What Really Happens In The Home: The Medication Environment Of Urban, Minority Youth

Abstract

To describe the asthma medication environment in the homes of urban minority youth, and to determine predictors of medication use, technique, and asthma control in this high risk population. Baseline data from two cohorts of minority youth with asthma in Chicago were combined for cross-sectional analysis. Bilingual research assistants (RAs) asked caregivers and children to self-report medications using pictures and observed children’s asthma medicines and inhaler technique. Adherence was determined using electronic actuation monitors and/or medication counters. The sample contained 162 mainly Latino (93%) youth ranging from 5-18 years old. Almost all were on public insurance (79%). Most had uncontrolled asthma (69% in last 4-weeks, 79% in last 12-months). Only 25% had a spacer, 78% had a quick relief medicine, and 49% had any controller. RA observations controllers showed good agreement with parent self-report (kappa=0.64) and child self-report (kappa=0.57). Children reported less parental help with medications (41%) than their parents (53%) (kappa=0.40). Only 6% of children with inhaled corticosteroids (n=54) took 4 doses/day. For the metered dose inhaler (n=141), 37% were able to properly demonstrate ≥ 6 correct steps; 33% did not actuate the medicine. Improved medication technique was associated with having an observed controller (p=0.05), having a spacer (p=0.01), more English spoken at home (p=0.02), and caregiver education level (p=0.01) but not with asthma control. This rigorous evaluation of the medication home environment of high risk youth demonstrated that many families lack critical medications, devices, technique, and adherence for proper medical management of asthma.