Issues and methods in disparities research: the Rhode Island-Puerto Rico asthma center.

BACKGROUND: Epidemiologic studies have documented higher rates of asthma prevalence and morbidity in minority children compared to non-Latino white (NLW) children. Few studies focus on the mechanisms involved in explaining this disparity, and fewer still on the methodological challenges involved in rigorous disparities research. OBJECTIVES AND METHODS: This article provides an overview of challenges and potential solutions to research design for studies of health disparities. The methodological issues described in this article were framed on an empirical model of asthma health disparities that views disparities as resulting from several factors related to the healthcare system and the individual/community system. The methods used in the Rhode Island-Puerto Rico Asthma Center are provided as examples, illustrating the challenges in executing disparities research. RESULTS: Several methods are described: distinguishing ethnic/racial differences from methodological artifacts, identifying and adapting culturally sensitive measures to explain disparities, and addressing the challenges involved in determining asthma and its severity in Latino and other minority children. The measures employed are framed within each of the components of the conceptual model presented. CONCLUSIONS: Understanding ethnic and/or cultural disparities in asthma morbidity is a complicated process. Methodologic approaches to studying the problem must reflect this complexity, allowing us to move from documenting disparities to understanding them, and ultimately to reducing them.

Beliefs and barriers to medication use in parents of Latino children with asthma.

OBJECTIVE: Disparities in asthma outcomes exist between Latino and non-Latino white (NLW) children. We examined rates of medication use, medication beliefs, and perceived barriers to obtaining medication in US and island Puerto Rican parents of children with asthma. HYPOTHESES: Island PR parents would report the lowest rates of controller medication use, followed by RI Latino and RI NLW parents; Latino parents would report more medication concerns than NLW parents; and Island PR parents would report the most barriers to medication use. STUDY DESIGN: Five hundred thirty families of children with persistent asthma participated, including 231 Island PR, 111 RI NLW, and 188 RI Latino. Parents completed survey measures. RESULTS: Group differences were found on reported use of ICS (X(2) = 50.96, P < 0.001), any controller medication (X(2) = 56.49, P < 0.001), and oral steroids (X(2) = 10.87, P < 0.01). Island PR parents reported a greater frequency of barriers to medication use than the other two groups (X(2) = 61.13, P < 0.001). Latino parents in both sites expressed more medication concerns than NLW parents (F = 20.18, P < 0.001). Medication necessity was associated with ICS use in all three groups (all P's < 0.01). Medication concerns were positively associated with ICS use in PR only (OR = 1.64, P < 0.05). CONCLUSIONS: Differences in medication beliefs and the ability to obtain medications may explain the reported disparity in controller medication use. Further studies are needed to evaluate these obstacles to medication use.