Explanatory Model for Asthma Disparities in Latino Children: Results from the Latino Childhood Asthma Project

Kimberly Arcoleo, Flavio Marsiglia, Denise Serebrisky, Juliana Rodriguez, Colleen Mcgovern, Jonathan Feldman, Kimberly Arcoleo, Flavio Marsiglia, Denise Serebrisky, Juliana Rodriguez, Colleen Mcgovern, Jonathan Feldman

Abstract

Background: Little research has been conducted that integrates, in one explanatory model, the multitude of factors potentially leading to disparities among Latino children.

Purpose: A longitudinal, observational study tested an explanatory model for disparities in asthma control between Mexican and Puerto Rican children with persistent asthma requiring daily controller medication use.

Methods: Mexican and Puerto Rican children aged 5-12 years (n = 267) and their caregivers (n = 267) were enrolled and completed interviews and child spirometry at baseline and 3, 6, 9, and 12 months postenrollment. A 12 month retrospective children's medical record review was completed. Participants were recruited from two school-based health clinics and the Breathmobile in Phoenix, AZ, and two inner-city hospital asthma clinics in the Bronx, NY.

Results: Statistically significant differences in the social/contextual predictors of asthma illness representations (IRs) were noted between Mexican and Puerto Rican caregivers. The structural equation model results revealed differences in asthma control over time by ethnicity. This model accounted for 40%-48% of the variance in asthma control test scores over 12 months. Caregivers' IRs aligned with the professional model of asthma management were associated with better children's asthma control across 1 year. These results also supported the theoretical notion that IRs change over time impacting caregivers' treatment decisions and children's asthma control.

Conclusions: These findings extend a previous cross-sectional model test using a more comprehensive model and longitudinal data and highlight the importance of considering within-group differences for diagnosis and treatment of children coming from the vastly heterogeneous Latino umbrella group.

Trial registration: Trial number NCT01099800.

Keywords: Asthma; Child; Health status disparities; Latino.

© The Author(s) 2019. Published by Oxford University Press on behalf of the Society of Behavioral Medicine.

Figures

Fig. 1.
Fig. 1.
Conceptual model.
Fig. 2.
Fig. 2.
Model test for AIRS—Mexicans.
Fig. 3.
Fig. 3.
Model test for AIRS—Puerto Ricans.
Fig. 4.
Fig. 4.
Latent growth model to identify changes in caregivers’ illness representations, treatment decisions, and children’s asthma health outcomes. I = intercept for asthma control; S = slope for the growth factor of asthma control.

