Despite having frequent symptoms of undiagnosed asthma, low-income urban adolescents do not seek medical care even when it is available to them, according to a new study led by Columbia University School of Nursing researcher Jean-Marie Bruzzese, PhD. Adolescents cite an average of four reasons for not seeking care, while two psychological factors—asthma-related anxiety and depression—increase the odds that they will seek asthma care.
According to the study, an increase of just one point on a six-point scale measuring asthma-related anxiety increases the odds of an adolescent seeking asthma care by more than 60 percent. Symptoms of depression also increased the odds of seeking care, but by a much smaller 3 percent for each one-point increase. Increases in scores on measurements of general anxiety and stress had no impact on whether adolescents sought care.
“Adolescents in our study reported to us that they had symptoms of moderate to severe persistent asthma, but that they had never been diagnosed,” says Bruzzese, associate professor of applied developmental psychology at Columbia University School of Nursing. “We need to understand what’s driving teens to avoid medical care even when they have serious asthma-like symptoms, so we can find ways to bridge the gaps and connect them to the care they greatly need in order to help them control their asthma.”
The top reasons adolescents gave for avoiding care include forms of denial, according to researchers. The four reasons cited most often are 1) a perception that symptoms are not serious, 2) not wanting to know they have asthma, 3) not wanting to take medications, and 4) believing that their parent or caregiver does not want them to see a medical provider. Only a small proportion of this low-income group said a lack of medical insurance or access to care was the reason they did not seek care.
Asthma affects up to 7 million, or 9 percent of all U.S. children, and about half are undiagnosed. Asthma is more common in adolescents than younger children. Adolescents also have more frequent asthma attacks and higher death rates from the disease. Adolescents make fewer routine healthcare visits than younger children. Because of this, the investigators say it is vital to encourage them to actively seek care when they need it.
“The results of our study suggest that adolescents and their caregivers would benefit from education and more awareness about the seriousness of asthma and how important it is to have routine medical visits to manage it,” says Bruzzese. “We need to encourage good health behaviors in adolescents to establish trusting relationships with medical providers that they can take into adulthood.”
About the study
The study enrolled 349 New York City students from 20 public high schools. The students were in grades 9 through 11, with a mean age of 15.8 years. Forty-six percent of students were Hispanic/Latino, 37 percent were African American/black, and 83 percent were female. Just over half (53 percent) reported symptoms consistent with moderate persistent asthma, while 47 percent had symptoms consistent with severe persistent asthma.
The paper, “Psychological Factors Influencing the Decision of Urban Adolescents With Undiagnosed Asthma to Obtain Medical Care,” was published in The Journal of Adolescent Health. Other contributors are Maureen George, PhD, from Columbia University School of Nursing in New York City; Sharon Kingston, PhD, from Dickinson College in Carlisle, Pennsylvania; and Yihong Zhao, PhD, John DiMeglio, and Amarilis Céspedes, all from New York University School of Medicine in New York City. RNL
Source: Columbia University School of Nursing