title: Modifiable risk factors for suboptimal control and controller medication underuse among children with asthma.
abstract: OBJECTIVE
  Our aims were (1) to describe rates of suboptimal control and controller medication underuse in a diverse population of children with asthma and (2) to identify potentially modifiable parental behaviors and beliefs associated with these outcomes.
  
  
  METHODS
  We conducted telephone interviews with parents of 2- to 12-year-old children with persistent asthma, in a Medicaid plan and a large provider group. Suboptimal control was defined as >or=4 symptom days, >or=1 symptom night, or >or=4 albuterol use days in the previous 2 weeks. Controller medication underuse was defined as suboptimal control and parent report of <6 days/week of inhaled steroid use. Multivariate analyses identified factors that were independently associated with suboptimal control and controller medication underuse.
  
  
  RESULTS
  Of the 754 study children, 280 (37%) had suboptimal asthma control; this problem was more common in Hispanic children (51%) than in black (37%) or white (32%) children. Controller medication underuse was present for 133 children (48% of those with suboptimal asthma control and 18% overall). Controller medication underuse was more common among Hispanic (44%) and black (34%) children than white (22%) children. In multivariate analyses, suboptimal control was associated with potentially modifiable factors including low parental expectations for symptom control and high levels of worry about competing household priorities. Controller medication underuse was associated with potentially modifiable factors including parental estimation of asthma control that was discordant with national guidelines and no set time to administer asthma medications.
  
  
  CONCLUSIONS
  Deficiencies in asthma control and controller medication use are associated with potentially modifiable parental beliefs, which seem to mediate racial/ethnic and socioeconomic disparities in suboptimal control and controller medication underuse.
authors.affiliation: Department of Pediatrics, School of Medicine, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, Massachusetts, USA. Lauren.smith@state.ma.us
authors.forename: Lauren A
authors.initials: LA
authors.lastname: Smith
authors.forename: Barbara
authors.initials: B
authors.lastname: Bokhour
authors.forename: Katherine H
authors.initials: KH
authors.lastname: Hohman
authors.forename: Irina
authors.initials: I
authors.lastname: Miroshnik
authors.forename: Kenneth P
authors.initials: KP
authors.lastname: Kleinman
authors.forename: Ellen
authors.initials: E
authors.lastname: Cohn
authors.forename: Dharma E
authors.initials: DE
authors.lastname: Cortés
authors.forename: Alison
authors.initials: A
authors.lastname: Galbraith
authors.forename: Cynthia
authors.initials: C
authors.lastname: Rand
authors.forename: Tracy A
authors.initials: TA
authors.lastname: Lieu
mesh_terms: D018927:Anti-Asthmatic Agents / Q000191:economics / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy* / Q000191:economics; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004363:Drug Utilization / Q000706:statistics & numerical data*; D006801:Humans; D008484:Medicaid; D018570:Risk Assessment; D012307:Risk Factors; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014481:United States
chemical_list: D018927:Anti-Asthmatic Agents