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Kaur K, Arcoleo KJ, Serebrisky D, Rastogi D, Marsiglia FF, Feldman JM. Impact of caregiver depression on child asthma outcomes in Mexicans and Puerto Ricans. J Asthma 2022; 59:2246-2257. [PMID: 34793283 PMCID: PMC9534376 DOI: 10.1080/02770903.2021.2008427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 10/06/2021] [Accepted: 11/16/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Examine whether caregiver depressive symptoms at baseline predict longitudinal child asthma outcomes in the two populations with the largest asthma disparities: Mexicans and Puerto Ricans. METHODS Two hundred and sixty-seven Hispanic caregiver-child dyads (Mexican = 188, Puerto Rican = 79; children 5-12 years) were recruited from clinics and hospitals in Phoenix, AZ and the Bronx, NY. The Center for Epidemiological Studies Depression Scale assessed caregiver depressive symptoms; higher scores indicate greater depressive symptomology. Medical records verified child asthma diagnosis. Assessments for outcome variables occurred at baseline, 3, 6, 9, and 12-month follow-ups. Pulmonary function was measured by spirometry, asthma control was measured by the Asthma Control Test, steroid bursts and acute healthcare utilization were assessed by caregiver report and medical records, and adherence was measured by doser devices on controller medications. Structural equation modeling analyzed baseline caregiver depressive symptoms as a predictor of longitudinal child asthma outcomes, and differences between subgroups. RESULTS Higher caregiver depressive symptoms predicted better pulmonary function (β = .02, p = .001) in Mexican children, and fewer steroid bursts (β = -.41, p = .01) and better medication adherence (β = .02, p = .07) in Puerto Rican children. Caregiver depressive symptoms did not predict pediatric asthma control or acute healthcare utilization in either subgroup. CONCLUSIONS Caregiver depressive symptomology had unexpected effects on child asthma outcomes. Results may be explained by the Hispanic paradox, caregiver resilience, acculturation, and the study's longitudinal nature. Further research is needed on social determinants of health that may influence differences in child asthma outcomes in heterogeneous Hispanic communities.
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Affiliation(s)
- Karenjot Kaur
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York
| | | | | | - Deepa Rastogi
- Children’s National Medical Center, GW University School of Medicine and Health Science, Washington, DC
| | | | - Jonathan M. Feldman
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York
- Albert Einstein College of Medicine, Children’s Hospital at Montefiore, Bronx, NY
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Heintzman J, Kaufmann J, Bailey S, Lucas J, Suglia SF, Puro J, Giebultowicz S, Ezekiel-Herrera D, Marino M. Asthma Ambulatory Care Quality in Foreign-Born Latino Children in the United States. Acad Pediatr 2022; 22:647-656. [PMID: 34688905 PMCID: PMC10602714 DOI: 10.1016/j.acap.2021.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 10/04/2021] [Accepted: 10/08/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Foreign-born Latino children in the United States (US) have poor asthma outcomes, but the role of routine care utilization in these outcomes is unclear. Our objective was to compare select ambulatory care utilization measures for asthma between foreign-born Latino, US-born Latino, and non-Hispanic white children. METHODS Using a multistate network of clinics with a linked electronic health record, we compared the International Classification of Disease (ICD)-coded asthma diagnosis among those with respiratory symptoms, electronic health records documentation of diagnosis, prescriptions, and influenza vaccination of foreign-born and US-born Latino children, and non-Hispanic white children over a 10+ year study period. We also examined outcomes by country of birth in children from Mexico, Cuba, and Guatemala. RESULTS Among our study population (n = 155,902), 134,570 were non-Hispanic white, 19,143 were US-born Latino, and 2189 were foreign-born Latino. Among those with suspicious respiratory symptoms, there was no difference between these groups in the predicted probability of an ICD-coded asthma diagnosis. US-born Latino children with asthma were less likely to have asthma documented on their problem list, more likely to have an albuterol prescription, and less likely to have an inhaled steroid prescribed. All Latino children had higher rates of influenza vaccination than non-Hispanic white children. CONCLUSIONS In a national network, there were few disparities between Latino (US- and foreign-born) children and non-Hispanic white comparators in many common asthma care services, except some measures in US-born Latino children. Providers should understand that their US-born Latino children may be at elevated risk for not receiving adequate asthma care.
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Affiliation(s)
- John Heintzman
- Department of Family Medicine, Oregon Health & Science University (J Heintzman, J Kaufmann, S Bailey, J Lucas, and D Ezekiel-Herrera), Portland, Ore; OCHIN Inc. (J Heintzman, J Puro, and S Giebultowicz), Portland, Ore.
| | - Jorge Kaufmann
- Department of Family Medicine, Oregon Health & Science University (J Heintzman, J Kaufmann, S Bailey, J Lucas, and D Ezekiel-Herrera), Portland, Ore
| | - Steffani Bailey
- Department of Family Medicine, Oregon Health & Science University (J Heintzman, J Kaufmann, S Bailey, J Lucas, and D Ezekiel-Herrera), Portland, Ore
| | - Jennifer Lucas
- Department of Family Medicine, Oregon Health & Science University (J Heintzman, J Kaufmann, S Bailey, J Lucas, and D Ezekiel-Herrera), Portland, Ore
| | - Shakira F Suglia
- Department of Epidemiology, Emory University Rollins School of Public Health (SF Suglia), Atlanta, Ga
| | - Jon Puro
- OCHIN Inc. (J Heintzman, J Puro, and S Giebultowicz), Portland, Ore
| | | | - David Ezekiel-Herrera
- Department of Family Medicine, Oregon Health & Science University (J Heintzman, J Kaufmann, S Bailey, J Lucas, and D Ezekiel-Herrera), Portland, Ore
| | - Miguel Marino
- Department of Family Medicine, Oregon Health & Science University (J Heintzman, J Kaufmann, S Bailey, J Lucas, and D Ezekiel-Herrera), Portland, Ore; Biostatistics Group, OHSU-PSU School of Public Health (M Marino), Portland, Ore
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Sclar GD, Mosler HJ. Caregiver social support and child toilet training in rural Odisha, India: What types of support facilitate training and how? Appl Psychol Health Well Being 2021; 14:413-433. [PMID: 34668329 PMCID: PMC9297906 DOI: 10.1111/aphw.12311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 09/19/2021] [Accepted: 09/20/2021] [Indexed: 11/30/2022]
Abstract
Studies show positive impacts of social support on childcare practices, but there is limited research on child toilet training. Social support with toilet training may be especially important for rural Indian caregivers as this is a new childcare practice for many and mothers face an already demanding workload. The aim of this study was to examine the role of social support in toilet training using mediation and conditional process analyses. We surveyed 570 caregivers of children <5 years old living in rural Odisha, India. We found certain types of support aid toilet training through three mechanisms: directly, by improving self‐efficacy, and by buffering against stress. Informational and instrumental support had a positive direct effect on toilet training while emotional support had no effect. Instrumental support also aided toilet training indirectly through bolstering a caregiver's perceived self‐efficacy. These effects of instrumental support were not moderated by the caregiver's support network size. Additionally, we found perceived stress had a negative indirect effect on caregivers' toilet training efforts through diminishing self‐efficacy, but this effect was buffered (i.e. moderated) by social support. These findings offer useful programmatic insights and expand the evidence‐base on how social support functions to another childcare practice and cultural context.
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Affiliation(s)
- Gloria D Sclar
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.,Department of Psychology, University of Zürich, Zürich, Switzerland
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