A Multi-factorial Model for Examining Racial and Ethnic Disparities in Acute Asthma Visits by Children
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ORIGINAL ARTICLE
A Multi-factorial Model for Examining Racial and Ethnic Disparities in Acute Asthma Visits by Children Kimberly Sidora-Arcoleo, Ph.D, M.P.H & Jonathan M. Feldman, Ph.D & Denise Serebrisky, M.D & Amanda Spray, M.A
Published online: 13 December 2011 # The Society of Behavioral Medicine 2011
Abstract Background Causes of children’s asthma health disparities are complex. Parents’ asthma illness representations may play a role. Purpose The study aims to test a theoretically based, multifactorial model for ethnic disparities in children’s acute asthma visits through parental illness representations. Methods Structural equation modeling investigated the association of parental asthma illness representations, sociodemographic characteristics, health care provider factors, and social–environmental context with children’s acute asthma visits among 309 White, Puerto Rican, and African American families was conducted.
Results Forty-five percent of the variance in illness representations and 30% of the variance in acute visits were accounted for. Statistically significant differences in illness representations were observed by ethnic group. Approximately 30% of the variance in illness representations was explained for whites, 23% for African Americans, and 26% for Puerto Ricans. The model accounted for >30% of the variance in acute visits for African Americans and Puerto Ricans but only 19% for the whites. Conclusion The model provides preliminary support that ethnic heterogeneity in asthma illness representations affects children’s health outcomes. Keywords Asthma . Illness representation . Acute visits . Ethnicity . Disparities
K. Sidora-Arcoleo (*) Ohio State University College of Nursing, 1595 Neil Avenue, Columbus, OH 43210, USA e-mail: [email protected] J. M. Feldman Ferkauf Graduate School of Psychology, Albert Einstein College of Medicine, Yeshiva University, Rousso Building 1300 Morris Park Avenue, Bronx, NY 10461, USA e-mail: [email protected] D. Serebrisky Jacobi Medical Center, Albert Einstein College of Medicine, Yeshiva University, 1400 Pelham Parkway, South Bronx, NY 10461, USA e-mail: [email protected] A. Spray Ferkauf Graduate School of Psychology, Yeshiva University, Rousso Building 1300 Morris Park Avenue, Bronx, NY 10461, USA e-mail: [email protected]
Introduction The causes of children’s asthma health outcomes disparities are complex and include genetic, environmental, health care system factors, and individual health and illness beliefs. Compared to white children, Black and Hispanic children are more likely to have a diagnosis of asthma, incur potentially avoidable asthma hospitalizations and asthma-related emergency department visits, exhibit lower adherence to the medication regimen, and are less likely to see a specialist [1–4]. There is emerging data demonstrating within-race heterogeneity in asthma outcomes [5, 6], which highlights the necessity of conducting subgroup analyses based on ethnic origin, not solely race. Earlier studies showed that Black childr
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