Protective Factors in Urban Children with Asthma

Rhode Island Hospital, Providence RI

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Abstract

DESCRIPTION (provided by applicant): Pediatric asthma is over-represented in children from low income, urban, and ethnic minority backgrounds in the U.S. The NIH is actively promoting research that identifies factors that decrease the health disparities between ethnic minority, low-income children and their healthier, white counterparts. The combined risks related to having asthma and facing social stressors (poverty, acculturative stress) may increase functional impairment (e.g., increased emergency visits). However, there are urban children and families who are managing asthma effectively, despite facing such risks. The primary objectives of this project are to identify child-specific, cultural, and disease-specific protective processes that minimize asthma morbidity despite exposure to adversity in urban, low-income children. Indices of asthma morbidity to be examined at baseline (initial visit) and follow-up (one year later) include: the number of asthma-related emergency room visits, hospitalizations, and degree of functional limitation. A risk and resilience theoretical model will be applied to this study. A Cumulative Risk Index (CRI) will provide a score that indicates the number and severity of several urban risks that families may face. Participants will include low-income and urban, 8-11 year old children from African-American, Latino, and Anglo backgrounds (N= 150, 50 families in each ethnic group). Children with asthma and their primary caregivers will participate in a home observation and interview-based assessments on risk, protective processes, and morbidity. Three months after the baseline interview, families will participate in a longitudinal, follow-up component (for one year). Four phone interviews that occur three months apart will collect information on morbidity. It is proposed that higher levels of child, cultural, and asthma-specific factors will moderate the relation between the cumulative level of risks and minimal asthma morbidity for urban children at baseline and follow-up. Higher levels of child-specific and asthma-specific factors will minimize morbidity for African- American, Hispanic, and Anglo children. Cultural factors (family values and beliefs) related to minimal morbidity will differ by ethnic subgroup. Results will be used to design a culturally sensitive asthma intervention to enhance asthma management behaviors of ethnic minority, urban and poor families.