Disentangling the influences of acculturation, housing and health care on asthma management and morbidity in an urban, low income community

Socioeconomic and racial/ethnic disparities in asthma prevalence, morbidity and mortality have been well documented in the US, where asthma disproportionately affects minority children living in urban areas and children living in poverty. Immigrants represent a large and growing segment of the urban poor in the US and evidence to date suggests that immigrants may experience increased asthma risk with increased length of residence in the US, but few studies have been conducted with immigrant populations. This study examines the role of immigrant acculturation in asthma outcomes in a low-income, urban community in Los Angeles County.

Data were obtained from 250 high acculturation Latino, low acculturation Latino and African American participants in a community health worker (CHW) home-based asthma intervention. The prevalence of housing, health care, and asthma characteristics was assessed by racial/ethnic and acculturation group at baseline. Further, regression analyses assessed the independent effects of caregiver racial/ethnic and acculturation group on asthma management and morbidity outcomes. A longitudinal analysis was conducted to examine the effects of race/ethnicity and acculturation on asthma outcomes in the high intensity and low intensity intervention groups at 6 month and 12 month follow-up.

Patterns of risk factors for asthma and levels of morbidity varied significantly by racial/ethnic group and level of acculturation in this study population. Aspects of caregiver acculturation were independently associated with asthma symptoms, caregiver quality of life, and caregiver management scores. The CHW home-based asthma intervention targeting immigrant parents of children with asthma reduced asthma symptoms, urgent care use and reliance on b2-agonist medication. It improved caregiver asthma management efforts, caregiver management confidence, caregiver quality of life, caregiver rating of the quality of their child's asthma care, and trigger reduction efforts in the home. Further research is needed to understand the role of acculturation in asthma outcomes.