BUILDING EVIDENCE TO REDUCE CHILDHOOD ASTHMA HEALTH DISPARITIES IN HAWAI‘I

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2021

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Asthma, a chronic lung disease that inflames and narrows the airways, affects about 6.2 million children in the United States (US). In 2013, childhood asthma was the leading cause of school absenteeism. Racial/ethnic disparities also exist, with Native Hawaiian children suffering from an extremely high prevalence of asthma. In Hawai‘i, important questions exist on this topic. The purpose of this dissertation was to shed light on childhood asthma disparities in Hawai‘i and provide evidence for developing asthma education programs to improve asthma-related health outcomes among children in Hawai‘i. This dissertation was comprised of three studies. Study 1 analyzed the Hawai‘i Health Information Corporation (HHIC) data (2015-2016) to establish the total direct cost of asthma-related emergency department (ED) visits among children with asthma in Hawai‘i. Findings showed Native Hawaiians had the largest proportion of all preventable ED visits compared to Asian Americans and Whites in Hawai‘i. Preventable ED visits also differed significantly by age, insurance provider, and island of residency. Study 2 was a systematic literature review assessing the effectiveness of school-based asthma education programs for children in the US in reducing acute health care services. The overall findings suggested school-based asthma education programs are associated with reductions in acute care services. Study 3 used qualitative methods through Photovoice to ascertain perceived factors that affect asthma management among children in Hawai‘i. Eight key themes (four supports and four barriers) were identified by students from the Wai‘anae Coast. The four supports were ‘āina (land), safe haven, alternative remedies, and communtiy support. The four barriers were various physical activity, food/edibile, environmental, and emotional triggers. Findings provided a better understanding on the role a student’s environment plays in asthma management. Overall, findings from this dissertation highlight the need for asthma education programs in Hawai‘i to reduce the financial burden on insurance payers, families, and health care systems from preventable acute asthma-related health care services, and provide evidence about the best ways to build such programs.

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Public health, asthma, childhood, education, Hawaii

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152 pages

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