Adolescent Views on Asthma Severity and Management During the COVID-19 Pandemic.

Background: Asthma and COVID-19 have overlapping symptoms. During the 2019-2022 pandemic, pediatric asthma control appears to have improved, with some researchers theorizing that that is due to changes in asthma self-management. This study examined adolescents' views regarding how the pandemic impacted their asthma severity and self-management. Differences by urbanicity, sex, and race/ethnicity were explored. Methods: We utilized baseline data from adolescents with poorly controlled asthma (n = 183) who were participating in 1 of 2 school-based clinical trials-1 in rural schools and 1 in urban schools-testing the impact of interventions to improve asthma control. Adolescents reported if they believed their asthma severity remained the same, improved, or worsened during the pandemic, and if it changed, how it changed. They also reported if and how they modified their asthma management since the pandemic. We used multinomial logistic regression and binary logistic regression to assess the relationship between demographic factors and changes in asthma severity during the pandemic, and if adolescents altered their asthma management. Results: Adolescents' mean age was 15.9 years; most lived in rural communities (65.6%) and identified as female (66.7%). About half (56.2%) self-identified as black, 13.1% as Hispanic, and 10.4% as another race/ethnicity. Most (68.4%) reported that their asthma severity remained unchanged; 26.0% reported it worsened. Nearly 30% reported they altered how they managed their asthma, with most (80%) reporting additional efforts. Compared with asthma remaining the same, females had a higher relative risk than males of reporting that their asthma worsened [adjusted relative risk ratio = 3.65, 95% confidence interval (CI) = 1.34-9.90, P < 0.05]. Urban youth had greater odds (adjusted odds ratio = 5.4, 95% CI = 2.0-14.5, P < 0.001) of reporting they changed their asthma self-management compared with rural peers. Conclusion: This study demonstrates that during the 2019-2022 pandemic, adolescents generally believed their asthma severity stayed consistent and many took additional self-management efforts.

Group-Based Medical Mistrust in Adolescents With Poorly Controlled Asthma Living in Rural Areas.

Black youth and rural adolescents are two groups who experience asthma disparities. Racism and discrimination in health care likely lead to group-based (systems-level) medical mistrust for some adolescents. Group-based medical mistrust, one pathway by which racism drives health inequities, is associated with poorer outcomes for patients with chronic conditions. Despite its potential importance in adolescent asthma, previous research has not considered group-based medical mistrust in this population. To fill this gap, we characterize group-based medical mistrust among rural adolescents with poorly controlled asthma, examining demographic differences. We analyzed baseline data from a school-based clinical trial in which 164 adolescents (mean age = 16.3; 76.2% Black) completed the Group-Based Medical Mistrust Scale (GBMMS). Using linear regression, we tested associations with race, gender, and age, controlling for recent medical visits and insurance status. The total GBMMS mean score was 2.3 (SD = 1.22); subscale scores ranged from 2.3 to 2.4. Black adolescents reported significantly higher total GBMMS scores (ß = .45, p = .003) and significantly higher scores on two GBMMS subscales: suspicion of health care providers (ß = .56, p = .007) and lack of support from health care providers (ß = .36, p = .007). Gender and age were not associated with GBMMS scores. Health care providers need to consider medical mistrust and its role in their clinical care. Together with their institutions, health care providers and researchers should work toward changing systems that perpetuate racism to build trust as a means of reducing asthma disparities among adolescents.

Marketing Sustainability Analysis of Stores Participating in a Healthier Retail Food Program.

