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BACKGROUND: Black adults are disproportionately affected by asthma and are often considered a homogeneous group in research studies despite cultural and ancestral differences. OBJECTIVE: We sought to determine if asthma morbidity differs across adults in Black ethnic subgroups. METHODS: Adults with moderate-severe asthma were recruited across the continental United States and Puerto Rico for the PREPARE (PeRson EmPowered Asthma RElief) trial. Using self-identifications, we categorized multiethnic Black (ME/B) participants (n = 226) as Black Latinx participants (n = 146) or Caribbean, continental African, or other Black participants (n = 80). African American (AA/B) participants (n = 518) were categorized as Black participants who identified their ethnicity as being American. Baseline characteristics and retrospective asthma morbidity measures (self-reported exacerbations requiring systemic corticosteroids [SCs], emergency department/urgent care [ED/UC] visits, hospitalizations) were compared across subgroups using multivariable regression. RESULTS: Compared with AA/B participants, ME/B participants were more likely to be younger, residing in the US Northeast, and Spanish speaking and to have lower body mass index, health literacy, and <1 comorbidity, but higher blood eosinophil counts. In a multivariable analysis, ME/B participants were significantly more likely to have ED/UC visits (incidence rate ratio [IRR] = 1.34, 95% CI = 1.04-1.72) and SC use (IRR = 1.27, 95% CI = 1.00-1.62) for asthma than AA/B participants. Of the ME/B subgroups, Puerto Rican Black Latinx participants (n = 120) were significantly more likely to have ED/UC visits (IRR = 1.64, 95% CI = 1.22-2.21) and SC use for asthma (IRR = 1.43, 95% CI = 1.06-1.92) than AA/B participants. There were no significant differences in hospitalizations for asthma among subgroups. CONCLUSIONS: ME/B adults, specifically Puerto Rican Black Latinx adults, have higher risk of ED/UC visits and SC use for asthma than other Black subgroups.

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Assuntos

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OBJECTIVE: To determine the risk of herpes zoster (HZ) in children with and without asthma. STUDY DESIGN: This study was designed as a population-based case-control study. We examined all children (aged <18 years) with possible HZ in Olmsted County, Minnesota, between 1996 and 2001 (n = 306; identified by International Classification of Diseases, Eighth Revision codes and predetermined criteria for HZ) to identify true cases. To determine the association between asthma and HZ, we compared the frequency of asthma among children with HZ with that among age- and sex-matched corresponding controls (1:1 matching) who resided in Olmsted County, Minnesota, during the study period. Asthma was ascertained based on predetermined criteria. A conditional logistic regression model was used to calculate ORs and 95% CIs. RESULTS: We identified 277 eligible patients with HZ, 63 (23%) of whom had a history of asthma before the index date of HZ, compared with 35 of 277 (12.6%) matched controls (aOR, 2.09; 95% CI, 1.24-3.52; P = .006), adjusting for varicella vaccination and atopy status. The population-attributable risk percentage was 12%. Controlling for asthma and atopy status, varicella vaccination was associated with reduced risk of HZ (aOR, 0.44; 95% CI, 0.21-0.92; P = .028). CONCLUSION: Asthma may be an unrecognized risk factor for reactivation of a non-airway-related latent infection such as HZ in children.

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Breastfeeding is highly beneficial to mothers and children. Yet even among women who intend to breastfeed their babies, it is not always initiated or sustained. We decided to examine whether cultural beliefs affect breastfeeding practices. Specifically, we looked at those of immigrant Mexican and Somali women who gave birth at a community hospital in southeastern Minnesota and those of the nurses and lactation educators who supported them. To study this, we conducted focus groups with health professionals (N=10) and in-person interviews with Somali and Mexican mothers (N=9). Although the mothers in this study stated their intention to breastfeed, our data show they faced significant challenges to early breastfeeding initiation and exclusive breastfeeding, including their belief that they did not initially produce enough milk. We found the nurses' and lactation educators' discomfort with counseling people from another background as well as language differences and lack of cultural understanding were also barriers to early breastfeeding initiation and exclusive breastfeeding. This study highlights how the beliefs of new mothers and the attitudes of nurses and educators can affect breastfeeding outcomes.

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OBJECTIVE: Using a unique county-wide resource that links all health care providers' medical records to assess current and "ever" prevalence of physician-diagnosed asthma. To describe the age and sex rates and temporal trends in new asthma diagnoses and associations with race and socio-economic status. STUDY DESIGN: A longitudinal retrospective evaluation of a population-based cohort of school children using linked medical and school records. RESULTS: Overall, 17.6% of children in grades kindergarten through 12 had a physician diagnosis of asthma and 12.9% had an asthma-related visit within the past 2 years. An additional 19.7% had visits for reactive airway disease or recurrent wheezing or bronchospasm with no diagnosis of asthma. Children provided with free and reduced-cost lunches had lower cumulative and incident asthma rates from birth through their current school age. Race was not related to rates of physician-diagnosed asthma. There was a significant temporal increase in rates of new asthma diagnoses. CONCLUSIONS: In this community, 1 in 3 children have had a physician-documented recurrent wheezing-type illness, and 1 in 6 were diagnosed with asthma. Diagnoses rates were directly related to socioeconomic status.

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