressed on pollutants using mixed models. We found positive associations of symptoms with criteria air pollutants (O3, NO2, SO2, PM10), EC-OC, and VOCs (benzene, ethylbenzene, formaldehyde, acetaldehyde, acetone, 1,3-butadiene, tetrachloroethylene, toluene, m,p-xylene, and o-xylene). Selected adjusted odds ratios for bothersome or more severe asthma symptoms from interquartile range increases in pollutants were, for 1.4 ppb 8-hr NO2, 1.27 [95% confidence interval (CI), 1.05-1.54]; 1.00 ppb benzene, 1.23 (95% CI, 1.02-1.48); 3.16 ppb formaldehyde, 1.37 (95% CI, 1.04-1.80); 37 microg/m3 PM10, 1.45 (95% CI, 1.11-1.90); 2.91 microg/m3 EC, 1.85 (95% CI, 1.11-3.08); and 4.64 microg/m3 OC, 1.88 (95% CI, 1.12-3.17). Two-pollutant models of EC or OC with PM10 showed little change in odds ratios for EC (to 1.83) or OC (to 1.89), but PM10 decreased from 1.45 to 1.0. There were no significant associations with PEF. Findings support the view that air toxins in the pollutant mix from traffic and industrial sources may have adverse effects on asthma in children.

Author(s): Jones JA ; Wahlgren DR ; Meltzer SB ; Meltzer EO ; Clark NM ; Hovell MF
Affiliation: Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University, San Diego, CA, USA.

Title: Increasing asthma knowledge and changing home environments for Latino families with asthmatic children. Source: Patient Educ Couns (Patient education and counseling.) 2001 Jan; 42(1): 67-79

Abstract: We tested an asthma education program in 204 underserved Latino families with an asthmatic child. The education program consisted of one or two sessions delivered in each family's home in the targeted participant's preferred language by a bilingual, bicultural educator. We encouraged, but did not require, attendance by the child. The curriculum was culturally-tailored, and all participants received education on understanding asthma, preventing asthma attacks, and managing asthma. Outcomes included change in asthma knowledge and change in home environment asthma management procedures. Asthma knowledge increased significantly (39 to 50% correct from pre- to post-test, P < 0.001) and participants made significant changes to the child's bedroom environment (mean number of triggers decreased from 2.4 to 1.8, P < 0.001; mean number of controllers increased from 0.7 to 0.9, P < 0.001). The results support the value of asthma education and its importance in the national agenda to reduce health disparities among minorities.

Author(s): Pachter LM ; Weller SC ; Baer RD ; de Alba Garcia JE ; Trotter RT 2nd ; Glazer M ; Klein R
Affiliation: Department of Pediatrics, University of Connecticut School of Medicine and St. Francis Hospital and Medical Center, Hartford 06105, USA. lpachter@stfranciscare.org

Title: Variation in asthma beliefs and practices among mainland Puerto Ricans, Mexican-Americans, Mexicans, and Guatemalans. Source: J Asthma (The Journal of asthma : official journal of the Association for the Care of Asthma.) 2002 Apr; 39(2): 119-34

Abstract: This study reports on community surveys of 160 representative Latino adults in Hartford, CT, Edinburg, TX, Guadalajara, Mexico; and in rural Guatemala. A 142-item questionnaire covered asthma beliefs and practices (e.g., causes, symptoms, and treatments). The cultural consensus model was used to analyze the agreement among respondents within each sample and to describe beliefs. Beliefs were then compared across the four samples. Analysis of the questionnaire data shows that there was overall consistency or consensus regarding beliefs and practices among individuals at each site (intraculturally) and to a lesser extent across respondents of all four different Latino cultural groups (i.e., interculturally). This pattern of response is indicative of a shared belief system among the four groups with regard to asthma. Within this shared belief system though, there is systematic variation between groups in causes, symptoms, and treatments for asthma. The most widely recognized and shared beliefs concerned causes of asthma. Notable differences were present between samples in terms of differences in beliefs about symptoms and treatments. The biomedical model is shown to be a part of the explanatory model at all sites; in addition to the biomedical model, ethnocultural beliefs such as the humoral ("hot/cold") aspects and the importance of balance are also evident. The Connecticut Puerto Ricans had a greater degree of shared beliefs about asthma than did the other three samples (p < 0.00005). It was concluded that the four Latino groups studied share an overall belief system regarding asthma, including many aspects of the biomedical model of asthma. In addition, traditional Latino ethnomedical beliefs are present, especially concerning the importance of balance in health and illness. Many beliefs and practices are site-specific, and caution should be used when using inclusive terms such as "Hispanic" or "Latino," since there is variation as well as commonality among different ethnic groups with regard to health beliefs and practices.

Author(s): Bearison DJ ; Minian N ; Granowetter L
Affiliation: The Graduate Center, City University of New York, Mount Sinai School of Medicine, New York, New York 10036, USA. dbearison@gc.cuny.edu

Title: Medical management of asthma and folk medicine in a Hispanic community. Source: J Pediatr Psychol (Journal of pediatric psychology.) 2002 Jun; 27(4): 385-92

Abstract: OBJECTIVE: To describe beliefs about asthma and asthma treatment in a Hispanic (Dominican-American) community to determine how alternative belief systems affect compliance with medical regimens. METHOD: Twenty-five mothers of children with asthma were interviewed in their homes, in their primary language, Spanish. Mothers were questioned about their beliefs regarding asthma etiology, treatment, prevention of acute episodes, and use of prescribed medications. RESULTS: Most mothers (72%) said that they did not use prescribed medicines for the prevention of asthma; instead, they substituted folk remedies called "zumos." The home remedies were derived from their folk beliefs about health and illness. Most mothers (60%) thought that their child did not have asthma in the absence of an acute episode. Eighty-eight percent said that medications are overused in this country and that physicians hide therapeutic information from them. CONCLUSIONS: Mothers' reliance on home remedies for asthma prevention leads to a high rate of noncompliance with prescribed regimens. Yet they perceive themselves as compliant with an effective regimen that differs from standard medical practice. Further studies should explore ways of promoting physician/patient communication in order to find ways of coordinating medical and folk beliefs to enhance compliance with medically prescribed regimens.

Author(s): Freeman NC ; Schneider D ; McGarvey P
Affiliation: Robert Wood Johnson Medical School, Piscataway, New Jersey 08558, USA. nfreeman@eohsi.rutgers.edu

Title: Household exposure factors, asthma, and school absenteeism in a predominantly Hispanic community. Source: J Expo Anal Environ Epidemiol (Journal of exposure analysis and environmental epidemiology.) 2003 May; 13(3): 169-76

Abstract: The Passaic Asthma Reduction Effort (PARE) used an asthma symptom and household exposure factor questionnaire to screen 4634 elementary school children over a 4-year period in Passaic, New Jersey. During the first year, an additional 240 preschool children were also screened. Overall, 16% of the school children were reported by their parents to have been diagnosed with asthma. In all, 30% of responding families claimed to have at least one family member diagnosed with asthma and this was five times more likely if the target child had asthma. Exposures consistently associated with childhood asthma diagnosis included environmental tobacco smoke (ETS), presence of dampness/mold, roaches, and furry pets in the home. Diagnosis of asthma was primarily associated with all six symptoms used in the PARE questionnaire, and secondarily with environmental factors. Puerto Rican and black children had the highest asthma prevalence (26% and 33%), while Mexican children had the lowest (7%). Use of medications and school absenteeism among asthmatic children were associated with wheeze and night cough, but not with any specific environmental exposure. Increased school absenteeism by children undiagnosed with asthma was associated with ETS and dampness/mold in the home. Differences in asthma diagnosis and absenteeism in response to environmental factors were found across ethnic subgroups. Getting asthmatic children on medical management protocols and providing families with education about environmental risk reduction should aid in reducing morbidity in this ethnically complex population. Such coordinated efforts offer the promise of reducing school absenteeism.

Author(s): Hovell MF ; Meltzer SB ; Wahlgren DR ; Matt GE ; Hofstetter CR ; Jones JA ; Meltzer EO ; Bernert JT ; Pirkle JL
Affiliation: Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University, San Diego, California 92123, USA. behepi@rohan.sdsu.edu

Title: Asthma management and environmental tobacco smoke exposure reduction in Latino children: a controlled trial. Source: Pediatrics (Pediatrics.) 2002 Nov; 110(5): 946-56

Abstract: OBJECTIVES: This study tested the efficacy of coaching to reduce environmental tobacco smoke (ETS) exposure among asthmatic Latino children. DESIGN: After asthma management education, families were randomly assigned to no additional service (control condition) or to coaching for ETS exposure reduction (experimental condition). SETTING: The study was conducted in San Diego, California. PARTICIPANTS: Two hundred four Latino children (ages 3-17 years) with asthma participated. INTERVENTION: Approximately 1.5 hours of asthma management education was provided; experimental families also obtained 7 coaching sessions ( approximately 45 minutes each) to reduce ETS exposure. OUTCOME MEASURES: Reported ETS exposure and children's urine cotinine were measured. RESULTS: Parents in the coached condition reported their children exposed to significantly fewer cigarettes than parents of control children by 4 months (postcoaching). Reported prevalence of exposed children decreased to 52% for the coached families, but only to 69% for controls. By month 4, mean cotinine levels decreased among coached and increased among control children. Cotinine prevalence decreased from 54% to 40% among coached families, while it increased from 43% to 49% among controls. However, cotinine levels decreased among controls to the same level achieved by coached families by the 13-month follow-up. CONCLUSIONS: Asthma management education plus coaching can reduce ETS exposure more than expected from education alone, and decreases in the coached condition may be sustained for about a year. The delayed decrease in cotinine among controls is discussed.

Author(s): Kromer ME ; Prihoda TJ ; Hidalgo HA ; Wood PR
Affiliation: University of Texas Health Science Center, San Antonio, Texas 78229-3900, USA.

Title: Assessing quality of life in Mexican-American children with asthma: impact-on-family and functional status. Source: J Pediatr Psychol (Journal of pediatric psychology.) 2000 Sep; 25(6): 415-26

Abstract: OBJECTIVE: To assess the internal consistency reliability and construct validity of two questionnaires, the Impact on Family (IOF) and the Functional Status II (R) (FSIIR), in a Mexican-American population of children with asthma. METHODS: We interviewed 115 Hispanic parents of children with asthma and compared the IOF and FSIIR scores and reliability coefficients for the following subgroups: English or Spanish language and high or low educational level. We assessed the construct validity of the IOF Total score and FSIIR Illness score by examining the relationship between these scores and other health status variables. RESULTS: The IOF Total score and FSIIR Illness score demonstrated acceptable construct validity and reliability for language and education subgroups, although several of the IOF subscales had low reliability. CONCLUSIONS: IOF Total score and FSIIR Illness score can be recommended for use by Spanish- and English-speaking Mexican-American respondents.

