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Original Research: Asthma |

Parental Numeracy and Asthma Exacerbations in Puerto Rican ChildrenParental Numeracy, Childhood Asthma, Puerto Ricans

Christian Rosas-Salazar, MD; Sima K. Ramratnam, MD; John M. Brehm, MD, MPH; Yueh-Ying Han, PhD; Edna Acosta-Pérez, PhD; María Alvarez, MD; Angel Colón-Semidey, MD; Glorisa Canino, PhD; Andrea J. Apter, MD; Juan C. Celedón, MD, DrPH
Author and Funding Information

From the Division of Pediatric Pulmonary Medicine, Allergy, and Immunology (Drs Rosas-Salazar, Ramratnam, Brehm, Han, and Celedón), Children’s Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, PA; the Behavioral Sciences Research Institute and Department of Pediatrics (Drs Acosta-Pérez, Alvarez, Colón-Semidey, and Canino), University of Puerto Rico, San Juan, Puerto Rico; and the Division of Pulmonary, Allergy, and Critical Care Medicine (Dr Apter), Department of Medicine, University of Pennsylvania, Philadelphia, PA.

Correspondence to: Juan C. Celedón, MD, DrPH, 4401 Penn Ave, Pittsburgh, PA 15224; e-mail: juan.celedon@chp.edu


Funding/Support: This work was supported by the US National Institutes of Health (NIH) [Grant HL079966]. Dr Brehm’s contribution was supported by the NIH [Grant HD052892], and Dr Apter’s contribution was supported by the NIH [Grants HL088469 and HL099612].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;144(1):92-98. doi:10.1378/chest.12-2693
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Background:  Puerto Ricans share a disproportionate burden of childhood asthma in the United States. Little is known about the impact of low parental numeracy (a health literacy skill) on asthma morbidity in Puerto Rican children. Our objective was to examine whether low parental numeracy is associated with increased asthma morbidity in Puerto Rican children.

Methods:  This was a cross-sectional study of 351 children with asthma, aged 6 to 14 years, living in San Juan, Puerto Rico. Parents of study participants completed a modified version of the Asthma Numeracy Questionnaire. Multivariate linear or logistic regression was used to examine the relation between low parental numeracy (defined as no correct answers in the modified Asthma Numeracy Questionnaire) and indicators of asthma morbidity (severe asthma exacerbations, core measures of asthma exacerbations, and lung function measures). All multivariate models were adjusted for age, sex, household income, reported use of inhaled corticosteroids in the previous 6 months, and exposure to secondhand tobacco smoke.

Results:  Low parental numeracy was associated with increased odds of visits to the ED or urgent care for asthma (adjusted OR [aOR] = 1.7, 95% CI = 1.03-2.7, P = .04). The association between low parental numeracy and hospitalizations for asthma was significant only among children not using inhaled corticosteroids (aOR = 2.8, 95% CI = 1.4-5.6, P = .004). There was no association between low parental numeracy and use of systemic steroids or lung function measures.

Conclusions:  Low parental numeracy is associated with increased asthma morbidity in Puerto Rican children.

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