Does where you live influence asthma outcomes?

Education is one of the most effective ways to help people with asthma manage the disease. Learning how to recognize symptoms, properly use medication and avoid environmental triggers can improve health outcomes for the 25 million Americans with asthma. A wide variety of asthma education programs are available—ranging from hospital-based interventions to education programs in the home—but the availability of such programs varies around the state.

In an effort to close this gap, a research team from the Texas A&M School of Public Health investigated the prevalence of asthma in adults in Texas as well as distribution of asthma education programs around the state to determine whether there is a geographic disparity in education program availability. The study was recently published in the Journal of Environmental and Public Health.

The research team, led by Genny Carrillo, MD, ScD, associate professor in the Department of Environmental and Occupational Health and director of the Program on Asthma Research and Education at the School of Public Health, used publicly available data on asthma rates from 2015 that included nearly 15,000 Texas adults. They also searched for active asthma education programs in Texas, finding 27 currently in operation. The team then analyzed data on asthma prevalence and education programs at the level of Texas’ 11 public health regions (PHRs).

The researchers found that adult asthma prevalence ranged from 5.1 percent to 11.5 percent, varying widely between different PHRs. They also found regional variations in program availability across the state. Some PHRs had several education programs whereas others had few, with three regions having no education programs. The distribution of programs seems skewed toward PHRs containing large cities: PHR 3 (Arlington) has eight programs, PHR 6 (Houston) has seven and PHR 11 has three (one in McAllen and two in Corpus Christi). The research team also observed that the PHR with the highest asthma prevalence (PHR 2) had no education programs at all. Their analysis found a statistically insignificant association between asthma prevalence and the number of programs.

Research has shown that adults with asthma can reap huge benefits from education programs, however, the geographic disparity in programs can keep many from getting the help they need. People living in PHRs with few or no education programs frequently must travel long distances to attend either education sessions or routine medical visits, and transportation can be an additional barrier for people with lower socioeconomic status, which research has shown correlates to greater asthma prevalence. Having a better understanding of not only the geographic disparities present in asthma education programs but the barriers people living in underserved PHRs face can be useful for creating effective targeted interventions.

Health care providers play a crucial role in educating people with asthma, but the researchers note that time and resource constraints make this difficult. Having more education programs available would be helpful, and it is crucial that physicians, patients and policymakers form partnerships to create effective education programs. Such programs would also need to consider additional patient barriers such as a lack of time and financial resources as well as cultural and language barriers. Thus, research on culture-based differences will be vital in efforts to educate adults with asthma.

Although it sheds light on geographic differences in asthma prevalence and education program availability, the researchers note that this study has a few limitations. First, there may be additional education resources that were not identified; however, the relaunch of TACP may help produce a clearer view in the near future. Second, the study focused only on adult asthma because that was the most readily available data. Further research that includes childhood asthma prevalence will be helpful. Other avenues for future research are studies that include online and telehealth asthma education programs, as these are methods that could help overcome transportation barriers and address the geographic disparities noted in this study. Lastly, this study looked at the level of Texas’ 11 PHRs. Further research at the county or census tract level would likely provide additional detail.

Despite these limitations, this study clearly demonstrated wide variations in adult asthma prevalence and an uneven distribution of asthma education programs, and provided a picture of underserved areas of the state. This information serves as a starting point for additional research and will likely benefit efforts by health care providers and policymakers to produce better targeted and culturally relevant asthma education programs. With better programs, adults with asthma stand to better manage the disease and improve their health outcomes and quality of life.

Carrillo’s co-authors on the study from the School of Public Health include: Jessica John, MPH student in the Department of Health Promotion and Community Health Sciences, Juha Baek, MPSA, DrPH student in the Department of Environmental and Occupational Health, Taehyun Roh, PhD, Assistant Professor in the Department of Epidemiology and Biostatistics, and Lucia Conner, MPH, CHWI, program Manager of the Program on Asthma Research and Education and Healthy South Texas Initiative, McAllen Campus.