Academic journal article Family Relations

Asthma Management among Low-Income Latino and African American Families of Infants and Young Children*

Academic journal article Family Relations

Asthma Management among Low-Income Latino and African American Families of Infants and Young Children*

Article excerpt

To discover the underlying understandings that organize how low-income Latino and African American parents of infants and toddlers with severe persistent asthma manage symptoms in their children, 11 families with children 12-48 months old and recently hospitalized with asthma were interviewed over 3-6 months. Interpretive phenomenology was used to analyze parents' narratives about everyday asthma management practices. Four different family management styles were discovered: determined, discontinuous, flexible, and disrupted. Each arose from parents' particular understandings of asthma and asthma management. Attention to illness meaning and individually developed management plans would improve the family management of asthma in these high-risk families.

Key Words: African American, asthma, family, illness, Latino, low-income.

In the United States, children with asthma who are under 4 years of age experience higher rates of asthma and rates that are rising faster than other groups at risk for asthma (Grain et al., 1994; Sly, 1999). Between 1980 and 1994, children under 5 living in inner cities suffered an alarming 160% rise in prevalence and the highest prevalence in any age group. Moreover, disparities of disease incidence and severity are associated with poverty and ethnic identity. Children under 4 years old who live in poverty are hospitalized for asthma more often than any other age group (Gergen & Weiss, 1990; Wissow, Gittelsohn, Szklo, Starfield, & Mussman, 1988). Living in poverty and also being African American or Latino put children at higher risk for severe disease (Chabra, Chavez, Adams, & Taylor, 1998; Lin, Fitzgerald, Hwang, Munsie, & Stark, 1999).

Asthma is a disease of complex relationships between airway inflammation, obstruction, and hyperresponsiveness that is triggered by infectious agents, allergens, irritants, and/ or emotional Stressors. Genetic predisposition also contributes to asthma (National Institutes of Health [NIH], 1997). Understanding and managing asthma in infants and toddlers is complicated by the inability of children to communicate their distress verbally, by the subtlety of early illness signs, and by the difficulty of determining when early symptoms will progress to severe crisis (R. Sudhakkar, January, 1999). Moreover, there are no uniform criteria for the diagnosis of asthma in infants and toddlers. Objective measurement of respiratory function depends on peak flow meter readings, which are unreliable in children under 5 (Warman, Silver, McCourt, & Stein, 1999). Often these children are treated as if they have episodic rather than chronic respiratory disease (Werk, Steinbach, Adams, & Bauchner, 2000). In addition, National Institutes of Health Guidelines of the Diagnosis and Management of Asthma fail to address the special needs of children under 4 (NIH, 1997).

Risk for Asthma Severity

In addition to examination of the pathophysiology and genetics of asthma, the causes for disparities in asthma prevalence, morbidity, and severity in very young children are being studied from other perspectives, including indoor and outdoor environments, maternal stress, and symptom management. Environmental risk factors for asthma put low-income inner-city families at high risk and are difficult to ameliorate. These include exposure to viral illness, tobacco smoke, cockroaches, dust mites, and animal dander (Izurieta et al., 2000; Rosenstreich et al., 1997). Increased knowledge of pathophysiology and risk factors, the development of new medicines, and comprehensive guidelines for asthma management have reduced the long-held stigma that asthma is largely a psychological illness (Williams, 1975). However, the importance of the psychological Stressors on illness severity in young inner-city children is being revisited (Wright, Rodriguez & Cohen, 1998). In 2001, Wright reported that among low-income inner-city children, maternal stress contributed significantly to asthma severity. …

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