Biopsychosocial Considerations of Pediatric Asthma Morbidity in Latino Families

As the most prevalent chronic health condition in children under the age of 18, asthma is a disease for which significant health disparities exist. Current literature has established that ethnic minorities, families living in poverty, and families living in urban environments are at higher risk for worse morbidity. In recent years, studies focusing distinctly on Latino families, with emphasis on Puerto Rican families, have emerged. As a singular group, Puerto Rican children have demonstrated the worst outcomes and a significantly greater use of emergency room (ER) services, often related to poor adherence to adequate asthma care regimens. Guided by the biopsychosocial approach, this study sought to examine cultural and family variables and their relationship to pediatric asthma morbidity. Data from a sample of 639 children and their families from the Rhode Island region and Puerto Rico participated in this study. The data derived from the Rhode Island/Puerto Rico Asthma Center (RIPRAC) study and collected between 2002 and 2007. Bivariate analyses investigated correlations among familism and morbidity variables. Group comparisons were conducted between mainland Puerto Ricans living in the Rhode Island region and island Puerto Ricans and between Latino and non-Latino White families living in mainland United States. Confirmatory factor analysis using Mplus software evaluated a measurement model of familism and morbidity, followed by invariance testing in multiple group analyses by asthma severity and ethnicity. Lastly, structural equation modeling investigated a predictive relationship between the latent variables of familism and morbidity and meditational relationships through balanced integration. A secondary analysis for families who endorsed alternate child caregivers investigated a meditational relationship between familism and morbidity through involvement in asthma management by alternate caregivers. Significant correlations and group differences on mediator variables and observed familism variables and morbidity variables were found. Although a significant relationship between familism and morbidity was not found, significant relationships between familism and balanced integration and between balanced integration and morbidity were identified. This study contributes to emerging research on family variables as potential protective factors in pediatric asthma by focusing on familism as a primary concept amongst biological and psychosocial variables