Racial and ethnic differences in the management of childhood asthma in the United States.

OBJECTIVES: We examined racial and ethnic differences in the management of childhood asthma in the United States and the extent that care conformed to clinical best practices. METHODS: Two years of pooled data from the National Health Interview Survey were analyzed using logistic regression. The sample included all children between ages 2 and 17 years who had asthma currently and had been diagnosed with asthma by a doctor or health professional (n = 1757; 465 African-American, 212 Mexican-American, 190 Puerto Rican and other Hispanic, 806 white, non-Hispanic, and 84 children of other and multiple races and ethnicities). RESULTS: African-American children with asthma were significantly less likely than white, non-Hispanic children to have taken preventive asthma medication, but more likely to have had an asthma management plan. Mexican-American and Puerto Rican and other Hispanic children did not differ significantly from white, non-Hispanic children in either receiving preventive asthma medication or having an asthma management plan. Caregivers of African-American and Puerto Rican and other Hispanic children were more likely to report that they or their child had taken a course or class on how to manage their child's asthma. We did not find racial or ethnic differences in the extent children used quick-relief asthma medication or received advice about reducing asthma triggers in their home, school, or work environments. CONCLUSIONS: This work highlights a need for more research on racial and ethnic differences in asthma management. Implications for public health responses and racial and ethnic disparities in asthma morbidity are discussed.

Racial disparities in childhood asthma in the United States: evidence from the National Health Interview Survey, 1997 to 2003.

OBJECTIVE: To examine differences in asthma prevalence and emergency department (ED) visits for asthma between non-Hispanic black and white children, and factors that might explain those differences, in a large, nationally representative sample covering the period 1997 to 2003. METHODS: Bivariate and multivariate regression analyses (with logit and multinomial logit methods) were conducted with a sample consisting of all non-Hispanic black and white children (<18 years of age) from the 1997 to 2003 rounds of the National Health Interview Survey. Models included a progressively larger set of controls for factors that might explain racial differences in asthma prevalence and ED visits for asthma. RESULTS: Being black was associated with a greater likelihood of currently having asthma and with a greater likelihood of having gone to the ED for asthma treatment in the past 1 year. Elevated asthma risks for black children were robust after controlling for a host of child and family characteristics that might explain them. CONCLUSIONS: Black children are more likely to have asthma and to experience ED visits for asthma, compared with otherwise comparable white children, and these racial disparities cannot be explained by differences in measurable child or family characteristics. These results suggest that racial disparities in asthma continue to pose risks for black children, and they point to the need for additional research into potential explanations and remedies.

Understanding the risks of child neglect: an exploration of poverty and parenting characteristics.

A strong association between poverty and child neglect has been established, but the mechanisms that explain this relationship have not been clearly articulated. This research takes advantage of survey and child maltreatment administrative data about families with young children and assesses the influence of poverty and parenting characteristics on subsequent child neglect. The authors find that indicators of poverty, such as perceived material hardship and infrequent employment, and parenting characteristics, such as low parental warmth, use of physical discipline, and allowing a child to engage in frequent television viewing, are predictive of child neglect. Parenting characteristics do not appear to mediate the link between perceived hardship and neglect, although they suppress the link between employment and neglect. Results from this study provide information that is highly relevant to the approach and design of child maltreatment prevention and intervention strategies.

Improving the measurement of child neglect for survey research: issues and recommendations.

There is a great need for developing and validating measures of child neglect that can be applied to survey samples outside of a child welfare context. A prospective assessment of child neglect would afford a better estimation of the etiology of various types of child neglect and would greatly inform the development of primary prevention strategies related to child maltreatment. This article offers guidance on the tasks involved with constructing new measures of neglect for prospective survey research. Methodological issues pertaining to child neglect measurement are discussed, and a framework is offered for developing neglect measures for survey research. A discussion is also offered on how this framework is being applied in an ongoing longitudinal study of low-income families with young children. The intended result of this exercise is to encourage the development of new child neglect measures for survey research with both high-risk and general populations.