OBJECTIVES: To examine how food retailers completing Shop Healthy NYC, a healthy food retail program, (1) changed availability, placement, and promotion of healthier food immediately after participation and (2) sustained changes 1-year postintervention. METHODS: From 2014 to 2017, stores in 2 high-poverty New York City neighborhoods participated in a low-intensity intervention focused on in-store advertising or a high-intensity intervention to meet 7 criteria related to availability, placement, and promotion of healthy items. Stores were assessed preintervention (Pre), 1-month postintervention (Post 1), and 12-16 months postintervention (Post 2). Analyses were restricted to stores that completed the intervention and were assessed at all time points (n = 64). Changes were compared across time points. RESULTS: Across stores participating in the low-intensity intervention, the ratio of unhealthy-to-healthy ads decreased from Pre to Post 1, and by Post 2 remained improved over baseline. Among stores participating in the high-intensity intervention, the median number of healthy criteria met increased from 3.5 to 6 from Pre to Post 1 and decreased to 5 at Post 2. CONCLUSIONS: Improvements in the marketing and availability, placement, and promotion of healthy products are feasible but may require reinforcement and additional support over time.

Depressive symptoms are related to asthma control but not self-management among rural adolescents.

Background: Depression, a relevant comorbidity with asthma, has been reported to be associated with asthma morbidity. Asthma self-management is essential to asthma control and may be negatively impacted by depression. We examined these associations in rural adolescents, a group with relatively high asthma morbidity and depressive symptoms, a population often ignored in asthma research. Methods: We used baseline data from a randomized trial of an asthma intervention for adolescents in rural South Carolina (n = 197). Adolescents completed the Center for Epidemiological Studies-Depression (CES-D), three indices of asthma self-management (the Asthma Prevention Index, the Asthma Management Index and the Asthma Self-Efficacy Index), and the Asthma Control Test (ACT). Poisson and linear regression tested associations between depression, self-management, and asthma control. The models controlled for demographic variables and included school as a fixed effect. Results: Most participants (mean age = 16.3 ± 1.2 years) self-identified as female (68.5%) and Black (62.43%). The mean CES-D score was 19.7 ± 10.3, with 61.4% of participants at risk for depression. The depressive symptoms were significantly related to asthma control [ß = -0.085, 95% confidence interval (CI) = -0.14 to -0.03] but not to prevention [relative risk (RR) = 1.00, 95% CI = 0.99-1.01], management (RR = 1.00, 95% CI = 0.99-1.01), or self-efficacy (ß = -0.002, 95% CI = -0.01 to 0.01). Conclusions: In this sample of rural adolescents, as depressive symptoms increased, asthma control declined. Depressive symptoms were not associated with asthma self-management, suggesting that the aspects of self-management we assessed are not an avenue by which depression impacts asthma control. Additional research is needed to further understand the relationship between depressive symptoms, asthma self-management, and control.

Asthma Knowledge, Self-Efficacy, and Self-Management Among Rural Adolescents with Poorly Controlled Asthma.

Rural adolescents with asthma are a disparate group. Self-management is essential to asthma control. We describe asthma knowledge, self-efficacy, and self-management behaviors among 198 rural adolescents with poorly controlled asthma, exploring demographic differences; we also test the application of Social Cognitive Theory to asthma self-management examining if self-efficacy mediates associations between knowledge and self-management. Asthma knowledge and self-management were relatively poor in our sample, particularly among male and White adolescents; greater knowledge was significantly associated with better symptom prevention and management. Self-efficacy partially mediated the association between knowledge and symptom prevention, but not acute symptom management, suggesting that knowledge may not improve symptom prevention behaviors without confidence to implement such behaviors and that factors beyond knowledge and self-efficacy likely play a role in asthma self-management in this population. Addressing asthma knowledge and self-efficacy could improve self-management and, ultimately, enhance asthma control among rural adolescents with poorly controlled asthma.

The Association of Mental Health, Asthma Control and Acute Care Visits Among Rural Adolescents with Poorly Controlled Asthma.

Anxiety and depressive symptoms are associated with asthma-related acute care utilization. Few studies include rural adolescents. Asthma control may be the mechanism by which mental health affects acute care. This study explored associations between generalized anxiety, asthma-related anxiety, depressive symptoms, and acute care visits, and tested if asthma control mediates these associations among 197 rural adolescents with asthma. Data analysis included descriptive statistics and regression. Controlling for age, sex and race/ethnicity, asthma-related anxiety was associated with higher odds of acute care visits (OR = 2.09, 95% CI [1.42, 3.07]). Asthma control mediated this relationship: one unit increase in anxiety, on average, increased the odds of having any acute care visit by 5%. Generalized anxiety and depressive symptoms were not associated with acute care visits. Helping adolescents reduce their concerns regarding asthma while improving their self-management skill may potentially to reduce acute care among rural adolescents.

