Acculturation and Asthma Management and Outcome Among Californian Hispanic Adults Pubblico

Abstract

BACKGROUND: In the United States, asthma is both prevalent¹ and expensive.² Hispanics in the U.S. bear a disproportionate burden of asthma.^3,4 Compared to non-Hispanic whites, Hispanic adults have lower odds of being prescribed preventive medication for asthma³ and a much higher urgent care visit rate due to asthma.⁴ Even within the Hispanic populations, there exists tremendous heterogeneity in asthma prevalence and management.^1,5 Puerto Ricans also have a much higher prevalence of both asthma diagnosis and self-reported asthma attacks than Mexican/Mexican Americans.¹

 

Acculturation describes the multidimensional process of cultural adaptation, and it has been found to affect Latino health through various mechanisms,⁶ including those shown to be associated with asthma management and outcomes. Previous research has also presented mixed results on how proxies of acculturation are associated with asthma. However, no studies have examined how acculturation as a composite measure correlates with asthma management and outcomes for Hispanic adults.

 

METHODS: This study used California Health Interview Survey data from 2011 to 2016, and the final sample included 1,997 self-identified Hispanic adults with current asthma at the time of survey. Acculturation index was derived from three proxies: birthplace, U.S. residency, and language at home. Dependent variables included preventive medication use for asthma, self-reported asthma attacks, and emergency department (ED) use due to asthma. We ran logistic regressions on the weighted sample, adjusting for individual and contextual confounders, and reported odds ratios.

 

RESULTS: Significantly positive association was found between acculturation and taking daily preventive asthma medication, when controlling for individual and contextual confounders and years (OR=1.67; 95% CI = 1.06-2.66). The two acculturation groups had no significant difference in the odds of having asthma attacks or ED visits due to asthma in the past 12 months in fully adjusted models.

 

CONCLUSIONS: Among Californian Hispanic adults with current asthma, more acculturated individuals were significantly more likely to take preventive medication for asthma, but they did not have significantly better asthma outcomes in terms of asthma attacks and ED use due to asthma. This suggests the need for policymakers and researchers to tailor interventions to reduce asthma burden based on acculturation levels.

Table of Contents

Contents

I.              INTRODUCTION…………………………………………………………………..1

II.            BACKGROUND AND REVIEW OF LITERATURE…………………….…………..….3

Background on Asthma and Asthma Attacks……………………………………...…3

Asthma Prevalence and Burden: Nationwide vs. California…………………………4

Acculturation Status: Definition and Measurement…………………………………5

Acculturation Status and Health………………………………………………………5

Current Literature and Gaps on Acculturation and Asthma………………………………6

Cultural Barriers as Risk Factors for Asthma…………………………………………6

Birthplace & Length of Time in the U.S. ………………………………………………6

English Proficiency……………………………………………………………………7

Acculturation Levels…………………………………………………………………7

III.          METHODOLOGY…………………………………………………………………..9

Theoretic Framework…………...……………………………………………………..9

Focal Relationships…………...…………………………………...…………………..9

Mechanisms…………...……………………………….………...…………………..10

Confounders …………...………………………………………...…………………..13

Testable Hypotheses…………...………………………………………...……..……18

Data Description & Analytic Sample…………...…………………………...………19

Analytic Sample Derivation…………...…………………………...………...………20

Measures…………...…………………………...……………………………………21

Analytic Plan…………...…………………………...………………………………27

IV.         RESULTS………………………………………………………………………………28

     Results of Descriptive Analyses……………………………………………………28

     Results of Regression Analyses…………………………………………………….30

V.           DISCUSSION………………………………………………………………………….38

About this Master's Thesis

Rights statement

• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Health Policy and Management
Degree	M.S.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Parola chiave	California Asthma Health Disparities Acculturation
Committee Chair / Thesis Advisor	Becker, Edmund, Emory University
Committee Members	Gaydos, Laurie, Emory University Joski, Peter, Emory University

Ultima modifica

Primary PDF

Thumbnail	Title	Date Uploaded	Actions
	Acculturation and Asthma Management and Outcome Among Californian Hispanic Adults ()	2023-04-17 14:12:14 -0400	Press to Select an action Download

Supplemental Files

Thumbnail	Title	Date Uploaded	Actions