Gender-Related Asthma Challenges in a Sample of African American Women

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Lara J Thomas MPH1, Mary R Janevic MPH1, Georgiana Sanders MD2, Noreen M Clark PhD1
for Managing Chronic Disease, University of Michigan School of Public Health, Ann Arbor, MI, United States 2 Division of Allergy and Clinical Immunology, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI, United States
1Center

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Background
Women bear an excess asthma burden in terms of prevalence and severity (1,8). Race disparities in asthma morbidity and mortality (5) mean that African American women face double jeopardy in terms of asthma-related outcomes. Factors associated with female gender roles can influence both asthma symptoms and asthma management (2). No prior study has examined gender influences on asthma control among African American women, and whether these influences might vary within this population.

Table 1:Gender-related triggers/barriers Asthma triggers: Asthmamanagement barriers Family and work responsibilities Balancing responsibilities Communication with physicians Weight or body image Money worries

Table 4: Differences in role related problems and asthma management problems by age group and education level Table 2: Percent of women bothered by asthma at least some of the time when doing activities or using products by education level (n=223)
Dusting* Fragrances Cleaning Vacuuming Social activities Child care Hair products* Shopping* Cooking Sexual activity
19.7% 22.4% 19.7% 16.9% 14.1% 11.3% 9.9% 34.9% 36.2% 35.2% 40.8% 43.4% 41.4% 57.7% 54.9% 52.1%

MODEL 1: Gender Related Problems*

N Age Group 18-45 46-64
71.7%

MODEL 2: Asthma Management Problems*

LSMean (95% CI) 2.15 (2.0, 2.3) 2.29 (2.1, 2.5) 1.82 (1.4, 2.3) p-value

LSMean (95%CI) 2.13 (2.0, 2.3) 2.16 (2.0, 2.3) 1.86 (1.5, 2.2)

p-value

Objectives
We used baseline data from an ongoing randomized controlled trial of an asthma-management intervention for African American women (6) to answer these two research questions: 1. What are the most common gender-related asthma triggers and asthma-management barriers among African American women? 2. Does the frequency of these triggers and barriers vary by age and education level?

Vacuuming Dusting Cooking Shopping Cleaning products Fragrances Cosmetics Hair products Child care Social activities Sexual activity

127 80 16

NS

NS

65+ Education High school / some college College / graduate degree

65.1% 61.2%

152 71

2.17 (2.0, 2.3) 0.02 1.96 (1.7, 2.1)

2.24 (2.0, 2.4) 0.03 1.94 (1.7, 2.2)

*Outcome is a mean score of responses to all items. Responses were on a scale of 1-5 where 1=it is never a problem and 5=it is always a problem. College or graduate degree (n=71) High school or some college (n=152) LSMean is the mean value of the outcome at each level of the variable adjusted for all other variables in the model.

21.1%

17.1%

Conclusions
30% 40% 50% 60% 70% 80%

Cosmetics 0%

16.4%

10%

20%

*The difference between education levels for these items is significant, p<0.05

Results
The majority of women are bothered by asthma when dusting, using fragrances or using cleaning products (see Table 2). Dusting, using hair products and shopping are significantly more likely to be triggers for women without a college degree (see Table 2). Controlling for age, women without a college degree also scored significantly lower on a summary score of asthma triggers and of asthma-management barriers (see Table 3). The frequency of triggers and barriers was not associated with age (see Table 3).

Table 3: Percent of women who find managing asthma a challenge due to the following reasons by education level (n=223)

Methods
Data source: Trained telephone interviewers collected data on health, sociodemographics, and gender role influences (see Table 1) from 223 women (mean age 44 years) with persistent asthma receiving care at the University of Michigan, who agreed to participate in the RCT. Analysis: We calculated the overall frequency of these triggers and barriers (1=never and 5=all the time). Multiple linear regression was used to determine whether the frequency varied by age group and education level.

Weight or body image

47.9% 57.9% 45.1% 56.6% 40.8% 43.4% 32.4% 44.1% 31.0% 34.9% 21.1% 21.1%

Preliminary data suggest gender-related triggers and barriers to asthma management may be greater for those African American women without a college degree, possibly because of differences in gender role expectations and fewer resources to manage family responsibilities and health related demands. Future research should expand understanding of within-group variation in gender-related factors influencing disease management, to better target intervention strategies to subgroups of women.

Money concerns

References
1. Centers for Disease Control and Prevention (CDC). Vital signs: Asthma prevalence, disease characteristics, and self-management education: United States, 2001--2009. MMWR Morb Mortal Wkly Rep. 2011 May 6;60(17):547-52. 2. Clark NM, Gong ZM, Valerio MA: Self-regulation and women with asthma. Curr Opin Allergy Clin Immunol 2008 Jun;8(3):222-7. 3. Clark NM, Gong ZM, Wang SJ, Lin X, Bria WF, Johnson TR: A randomized trial of a self-regulation intervention for women with asthma. Chest 2007;132(1):88-97. 4. Clark NM, Gong ZM, Wang SJ, Valerio MA, Bria WF, Johnson TR: From the female perspective: Long-term effects on quality of life of a program for women with asthma. Gend Med 2010;7(2):125-136. 5. Ginde AA, Espinola JA, Camargo CA,Jr: Improved overall trends but persistent racial disparities in emergency department visits for acute asthma, 1993-2005. J Allergy Clin Immunol 2008 Aug;122(2):313-8. 6. Janevic MR, Sanders GM, Thomas LJ, Williams DM, Nelson B, Gilchrist E, Johnson TRB, Clark, NM: Study protocol for Women of Color and Asthma Control: A randomized controlled trial of an asthma-management intervention for African American women. BMC Public Health 2012 Jan 24;12(1):76. [Epub ahead of print]. 7. Moorman JE, Mannino DM: Increasing U.S. asthma mortality rates: Who is really dying? J Asthma 2001 Feb;38(1):65-71. 8. Ostrom NK: Women with asthma: A review of potential variables and preferred medical management. Ann Allergy Asthma Immunol 2006;96(5):655-665.

Work/family balance

Family responsibilities

Too many work responsibilities

College or graduate degree (n=71) High school or some college (n=152)

Communicating with doctor 0%

20%

40%

60%

80%

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