Home health aide perceived information needs for dementia-specific care plans.

Home health aides (HHAs) are a vital workforce essential to meet the complex care needs of the persons living with dementia (PLWD) who remain at home. Care plans for PLWD in the home healthcare setting should incorporate HHAs perspectives. We sought to understand HHAs' perspectives about their information needs in caring for PLWD, from June to August 2020, semi-structured interviews telephone interviews (n = 25) with English and Spanish-speaking HHAs with limited English proficiency in the New York metropolitan area. Interviews were audio-recorded, transcribed verbatim and transcripts were analyzed using conventional content analysis. Four key themes emerged reflective of information needs of HHAs caring for PLWD: (1) ambiguities of scope of HHA tasks related to medication management; (2) clinical information needs of HHAs; (3) dementia-related concerns; and (4) going above and beyond. Findings from this research can guide efforts to develop dementia-specific care plans, and training to support the HHA workforce caring for the growing population of PLWD.

All alone: A qualitative study of home health aides' experiences during the COVID-19 pandemic in New York.

BACKGROUND: Despite their integral role, Home Health Aides (HHAs) are largely unrecognized as essential to implementing effective infection prevention and control practices in the home healthcare setting. We sought to understand the infection prevention and control needs and challenges associated with caring for patients during the pandemic from the perspective of HHAs. METHODS: From June to August 2020, data were collected from HHAs in the New York metropolitan area using semi-structured qualitative interviews by telephone; 12 HHAs were interviewed in Spanish. Audio-recorded interviews were transcribed, translated and analyzed using conventional content analysis. RESULTS: In total, 25 HHAs employed by 4 unique home care agencies participated. HHAs had a mean age of 49.8 (± 9.1), 24 (97%) female, 11 (44%) Black, 12 (48%) Hispanic. Three major themes related to the experience of HHA's working during the COVID-19 pandemic emerged: (1) all alone, (2) limited access to information and resources, and (3) dilemmas related to enhanced COVID-19 precautions. Hispanic HHAs with limited English proficiency faced additional difficulties related to communication. CONCLUSIONS: We found that HHA communication with nursing staff, plays a key role in infection control efforts in home care. Efforts to manage COVID-19 in home care should include improving communication between HHAs and nursing staff.

Asthma and subjective sleep disordered breathing in a large cohort of urban adolescents.

OBJECTIVE: Sleep disordered breathing (SDB) has not been well studied in urban adolescents with asthma in community settings. Nor has the association of SDB symptoms and asthma severity been studied. We characterized self-reported symptoms suggesting SDB and investigated the association of SDB symptoms, probable asthma, and asthma severity. METHODS: 9,565 adolescents from 21 inner-city high schools were screened for an asthma intervention study. Students reported on symptoms suggesting SDB using questions from the 2007 NHANES, if they were ever diagnosed with asthma, and on asthma symptoms. Using generalized linear mixed models with logit link with school as a random intercept and adjusting for age, gender, and race/ethnicity, we examined associations of SDB symptoms, and demographic characteristics, probable asthma, and asthma severity. RESULTS: 12% reported SDB symptoms. Older and bi-racial participants (compared to Caucasian) had higher odds of symptoms suggesting SDB (p <.001). Compared to those without probable asthma, adolescents with probable asthma had 2.63 greater odds of reporting SDB symptoms (p <.001). Among those with probable asthma, the odds of reporting SDB symptoms increased with asthma severity. When exploring daytime severity and severity due to night wakening separately, results were similar. All results remained significant when controlling for age, gender, and ethnicity. CONCLUSIONS: In a large urban community cohort of predominately ethnic minority adolescents, self-reported SDB symptoms were associated with probable asthma and increased asthma severity. This study highlights the importance of SDB as a modifiable co-morbidity of asthma.