Author(s): Homa DM ; Mannino DM ; Lara M
Affiliation: Air Pollution and Respiratory Health Branch, Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA. dgh3@cdc.gov

Title: Asthma mortality in U.S. Hispanics of Mexican, Puerto Rican, and Cuban heritage, 1990-1995. Source: Am J Respir Crit Care Med (American journal of respiratory and critical care medicine.) 2000 Feb; 161(2) Pt 1: 504-9

Abstract: We used national vital statistics data for 1990 through 1995 to examine both national and regional age-adjusted asthma mortality rates for U.S. Hispanics of Mexican, Cuban, and Puerto Rican heritage, as well as for non-Hispanic whites and non-Hispanic blacks. Nationally, Puerto Ricans had an age-adjusted annual asthma mortality rate of 40.9 per million, followed by Cuban-Americans (15. 8 per million) and Mexican-Americans (9.2 per million). In comparison, non-Hispanic whites had an age-adjusted annual asthma mortality rate of 14.7 per million and non-Hispanic blacks had a rate of 38.1 per million. Age-adjusted asthma mortality for Puerto Ricans was highest in the Northeast (47.8 per million); this region accounted for 81% of all asthma deaths among Puerto Ricans in the United States. In the U.S., Puerto Ricans had the highest asthma mortality rates among Hispanics, followed by Cuban-Americans and Mexican-Americans. In addition, among Hispanic national groups, mortality rates were consistently higher in the Northeast than the Midwest, South, or West regions. These results further support that Hispanics do not represent a uniform, discrete group in terms of health outcomes, and that further public health research and interventions should take Hispanic national origin into account.

Author(s): Martinez FD ; Holberg CJ ; Halonen M ; Morgan WJ ; Wright AL ; Taussig LM
Affiliation: Department of Pediatrics, University of Arizona College of Medicine, Tucson.

Title: Evidence for Mendelian inheritance of serum IgE levels in Hispanic and non-Hispanic white families. Source: Am J Hum Genet (American journal of human genetics.) 1994 Sep; 55(3): 555-65

Abstract: Considerable evidence is available suggesting a significant genetic component in the pathogenesis of asthma, but the mechanism of inheritance is not well understood. The main objective of this study was to assess if total serum IgE level, a known intermediate phenotype for asthma, is under the control of a major autosomal gene. We studied nuclear families participating in the Tucson Children's Respiratory Study in Tucson and originally selected because they belonged to a health maintenance organization. One hundred twenty-five Hispanic and 673 non-Hispanic White nuclear families were eligible; 50 Hispanic families (with 191 subjects) and 241 non-Hispanic White families (with 886 subjects) were included. Prevalence of asthma, hay fever, and parental smoking was similar among eligible families who were included and those who were not. Segregation analyses using regressive models for continuous traits showed that the best fit to the data was given by a model of Mendelian codominant inheritance of a major autosomal gene associated with higher serum IgE level. Log-likelihood for this model was not significantly different from that of the best-fitting ("unrestricted") model (P = .3) and was significantly better than log-likelihood for a dominant model (P < .0001) and a recessive model (P < .0001). An environmental model showed significant departure (P < .0001) from the unrestricted model. Tests for genetic heterogeneity showed no significant difference between the two ethnic groups. The data strongly suggest that total serum IgE levels are controlled by a major autosomal codominant gene.

Author(s): Di Pede C ; Viegi G ; Quackenboss JJ ; Boyer-Pfersdorf P ; Lebowitz MD
Affiliation: Division of Respiratory Sciences, College of Medicine, University of Arizona, Tucson 85724.

Title: Respiratory symptoms and risk factors in an Arizona population sample of Anglo and Mexican-American whites. Source: Chest (Chest.) 1991 Apr; 99(4): 916-22

Abstract: Prevalence rates of respiratory symptoms and diseases in a large group of Anglos and Mexican-Americans were analyzed. Each subject completed a questionnaire. Among current smokers, chronic productive cough and dyspnea were significantly higher in both ethnic groups; wheezy symptoms were higher in Anglos. There were no significant differences in the symptom prevalence rates between the two groups, after stratifying by current cigarette consumption and CRT. The spirometric values were not significantly different. In both ethnic groups, the prevalence rates of wheeze, SOBWHZ and asthma were significantly higher in those who had CRT. Among Anglos, less educated smokers had significantly higher prevalence rates of SOBWHZ and dyspnea; nonsmokers with less education had higher prevalence rates of cough, chronic cough and dyspnea. Our results confirm the importance of CRT and lower educational level as risk factors for respiratory symptoms. Ethnicity is not associated with symptomatology or lung function impairment.

Author(s): Lara M ; Sherbourne C ; Duan N ; Morales L ; Gergen P ; Brook RH
Affiliation: UCLA Department of Pediatrics, and RAND Health, Los Angeles, California, USA. lara@rand.org

Title: An English and Spanish Pediatric Asthma Symptom Scale. Source: Med Care (Medical care.) 2000 Mar; 38(3): 342-50

Abstract: BACKGROUND: Pediatric asthma survey measures have not been adequately tested in non-English-speaking populations. OBJECTIVES: To test the reliability and validity of an English and Spanish symptom scale to measure asthma control in children. SUBJECTS: Parents (54% Spanish-speaking; 61% not high school graduates) of 234 children seen in the emergency department for an asthma exacerbation. MEASURES: Parent report of frequency and perceived severity of child asthma symptoms during the beginning and after resolution of the exacerbation. RESULTS: An 8-item scale composed of reports of cough, wheezing, shortness of breath, asthma attacks, chest pain, night symptoms, and overall perceived severity had very good psychometric properties in both English and Spanish. The reliability (Cronbach's alpha) of the scale ranged from 0.81 to 0.87 for both languages and time frames. In both languages, the validity of the scale was supported by responsiveness to changes in clinical status (lower symptom score after resolution of the exacerbation, P < 0.001) and by moderate to strong correlations (P < 0.001) with other asthma morbidity measures (parent report of child bother: r = 0.59-0.65; school days lost: r = 0.38-0.67; and activity days lost: r = 0.41-0.59). There were no statistically significant differences in the reliability or construct validity of the summary symptom scale by language, although Spanish speakers reported a lower frequency of some symptoms than did English speakers. CONCLUSIONS: A reliable and valid 8-item scale can be used to measure control of asthma symptoms in Spanish-speaking populations of low literacy. Additional research to evaluate language equivalency of asthma measures is necessary.

Author(s): Xu J ; Meyers DA ; Ober C ; Blumenthal MN ; Mellen B ; Barnes KC ; King RA ; Lester LA ; Howard TD ; Solway J ; Langefeld CD ; Beaty TH ; Rich SS ; Bleecker ER ; Cox NJ
Affiliation: Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA. Corp Author: Collaborative Study on the Genetics of Asthma

Title: Genomewide screen and identification of gene-gene interactions for asthma-susceptibility loci in three U.S. populations: collaborative study on the genetics of asthma. Source: Am J Hum Genet (American journal of human genetics.) 2001 Jun; 68(6): 1437-46

Abstract: The genomewide screen to search for asthma-susceptibility loci, in the Collaborative Study on the Genetics of Asthma (CSGA), has been conducted in two stages and includes 266 families (199 nuclear and 67 extended pedigrees) from three U.S. populations: African American, European American, and Hispanic. Evidence for linkage with the asthma phenotype was observed for multiple chromosomal regions, through use of several analytical approaches that facilitated the identification of multiple disease loci. Ethnicity-specific analyses, which allowed for different frequencies of asthma-susceptibility genes in each ethnic population, provided the strongest evidence for linkage at 6p21 in the European American population, at 11q21 in the African American population, and at 1p32 in the Hispanic population. Both the conditional analysis and the affected-sib-pair two-locus analysis provided further evidence for linkage, at 5q31, 8p23, 12q22, and 15q13. Several of these regions have been observed in other genomewide screens and linkage or association studies, for asthma and related phenotypes. These results were used to develop a conceptual model to delineate asthma-susceptibility loci and their genetic interactions, which provides a promising basis for initiation of fine-mapping studies and, ultimately, for gene identification.

Author(s): Ortega AN ; Gergen PJ ; Paltiel AD ; Bauchner H ; Belanger KD ; Leaderer BP
Affiliation: Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut, USA. alexander.ortega@yale.edu

Title: Impact of site of care, race, and Hispanic ethnicity on medication use for childhood asthma. Source: Pediatrics (Pediatrics.) 2002 Jan; 109(1): E1

Abstract: OBJECTIVE: To understand the importance of source of care and other factors that influence differences in asthma medication use by race and Hispanic ethnicity. METHODS: The Childhood Asthma Severity Study provided 12-month, retrospective, parent-reported questionnaire data on a monthly basis for children ages </=12 years in a community sample of 1002 children and their families from Connecticut and Massachusetts. Medications considered included cromolyn, beta2-agonist, inhaled steroids, anticholinergics, theophylline, and systemic steroids. Information was available on demographics, insurance status, symptom severity, primary care contact, and provider practice types. RESULTS: Black and Hispanic children received fewer beta2-agonists, and Hispanic children received fewer inhaled steroids than white children after adjusting for patients' race, age, gender, insurance status, symptom severity, number of primary care visits for asthma, number of urgent visits to the regular provider, family income, maternal education, and site of care. When multivariate analyses were restricted to patients in private practice, the significant association between Hispanic ethnicity and low inhaled steroid use persisted, whereas differences in beta2-agonist use by race and ethnicity changed little but became nonsignificant. CONCLUSION: Even within private practices, patients' race and ethnicity are associated with clinician nonadherence to national guidelines. Programs to eliminate these disparities will need both to focus on site of care and to intervene at the provider and patient levels to be successful.

Author(s): Berg J ; Wahlgren DR ; Hofstetter CR ; Meltzer SB ; Meltzer EO ; Matt GE ; Martinez-Donate A ; Hovell MF
Affiliation: UCLA School of Nursing, Los Angeles, California, USA.

