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Asthma Mitigation Strategies

Professional, Charitable, and Community Coalitions
  • Carla C. Keirns
    Correspondence
    Address correspondence and reprint requests to: Carla C. Keirns, MD, PhD, MS, Department of Preventive Medicine, HSC Level 3, Rm 080, Stony Brook University, Stony Brook NY 11794-8335
    Affiliations
    Robert Wood Johnson Clinical Scholars Program, University of Michigan, Ann Arbor, Michigan; and the Center for Medical Humanities, Compassionate Care, and Bioethics, Department of Preventive Medicine and Department of Medicine, Stony Brook University, Stony Brook, New York
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      Background

      Asthma symptoms, severity, and mortality are known to be affected by personal, family, and neighborhood social factors. Many groups have become involved in asthma research, education, and activism in the past 20 years. This study explores the approaches to asthma taken by community-based organizations compared with those taken by other organizations that have a focus on asthma.

      Methods

      Priorities in asthma research and intervention were assessed through interviews with representatives of urban community-based participatory research (CBPR) coalitions; interviews with staff from charities focused on asthma, allergy, or lung diseases; interviews with physicians and scientists studying and treating asthma; participation in community forums; and participant observation of urban asthma coalitions. Interviews and data analysis were conducted in 2008.

      Results

      There are marked differences in priorities and approaches to asthma among experts in the field, organizations and coalitions at the national and local levels, and other stakeholders in asthma research and activism. CBPR coalitions are more likely than asthma-focused organizations to explore environmental and community-level structural factors that exacerbate asthma or complicate its management, while disease-focused organizations, especially physician specialty groups, place more emphasis on individual-level factors. CBPR coalitions have been particularly strong in producing the data needed to demonstrate that individual communities are affected by pollution hot spots or that local neighborhoods lack geographic access to affordable medical care, and in providing this data to improve local policy-making.

      Conclusions

      Because of its focus on structural rather than individual factors, CBPR has helped to broaden the debate on asthma beyond clinical care and education into social and environmental justice.
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