Bradley/Hasbro Children's Research Center, 1 Hoppin St, Providence, RI 02903, USA.
Pediatrics. 2012 Jun;129(6):e1404-10. doi: 10.1542/peds.2011-1391. Epub 2012 May 7.
Latino children of Caribbean descent remain at high risk for poorly controlled asthma. Controller medications improve asthma control; however, medication adherence remains suboptimal, particularly among minorities. This study assessed socioeconomic, family-based, and parent factors in medication adherence among children with asthma from Rhode Island (RI; Latino and non-Latino white [NLW]) and Puerto Rico.
Data collection occurred as part of a multicenter study of asthma disparities. Our sample included children (ages 7-16) prescribed objectively monitored controller medications (n = 277; 80 island Puerto Rico, 114 RI Latino, 83 RI NLW). Parents completed questionnaires regarding family background and beliefs about medications. Families participated in an interview regarding asthma management. Multilevel analyses (maximum likelihood estimates) accounting for children being nested within site and ethnic group assessed the contribution of social context, family, and parent variables to medication adherence.
Medication adherence differed by ethnic group (F(2, 271) = 7.46, P < .01), with NLW families demonstrating the highest levels of adherence. Multilevel models indicated that parental beliefs about medication necessity and family organization regarding medication use were significant predictors of adherence, even for families below the poverty threshold. With family factors in the model, a substantial improvement in model fit occurred (Akaike Information Criterion change of 103.45).
Adherence to controller medications was lower among Latino children in our sample. Targeted interventions that capitalize on existing family resources, emphasize structure, and address parental beliefs about the importance of medications may be of benefit to families from different cultural backgrounds.
加勒比海裔拉丁裔儿童的哮喘控制仍然很差。控制药物可改善哮喘控制；然而，药物依从性仍然不理想，尤其是在少数族裔中。本研究评估了罗得岛（RI；拉丁裔和非拉丁裔白人[NLW]）和波多黎各的哮喘儿童的社会经济、家庭和父母因素与药物依从性的关系。
数据收集是作为哮喘差异的多中心研究的一部分进行的。我们的样本包括服用客观监测控制药物的儿童（年龄 7-16 岁；80 名波多黎各岛，114 名 RI 拉丁裔，83 名 RI NLW）。父母完成了关于家庭背景和药物信念的问卷。家庭参与了关于哮喘管理的访谈。多层次分析（最大似然估计）考虑了儿童嵌套在站点和族裔群体内，评估了社会背景、家庭和父母变量对药物依从性的贡献。
药物依从性因族裔群体而异（F（2,271）=7.46，P<.01），NLW 家庭的依从性最高。多层次模型表明，父母对药物必要性的信念和家庭组织对药物使用的组织与药物依从性密切相关，即使是贫困家庭也是如此。在模型中加入家庭因素后，模型拟合度有了显著提高（Akaike 信息准则变化 103.45）。
在我们的样本中，拉丁裔儿童对控制药物的依从性较低。针对不同文化背景的家庭，利用现有家庭资源、强调结构并解决父母对药物重要性的信念的针对性干预可能会对家庭有所帮助。