Title: Latino children with asthma: rates and risks for medical care utilization. Source: J Asthma (The Journal of asthma : official journal of the Association for the Care of Asthma.) 2004 Apr; 41(2): 147-57

Abstract: Latino families have been reported to underutilize health care services compared with families from other ethnic backgrounds. As part of a community trial in a low income Latino population designed to decrease environmental tobacco smoke (ETS) exposure in children with asthma in San Diego, we examined unscheduled medical care for asthma. Latino families (N = 193) reported information about medical care use for their children during the past 12 months. About 23% were hospitalized, 45% used the emergency department, and 60% used urgent care services. About 8.5% of families had two or more hospitalizations in 12 months. Most families were insured by Medicaid or had no insurance. Significant risk factors for a child's hospitalization were age (under age six), failure to use a controller medication, and a parental report of the child's health status as being poor. Risk factors for emergency department use were age (under age six) and male gender. These findings indicate that low-income Latino families with young children with asthma lack the medical resources necessary for good asthma control. Quality and monitored health care with optimization of asthma management could reduce costly acute care services.

Author(s): Christiansen SC ; Martin SB ; Schleicher NC ; Koziol JA ; Hamilton RG ; Zuraw BL
Affiliation: Department of Molecular and Experimental Medicine, Scripps Research Institute, La Jolla, CA, USA.

Title: Exposure and sensitization to environmental allergen of predominantly Hispanic children with asthma in San Diego's inner city. Source: J Allergy Clin Immunol (The Journal of allergy and clinical immunology.) 1996 Aug; 98(2): 288-94

Abstract: BACKGROUND: Environmental living conditions co-sorting with economic status may influence the disease morbidity rate of childhood asthma in ethnic minority urban poor populations. OBJECTIVES: This study was carried out to assess exposure and sensitization to environmental allergens in southeast San Diego children with current asthma-related symptoms and to determine the utility of environmental control measures. METHODS: Children, 9 to 12 years old, with current asthma-related symptoms were identified and enrolled at four school sites. Skin prick testing with aeroallergens was performed, and allergen in collected dust (from mattresses, pillows, and bedroom carpets) was quantified by enzyme immunoassay. Environmental control instruction and products were provided. RESULTS: Of 41 subjects who underwent skin testing, 51.2% were reactive to environmental allergens (39% to mite, 22% to cockroach, and 9.8% to cat). Mean allergen levels for sensitized subjects were: Der p 1 (11 subjects), 18,722 ng/gm dust; Der f 1 (8 subjects), 5345 ng/gm dust; Fel d 1 (3 subjects), 214 ng/gm dust; Bla 1 (8 subjects), 7.15 U/gm dust; and Bla 2 (8 subjects) 7.13 U/gm dust. Environmental allergen exposure levels were not significantly different between sensitized and nonsensitized subjects. Environmental control measures for mite exposure were completed in six homes of sensitized subjects. One month after treatment, allergen levels fell 91.2% for Der p 1, 98.9% for Der f 1, and 88.2% for Fel d 1. One year after treatment, mite and cat allergen levels remained low. Environmental control had no consistent impact on cockroach allergen levels. CONCLUSION: Environmental allergen sensitization and exposure may be cofactors contributing to increased disease severity in urban poor populations.

Author(s): Freeman NC ; Schneider D ; McGarvey P
Affiliation: Robert Wood Johnson Medical School, Piscataway, NJ, USA. nfreeman@eohsi.rutgers.edu

Title: The relationship of health insurance to the diagnosis and management of asthma and respiratory problems in children in a predominantly Hispanic urban community. Source: Am J Public Health (American journal of public health.) 2003 Aug; 93(8): 1316-20

Abstract: OBJECTIVES: As part of an asthma screening study, we evaluated the relationship of health care insurance coverage to the diagnosis and treatment of elementary school children for asthma and related respiratory problems from 1998 through 2001. METHODS: A bilingual questionnaire assessing health care coverage, asthma diagnosis, respiratory symptoms, and use of medications was distributed to parents of 6235 public and private school children in grades 2 through 5 in Passaic, NJ. RESULTS: Responses for 4380 children (70%) revealed disparities in health care coverage and asthma diagnosis among racial and ethnic groups. Mexican and Dominican children had significant increases in health care coverage over the 4 years. CONCLUSIONS: The percentage of children with health insurance grew from 67% in 1998 to 81% in 2001, and the increase was related to NJ KidCare. Diagnosis of asthma and treatment were related to health care coverage.

Author(s): Boudreaux ED ; Emond SD ; Clark S ; Camargo CA Jr
Affiliation: Department of Emergency Medicine, Cooper Hospital and University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, Camden, New Jersey, USA. Corp Author: Multicenter Airway Research Collaboration Investigators

Title: Race/ethnicity and asthma among children presenting to the emergency department: differences in disease severity and management. Source: Pediatrics (Pediatrics.) 2003 May; 111(5) Pt 1: e615-21

Abstract: OBJECTIVE: To investigate racial/ethnic differences in acute asthma among children who present to the emergency department (ED). METHOD: We analyzed data from 2 prospective cohort studies performed during 1997-1998 as part of the Multicenter Airway Research Collaboration. Using a standardized protocol, researchers at 40 EDs in 18 US states provided 24-hour-per-day coverage for a median of 2 weeks per year. Children with acute asthma were interviewed in the ED and by telephone 2 weeks after discharge. RESULTS: Among 1095 patients, 679 (62%) were black, 256 (23%) were Hispanic, and 160 (15%) were white. Black and Hispanic children had greater histories of lifetime (63%, 64%, 46%) and past-year (34%, 31%, 14%) hospitalization and more ED visits in the past year (medians: 2, 3, 1). Asthma severity at ED presentation, ED management and course, hospitalization during the index visit, discharge prescriptions, and postdischarge outcomes were equivalent among all race/ethnic groups. CONCLUSION: Despite pronounced race/ethnicity-based differences in chronic asthma, all racial/ethnic groups exhibited similar acute asthma severity, ED management, and course. However, given that black and Hispanic children exhibited much higher admission histories and past ED use, the equivalence in inhaled corticosteroid prescriptions on discharge is a disconcerting pattern that mirrors previous literature on outpatient prescription practices. In addition to barriers attributable to socioeconomic factors, health care providers and policy makers should target equalizing deficiencies in preventive medication prescription practices.

Author(s): Affiliation: COSSMHO, Washington, DC 20036, USA.

Title: Hispanic environmental health: ambient and indoor air pollution. National Coalition of Hispanic Health and Human Services Organizations (COSSMHO). Source: Otolaryngol Head Neck Surg (Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.) 1996 Feb; 114(2): 256-64

Abstract: Air pollution has serious deleterious effects on health and is a public health matter of the utmost importance. The National Coalition of Hispanic Health and Human Services Organizations (COSSMHO) believes that reducing exposure to air pollution is a priority issue for the Hispanic community because 80% of Hispanics (compared with 65% of non-Hispanic blacks and 57% of non-Hispanic whites) live in nonattainment areas--areas that fail to meet the Environmental Protection Agency ambient air quality standard. Although Hispanics in general live as long as or longer than non-Hispanic whites, what morbidity data are available reveal that the quality of that life is severely impaired by a variety of chronic conditions, such as asthma. This makes environmental health a pressing matter for Hispanic communities, particularly in the area of air pollution. Action items are included.

Author(s): Hendricson WD ; Wood PR ; Hidalgo HA ; Ramirez AG ; Kromer ME ; Selva M ; Parcel G
Affiliation: Division of Educational Research and Development, University of Texas Health Science at San Antonio 78284-7896, USA.

Title: Implementation of individualized patient education for Hispanic children with asthma. Source: Patient Educ Couns (Patient education and counseling.) 1996 Nov; 29(2): 155-65

Abstract: An educational program known as the Childhood Asthma Project (CAP) was implemented to reduce morbidity among Hispanic children with chronic asthma. Seventy-three children, ages 6-16, participated in 4 program phases: baseline assessment, one-on-one child-centered education, application, and maintenance. During baseline assessment, child and parent asthma beliefs and behaviors were evaluated and used to create educational modules on symptom recognition, peak low meters, medications, and precipitating factors in Spanish and English. Children learned the importance of self-management, practiced using inhalers and peak flow meters and charted peak flow recordings. Videotapes provided peer modeling by showing Hispanic children with asthma performing self-management tasks. During the application phase, patients practiced self-management behaviors at home and reviewed progress with a nurse educator. During maintenance, the success of self-monitoring was reviewed at follow-up appointments. Recommendations for designing health education interventions for Hispanic children are provided.

Author(s): Stein RT ; Holberg CJ ; Sherrill D ; Wright AL ; Morgan WJ ; Taussig L ; Martinez FD
Affiliation: Department of Pediatrics, College of Medicine, Pontificia Universidade Catolica RS, Porto Alegre, Brazil.

Title: Influence of parental smoking on respiratory symptoms during the first decade of life: the Tucson Children's Respiratory Study. Source: Am J Epidemiol (American journal of epidemiology.) 1999 Jun 1; 149(11): 1030-7

Abstract: Compelling evidence suggests a causal relation between exposure to parental cigarette smoking and respiratory symptoms during childhood. Still, the roles of prenatal versus postnatal parental smoking need clarification. In this study, the authors assessed the effects of passive smoking on respiratory symptoms in a cohort of over 1,000 children born during 1980-1984. The children were enrolled in the Tucson Children's Respiratory Study in Tucson, Arizona, and were followed from birth to age 11 years. The population was generally middle class and consisted of two main ethnic groups, non-Hispanic Whites (75%) and Hispanics (20%), reflecting Tucson's population. Information on parental smoking and on wheeze and cough in their children was elicited from parents by using questionnaires at five different surveys. Data were analyzed both cross-sectionally and by using the generalized estimation equation approach, a longitudinal mixed-effects model. The best-fitting model indicated that maternal prenatal but not postnatal smoking was associated with current wheeze (odds ratio = 2.3, 95% confidence interval 1.4-3.8) independently of a family history of asthma, socioeconomic factors, and birth weight. This effect was time dependent and significant only below age 3 years; although independent of gender, the association was stronger for girls (odds ratio = 3.6, 95% confidence interval 1.6-8.0). Cough was not associated with parental smoking during the first decade of life. This transitory effect of maternal prenatal smoking on wheezing could be due to changes that affect the early stages of lung development.

