Center for Reducing Asthma Disparities - Rhode Island/Puerto Rico Centers
Condition: Asthma; Lung Diseases
MeSH terms: Asthma; Lung Diseases
Study type: Observational

Summary: 
      To reduce disparities in asthma among Latino children.
    

Detailed description: 
      BACKGROUND:

      Asthma is a serious chronic condition affecting over 14 million Americans, but the prevalence
      rates are higher in certain populations (e.g. 10 percent in inner-cities and 30 percent among
      the homeless vs. 5 percent in a general population of whites). African Americans and
      Hispanics from the Northeast are twice as likely to die from asthma as whites. African
      Americans are four times as likely to be hospitalized for asthma and are five times more
      likely than whites to seek care for asthma at an emergency department. Reasons for these
      higher rates are not certain, and most likely result from an interaction of risk factors such
      as environmental exposures, genetic predisposition, access to appropriate medical care,
      socioeconomic status, and cultural health practices. The National Heart, Lung, and Blood
      Institute supports a variety of activities to address the pressing public health problems
      posed by asthma. However, progress in reducing disparities has been disappointingly slow.
      Separate, independent research projects have generated important clues for understanding the
      nature and scope of the problem. A more coordinated, interdisciplinary and comprehensive
      approach to research is needed to take advantage of these clues, move the science further and
      faster, and increase our capacity to improve health outcomes among minority and economically
      disadvantaged populations. Cooperative centers of research that foster partnerships among
      minority medical centers, research intensive institutions, and the communities in which
      asthma patients live will promote such advancement.

      The Request for Applications for the Centers for Reducing Asthma Disparities was released in
      October, 2001. The objective of the program is to promote partnerships (called Centers)
      between a minority serving institution (MSI) that may not have a strong research program and
      a research intensive institution (RII) that has a track record of NIH-supported research and
      patient care. The purpose of the partnership is to conduct collaborative research on asthma
      disparities (i.e. greater prevalence of asthma, higher rates of morbidity due to asthma, and
      lesser access or use of quality medical care among minorities and poor).

      DESIGN NARRATIVE:

      The Rhode Island : Puerto Rico Asthma Center (RIPRAC) has been established to reduce
      disparities in asthma among Latino children. Brown University faculty involved with an
      extensive pediatric asthma research program will join with epidemiologists, clinicians, and
      health services researchers from the minority serving University of Puerto Rico to study
      potentially overlooked determinants of disparity. A training component (based on a successful
      T32 research training program) will involve individuals from both sites at both sites. The
      Rhode Island : Puerto Rico Asthma Center includes four projects that seek to understand the
      causes of disparities at multiple levels : the biomedical, the individual/family, and the
      socioenvironmental level. The four projects, respectively, will 1) examine discrepancies
      between the diagnosis of asthma as assessed by parental report, the primary care medical
      record and our systematic diagnosis based on the NHLBI guidelines; 2) assess characteristics
      (prescription practices, shared decision making, continuity and access to care) of the health
      care system that may differentially affect asthma morbidity; 3) evaluate family beliefs, the
      burden of asthma management and medication adherence as they affect asthma morbidity and
      health care utilization in Latino and Anglo children; and 4) study the relation of symptom
      perception to pediatric asthma discrepancies. Subjects for all four projects will be the same
      300 mainland Anglos, 200 mainland Latinos (of Puerto Rican and Dominican descent) and 400
      island Puerto Rico children with asthma, aged 7-15, thereby promoting comparability and
      efficiency. Chi-square analyses and ANOVA's will be used to assess differences between
      groups; techniques of logistic regression and multiple regression will be used to model the
      effects of covariates. The Center Training component will provide clinical research education
      and supervision to Puerto Rican trainees and faculty, enhance cultural awareness of Brown
      personnel as it relates to asthma disparities, and launch at least three trainee-led pilot
      research projects in the area.
    

Observational model: Cohort
Time perspective: Cross-Sectional
Sampling method: Non-Probability Sample
Study population: 
        Children with asthma or a history of breathing problems, from Non-Latino white, Puerto
        Rican or Dominican ethnicities. Participant recruitment occurred in Rhode Island and in
        island Puerto Rico.