References

    1. Lara M, Rosenbaum S, Rachelefsky G, et al. . Improving childhood asthma outcomes in the United States: A blueprint for policy action. Pediatrics. 2002;109:919–930.
    1. Smedley BD, Stith AY, Nelson AR, eds. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: National Academies Press; 2003.
    1. Centers for Disease Control and Prevention. Most recent asthma data 2017. Available at . Accessibility verified April 20, 2018.
    1. Lara M, Akinbami L, Flores G, Morgenstern H. Heterogeneity of childhood asthma among Hispanic children: Puerto Rican children bear a disproportionate burden. Pediatrics. 2006;117:43–53.
    1. Kaptein AA, Klok T, Moss-Morris R, Brand PL. Illness perceptions: Impact on self-management and control in asthma. Curr Opin Allergy Clin Immunol. 2010;10(3):194–199. Available at . Accessibility verified May 10, 2019.
    1. Kaptein AA, Hughes BM, Scharloo M, et al. . Illness perceptions about asthma are determinants of outcome. J Asthma. 2008;45(6):459–464. Available at . Accessibility verified May 10, 2019.
    1. Tumiel-Berhalter L, Zayas LE. Lay experiences and concerns with asthma in an urban Hispanic community. J Natl Med Assoc. 2006;98:875–880.
    1. Yoos HL, Kitzman H, Henderson C, et al. . The impact of the parental illness representation on disease management in childhood asthma. Nurs Res. 2007;56:167–174.
    1. National Heart, Lung, and Blood Institute. Guidelines for the diagnosis and management of asthma (EPR-3) 2012. Available at . Accessibility verified August 16, 2017.
    1. Klok T, Kaptein AA, Duiverman EJ, Brand PL. High inhaled corticosteroids adherence in childhood asthma: The role of medication beliefs. Eur Respir J. 2012;40:1149–1155.
    1. Arcoleo K, Zayas LE, Hawthorne A, Begay R. Illness representations and cultural practices play a role in patient-centered care in childhood asthma: Experiences of Mexican mothers. J Asthma. 2015;135(4):e965–e973.
    1. Sonney J, Insel KC, Segrin C, Gerald LB, Ki Moore IM. Association of asthma illness representations and reported controller medication adherence among school-aged children and their parents. J Pediatr Health Care. 2017;31(6):703–712.
    1. Sidora-Arcoleo K, Feldman JM, Serebrisky D, Spray A. A multi-factorial model for examining racial and ethnic disparities in acute asthma visits by children. Ann Behav Med. 2012;43:15–28.
    1. Global Initiative for Asthma. Global strategy for asthma management and prevention 2019. Available at . Accessibility verified May 13, 2019.
    1. Price D, Fletcher M, van der Molen T. Asthma control and management in 8,000 European patients: The REcognise Asthma and LInk to Symptoms and Experience (REALISE) survey. NPJ Prim Care Respir Med. 2014;24:14009.
    1. Tiggelman D, van de Ven MO, van Schayck OC, Kleinjan M, Engels RC. The Common Sense Model in early adolescents with asthma: Longitudinal relations between illness perceptions, asthma control and emotional problems mediated by coping. J Psychosom Res. 2014;77:309–315.
    1. Leventhal H, Benyamini Y, Brownlee S, et al. . Illness representations: Theoretical foundations. In: Petrie KJ, Weinman JA, eds. Perceptions of Health and Illness. Amsterdam, Netherlands: Harwood Academic Publishers; 1997:19–45.
    1. Leventhal H, Leventhal EA, Contrada RJ. Self-regulation, health, and behavior: A perceptual-cognitive approach. Psychol Health. 1998;13:717–733.
    1. Leventhal H, Diefenbach M, Leventhal EA. Illness cognition; using common sense to understand treatment adherence and affect cognition interactions. Cognit Ther Res. 1992;16(2):143–163.
    1. Martin R, Rothrock N, Leventhal H, Leventhal EA. Common sense models of illness: Implications for symptom perception and health-related behaviors. In: Suls J, Wallston KA, eds. Social Psychological Foundations of Health and Illness. Malden, MA: Blackwell Publications; 2003:199–225.
    1. Diefenbach M, Leventhal H. The common-sense model of illness representations: Theoretical and practical considerations. J Soc Distress Homeless. 1996;5(1):11–38.
