Center for Reducing Asthma Disparities - Rhode Island/Puerto Rico Centers
Center for Reducing Asthma Disparities - Rhode Island/Puerto Rico Centers
To reduce disparities in asthma among Latino children.
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.
1) Diagnosed asthma or history of breathing problems (coughing, wheezing, shortness of
 breath) in the 12 months prior to study enrollment; 2) Non-Latino white, Puerto Rican or
 Dominican ethnic background; 3)ages 7-15 years