title: Addressing asthma health disparities: a multilevel challenge.
abstract: Substantial research has documented pervasive disparities in the prevalence, severity, and morbidity of asthma among minority populations compared with non-Latino white subjects. The underlying causes of these disparities are not well understood, and as a result, the leverage points to address them remain unclear. A multilevel framework for integrating research in asthma health disparities is proposed to advance both future research and clinical practice. The components of the proposed model include health care policies and regulations, operation of the health care system, provider/clinician-level factors, social/environmental factors, and individual/family attitudes and behaviors. The body of research suggests that asthma disparities have multiple, complex, and interrelated sources. Disparities occur when individual, environmental, health system, and provider factors interact with one another over time. Given that the causes of asthma disparities are complex and multilevel, clinical strategies to address these disparities must therefore be comparably multilevel and target many aspects of asthma care. Several strategies that could be applied in clinical settings to reduce asthma disparities are described, including the need for routine assessment of the patient's beliefs, financial barriers to disease management, and health literacy and the provision of cultural competence training and communication skills to health care provider groups.
authors.affiliation: Behavioral Sciences Research Institute and the Department of Pediatrics, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico. Glorisa.canino@upr.edu
authors.forename: Glorisa
authors.initials: G
authors.lastname: Canino
authors.forename: Elizabeth L
authors.initials: EL
authors.lastname: McQuaid
authors.forename: Cynthia S
authors.initials: CS
authors.lastname: Rand
mesh_terms: D001249:Asthma / Q000191:economics / Q000453:epidemiology* / Q000517:prevention & control*; D019983:Guideline Adherence / Q000191:economics / Q000592:standards; D006297:Health Services Accessibility / Q000191:economics* / Q000592:standards; D054624:Health Status Disparities; D054625:Healthcare Disparities / Q000191:economics* / Q000592:standards; D006801:Humans; D011787:Quality of Health Care / Q000191:economics* / Q000592:standards; D012959:Socioeconomic Factors