Elevated Asthma Morbidity In Puerto Rican Children: A Review of Possible Risk and Prognostic Factors

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Latino children represent a significant proportion of all US children, and asthma is the most common chronic illness affecting them. Previous research has revealed surprising differences in health among Latino children with asthma of varying countries of family origin. For instance, Puerto Rican children have a higher prevalence of asthma than Mexican American or Cuban American children. In addition, there are important differences in family structure and socioeconomic status among these Latino populations: Cuban Americans have higher levels of education and family income than Mexican-Americans and Puerto Ricans; mainland Puerto Rican children have the highest proportion of households led by a single mother. Our review of past research documents differences in asthma outcomes among Latino children and identifies the possible genetic, environmental, and health care factors associated with these differences. Based on this review, we propose research studies designed to differentiate between mutable and immutable risk and prognostic factors. We also propose that the sociocultural milieus of Latino subgroups of different ethnic and geographic origin are associated with varying patterns of risk factors that in turn lead to different morbidity patterns. Our analysis provides a blueprint for future research, policy development, and the evaluation of multifactorial interventions involving the collaboration of multiple social sectors, such as health care, public health, education, and public and private agencies. Viagra Professional 100 mg

Health status, use of health services, and socio-demo-graphic attributes vary among subgroups of Latino children. For example, the 1982-84 Hispanic Health and Nutrition Examination Survey (HHANES) revealed that mainland Puerto Rican children have higher rates of asthma (11.5%), psychological and behavioral problems (5.7%), speech problems (6.7%), and mental retardation (3.1%) than Mexican American and Cuban American children. The 1989-1991 National Health Interview Surveys (NHIS) indicated that mainland Puerto Rican children had the highest average number of annual bed days due to illness (9 annual bed days), followed by Mexican American children, then Cuban American children who did not differ from non-Latino white children (6 annual bed days). Puerto Rican children, who are both the poorest of all children in the United States and the sickest among Latino children, also had the highest average number of doctor visits of all US children (13 doctor visits per year). In comparison, one quarter of Mexican American children did not visit a doctor at least once a year, and poor children of Mexican origin spent fewer days in bed than their non-poor counterparts. These differences in disease prevalence and health outcome suggest that specific patterns of risk factors may vary by Latino subgroup. canadian healthcare viagra

In 1990 in the United States and Puerto Rico, 13% of children younger than 15 were of Latino origin. An estimated half million Latino children had asthma symptoms, two-thirds of whom were of Puerto Rican origin. In this paper, we use asthma as a model to explore differences in morbidity among Latino children. In particular, we review what is known about asthma morbidity among Latino subgroups; identify risk and prognostic factors that may explain these differences, placing special emphasis on those factors that are mutable or amenable to intervention; and discuss the research, clinical, and public health implications of these differences in morbidity.

Definitions
Asthma Prevalence and Morbidity
Past studies have measured prevalence rates for asthma, or the proportion of a population having the condition, using reports of asthma symptoms or physician diagnosis and the time period for which prevalence is estimated. Wheezing is the asthma symptom on which most prevalence estimates are based. Prevalence can be considered in two time periods: ever asthma, referring to lifetime or cumulative prevalence, and active asthma, referring to point or period prevalence. Ever asthma refers to children whose parents have been told that the child has asthma, but who have not had any symptoms or impairment in the last year. Active asthma refers to children whose parents have been told that the child has asthma and who have experienced symptoms or impairment within the last 12 months. canadian cialis

Morbidity level, on the other hand, refers to the degree to which a child with active asthma experiences symptoms or pulmonary and functional impairment. In characterizing morbidity level, three dimensions are important: control of asthma symptoms, functional status, and quality of life. Asthma control refers to the frequency and intensity of asthma symptoms and variations in objective measures of pulmonary function. Functional status refers to the degree to which asthma affects the physical, mental, and social function of the child, such as the number of school and activity days lost as a result of asthma. Lastly, quality of life refers to the perception of impairment, in that the children or parents may perceive children with the same level of symptoms and number of school days lost to be impaired to different degrees. Previous research also indicates that the report of symptoms and the perception of impairment can differ by reporter, or parent versus child, and by ethnicity, for instance Latino versus non-Latino.

Latino Ethnicity
People of Latino ethnicity can differ by country of origin and place of residence. Puerto Ricans are either born on the island of Puerto Rico (island Puerto Ricans) or in the continental United States to parents born in Puerto Rico or of Puerto Rican ancestry (mainland Puerto Ricans). Because migration between the island and the mainland is common, island and mainland Puerto Ricans can also be identified by place of past and current residence. Island Puerto Ricans are US citizens by birth. Mexican Americans are either born in the Unites States to Mexican born parents or are naturalized immigrants from Mexico. Similarly, Cuban Americans may have been born in the United States or may be naturalized Cuban immigrants. Because place of birth and early life residence may be risk factors for asthma, it is important to define Latino ethnicity as specifically as possible. buy cheap levitra