    1. Cameron LD, Leventhal H, eds. The Self-Regulation of Health and Illness Behavior. London, UK: Taylor & Francis; 2003.
    1. Horne R, Weinman J. Self-regulation and self-management in asthma: Exploring the role of illness perceptions and treatment beliefs in explaining non-adherence to preventer medication. Psychol Health. 2002;17(1):17–32.
    1. Sofianou A, Martynenko M, Wolf MS, et al. . Asthma beliefs are associated with medication adherence in older asthmatics. J Gen Intern Med. 2013;28:67–73.
    1. Hagger MS, Koch S, Chatzisarantis NLD, Orbell S. The common sense model of self-regulation: Meta-analysis and test of a process model. Psychol Bull. 2017;143:1117–1154.
    1. Sonney JT, Gerald LB, Insel KC. Parent and child asthma illness representations: A systematic review. J Asthma. 2016;53:510–516.
    1. Cabassa LJ, Lagomasino IT, Dwight-Johnson M, Hansen MC, Xie B. Measuring Latinos’ perceptions of depression: A confirmatory factor analysis of the Illness Perception Questionnaire. Cultur Divers Ethnic Minor Psychol. 2008;14:377–384.
    1. Santos SJ, Hurtado-Ortiz MT, Lewis L, Ramirez-Garcia J. Common sense illness beliefs of diabetes among at-risk Latino college students. Am J Health Stud. 2015;30:13–22.
    1. Ailinger RL, Dear MR. Latino immigrants’ explanatory models of tuberculosis infection. Qual Health Res. 1997;7(4):521–531.
    1. Eisenman DP, Meredith LS, Rhodes H, et al. . PTSD in Latino patients: Illness beliefs, treatment preferences, and implications for care. J Gen Intern Med. 2008;23:1386–1392.
    1. American Thoracic Society. Standardization of spirometry: 1994. Am J Respir Criti Care Med. 1995;152(3):1107–1136.
    1. Sousa VD, Rojjanasrirat W. Translation, adaptation and validation of instruments or scales for use in cross-cultural health care research: A clear and user-friendly guideline. J Eval Clin Pract. 2011;17:268–274.
    1. Gore S, Aseltine RH Jr, Colton ME. Social structure, life stress and depressive symptoms in a high school-aged population. J Health Soc Behav. 1992;33:97–113.
    1. Radloff LS. The CES-D scale: A self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1:385–401.
    1. Vázquez FL, Blanco V, López M. An adaptation of the Center for Epidemiologic Studies Depression Scale for use in non-psychiatric Spanish populations. Psychiatry Res. 2007;149:247–252.
    1. González-Forteza C, Jiménez-Tapia JA, Ramos-Lira L, Wagner FA. [Application of the revised version of the Center of Epidemiological Studies Depression Scale in adolescent students from Mexico City]. Salud Publica Mex. 2008;50:292–299.
    1. Galvis FH. Factorial structure and psychometric properties of a scale for depression among university students in Colombia. Rev Panam Salud Publica. 2010;27:110–116.
    1. Stephenson M. Development and validation of the Stephenson Multigroup Acculturation Scale (SMAS). Psychol Assess. 2000;12:77–88.
    1. Sidora-Arcoleo K, Feldman J, Serebrisky D, Spray A. Validation of the Asthma Illness Representation Scale (AIRS). J Asthma. 2010;47:33–40.
    1. Sidora-Arcoleo KJ, Feldman J, Serebrisky D, Spray A. Validation of the Asthma Illness Representation Scale-Spanish (AIRS-S). J Asthma. 2010;47:417–421.
    1. Alegria M, Vila D, Woo M, et al. . Cultural relevance and equivalence in the NLAAS instrument: Integrating etic and emic in the development of cross-cultural measures for a psychiatric epidemiology and services study of Latinos. Int J Methods Psychiatr Res. 2004;13:270–288.
    1. Fritz GK, Overholser JC. Patterns of response to childhood asthma. Psychosom Med. 1989;51:347–355.
    1. Ritz T, Bobb C, Edwards M, Steptoe A. The structure of symptom report in asthma: A reevaluation. J Psychosom Res. 2001;51:639–645.
    1. Fritz GK, McQuaid EL, Spirito A, Klein RB. Symptom perception in pediatric asthma: Relationship to functional morbidity and psychological factors. J Am Acad Child Adolesc Psychiatry. 1996;35:1033–1041.