Author(s): Apter AJ ; Reisine ST ; Affleck G ; Barrows E ; ZuWallack RL
Affiliation: Department of Medicine, General Clinical Research Center, University of Connecticut Health Center, Farmington, USA. Title: The influence of demographic and socioeconomic factors on health-related quality of life in asthma. Source: J Allergy Clin Immunol (The Journal of allergy and clinical immunology.) 1999 Jan; 103(1) Pt 1: 72-8
Additional Info: UNITED STATES Standard No: ISSN: 0091-6749; NLM Unique Journal Identifier: 1275002 Language: English Abstract: BACKGROUND: Although health-related quality of life (HRQL) in asthma is strongly influenced by disease severity, demographic and socioeconomic variables may also be important factors. OBJECTIVE: We related demographics, asthma severity, and socioeconomic factors to HRQL. METHODS: We interviewed 50 patients with moderate or severe asthma recruited from outpatient health center-based clinics to determine demographics, socioeconomic status, asthma severity, medication use, and HRQL. For HRQL, the mean total score of the Asthma Quality of Life Questionnaire (AQLQ) and the Medical Outcomes Study Short-Form 36 questionnaires physical and mental component summary scores (PCS and MCS, respectively) were used. RESULTS: The mean patient age was 46 +/- 14 years, and the FEV1 was 75% +/- 21% of predicted value. Twenty-nine subjects had been hospitalized for asthma, 29 belonged to a minority racial/ethnic group, and 16 had less than 12 years of education. The mean total AQLQ score was 4.12 +/- 1.42, the PCS was 37 +/- 10, and the MCS was 45 +/- 13. In univariate analyses, severity (nighttime awakenings, prednisone use, and a history of emergency department visits), racial/ethnic group (African American, white, or Hispanic), and socioeconomic status (low educational level, unemployed, family income under $20,000, public assistance, or no health insurance) were related to HRQL. These factors explained 67% of the variance of AQLQ and 48% of the variance of the PCS. Much of the quality of life variance was shared among these variables. Explanatory variables were not related to MCS in multivariate analysis. CONCLUSION: Socioeconomic status is an additional important independent factor influencing HRQL in asthma. In this study it was difficult to separate out the unique effects of socioeconomic status and race/ethnicity.

Author(s): Lind DL ; Choudhry S ; Ung N ; Ziv E ; Avila PC ; Salari K ; Ha C ; Lovins EG ; Coyle NE ; Nazario S ; Casal J ; Torres A ; Rodriguez-Santana JR ; Matallana H ; Lilly CM ; Salas J ; Selman M ; Boushey HA ; Weiss ST ; Chapela R ; Ford JG ; Rodriguez-Cintron W ; Silverman EK ; Sheppard D ; Kwok PY ; González Burchard E
Affiliation: University of California at San Francisco, San Francisco, CA 94143-0833, USA.

Title: ADAM33 is not associated with asthma in Puerto Rican or Mexican populations. Source: Am J Respir Crit Care Med (American journal of respiratory and critical care medicine.) 2003 Dec 1; 168(11): 1312-6

Abstract: A recent study identified the ADAM33 gene as a promising candidate contributing to asthma. In Puerto Rican and Mexican populations, we have genotyped six single nucleotide polymorphisms (SNPs) that were used in the Genetics of Asthma in Latino Americans Study. We chose to study these two populations because in the United States, Puerto Ricans have the highest asthma prevalence, morbidity, and mortality and Mexicans the lowest. We used the transmission disequilibrium test to analyze associations between the ADAM33 gene variants and asthma, asthma severity, bronchodilator responsiveness, and total IgE levels using single SNPs, two to six SNP combinations, and specific haplotypes in 583 trios (proband with asthma and both biological parents). We also genotyped matched control samples to allow case-control analyses. None of the transmission disequilibrium test or case-control results showed significant association in either population. We found no evidence for association of single SNPs with asthma severity, bronchodilator response, or IgE levels in Mexicans or in the combined population. Two SNPs showed a modest association in Puerto Ricans, insignificant when the number of comparisons was taken into account. We conclude that the ADAM33 gene is not an important risk factor for asthma or for asthma-associated phenotypes in Mexicans or in Puerto Ricans.

Author(s): Freeman NC ; Schneider D ; McGarvey P
Affiliation: Robert Wood Johnson Medical School, Piscataway, New Jersey 08558, USA. nfreeman@eohsi.rutgers.edu

Author(s): Lara M ; Duan N ; Sherbourne C ; Lewis MA ; Landon C ; Halfon N ; Brook RH
Affiliation: Department of Pediatrics, University of California, Los Angeles, USA.

Title: Differences between child and parent reports of symptoms among Latino children with asthma. Source: Pediatrics (Pediatrics.) 1998 Dec; 102(6): E68

Abstract: OBJECTIVES: To determine, in a population of predominantly Latino children with asthma 6 to 18 years old, whether parent and child reports of asthma symptoms with exercise differ and to evaluate the validity of child and parent reports of symptoms. DESIGN: Data obtained from child and parent interviews; pulmonary function tests (forced vital capacity, forced expiratory volume in 1 second, forced expiratory flow25-75, peak expiratory flow), and observation of symptoms after exercise. SETTING: Three summer camps for minority children with asthma in Los Angeles County. PARTICIPANTS: A total of 97 children with asthma (78% Latino, 12% non-Latino White, 9% Other; 6 to 18 years of age) and their parents. INTERVENTION(S): None. PRIMARY OUTCOME MEASURES: Child and parent reports of cough and wheezing with exercise and pulmonary function tests before and after exercise. While at camp, children underwent spirometry after completing the self-administered survey. The pulmonary function tests were conducted and interpreted according to the pediatric specifications for spirometry, and results >80% of predicted, adjusted for gender, age, height, and race, were considered normal. Six peak expiratory flow rates (PEFR) by peak flow meter also were recorded by trained research assistants immediately before spirometry, and values >80% of predicted based on height were considered normal. To observe child symptoms with exercise, children participated in a relay running race of 200 feet followed by a swimming race of 300 feet. Research assistants measured heart rate and 6 PEFRs using ASSESS portable peak flow meters immediately before and after each exercise. A positive exercise challenge was defined as a 15% reduction in mean PEFR and/or observed asthma symptoms (cough, wheezing, chest pain, asthma attack). RESULTS: Of the children, 18% reported never having a cough when they exercised, 46% reported having it occasionally when they exercised, and 36% reported having it quite often or always when they exercised. For wheezing, 20% of children reported never having wheezing when they exercised, 35% having it occasionally when they exercised, and 45% having it quite often or always when they exercised. Parents reported fewer symptoms than did their children. Of the parents, 34% reported that their children did not have cough with exercise, 37% reported few to some days, and 29% reported most days or every day. Forty-seven percent of parents reported that their child did not wheeze with exercise in the last 2 months, 35% reported wheezing on a few days to some days, and 17% reported wheezing most days to every day. Parent and child reports of cough or wheezing after exercise correlated mildly with each other (parent/child cough r = 0. 23; kappa = 0.03; parent/child wheezing r = 0.21; kappa = 0.14). Children were more likely to report cough: 59 of 71 (83%) of children versus 44 of 71 (62%) of parents. The 22 children who reported cough when their parents did not account for most of the disagreement between parents and children. Children were more likely than were their parents to report wheezing; 55 of 69 (80%) children versus 36 of 69 (52%) parents reported that the child wheezed. The 24 children who reported wheezing when their parents did not account for most of the disagreement between parents and children. Forty-seven percent of the children had a value <80% of predicted for at least one of the four spirometry tests; 29% of mean baseline PEFRs were <80% of predicted. Overall, 86% of the children met one or more of the following: any percent of predicted pulmonary function tests <80% or any symptom or PEFR reduction of 15% after exercise, or other occurrence of nonexercise symptoms during camp. Almost all child reports of cough and wheezing correlated significantly with the criterion validity criteria. For example, child reports of wheezing were, as expected, correlated negatively with the percent of predicted FEV1 (r = -0.28) and correlated positive

Author(s): Del-Rio-Navarro BE ; Fanghänel G ; Berber A ; Sánchez-Reyes L ; Estrada-Reyes E ; Sienra-Monge JJ
Affiliation: Allergy Service, Hospital Infantil de México, Mexico City, Mexico.

Title: The relationship between asthma symptoms and anthropometric markers of overweight in a Hispanic population. Source: J Investig Allergol Clin Immunol (Journal of investigational allergology & clinical immunology : official organ of the International Association of Asthmology (INTERASMA) and Sociedad Latinoamericana de Alergia e Inmunologia.) 2003; 13(2): 118-23

Abstract: BACKGROUND: Previous studies have revealed the relationship between asthma and obesity, but the relationship with other markers of overweight and obesity has not yet been investigated. OBJECTIVE: To establish the relationship between asthma symptoms and simple anthropometric indexes (BMI, waist circumference (WC), and waist-to-hip ratio (WHR)) as markers of overweight in an adult Hispanic population. METHODS: The data were obtained from the PRIT (Prevalence of Cardiovascular Risks in General Hospital Workers) 2001 survey. The participants were workers at the Hospital General de México in Mexico City and included 135 men and 398 women aged 43.8 +/- 11.9 and 43.0 +/- 10.5, respectively. Odds ratios for asthma symptoms at different BMI, WC, and WHR cutoff points associated with excessive weight were calculated. The likelihood ratios for having asthma symptoms in participants with various cutoff values of BMI, WC, and WHR also were calculated. RESULTS: Asthma symptoms were not related to anthropometric markers of overweight or obesity in men, while they were associated in women with WC cutoff levels of 80 and 85 cm, and BMI of 25 and 27 kg/m2. No level of WHR was related to asthma symptoms in women. In women, the likelihood ratio for asthma symptoms increased proportionally from WC levels of 73.5 cm up to 86 cm, while this risk increased significantly from BMI levels of 22 up to 29 kg/m2. CONCLUSION: Overweight as assessed by BMI and WC (but not WHR) was related to asthma symptoms in women in the studied population.

Author(s): Blumenthal MN ; Langefeld CD ; Beaty TH ; Bleecker ER ; Ober C ; Lester L ; Lange E ; Barnes KC ; Wolf R ; King RA ; Solway J ; Oetting W ; Meyers DA ; Rich SS
Affiliation: Department of Medicine, University of Minnesota, MMC 434 Mayo, 420 Delaware SE, Minneapolis, MN 55455, USA. blume001@umn.edu

Title: A genome-wide search for allergic response (atopy) genes in three ethnic groups: Collaborative Study on the Genetics of Asthma. Source: Hum Genet (Human genetics.) 2004 Jan; 114(2): 157-64

Abstract: Atopy is an IgE-mediated condition known to aggregate in families and is a major risk factor for asthma. As part of the Collaborative Study on the Genetics of Asthma (CSGA), a genome-wide scan for atopy, defined by skin sensitivity to one or more common environmental allergens, was conducted in 287 CSGA families (115 African American, 138 Caucasian and 34 Hispanic). Using a nonparametric genetic analysis approach, two regions were observed in the sample of all families that yielded multipoint lod scores >1.5 (chromosome 11q, lod=1.55 between D11S1986 and D11S1998; chromosome 20p between D20S473 and D20S604, lod=1.54). Modeling that included multiple genomic positions simultaneously indicated that four chromosomal regions accounted for the majority of evidence for linkage in the combined families. These four regions are on chromosomes 10p near D10S1412 (lod=0.94), 11q near D11S1986 (lod=1.76), 17q near D17S784 (lod=0.97) and 20p near D20S473 (lod=1.74). In the subset of pedigrees giving positive evidence for linkage on chromosome 11q, the evidence for linkage increased by lod scores greater than one in four other chromosomal regions: 5q (D5S1480, lod=1.65), 8p (D8S1113, lod=1.60), 12p (D12S372, lod=1.54) and 14q (D14S749, lod=1.70). These results suggest that several regions may harbor genes contributing to the risk for atopy and these may interact with one another in a complex manner.

