Multifactorial Asthma Determinants in Underresourced Pediatric Populations

Pediatric asthma, the most common chronic condition of childhood, has known disparities, particularly among racial and ethnic minority children who experience higher asthma morbidity. Asthma is also more prevalent among children in rural, impoverished areas, including rural Arkansas (AR), where rural and underresourced children face high rates of asthma prevalence, morbidity, and increased healthcare utilization. For example, asthma prevalence in the rural AR Delta region is 19%, compared to the state average of 10%. Additionally, preliminary state-wide data found that Black children with asthma in AR are more likely to have asthma-related ED visits (8.2%, p<0.001) than other race and ethnicity groups. Arkansan children living in low opportunity areas, as designated by the Child Opportunity Index, a measure of neighborhood differences, were also more likely to have worse asthma outcomes. Preliminary state-wide data also suggest that current asthma risk tools are inadequate for identifying Arkansan children at high risk for poor asthma outcomes. Research is needed to identify and understand factors influencing disparate pediatric asthma outcomes among rural, underresourced, and racial and ethnic minority pediatric populations. By understanding these specific factors, this proposal seeks to inform targeted interventions that address the unique needs of these populations in AR and other similar rural, underresourced populations. This K23 proposal for a 4-year mentored research career development award seeks to improve scientific knowledge of multilevel (patient, provider, and community-level) factors influencing pediatric asthma outcomes through systematically investigating multifactorial determinants of asthma in AR. Additionally, evaluating variation in asthma outcomes and care at multiple levels will aid in identifying children at risk for poor asthma outcomes and will be the foundation of clinically relevant patient-centered intervention strategies for children with asthma. The proposal aims to (Aim 1) identify population-specific pediatric asthma risk factors, barriers, intervention preferences, and opportunities for intervention through the engagement of children with asthma and their caregivers, and (Aim 2) examine patient, provider, and community-level factors impacting disparity in optimal delivery and receipt of asthma care using the Arkansas All-Payer Claims Database. An exploratory sequential mixed methods approach will be used to achieve these aims. The long-term goal of this study is to improve asthma outcomes and promote full health potential for underresourced populations by applying innovative research tools and strategies to enhance individual and population-level care in pediatric asthma. An outstanding mentorship team with cross-disciplinary expertise in (1) qualitative and mixed methods, (2) population health science, and (3) asthma health disparities research, along with a clear training plan to address the need for additional training in qualitative and mixed methods research approaches, will ensure success in completing the proposed K23 research, and development of the PI into an independent, extramurally-funded researcher.