Psychological Factors Influencing the Decision of Urban Adolescents With Undiagnosed Asthma to Obtain Medical Care.

PURPOSE: Adolescents are low users of medical care. Psychological factors and perceived reasons to not seek routine medical care may increase risk of nonuse by adolescents with undiagnosed asthma. This study tests if psychological factors were associated with seeing a medical provider for asthma-like symptoms; identifies adolescents' perceived reasons for not obtaining care; explores if psychological factors are associated with these perceptions; and explores if asthma severity moderates the relationships with psychological factors. METHODS: We analyzed cross-sectional data from a baseline assessment of 349 urban, primarily ethnic minority adolescents with moderate to severe asthma-like symptoms but no asthma diagnosis who were enrolled in a controlled trial. RESULTS: The odds of seeing a provider for their asthma-like symptoms were significantly higher for those with asthma-related anxiety (odds ratio [OR]: 1.644; 95% confidence interval [CI]: 1.242-2.176) and depressive symptoms (OR: 1.031; 95% CI: 1.004-1.059). The most commonly endorsed reason for noncare included a characterization of symptoms as not serious, past medical visits not diagnosed as asthma, fear of diagnosis, busy lifestyles, and not wanting medication. Psychological factors were not related to the number of reasons or to most of the commonly endorsed reasons. Adolescents with more asthma-related anxiety were less likely to characterize their breathing problems as serious (OR = .0583; 95% CI: .424-.802) and were more likely to report busy lifestyles (OR = 1.593; 95% CI: 1.122-2.261). CONCLUSIONS: Adolescent-perceived reasons for noncare were not pragmatic, but instead highlighted denial. Asthma-related anxiety was the most robust psychological factor associated with the decision to seek medical care.

The Association Between Asthma and Sleep in Urban Adolescents With Undiagnosed Asthma.

BACKGROUND: We examined associations between asthma and sleep in a sample of inner-city adolescents with asthma-like symptoms who are undiagnosed, and to assess the extent to which youth's report of perceived stress moderates this association. METHODS: A total of 349 adolescents (83% girls), with a mean age of 15.8 years, and their primary caregivers participated. Large segments of the sample were Latinos (46%) or African Americans (37%). Adolescents reported on asthma-namely, rate of waking up at night due to asthma-like symptoms and perceived severity of breathing problems-and sleep, specifically sleep-wake behavior problems and daytime sleepiness during activities. Caregivers provided demographic information by telephone. RESULTS: Night awakenings and perceived severity of breathing problems were each independently associated with sleep-wake behavior problems and daytime sleepiness during activities. Youth report of perceived stress moderated the association between perceived severity of breathing problems and sleep-wake behavior problems, and perceived severity of breathing problems and daytime sleepiness during activities. CONCLUSIONS: Results suggest the importance of interventions that consider undiagnosed asthma and its effects on sleep indicators related to daytime functioning in this high risk group of youth. This study highlights the need for interventions that consider asthma severity, nocturnal asthma, and sleep problems among urban adolescents with no asthma diagnosis.

Satisfaction with health care among Latinas.

Despite growing interest in disparities in access to health care, relatively little is known about different facets of care among Latinas, their satisfaction with the care they receive, and the predictors of satisfaction. This study examined whether various health care access and context factors, the quality of the patient-physician interaction, and medical mistrust predict satisfaction with health care among Latina immigrants in New York City. Structured interviews were conducted with 220 Latinas predominantly from the Dominican Republic and aged 40 years or over. Of the access to health care variables examined, greater waiting time predicted dissatisfaction with health care. Greater quality of the patient-physician interaction predicted less dissatisfaction. The effect of the patient-physician interaction on dissatisfaction was mediated, in part, by waiting time. The results illustrate the important role of specific health care factors in satisfaction with care.