Author(s): Rodríguez MA ; Winkleby MA ; Ahn D ; Sundquist J ; Kraemer HC
Affiliation: Department of Family Medicine, UCLA School of Medicine, 924 Westwood Blvd, Suite 725, Los Angeles, CA 90024, USA. mrodriguez@mednet.ucla.edu

Title: Identification of population subgroups of children and adolescents with high asthma prevalence: findings from the Third National Health and Nutrition Examination Survey. Source: Arch Pediatr Adolesc Med (Archives of pediatrics & adolescent medicine.) 2002 Mar; 156(3): 269-75

Abstract: OBJECTIVES: To provide national estimates of asthma prevalence in African-American, Mexican American and white (non-Latino) children and adolescents using several common definitions; to evaluate familial, sociodemographic, and environmental risk factors that are independently associated with current asthma in children; and to identify subgroups at particular risk for current asthma using 2 complementary data analytic approaches. DESIGN: Cross-sectional study, using the Third National Health and Nutrition Examination Survey, 1988-1994. SETTING: Eighty-nine mobile examination centers in the United States. PARTICIPANTS: Twelve thousand three hundred eighty-eight African American, Mexican American, and white (non-Latino) children and adolescents, aged 2 months through 16 years, selected from a systematic random, population-based, nationally representative sample. MAIN OUTCOME MEASURE: Current asthma, defined by caregivers who reported that their child currently had doctor-diagnosed asthma. RESULTS: The overall prevalence of current asthma was 6.7% (95% confidence interval [CI], 5.6-7.8). Odds ratios for current asthma from the multiple regression analysis were 4.00 (95% CI, 2.90-5.52) for children with a parental history of asthma or hay fever, 1.94 (95% CI, 1.09-3.46) for children with body mass index (calculated as weight in kilograms divided by the square of height in meters) greater than or equal to the 85th percentile, and 1.64 (95% CI, 1.20-2.26) for children of African American ethnicity. African American and Mexican American children showed a consistent prevalence of current asthma across age while white children showed an increase in prevalence with age. The 2 highest-risk subgroups identified by the signal detection analysis were composed of children with a parental history of asthma or hay fever who were 10 years or older with a body mass index greater than or equal to the 85th percentile (31.0% current asthma), and children with a parental history who were 10 years or younger and of African American ethnicity (15.6% current asthma). CONCLUSIONS: The findings from this analysis show a strong independent association between obesity and current asthma in children and adolescents, and confirm previous reports of a parental history of asthma or hay fever and African American ethnicity as additional important risk factors.

Author(s): Roberts EM
Affiliation: Department of Pediatrics and Health Policy Studies, University of California at San Francisco, 94143, USA. erobert@itsa.ucsf.edu

Title: Racial and ethnic disparities in childhood asthma diagnosis: the role of clinical findings. Source: J Natl Med Assoc (Journal of the National Medical Association.) 2002 Apr; 94(4): 215-23

Abstract: OBJECTIVES: To establish rates of childhood asthma symptoms, diagnosis, and hospitalization by race, ethnicity, and income, and to ascertain if elevated reported prevalence of asthma diagnosis among African-American children could be explained by differences in clinical findings. METHODS: Estimates of each indicator were calculated based on data from the third National Health and Nutrition and Examination Survey (NHANES III). Bivariate and multivariate logistic regression models were estimated to predict parent or guardian report of current asthma diagnosis. RESULTS: African-American children aged 1 to 5 have a 2-fold higher probability of both asthma diagnosis and hospitalization during the previous year but no significant difference in wheeze prevalence compared to Mexican-American and European-American children. These differences are not explained by household income or clinical information. Children aged 6 to 16 had similar rates of diagnosis and hospitalization for all racial/ethnic groups, although African-American children reported wheeze symptoms one-third less often. CONCLUSIONS: Although younger African-American children have higher morbidity from asthma than their Mexican-American and European-American peers, clinical findings were similar and did not explain increased rates of diagnosis. Interpersonal dynamics within families and communication between families and clinicians are believed to influence both symptom reporting and diagnosis generation.

Native American

New Mexico/Southwest Hispanic Native American Rural Poverty

Author(s): Van Sickle D ; Morgan F ; Wright AL
Affiliation: Arizona Respiratory Center and Department of Pediatrics, University of Arizona, College of Medicine, Tucson 85724, USA.

Title: Qualitative study of the use of traditional healing by asthmatic Navajo families. Source: Am Indian Alsk Native Ment Health Res (American Indian and Alaska native mental health research (Online)) 2003; 11(1): 1-18

Abstract: Despite increasing prevalence of asthma among American Indians and/or Alaska Natives, little is known about their use of traditional healing in its management. A convenience sample of 24 Navajo families with asthmatic members (n=35) was interviewed between June 1997 and September 1998. While 46% of families had previously used traditional healing, only 29% sought traditional healing for asthma. Use of traditional healing was unrelated to use of biomedical therapies, hospitalizations, or emergency services. Practical factors and questions about the nature and origins of asthma were the primary considerations determining use of traditional medicine. Little conflict between traditional healing and biomedical treatment was reported. The use of traditional healing for asthma is influenced by beliefs about the disease and factors specific to the individual, including their local social, economic, and cultural context.

Author(s): Clark D ; Gollub R ; Green WF ; Harvey N ; Murphy SJ ; Samet JM
Affiliation: Jemez Pueblo Clinic, Indian Health Service, Albuquerque, New Mexico 87131, USA.

Title: Asthma in Jemez Pueblo schoolchildren. Source: Am J Respir Crit Care Med (American journal of respiratory and critical care medicine.) 1995 May; 151(5): 1625-7

Abstract: Asthma, a major chronic health problem of children, has received little investigation in Native Americans. We conducted a survey of asthma in children of Jemez Pueblo, Jemez, New Mexico, in response to concerns of the community and health care providers about the frequency of asthma. In collaboration with Jemez Pueblo, we developed a standardized questionnaire and administered it to parents of 318 children aged 3 to 13 years. Parents reported that 12.3% had been diagnosed as having asthma or reactive airway disease by a physician or other health care practitioner. Asthma was reported as still active at the time of the interview for 55% of those subjects. The study showed that asthma was not uncommon among the Jemez Pueblo children and, in fact, was more common than in recent nationwide surveys.

Author(s): Gupchup GV ; Hubbard JH ; Teel MA ; Singhal PK ; Tonrey L ; Riley K ; Rupp MT ; Coultas DB
Affiliation: College of Pharmacy, University of New Mexico Health Sciences Center, Albuquerque 87131, USA.

Title: Developing a community-specific health-related quality of life (HRQOL) questionnaire for asthma: the Asthma-Specific Quality of Life Questionnaire for Native American Adults (AQLQ-NAA). Source: J Asthma (The Journal of asthma : official journal of the Association for the Care of Asthma.) 2001 Apr; 38(2): 169-78

Abstract: The Asthma Quality of Life Questionnaire for Native American Adults (AQLQ-NAA) was developed by modifying the Asthma Quality of Life Questionnaire-Marks (AQLQ-M) using the focus group technique. The 19-item AQLQ-NAA has emphasis on restrictions in social, community, and cultural activities. Higher scores indicate a better quality of life. The modified questionnaire was administered to a sample of 51 Native American adults with asthma at the Albuquerque USPHS Indian Hospital and its affiliated field clinics. Principal components analysis identified three domains with eigenvalues greater than 1.00: Community and Social Restrictions (CSR), Psychological Impact (PIM), and Symptoms (SYM). Cronbach's coefficient alpha for the AQLQ-NAA was 0.95 and ranged from 0.82 to 0.93 for the individual domains, indicating good internal consistency. The AQLQ-NAA score correlated negatively and significantly to urgent care visits, physician visits, and total number of medications taken for asthma in the past 6 and 12 months (p < 0.05). Additionally, the AQLQ-NAA score was correlated positively and significantly to medication adherence in the past 6 and 12 months (p < 0.05). Similar patterns of correlations were found with all three domain scores. These results indicated that there is evidence for the construct validity of the AQLQ-NAA and its domains. The AQLQ-NAA should provide a useful measure of HRQOL in asthma-specific medical interventions for the population in which it was developed.

Author(s): Hisnanick JJ ; Coddington DA ; Gergen PJ
Affiliation: Indian Health Service, Office of Health Programs, Research and Development, Tucson, Ariz.

Title: Trends in asthma-related admissions among American Indian and Alaskan native children from 1979 to 1989. Universal health care in the face of poverty. Source: Arch Pediatr Adolesc Med (Archives of pediatrics & adolescent medicine.) 1994 Apr; 148(4): 357-63

Abstract: OBJECTIVE: To describe changes in asthma-related hospitalizations in Indian Health Service facilities and compare with national trends. DESIGN: Trend analysis. PATIENTS AND SETTING: Hospital discharge records of patients aged 17 years and younger treated by the Indian Health Service between 1979 and 1989. MAIN OUTCOME MEASURES: Patients discharged with asthma as the first listed diagnosis. RESULTS: The rates of asthma-related hospitalizations increased an average of 2.6% (95% confidence interval [CI], 0.1 to 5.2) per year between 1979 and 1989 among American Indian and Alaskan Native children aged 0 to 17 years. The increase was 3.7% among the 0- to 4-year age group (95% CI, 2.0 to 5.5) and 0.3% (95% CI, 0.26 to 0.3) among the 5- to 17-year age group. Boys tended to have a higher rate of increase (4.3% [95% CI, -0.1 to 8.7]) compared with girls (2.6% [95% CI, -0.2 to 5.4]). The rates for any hospitalization decreased during this period for 0- to 4-year-olds (-7.5% [95% CI, -10.5 to -4.5]). Little change was noted in hospitalization rates for lower respiratory tract diseases. Diagnostic transfer from bronchitis/bronchiolitis to asthma could not explain the increase. Both first admission and readmission for treatment of asthma contributed to the increase. Compared with previously published data, 0- to 4-year-old American Indian and Alaskan Native children more closely approximate white children than black children in both rates of hospitalization (1979-1987) and annual percentage increase in hospitalization (1979-1989 for American Indian and Alaskan Native children and 1979-1987 for white and black children) for the treatment of asthma. CONCLUSIONS: American Indian and Alaskan Native children who are cared for by the Indian Health Service have asthma-related hospitalization patterns that are similar to those seen in white children despite having socioeconomic characteristics more similar to those of black children.

