title: Persistent differences in asthma self-efficacy by race, ethnicity, and income in adults with asthma.
abstract: OBJECTIVE
  The objective of this population-based study was to determine if and to what extent there are differences in asthma self-efficacy by race/ethnicity and income, and whether health status, levels of acculturation, and health care factors may explain these differences.
  
  
  METHODS
  We conducted a secondary data analysis of asthma self-efficacy using the 2009 and 2011-2012 California Health Interview Survey, in adults with asthma (n=7874). In order to examine if and how the effect of race/ethnicity and income on asthma self-efficacy may have been altered by health status, acculturation, and health care factors, we used staged multivariable logistic regression models. We conducted mediation analyses to evaluate which of these factors might mediate disparities in self-efficacy by race/ethnicity and income.
  
  
  RESULTS
  69.8% of adults reported having high asthma self-efficacy. Latinos (OR 0.66; 95% CI 0.51-0.86), African-Americans (OR 0.50; 95% CI 0.29-0.83), American Indian/Alaskan Natives (OR 0.55; 95% CI 0.31-0.98) and Asian/Pacific Islanders (OR 0.34; 95% CI 0.23-0.52) were less likely to report high self-efficacy compared to Whites. Individuals with income below the federal poverty level (OR 0.56; 95% CI 0.40-0.78) were less likely to report high self-efficacy compared to higher income individuals. The relationship between income and self-efficacy was no longer significant after further adjustment for health care factors; however, the differences in race and ethnicity persisted. Receiving an asthma management plan mediated the relationship in certain subgroups.
  
  
  CONCLUSIONS
  Addressing modifiable health care factors may play an important role in reducing disparities in asthma self-efficacy.
authors: Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health , Madison, WI , USA .
authors: Ifna H
authors: IH
authors: Ejebe
authors: Elizabeth A
authors: EA
authors: Jacobs
authors: Lauren E
authors: LE
authors: Wisk
mesh_terms: D000328:Adult; D001249:Asthma / Q000208:ethnology / Q000628:therapy; D002140:California; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D007182:Income; D008297:Male; D008875:Middle Aged; D044469:Racial Groups; D020377:Self Efficacy
keywords: Education; management/control; prevention; quality of life