A systems-level approach to understanding asthma disparities in Mexican American children

About This Grant

Excess burden of asthma has been documented in Mexican/Mexican American (MA) children, but little is known about intervenable factors that impact asthma disparities for MA children. The overarching hypothesis is that microsystem factors at the family, school, neighborhood, and healthcare system level impact asthma morbidity and phenotype among MA children. These microsystem factors range from family psychological processes (e.g., caregiver depression) to school academic achievement, to neighborhood safety and patient-provider interactions, each of which suggests specific prevention and intervention strategies. The proposed R03 leverages data currently being collected in our TexHALE and Adapt 2 Asthma (A2A) studies. TexHALE and A2A have a large number of MA children enrolled (N=245) and contain data on the child’s family, neighborhood, school and healthcare systems and asthma morbidity and phenotype. The specific aims are: Aim 1. To estimate effects of microsystem factors on asthma morbidity (symptoms, control, exacerbations) in MA children with asthma. Aim 2. To estimate effects of microsystem factors on asthma phenotype (severity, lung function, type 2 asthma) in MA children with asthma. For each aim, we will characterize and estimate the independent effects of family, neighborhood, school, and healthcare factors and the combined effects of these factors. We will include specific, measurable factors within each microsystem environment, which are assessed using validated measures or objective data sources. These include caregiver depressive symptoms (measured by the Patient Health Questionnaire-8), school academic performance (measured by school report card grade and statewide standardized test results from the Texas Education Agency’s School Report Card database), neighborhood safety (measured using the CrimeViewer web application to map neighborhood crime data from Austin Police Department reports) and patient-provider interactions (measured with Krieger’s scale). This secondary analysis is meant to identify intervenable factors at the family, school, neighborhood and healthcare levels that contribute to asthma disparities in MA children. Our findings will indicate future specific or combined intervention efforts including cognitive-behavioral therapies for caregiver depression, school-based asthma screening and self-management programs, parenting programs to promote neighborhood safety, and healthcare provider training to improve patient-provider interactions.