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Original Research: Asthma |

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, MD, PhD; Esteban Gonzalez Burchard, MD, MPH
Author and Funding Information

FUNDING/SUPPORT: This work was 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 an 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.

Drs Thakur and Barcelo contributed equally to this manuscript.

This work was presented in abstract form at the annual meeting of the American Thoracic Society, May 16-21, 2014, San Diego, CA.

aDepartment of Medicine, University of California, San Francisco, San Francisco

bDepartment of Bioengineering and Therapeutic Sciences, University of California, San Francisco, San Francisco

cDepartment of Allergy and Immunology, Kaiser Permanente Vallejo Medical Center, Vallejo

dDepartment of Pediatrics, University of California, Los Angeles, Los Angeles, CA

eDepartment of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York, New York

fPediatric Pulmonary Division, Jacobi Medical Center, Bronx, NY

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

hBay Area Pediatrics, Oakland, CA

iDepartment of Medicine, Northwestern University, Chicago, IL

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

kVeterans Caribbean Health Care System, San Juan, Puerto Rico

lCentro de Neumología Pediátrica, San Juan, Puerto Rico

mDepartment of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN

CORRESPONDENCE TO: Luisa N. Borrell, DDS, PhD, Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York, 55 W 125th St, New York, NY 10027


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2017;151(4):804-812. doi:10.1016/j.chest.2016.11.027
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Background  Asthma disproportionately affects minority populations and is associated with psychosocial stress such as racial/ethnic discrimination. We aimed to examine the association of perceived discrimination with asthma and poor asthma control in African American and Latino youth.

Methods  We included African American (n = 954), Mexican American (n = 1,086), other Latino (n = 522), and Puerto Rican Islander (n = 1,025) youth aged 8 to 21 years from the Genes-Environments and Admixture in Latino Americans study and the Study of African Americans, Asthma, Genes, and Environments. 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 a 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 a 78% greater odds of experiencing asthma (OR, 1.78; 95% CI, 1.33-2.39) than did 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) over 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 among low-SES Mexican American youth (interaction P = .01) and among high-SES other Latino youth (interaction P = .04).

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

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