Feasibility and preliminary outcomes of a school-based intervention for inner-city, ethnic minority adolescents with undiagnosed asthma.

OBJECTIVE: To describe and test the feasibility of asthma self-management for adolescents with undiagnosed asthma (ASMA-Undx), an 8-week school-based intervention for urban adolescents comprised of three group and five individual coaching sessions, and academic detailing for their primary care providers (PCPs). METHODS: Thirty high school students (mean age 15.9; 92% female; 72% Latino/a) who reported symptoms of persistent asthma, but no diagnosis were randomized to ASMA-Undx or a no-treatment control group. Interviews were conducted pre- and post-intervention. RESULTS: All intervention students participated in the three group sessions; 64% received all five individual coaching sessions. Academic detailing telephone calls made by a pediatric pulmonologist reached 83% of the students' PCPs. Relative to controls, a significantly greater proportion of ASMA-Undx students were diagnosed (79% versus 6%, respectively), and prescribed asthma medication (57% versus 6%, respectively). Barriers to diagnosis and treatment included students' and parents' lack of knowledge about asthma. CONCLUSION: ASMA-Undx is a feasible and promising intervention to assist urban adolescents with undiagnosed asthma obtain a diagnosis and treatment. PRACTICE IMPLICATIONS: ASMA-Undx has the potential to reach many adolescents because it is school-based. It can serve as a model for interventions targeting other pediatric illnesses.

Fatalism or destiny? A qualitative study and interpretative framework on Dominican women's breast cancer beliefs.

BACKGROUND: A growing literature on Latino's beliefs about cancer focuses on the concept of fatalismo (fatalism), despite numerous conceptual ambiguities concerning its meaning, definition, and measurement. This study explored Latina women's views on breast cancer and screening within a cultural framework of destino ("destiny"), or the notion that both personal agency and external forces can influence health and life events. METHODS: Semi-structured interviews were conducted with 25 Latinas from the Dominican Republic aged 40 or over. RESULTS: Respondents reported complex notions of health locus of control that encompassed both internal (e.g., individual action) and external (e.g., the will of God) forces shaping breast cancer prevention efforts. Furthermore, women actively participated in screening because they believed that cancer could become a death sentence if diagnosed late or left untreated. DISCUSSION: In contrast to simplistic notions of "fatalism", our analysis suggests complex strategies and beliefs regarding breast cancer and cancer screening that speak of resiliency rather than hopelessness.

Commentary: fatalismo reconsidered: a cautionary note for health-related research and practice with Latino populations.

Over recent years, interest has grown in studying whether fatalismo (fatalism) deters Latinos from engaging in various health promotion and disease detection behaviors, especially with regard to cancer screening. This commentary presents problematic issues posed by the concept of fatalism, focusing on research on Latinos and cancer screening. We discuss key findings in the literature, analyze methodologic and conceptual problems, and highlight structural contexts and other barriers to health care as critical to the fatalism concept. Although the need to better understand the role of fatalistic beliefs on health is great, we discuss the public health implications of reaching premature conclusions concerning the effect of fatalism on Latinos' cancer screening behaviors.

Knowledge, attitudes, and practices regarding antibiotic use among Latinos in the United States: review and recommendations.

Inappropriate use of antibiotics contributes to antimicrobial resistance worldwide. In Latin America, antibiotics are easily obtained over the counter. In the United States, the Latino population is the largest and fastest growing immigrant group. Hence, it is necessary to understand Latino cultural practices in regards to antibiotic use to develop effective interventions that reduce inappropriate antibiotic use among this population. We conducted a systematic review of descriptive and intervention studies measuring knowledge, attitudes, and practices of antibiotic use among Latinos in the United States. The search yielded only 11 descriptive studies and no interventions. The literature suggests that many Latinos in the United States self-prescribe antibiotics because of financial and sociocultural barriers and inaccurately believe that antibiotics help treat viral infections. Increased access to health care and appropriate culturally tailored interventions specific to Latinos are needed to promote judicious antibiotic use among Latinos.