The effect of family adaptive resources on asthma care utilization in urban African-American children

Asthma is the most common childhood chronic disease in this country. African- American children bear a disproportionate burden of asthma. Race-comparative studies suggest that African-American children are more likely to seek asthma treatment from emergency departments compared to White children. From the public health perspective, emergency department utilization for asthma care represents an adverse pediatric health outcome because many of these visits can be prevented. The research objectives of this dissertation were to investigate the effects of family adaptive resources, defined as psychosocial assets secured from the social environment, on pediatric asthma care utilization. Secondary data analyses of Phase One of the National Cooperative Inner-City Asthma Study were conducted. Children of parents who self-identified as African-American and reported that a health care provider confirmed an asthma diagnosis were eligible for this study (n=1007). Independent variables included family adaptive resources, predisposing, enabling, and need factors, and family management behaviors. Asthma care utilization during the 9-month period following the baseline interview was measured as the number of emergency department visits and outpatient asthma care utilization. Analyses include negative binomial regression, multinomial logit regression, and mediation analysis. One-third of children completed one or more asthma ED visits. Surprising, all children with emergency department utilization also reported asthma visits to primary care providers. Compared to children of families with low emotional support, children whose caregiver perceived high availability emotional support had 31% fewer pediatric asthma emergency department visits (p < .05). In addition, the caregiver's perception of having tangible aid in caring for the index child increased the probability that the child did not utilize any asthma-related services by 8 percentage points (p < .05). Crime and employment-related stressors (past 12 month) also increased the likelihood of asthma emergency department utilization. This study provides support of the positive benefit of family adaptive resources in pediatric asthma outcomes