Effect of Ethnicity and Parental Illness Representations on Complementary and Alternative Medicine (CAM) Usage and Asthma Control in Childhood Asthma

Background: Asthma is the most prevalent chronic condition in childhood in the US. Puerto Ricans (PR) are disproportionately affected compared to Mexicans.  In the last decade, the incidence of asthma in the United States has increased by nearly 15% (CDC Asthma’s Impact on the Nation, 2013).   Particularly concerning is the asthma incidence disparity between ethnicities: 7.7% of whites have been diagnosed with asthma, compared to 11.2% of blacks, and 6.5% of Hispanics.  Despite the low prevalence in Hispanics as a whole, the statistics for different Latino subgroups tell a different story.  16.1% of Puerto Ricans have asthma, compared to only 5.4% of Mexicans (Akinbami et al., 2012). CAM usage in childhood asthma as high as 89% has been reported, but the evidence does not support CAM as an effective asthma management tool. Despite high CAM use, only 18% of parents reported CAM usage to the provider.  There is potential to improve controller medication adherence while remaining sensitive to parents’ ethnomedical beliefs.

Purpose:  To explore lifetime and current prevalence, ethnic differences, and role of parental illness representations (IR) in CAM use and asthma control.

Theory: The Common Sense Model of Illness Representation provides the theoretical framework.  The model describes a cognitive processing system that includes situational stimuli (perception of the child’s symptoms), objective representation of the health threat (illness representation) with its treatment decisions (CAM and controller medication use) and appraisal of the outcomes (asthma control) for the success or failure of the treatment decisions.  A feedback loop is included in the model with IRs potentially changing over time as the parents gain experience with their child’s asthma.  The model has three tenets: the parent is an active problem solver; the IR is the central cognitive contrast that drives the parent’s treatment decision and appraisal of the outcomes; and IRs are personalized and may not be in agreement with the medical facts. 

Subjects:  536 Latino parents and their children with asthma (aged 5-12 years).  Families were recruited from 4 clinics located in Bronx, NY and Phoenix, AZ.  To be eligible for the study, children must have met the following criteria: a) The child had to be between the ages of 5 and 12, b) had a diagnosis of asthma as obtained from their medical record, c) identified as Latino as described by the child’s primary care caregiver, d) had no other significant pulmonary complications or conditions, e) participating parent must have had the majority responsibility for the child’s day-to-day asthma management and care, f) no cognitive learning disability that would interfere with the parent or child’s ability to participate in the interview process.

Method:  Longitudinal study of parental IRs, treatment decision, and asthma control.  Structured interviews with parents (including questions about specific CAM therapies), short interviews with children, children’s lung function, and children’s medical records reviews were conducted at enrollment, and 3, 6, 9, and 12 months post-enrollment. Baseline data used for these analyses.

Results:  74% of the sample reported lifetime CAM use. Significantly more Mexicans reported lifetime and current CAM use compared to PR (67% versus 33%, p=.04; 65% versus 35%, p=.01, respectively). Parental IRs were significant predictors of current CAM use (OR=.49, p=.05) but not lifetime CAM use. There was significant interaction of ethnicity and CAM (p=<.0001).  Mexican children are significantly more likely to have well-controlled asthma, regardless of CAM/controller combination.  Parental beliefs aligned with the professional asthma management model were predictive of well-controlled asthma (p=0.4).

Conclusion:  This study demonstrated that Mexicans and PRs have different IRs, CAM usage, and asthma control.  It is important to understand IRs and CAM, so effective communication and shared decision-making can occur. HCPs who are familiar with and sensitive to IRs and care needs of diverse groups can play a decisive role in improving health outcomes of patients with asthma by heightened awareness of and respect for cultural differences among the children and families they interact with. To develop effective interventions that target asthma health disparities, we must first understand the characteristics of these groups and how they interact to impact parental IRs, CAM usage, and asthma control.