Author(s): Liu LL ; Stout JW ; Sullivan M ; Solet D ; Shay DK ; Grossman DC
Affiliation: Child Health Institute, 146 N Canal St, Suite 300, Seattle, WA 98103-8652, USA.

Title: Asthma and bronchiolitis hospitalizations among American Indian children. Source: Arch Pediatr Adolesc Med (Archives of pediatrics & adolescent medicine.) 2000 Oct; 154(10): 991-6

Abstract: OBJECTIVE: To compare asthma and bronchiolitis hospitalization rates in American Indian and Alaskan native (AI/AN) children and all children in Washington State. METHODS: A retrospective data analysis using Washington State hospitalization data for 1987 through 1996. Patients were included if asthma or bronchiolitis was the first-listed diagnosis. American Indian and Alaskan native children were identified by linking state hospitalization data with Indian Health Service enrollment data. RESULTS: Similar rates of asthma hospitalization were found for AI/AN children older than 1 year compared with all children. In AI/AN children younger than 1 year, hospitalization rates for asthma (528 per 100,000 population; 95% confidence interval [CI], 346-761) and bronchiolitis (2954 per 100,000 population; 95% CI, 2501-3456) were 2 to 3 times higher than the rates in all children (232 per 100,000 population [95% CI, 215-251] and 1190 per 100,000 population [95% CI, 1149-1232], respectively). Hospitalization rates for asthma and bronchiolitis increased 50% between 1987 and 1996 for all children younger than 1 year and almost doubled for AI/AN children younger than 1 year. CONCLUSIONS: American Indian and Alaskan native children have significantly higher rates of hospitalization for wheezing illnesses during the first year of life compared with children of other age groups and races. Furthermore, the disparities in rates have increased significantly over time. Future public health measures directed at managing asthma and bronchiolitis should target AI/AN infants.

Author(s): Rose D ; Garwick A
Affiliation: Department of Nursing, Bemidji State University, MN, USA.

Title: Urban American Indian family caregivers' perceptions of barriers to management of childhood asthma. Source: J Pediatr Nurs (Journal of pediatric nursing.) 2003 Feb; 18(1): 2-11

Abstract: American Indian family caregivers of children with asthma face numerous barriers to effective management of the illness. The purpose of this qualitative, community-based study is to identify those barriers as perceived by family caregivers in a large Midwestern city. An ecological perspective and principles of family-centered care provided the theoretical orientation for the study. Interviews were conducted with 16 urban Ojibwe family caregivers of children with asthma. Five categories of barriers characterize the families' experiences: provider (individual and system), condition-related, family caregiver, socioeconomic, and environmental. Examination of these findings suggests directions for improving care to American Indian children with asthma and their families.
Copyright 2003, Elsevier Science (USA). All rights reserved.

Author(s): Stout JW ; White LC ; Redding GJ ; Morray BH ; Martinez PE ; Gergen PJ
Affiliation: Department of Pediatrics, School of Medicine, University of Washington, Seattle, USA. jstout@u.washington.edu

Title: Differences in asthma prevalence between samples of American Indian and Alaska Native children. Source: Public Health Rep (Public health reports (Washington, D.C. : 1974)) 2001 Jan-Feb; 116(1): 51-7

Abstract: OBJECTIVES: To better understand the prevalence of asthma among American Indian and Alaska Native (AI/AN) children and to explore the contribution of locale to asthma symptoms and diagnostic assignment, the authors surveyed AI/AN middle school students, comparing responses from metropolitan Tacoma, Washington (metro WA) and a non-metropolitan area of Alaska (non-metro AK). METHODS: Students in grades 6-9 completed an asthma screening survey. The authors compared self-reported rates of asthma symptoms, asthma diagnoses, and health care utilization for 147 children ages 11-16 self-reporting as AI/AN in metro WA and 365 in non-metro AK. RESULTS: The prevalences of self-reported asthma symptoms were similar for the metro WA and non-metro AK populations, but a significantly higher percentage of metro WA than of non-metro AK respondents reported having received a physician diagnosis of asthma (OR 2.33; 95% CI 1.23, 4.39). The percentages of respondents who reported having visited a medical provider for asthma-like symptoms in the previous year did not differ. CONCLUSIONS: The difference in rates of asthma diagnosis despite similar rates of asthma symptoms and respiratory-related medical visits may reflect differences in respiratory disease patterns, diagnostic labeling practices, or environmental factors. Future attempts to describe asthma prevalence should consider the potential contribution of non-biologic factors such as diagnostic practices.

Author(s): Liu LL ; Stout JW ; Sullivan M ; Solet D ; Shay DK ; Grossman DC
Affiliation: Child Health Institute, 146 N Canal St, Suite 300, Seattle, WA 98103-8652, USA.

Author(s): Rhoades ER
Affiliation: Indian Health Service, U.S. Public Health Service, Rockville, Maryland 20857.

Title: The major respiratory diseases of American Indians. Source: Am Rev Respir Dis (The American review of respiratory disease.) 1990 Mar; 141(3): 595-600

Abstract: The most prominent respiratory diseases of American Indian adults are pneumonia, cancer of the lung, chronic obstructive pulmonary disease (COPD), and tuberculosis. Mortality and hospitalization rates of these diseases were compared with those for the rest of the U.S. population and between Indian groups in the various Indian Health Service Areas. Pneumonia and influenza constitute the sixth leading cause of death among Indians and the fifth leading cause of death among the U.S. All Races population. Chronic obstructive pulmonary disease is the fourth leading cause of death among U.S. All Races, but only the tenth leading cause of death among Indians. Pneumonia and tuberculosis are more significant causes of death and disability for Indians than are COPD and cancer of the lung. The explanation for these differences in mortality rates between Indians and the general population are not known. Respiratory system diseases are responsible for 10.6% of Indian hospitalizations. The most frequent is pneumonia, which accounts for approximately 4% of all Indian hospitalizations. Differences in respiratory diseases between Indian groups are sometimes striking, with a sharp increase in mortality and hospitalization in the Areas across the northern border of the lower 48 states. There is also a much higher prevalence of cigarette smoking in those same Areas.

Author(s): Morris K ; Morgenlander M ; Coulehan JL ; Gahagen S ; Arena VC ; Morganlander M
Affiliation: Department of Clinical Epidemiology and Preventive Medicine, University of Pittsburgh, Pa.

Title: Wood-burning stoves and lower respiratory tract infection in American Indian children. Source: Am J Dis Child (American journal of diseases of children (1960)) 1990 Jan; 144(1): 105-8

Abstract: Some studies suggest that home use of wood-burning stoves is an independent risk factor for lower respiratory tract infection in young children. To test this hypothesis in a population with a high prevalence of wood-burning stove use, we studied Navajo children with diagnosed pneumonia or bronchiolitis. We matched each case (less than or equal to 24 months of age) with a child of identical sex and age who was seen for well-child care or a minor health problem, and we interviewed an adult caretaker about family history and environmental exposures. Analyzing 58 case-control pairs, we found that home wood-burning stove use, recent respiratory illness exposure, family history of asthma, dirt floors, and lack of running water in the home increased the risk of lower respiratory tract infection. On multiple logistic regression analysis, however, only wood-burning stove use and respiratory illness exposure were independently associated with higher risk.

Rural

New Mexico/Southwest Hispanic Native American Rural Poverty

Author(s): Arif AA ; Borders TF ; Patterson PJ ; Rohrer JE ; Xu KT
Affiliation: Department of Family and Community Medicine and Rural and Community Health Center, Texas Tech University Health Sciences Center, Lubbock, Texas 79430, USA. ahmed.arif@ttuhsc.edu

Title: Prevalence and correlates of paediatric asthma and wheezing in a largely rural USA population. Source: J Paediatr Child Health (Journal of paediatrics and child health.) 2004 Apr; 40(4): 189-94

Abstract: OBJECTIVE: The prevalence of asthma among children has been increasing in the United States and it is estimated that there are approximately 5 million children with asthma. This cross-sectional survey sought to estimate the prevalence of asthma and asthma symptoms and potential risk factors among children aged 16 and younger, in a largely rural population in the USA. METHODS: This study was a telephone survey of 1500 households in the South Plains/Panhandle region of Texas. Parents of children were interviewed with a response rate of 64%. Having been diagnosed with asthma by a physician and a report of wheezing in the last 12 months were used as dependent variables in multivariate logistic regressions with several sociodemographic and environmental factors as potential confounders. RESULTS: The age-adjusted prevalence of asthma and wheezing among children were approximately 15 and 18%, respectively. The prevalence of asthma was highest (20%) among children aged 11-16 (P < 0.001). Living in urban areas was associated significantly with asthma and wheezing. Non-Hispanic blacks reported significantly increased odds of asthma in their children (adjusted odds ratio (OR) = 2.04, 95%CI 1.02-4.08), whereas Mexican-Americans reported significantly reduced odds of asthma (adjusted OR = 0.48, 95%CI 0.29-0.78) and wheezing (adjusted OR = 0.58, 95%CI 0.37-0.89) in their children. The odds of asthma (adjusted OR = 1.78, 95%CI 1.09-2.92) and wheezing (adjusted OR = 2.45, 95%CI 1.52-3.95) was highest among children in the highest body mass index quartile. No significant association with pet ownership and exposure to second-hand smoke with asthma and wheezing was observed in this study. CONCLUSION: Urban residence, non-Hispanic black and Mexican-American race/ethnicity, and being overweight were significantly associated with the increased risk of asthma and/or wheezing.

