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Original Research |

Perceived Discrimination Associated with Asthma and Related Outcomes in Minority Youth: The GALA II and SAGE II Studies

Neeta Thakur, MD, MPH; Nicolas E. Barcelo, MD; Luisa N. Borrell, DDS PhD; Smriti Singh, MPH; Celeste Eng, BS; Adam Davis, MA; Kelley Meade, MD; Michael A. LeNoir, MD; Pedro C. Avila, MD; Harold J. Farber, MD, MSPH; Denise Serebrisky, MD; Emerita Brigino-Buenaventura, MD; William Rodriguez-Cintron, MD; Shannon Thyne, MD; Jose R. Rodriguez-Santana, MD; Saunak Sen, PhD; Kirsten Bibbins-Domingo, PhD, MD; Esteban Gonzalez Burchard, MD MPH
Author and Funding Information

Funding Support:

Supported in part by the Sandler Family Foundation, the National Institutes of Health (R01-ES015794, U19-AI077439, R01-HL088133, R01-HL078885, R01-HL104608, R21ES24844-01, 1R01MD010443, and P60-MD006902); M01-RR00188 to H.J.F.; the Flight Attendant Medical Research Institute (FAMRI), the RWJF Amos Medical Faculty Development Award (to E.G.B.), and the American Asthma Foundation (to E.G.B.). N.T. was supported by institutional training grant from the NIGMS (T32-GM007546) and career development awards from the NHLBI (K12-HL119997 and K23- HL125551-01A1), Parker B. Francis Fellowship Program, and the American Thoracic Society. N.B. was supported by R25MD006832 from the NIMHD. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Role of sponsors: The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and the decision to submit the manuscript for publication.

Financial Disclosure Statement: The authors have no financial relationships relevant to this article to disclose.

Conflict of Interest: The authors have no conflicts of interest to disclose.

1Department of Medicine, University of California, San Francisco, San Francisco, CA

2Department of Epidemiology & Biostatistics, Graduate School of Public Health and Health Policy, City University of New York, New York, NY

3Children's Hospital Oakland Research Institute, UCSF Benioff Children’s Hospital, Oakland, CA

4Bay Area Pediatrics, Oakland, CA

5Department of Medicine, Northwestern University, Chicago, IL, USA

6Department of Pediatrics, Section of Pulmonology, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX

7Pediatric Pulmonary Division, Jacobi Medical Center, Bronx, NY, USA

8Department of Allergy and Immunology, Kaiser Permanente-Vallejo Medical Center, Vallejo, CA

9Veterans Caribbean Health Care System, San Juan, Puerto Rico

10Department of Pediatrics, University of California, Los Angeles, Los Angeles, CA

11Centro de Neumología Pediátrica, San Juan, Puerto Rico

12Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN

13Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, San Francisco, CA

Correspondence author: Luisa N. Borrell, DDS, PhD Department of Epidemiology & Biostatistics Graduate School of Public Health and Health Policy City University of New York 55 West 125th Street New York, NY 10027.


Copyright 2016, . All Rights Reserved.


Chest. 2016. doi:10.1016/j.chest.2016.11.027
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Abstract

Background  Asthma disproportionately affects minority populations and is associated with psychosocial stress, such as racial/ethnic discrimination. We aim to examine the association of perceived discrimination with having asthma and poor asthma control in African American and Latino youth.

Methods  We included African American (n=954), Mexican American (n=1086), other Latino (n=522), and Puerto Rican Islander (n=1025) youth (aged 8 to 21 years old) from the GALA II and SAGE II studies. Asthma was defined by physician-diagnosis and asthma control was defined based on the National Heart, Lung, and Blood Institute guidelines. Perceived racial/ethnic discrimination was assessed by the Experiences of Discrimination questionnaire with focus on school, medical, and public settings. We examined the associations of perceived discrimination with each outcome and whether socioeconomic status (SES) and global African ancestry modified these associations.

Results  African American children reporting any discrimination had 78% greater odds of asthma (OR: 1.78; 95% confidence intervals [CI]:1.33-2.39) than those not reporting discrimination. Similarly, African American children faced increased odds of poor asthma control with any experience of discrimination (OR: 1.97; 95%CI:1.42-2.76) than their counterparts not reporting discrimination. These associations were not observed among Latino children. We observed heterogeneity of the association between reports of discrimination and asthma according to SES with reports of discrimination increasing the odds of having asthma in low SES Mexican American youth (interaction-p-value=0.01) and amongst high SES other Latino youth (interaction-p-value=0.04).

Conclusion  Perceived discrimination is associated with increased odds of asthma and poorer control among African American youth. Socioeconomic status exacerbates the effect of perceived discrimination on having asthma among Mexican American and other Latino youth.


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