    1. Liu AH, Zeiger R, Sorkness C, et al. . Development and cross-sectional validation of the Childhood Asthma Control Test. J Allergy Clin Immunol. 2007;119:817–825.
    1. Nathan RA, Sorkness CA, Kosinski M, et al. . Development of the asthma control test: A survey for assessing asthma control. J Allergy Clin Immunol. 2004;113:59–65.
    1. Vega JM, Badia X, Badiola C, et al. ; Covalair Investigator Group. Validation of the Spanish version of the Asthma Control Test (ACT). J Asthma. 2007;44:867–872.
    1. Ritz T, Steptoe A, Bobb C, Harris AH, Edwards M. The asthma trigger inventory: Validation of a questionnaire for perceived triggers of asthma. Psychosom Med. 2006;68:956–965.
    1. Wood BL, Cheah PA, Lim J, et al. . Reliability and validity of the asthma trigger inventory applied to a pediatric population. J Pediatr Psychol. 2007;32:552–560.
    1. MacCallum RC, Browne MW, Sugawara HM. Power analysis and determination of sample size for covariance structure modeling. Psychol Methods. 1996;1(2):130–149.
    1. Hooper D, Coughlan J, Mullen M. Structural equation modelling: Guidelines for determining model fit. Electronic J Bus Res Methods. 2008;6(1):53–60.
    1. Hancock GR, Freeman MJ. Power and sample size for the root mean square error of approximation test of not close fit in structural equation modeling. Educ Psychol Meas. 2001;61(5):741–758.
    1. Preacher KJ, Coffman DL. Computing power and minimum sample size for RMSEA [computer software] 2006. Available at . Accessibility verified September 16, 2013.
    1. Kline RB. Principles and Practice of Structural Equation Modeling. 3rd ed New York, NY: The Guilford Press; 2011.
    1. Kline RB. Principles and Practice of Structural Equation Modeling. New York, NY: Guilford Publications; 2015.
    1. Muthen LK, Muthen BO.. MPLUS User’s Guide. 8th ed Los Angeles, CA: Muthen & Muthen; 1998–2017.
    1. Feldman JM, Acosta Pérez E, Canino G, McQuaid EL, Goodwin RD, Ortega AN. The role of caregiver major depression in the relationship between anxiety disorders and asthma attacks in island Puerto Rican youth and young adults. J Nerv Ment Dis. 2011;199:313–318.
    1. Feldman JM, Siddique MI, Thompson NS, Lehrer PM. The role of panic-fear in comorbid asthma and panic disorder. J Anxiety Disord. 2009;23:178–184.
    1. Feldman JM, Siddique MI, Morales E, Kaminski B, Lu SE, Lehrer PM. Psychiatric disorders and asthma outcomes among high-risk inner-city patients. Psychosom Med. 2005;67:989–996.
    1. Orrell-Valente JK, Jarlsberg LG, Hill LG, Cabana MD. At what age do children start taking daily asthma medicines on their own? Pediatrics. 2008;122:e1186–e1192.
    1. Sonney JT, Insel KC. Reformulating the common sense model of self-regulation: Toward parent-child shared regulation. Nurs Sci Q. 2016;29:154–159.
    1. Dowell JA. Experiences, functioning and needs of low-income African American mothers of children with asthma. J Pediatr Nurs. 2015;30:842–849.
    1. Shelley BM, Sussman AL, Williams RL, Segal AR, Crabtree BF; Rios Net Clinicians ‘They don’t ask me so I don’t tell them’: Patient-clinician communication about traditional, complementary, and alternative medicine. Ann Fam Med. 2009;7:139–147.
    1. Butz AM, Walker JM, Pulsifer M, Winkelstein M. Shared decision making in school age children with asthma. Pediatr Nurs. 2007;33:111–116.
    1. Sleath B, Ayala GX, Washington D, et al. . Caregiver rating of provider participatory decision-making style and caregiver and child satisfaction with pediatric asthma visits. Patient Educ Couns. 2011;85:286–289.
    1. Sleath B, Carpenter DM, Slota C, et al. . Communication during pediatric asthma visits and self-reported asthma medication adherence. Pediatrics. 2012;130:627–633.
    1. Wilson SR, Strub P, Buist AS, et al. ; Better Outcomes of Asthma Treatment (BOAT) Study Group. Shared treatment decision making improves adherence and outcomes in poorly controlled asthma. Am J Respir Crit Care Med. 2010;181:566–577.

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