Author(s): Schwartz DA
Affiliation: Veterans Administration Medical Center, Iowa City, IA 52242, USA. david-schwartz@uiowa.edu

Title: Etiology and pathogenesis of airway disease in children and adults from rural communities. Source: Environ Health Perspect (Environmental health perspectives.) 1999 Jun; 107 Suppl 3: 393-401

Abstract: Asthma is the most common chronic disease of childhood and affects nearly 5 million children. The prevalence and severity of childhood asthma have continued to increase over the past decade despite major advances in the recognition and treatment of this condition. A comparison of urban and rural children suggests that the etiology of airway disease is multifactorial and that unique exposures and genetic factors contribute to the development of asthma in both settings. The most important environmental exposure that distinguishes the rural environment and is known to cause asthma is the organic dusts. However, animal-derived proteins, common allergens, and low concentrations of irritants also contribute to the development of airway disease in children and adults living in rural communities. A fundamental unanswered question regarding asthma is why only a minority of children who wheeze at an early age develop persistent airway disease that continues throughout their life. Although genetic factors are important in the development of asthma, recurrent airway inflammation, presumably mediated by environmental exposures, may result in persistent airway hyperresponsiveness and the development of chronic airway disease. Increasing evidence indicates that control of the acute inflammatory response substantially improves airflow and reduces chronic airway remodeling. Reducing exposure to agricultural dusts and treatment with anti-inflammatory medication is indicated in most cases of childhood asthma. In addition, children with asthma from rural (in comparison to urban) America face multiple barriers that adversely affect their health e.g., more poverty, geographic barriers to health care, less health insurance, and poorer access to health care providers. These unique problems must be considered in developing interventions that effectively reduce the morbidity and mortality of asthma in children from rural communities.

Author(s): Finkelstein J ; Hripcsak G ; Cabrera MR
Affiliation: Department of Medical Informatics, Columbia University, New York, USA.

Title: Patients' acceptance of Internet-based home asthma telemonitoring. Source: Proc AMIA Symp (Proceedings / AMIA ... Annual Symposium. AMIA Symposium.) 1998: 336-40

Abstract: We studied asthma patients from a low-income inner-city community without previous computer experience. The patients were given portable spirometers to perform spirometry tests and palmtop computers to enter symptoms in a diary, to exchange messages with physician and to review test results. The self-testing was performed at home on a daily basis. The results were transmitted to the hospital information system immediately after completion of each test. Physician could review results using an Internet Web browser from any location. A constantly active decision support server monitored all data traffic and dispatched alerts when certain clinical conditions were met. Seventeen patients, out of 19 invited, agreed to participate in the study and have been monitored for three weeks. They have been surveyed then using standardized questionnaire. Most of the patients (82.4%) characterized self-testing procedures as "not complicated at all." In 70.6% of cases self-testing did not interfere with usual activities, and 82.4% of patients felt the self-testing required a "very little" amount of their time. All patients stated that it is important for them to know that the results can be reviewed by professional staff in a timely manner. However, only 29.5% of patients reviewed their results at least once a week at home independently. The majority of the patients (94.1%) were strongly interested in using home asthma telemonitoring in the future. We concluded that Internet-based home asthma telemonitoring can be successfully implemented in the group of patients without previous computer background.

Author(s): Ray NF ; Thamer M ; Fadillioglu B ; Gergen PJ
Affiliation: Medical Technology and Practice Patterns Institute, Washington, DC, USA.

Title: Race, income, urbanicity, and asthma hospitalization in California: a small area analysis. Source: Chest (Chest.) 1998 May; 113(5): 1277-84

Abstract: STUDY OBJECTIVES: To explicate the interrelationship between asthma hospitalization and race/ethnicity and income. DESIGN: Small area ecologic analysis using census and administrative data. SETTING AND PARTICIPANTS: All asthma hospitalizations in California were identified using the 1993 California Hospital Discharge file. Small area analyses of Los Angeles (LA) were compared with published rates in New York City (NYC). RESULTS: In 1993, the age-adjusted asthma hospitalization rate in California for nonelderly blacks was 42.5/10,000-approximately four times higher than other populations. Black rates remained fourfold higher after stratification by age, income, and urbanicity. Multivariate analyses suggest that the association between black race and asthma hospitalization is independent of income. Regardless of race, children and persons living in poverty were at increased risk for asthma hospitalization. Urbanicity was not a predictor for asthma hospitalization. Overall, asthma hospitalization rates in NYC were 2.8 times higher compared with rates in LA; while rates were similar among blacks (60 vs 40/10,000, respectively), Puerto Rican Hispanics in NYC had dramatically higher rates compared with Mexican Hispanics in LA (63 vs 14/10,000, respectively). CONCLUSIONS: After controlling for socioeconomic status, notable differences in asthma hospitalization by race and ethnicity persist. The reasons for the significantly elevated risk of asthma morbidity among blacks remain unclear.

Poverty

New Mexico/Southwest Hispanic Native American Rural Poverty

Author(s): Klinnert MD ; Price MR ; Liu AH ; Robinson JL
Affiliation: Department of Pediatrics, National Jewish Medical and Research Center, Denver, Colorado 80206, USA. klinnertm@njc.org

Title: Morbidity patterns among low-income wheezing infants. Source: Pediatrics (Pediatrics.) 2003 Jul; 112(1) Pt 1: 49-57

Abstract: OBJECTIVE: This study describes morbidity attributable to wheezing illness in a multi-ethnic sample of low-income infants younger than age 2, and examines biological, environmental, and psychosocial correlates of morbidity indexes. METHOD: Infants 9 to 24 months old, considered at risk for developing asthma on the basis of having had 3 or more health care contacts with documented wheezing, received comprehensive evaluations as part of an environmental intervention study. Baseline evaluations with the infants, their families, and their home environments focused on biological, environmental, and psychosocial factors that would potentially increase asthma risk for the children. At study entry, prior morbidity attributable to wheezing illness was assessed with caregiver reports of symptom frequency and severity and medication use, caregiver quality of life, and medical record documentation of hospitalizations and emergency department (ED) visits. RESULTS: Forty-six percent of the infants had 1 or more hospitalizations and 59% had 2 or more ED visits since birth for wheezing illness. Foreign-born Hispanic families had significantly more ED visits for their children's wheezing illness than US-born Hispanic families, whites, or blacks, although they used fewer controller medications and they reported less illness severity. Multivariate analyses showed 3 biological factors, respiratory syncytial virus, elevated child IgE, and cockroach allergen in the home, were independently associated with hospitalizations within this sample. Similar analyses showed that ED visits were not associated with biological variables, but rather with caregivers with single parent status and smokers. Caregiver reports of wheezing illness severity were correlated with ED visits, but not with hospitalizations. Severity ratings were higher for children of mothers with asthma and for those whose caregivers had higher anxiety and stress. The only correlate of caregiver ratings of poor quality of life was high caregiver anxiety. CONCLUSIONS: Ethnic and immigrant status was an important factor in morbidity attributable to infant wheezing illness. In addition to respiratory infection, both allergic processes and social variables were associated with morbidity as measured by health care utilization. Caregiver reports of illness severity were significantly correlated with psychosocial factors.

Author(s): Halfon N ; Newacheck PW
Affiliation: Department of Community Health Sciences, UCLA School of Public Health 90024-1772.

Title: Childhood asthma and poverty: differential impacts and utilization of health services. Source: Pediatrics (Pediatrics.) 1993 Jan; 91(1): 56-61

Abstract: Data from the 1988 National Health Interview Survey on Child Health showed that 4.3% of all children younger than 17 years of age had asthma, with poor children demonstrating a slightly greater prevalence than nonpoor (4.8 poor vs 4.2 nonpoor). This poor/nonpoor differential was even greater for children younger than 6 years old (4.2 vs 3.1). Poor children were also more likely to have had more than 7 bed days in the past year because of their asthma. Measures of health service utilization showed that poor children had 40% fewer doctor visits (3.2 vs 5.4) and had 40% more hospitalizations in the previous year (10.6% vs 7.4%). Although more than 90% of all children had a usual source of routine and/or sick care, poor children were more likely to receive routine care in a neighborhood health center (15.1% vs 1.6%) or hospital-based clinic (11.1% vs 2.8%) than in a doctor's office (67.2% vs 91.1%) and, when sick, then were more than four times more likely to report an emergency department as a usual source of care (8.1% vs 1.7%). Diminished accessibility to appropriate outpatient health services for poor children with asthma was associated with increased morbidity, measured by hospitalization, and bed days. These findings have significant implications for the development of comprehensive models of care and the potential role that community clinics could play with increased funding as a result of Medicaid changes that were instituted as part of the 1989 Omnibus Budget Reconciliation Act.

Author(s): Weinreb L ; Goldberg R ; Bassuk E ; Perloff J
Affiliation: Department of Family and Community Medicine, University of Massachusetts Medical Center, Worcester 01655-0309, USA.

Title: Determinants of health and service use patterns in homeless and low-income housed children. Source: Pediatrics (Pediatrics.) 1998 Sep; 102(3) Pt 1: 554-62

Abstract: OBJECTIVE: Previous studies of homeless children have described more health problems and service use than in housed children, but failed to control for potential confounding factors that may differ between these children. This observational study examines the relationship of homelessness and other determinants to health status and service use patterns in 627 homeless and low-income housed children. METHODS: Case-control study of 293 homeless and 334 low-income housed children aged 3 months to 17 years and their mothers conducted in Worcester, Massachusetts. Information was collected about mothers' housing history, income, education, emotional distress, and victimization history. Standardized instruments were administered to assess children's health. Health service use questions were adapted from national surveys. Main outcome measures included health status, acute illness morbidity, emergency department and outpatient medical visits. Multivariable regression analyses were used to examine the association of family and environmental determinants, including homelessness, with health status and service use outcomes. RESULTS: Mothers of homeless children were more likely to report their children as being in fair or poor health compared with their housed counterparts. Homeless children were reported to experience a higher number of acute illness symptoms, including fever, ear infection, diarrhea, and asthma. Emergency department and outpatient medical visits were higher among the homeless group. After controlling for potential explanatory factors, homeless children remained more likely to experience fair or poor health status (adjusted odds ratio [OR] = 2.83; 95% confidence interval [CI], 1.16, 4.87), and a higher frequency of outpatient (OR = 1.71; 95% CI, 1.18, 2.48) and emergency department visits (OR = 1.21; 95% CI, 0.83, 1.74). Mothers' emotional distress was independently associated with acute illness symptoms and frequent use of outpatient and emergency department settings. CONCLUSIONS: Homelessness is an independent predictor of poor health status and high service use among children. The present findings highlight the importance of preventive interventions and efforts to increase access to primary care among homeless children.

Author(s): Burr ML ; Verrall C ; Kaur B
Affiliation: Centre for Applied Public Health Medicine, Cardiff, UK.

Title: Social deprivation and asthma. Source: Respir Med (Respiratory medicine.) 1997 Nov; 91(10): 603-8

Abstract: This study was conducted to see whether children living in socially deprived areas were more likely than other children to be admitted to hospital for asthma, and, if so, whether their excess risk was attributable to a higher prevalence of asthma or poorer treatment. Hospital admission rates for asthma were obtained for Cardiff electoral wards and compared with the Townsend indices of deprivation. A survey of respiratory symptoms was conducted in schoolchildren; prevalence of symptoms was compared with Townsend index and asthma admission rate for the schools' catchment areas. Asthma admissions were strongly correlated with Townsend indices at all ages. The prevalence of reported asthma and various degrees of wheeze in the schools was not significantly correlated with Townsend index or hospital admission rate in the corresponding areas. The presence of a smoker in the house was strongly associated with Townsend index and admission rate; children whose houses contained a smoker were more likely than others to have wheezed in the past year and to have disturbed nights due to wheezing. There was a non-significant negative association between Townsend index and regular use of inhaled steroids. The relationship between hospital admission for asthma and social deprivation is not explained by variations in prevalence, but it may be attributable to the aggravation of symptoms by active or passive smoking, and perhaps also to differences in management.

Author(s): Mielck A ; Reitmeir P ; Wjst M
Affiliation: Institut fur Medizinische Informatik und Systemforschung (MEDIS), GSF-Forschungszentrum fur Umwelt und Gesundheit, Neuherherg, Germany.

Title: Severity of childhood asthma by socioeconomic status. Source: Int J Epidemiol (International journal of epidemiology.) 1996 Apr; 25(2): 388-93

Abstract: BACKGROUND. A review of studies on the association between childhood asthma and socioeconomic status (SES) in industrialized countries leads to the conclusion that there does not seem to be a clear association. A study from Aberdeen published 25 years ago, however, shows that among children with asthma, severe asthma is most prevalent in the lower social class, but this distinction between grades of asthma severity has been largely ignored since. METHODS. We screened all fourth grade schoolchildren of German nationality in Munich (4434 children, response rate 87 percent), distinguishing three severity grades in the same way as the study in Aberdeen. RESULTS. Prevalences of childhood asthma are reported by severity grade and SES. Prevalence of severe asthma was found to be significantly higher in the low as compared with the high socioeconomic group (Odds ratio = 2.37; 95 percent confidence interval: 1.28-4.41). This association could not be explained by established risk factors. CONCLUSIONS. More attention should be paid to the association between severe asthma and SES, with measures such as targeting early diagnosis and treatment towards low socioeconomic groups.

Author(s): Munro JF ; Haire-Joshu D ; Fisher EB ; Wedner HJ
Affiliation: Center for Health Behavior Research, Washington University School of Medicine, St. Louis, Missouri, USA.

Title: Articulation of asthma and its care among low-income emergency care recipients. Source: J Asthma (The Journal of asthma : official journal of the Association for the Care of Asthma.) 1996; 33(5): 313-25

Abstract: Low-income minority patients from East St. Louis, Illinois, a depressed midwestern urban city, who had visited acute care settings with asthma symptoms, participated in a focus group. Questions were constructed around the Health Belief Model to characterize participants' experiences in receiving asthma care, their confidence in long-term asthma self-management, barriers they perceived to managing their asthma, and recommendations they would make for improving asthma care in their community. Analysis of comments suggests an appreciable understanding of asthma triggers, limited coping behaviors for asthma symptoms, very limited practice of active asthma management, perception of the health care system as frequently insensitive to their needs or their knowledge of their own care, exchange of well-articulated information regarding how to deal with the system, and an apparent lack of awareness of any potential contribution of patient education or support system.

Author(s): Lewis MA ; Lewis CE ; Leake B ; Monahan G ; Rachelefsky G
Affiliation: School of Nursing, University of California, Los Angeles 90095-6917, USA.

Title: Organizing the community to target poor Latino children with asthma. Source: J Asthma (The Journal of asthma : official journal of the Association for the Care of Asthma.) 1996; 33(5): 289-97

Abstract: A community-university partnership to improve outcomes of care for poor Latino children (aged 6-14 years) with asthma in East Los Angeles was based on development of a community infrastructure. A family-centered educational program involved over 500 families. The Association of Latinos with Asthma and Allergy Symptoms (ALAAS) was formed. Parents report reductions in hospitalizations, emergency room, and acute care visits. Survival of the infrastructure following the end of grant funds is unlikely unless other resources offset the costs of volunteerism among poor families. Block grants to community agencies from established fund-raising groups might reduce dependency-producing practices currently employed to "help" the poor.

Author(s): Akinbami LJ ; LaFleur BJ ; Schoendorf KC
Affiliation: Infant and Child Health Studies Branch, National Center for Health Statistics, Centers for Disease Control and Prevention, 6525 Belcrest Road, Room 790, Hyattsville, MD 20782, USA. lea8@cdc.gov

Title: Racial and income disparities in childhood asthma in the United States. Source: Ambul Pediatr (Ambulatory pediatrics : the official journal of the Ambulatory Pediatric Association.) 2002 Sep-Oct; 2(5): 382-7

Abstract: OBJECTIVE: To examine racial and income disparities in asthma prevalence in US children, and disparities in morbidity and ambulatory health care use among children with asthma. METHODS: Using 1993-1996 National Health Interview Survey data, we measured asthma prevalence and morbidity in children aged 3 to 17 years (N = 14 211) stratifying by race and poverty status. Measures of morbidity included asthma-related activity limitation and number of bed days. We used the ratio of asthma-related doctor contacts to number of bed days in the past 2 weeks to measure health care use adjusted for severity of illness. RESULTS: An annual average of 7.4% of children aged 3 to 17 years had asthma. There were no significant differences in asthma prevalence between race and poverty groups. In contrast, asthma-related morbidity was higher among black and poor children. Black poor children were most likely to have activity limitations due to asthma: 49% were limited compared with about 20% of black nonpoor, white poor, and white nonpoor children. Among children with activity limitations, black children and white poor children were more likely to have severe limitations, and white nonpoor children were least likely. Finally, white nonpoor children had the highest level of ambulatory care use for asthma after accounting for disease severity, and black poor children had the lowest level. CONCLUSIONS: We found no significant racial or income disparities in asthma prevalence among children in the United States. However, black children and poor children are at higher risk for activity limitation, more severe activity limitation, and relative underuse of ambulatory health care. Black children living in poverty are at highest risk. Targeted interventions to reduce the burden of asthma morbidity in this population are likely to reduce disparities in asthma morbidity as well as reduce overall childhood asthma morbidity.

Author(s): Sharek PJ ; Mayer ML ; Loewy L ; Robinson TN ; Shames RS ; Umetsu DT ; Bergman DA
Affiliation: Division of General Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA. psharek@leland.stanford.edu

Title: Agreement among measures of asthma status: a prospective study of low-income children with moderate to severe asthma. Source: Pediatrics (Pediatrics.) 2002 Oct; 110(4): 797-804

English Abstract: BACKGROUND: Because no validated "gold standard" for measuring asthma outcomes exists, asthma interventions are often evaluated using a large number of disease status measures. Some of these measures may be redundant, whereas others may be complementary. Use of multiple outcomes may lead to ambiguous results, increased type I error rates, and be an inefficient use of resources including caregiver and patient/participant time and effort. Understanding the relationship between these measures may facilitate more parsimonious and valid evaluation strategies without loss of information. OBJECTIVE: To assess the relationships between multiple measures of asthma disease status over time. DESIGN/METHODS: We used data from a randomized, controlled trial of a comprehensive disease management program involving 119 disadvantaged inner-city children aged 5 to 12 years with moderate to severe asthma. Spearman correlations were calculated between the following asthma disease status measures: parent-reported disease symptoms, parent-reported health care utilization, functional health status using the American Academy of Pediatrics' validated Child Health Survey for Asthma (CHSA), diary data (symptom scores, night wakings, and bronchodilator use), and pulmonary function tests at baseline, 32 weeks, 52 weeks, and changes from baseline to 52 weeks. RESULTS: Ninety-four (79%) of randomized patients participated at baseline and 52 weeks. Completion rates for outcome measures ranged from 79% (CHSA, spirometry data) to 64% (diary data). At baseline, asthma symptoms, health care utilization, and individual domains from the CHSA were significantly correlated (r = 0.21-0.53). These correlations were stable over the 52-week follow-up. Forced expiratory volume in 1 second and diary data did not correlate to any other measures at baseline, and these measures correlated only inconsistently with other measures at 32 weeks and 52 weeks. Baseline to 52-week changes in asthma symptoms, utilization, and the CHSA domains were significantly correlated (0.22-0.56), as were baseline to 52-week changes in symptom days, night wakings, and the CHSA domains (r = 0.24-0.64). Baseline to 52-week changes in forced expiratory volume in 1 second and diary data did not correlate with other measures. CONCLUSIONS: These results suggest that asthma status and change in asthma status over time after introduction of a disease management intervention are best characterized by parent-reported symptoms, parent-reported utilization, and functional health status measures. Asthma diaries and pulmonary function tests did not seem to provide additional benefit, although they may play an important role in individual patient management. Our findings suggest a parsimonious evaluation strategy would include collection of key data elements regarding symptoms, utilization, and functional health status only, without loss of vital response information.

Author(s): Brito A ; Wurm G ; Delamater AM ; Grus CL ; Lopez-Hernandez C ; Applegate EB ; Wanner A
Affiliation: Department of Pediatrics, University of Miami School of Medicine, Miami, Florida 33136, USA.

Title: School-based identification of asthma in a low-income population. Source: Pediatr Pulmonol (Pediatric pulmonology.) 2000 Oct; 30(4): 297-301

Abstract: The increase in the prevalence, morbidity, and mortality of asthma among children over the last decade has been well documented, especially among low-income minority children. Hypotheses for the increases in morbidity and mortality include limited access to primary care services and the failure to recognize the presence and severity of asthma. The University of Miami Pediatric Mobile Clinic (Mobile Clinic) Asthma Intervention Program is designed to identify underserved asthmatic children at school and offer them culturally sensitive care. Nine elementary schools with low income, predominantly Hispanic and African-American populations regularly served by the Mobile Clinic, were chosen for study participation. All 5,800 students who were enrolled in kindergarten through third grade were given letters at the time of registration by their homeroom teachers about the asthma program. Caretakers who returned the questionnaire and reported that the student had asthma symptoms were invited to have the student undergo a medical evaluation in the Mobile Clinic. Over a 2-year period, caretakers of 423 students (7.3% of all students) expressed an interest in further evaluating their child's respiratory health. Of these, we enrolled and evaluated 154 in the Mobile Clinic's Asthma Intervention Program. The Mobile Clinic physicians identified 145 of the enrollees as having asthma. These results indicate that in elementary schools serving predominantly low-income minority populations, a large fraction of the asthmatic population (estimated prevalence, 6-10%) can be identified by a school-based letter. Further, in a subset of asthmatic students (children of interested caretakers), there is good agreement between caretaker responses and physician diagnosis of asthma. Since school attendance is mandatory, school-based methods may be an effective method for identifying low-income children with asthma.