Discussion and Conclusion
The purpose of this study was to examine risk factors predicting asthma among adult foreign-born African Americans in California. The study was premised on the backdrop of the failure of past researchers to investigate the health status of adult foreign-born African Americans as a significant minority group in the U.S. In this study, I sought to fill this research gap by focusing specifically on foreign-born African American immigrants in California. The dependent variable was asthma status and independent variables were tobacco use, alcohol use, education level, income level, and health insurance. Cofounders moderated the relationship between the two variables and they included age, gender, marital status, and housing type.
Based on the review of the California Health Interview Survey (CHIS) 2011-2016 SPSS Dataset and Codebook plus the subsequent analysis of the same information using the SPSS software, I established that there was no significant relationship between asthma status and the independent variables. I developed these findings after accounting for the effects of age, gender, marital status, and housing type. Relative to the research questions that guided this study, I also found that H03 (education and income levels do not predict asthma among adult foreign-born African Americans in California) and H02 (there is no relationship between asthma and health insurance among adult foreign-born African Americans in California) were correct. The case was the same for H01, (tobacco smoking and alcohol use do not predict asthma among adult foreign-born African Americans in California).
Interpretation of Findings
The findings highlighted in this report depart from those of previous researchers who have investigated the relationship between asthma, tobacco use, alcohol use, education level, income level, and health insurance. Particularly, they are fundamentally different from studies, which have shown that tobacco use affects asthma status. I have highlighted such findings in the literature review segment and they include reviews, such as those developed by Coogan et al. (2015), which show that asthma incidences rise with an increase in tobacco use. Therefore, it is important to point out that the findings highlighted in this report differ from those of such studies (concerning the effects of tobacco use on asthma status).
The same difference is also seen in the findings of past studies, which have investigated the effects of income levels on asthma status. They have shown that asthma incidences change with variations in income. Studies by Li et al. (2017), Lee et al. (2017), and Lenney et al. (2018) affirm this point of view. The same is not true for this paper because income levels did not affect the asthma status of the sampled population. The findings reported concerning the relationship between alcohol use and asthma status also follow the same pattern of lack of uniformity because they differ from those of previous researchers. In other words, past studies have shown that alcohol use affects asthma status. For example, the study by Linneberg and Gonzalez-Quintela (2016) affirms this point of view. However, the findings presented in this report show that alcohol use has an insignificant relationship with asthma.
In this study, I have also found that there is an insignificant relationship between asthma status and health insurance. This finding is also different from those of past studies, which have shown a significant relationship between asthma status and health insurance. For example, those of Gong et al. (2014) show that asthma incidences decline with an increase in the availability of health insurance. Another area of departure between the findings I developed in this study and those of past researchers is the relationship between education levels and asthma status. In other words, the findings developed in this study do not align with the views of researchers, such as Imami et al. (2015), Gong et al. (2014), Mirabelli, Beavers, Shepler, and Chatterjee (2015) who affirm a positive relationship between asthma status and education levels.
A review of the above findings, relative to the framework of the social-ecological model, implies that environmental and social factors could account for the difference in the findings highlighted in this paper and those of other researchers. This view stems from the fact that the social-ecological model integrates the complex interplay between people’s health and the environment with their health outcomes, through an assessment of their societal, community, and relationship influences. This framework could explain why there are significant differences between the findings of this paper and those of other researchers, which have also investigated the effects of different risk factors on asthma incidences among immigrant populations.
Based on this school of thought, it is possible to understand why income levels, access to health insurance, tobacco use, and alcohol consumption do not affect the asthma status of foreign-born African Americans in California. Indeed, as postulated by the social-ecological model, the differences could emerge from environmental, social, and cultural factors, which could be protecting the target population from experiencing increased cases of asthma even when exposed to negative risk factors, such as the lack of health insurance, alcohol use or tobacco smoking. This finding largely stems from studies, which show that the health status of immigrant populations tend to be stronger in their countries of origin compared to when the same population resides in the U.S (Iqbal, Oraka, Chew, & Flanders, 2014). This view has been highlighted by researchers who have investigated the health status of immigrant populations from parts of Asia and Africa. They say that cultural factors associated with their countries of origin, such as the stigma associated with women who smoke, enable them to have better health outcomes compared to their counterparts in the U.S (Iqbal et al., 2014).
The difference often arises from the fact that the U.S offers immigrants more freedom to engage in social ills and vices, such as tobacco or alcohol use, compared to their countries of origin where such behaviors are discouraged. Most of these findings have been based on the analysis of the health statuses of second-generation immigrants. This study specifically focuses on first-generation immigrants. The different generations of populations used to undertake these health studies could account for variations in findings between this study and those of other researchers. Stated differently, the health status (asthma status) of the sampled population (foreign-born African immigrants) could still be influenced by environmental factors from their countries of origin.
Although insignificantly correlated with asthma status, it is important to point out that education levels had a stronger effect on asthma status relative to all the other independent variables investigated in this study. This could be fueled by the fact that education standards have a significant impact on the health choices made by the sampled population. In other words, people who are more educated tend to make broad health changes in their lives compared to those who have lower levels of education (Mirabelli et al., 2015). Based on this analysis alone, it is possible to understand how environmental factors originating from the respondents’ countries of origin could have an impact on the findings.
The impact of the confounding factors (age, gender, marital status, and housing type) on the relationship between asthma status and the independent variables could be largely confined to the first level of the social-ecological model, which postulates that individual factors influence people’s health outcomes. Relative to the findings of this investigation, it has been established that these individual attributes did not have significant effects on the relationship between asthma status and the independent variables. Therefore, it is possible to generalize the findings across different demographic variables underpinning the investigation.
The “relationship” level of the social-ecological model postulates that people who are close to a patient affect their health. This tenet of the social-ecological model could influence the likelihood of the sample population taking health insurance, consuming more alcohol, and using more tobacco (among other health risk factors). Therefore, they have a strong likelihood of influencing the relationship between asthma status and the independent variables.
The community level of the social-ecological model is largely represented in this study through the cultural and social dynamics of foreign-born African Americans in California. Community issues relating to their employment and housing opportunities, as well as policies relating to their housing and workplace settings, could have an impact on the relationships identified in this study.
The fourth level of the social-ecological model relating to societal factors influencing health outcomes could also have influenced the findings of this report by affecting some of the confounding and independent variables, such as access to health insurance, housing type, and alcohol use. Economic, education, and societal policies influencing the health status of African American immigrants could also have affected the risk factors predicting asthma status among the sample population.
Broadly, the findings of this paper mirror those of Iqbal et al. (2014), which show that a person’s place of birth affects their health. This view was developed after the researchers found significant differences in the asthma status of people born within and outside the U.S. It also emphasizes the findings of other researchers, such as Silverberg, Simpson, Durkin, and Joks (2013) and Rosser, Forno, Cooper, and Celedón (2014), who have demonstrated that asthma status varies with the period of residency in the U.S. Therefore, the findings highlighted in this paper are useful in the sense that they provide a holistic picture of the risk factors predicting the occurrence of asthma incidences among adult foreign-born African Americans.
Limitations of the Study
Limitations of a study are generally related to factors that are outside the control of a researcher. The scope of this study, which was limited to California, is one such limitation. Therefore, the findings highlighted in this paper are generally applicable to foreign-born African Americans in the same locality. Consequently, it may be difficult to extrapolate them beyond populations of foreign-born African Americans who are outside this geographical region. This study is also limited by the fact that the only source of information was CHIS data. The use of secondary information means that the present study assumes the same limitations as those of the CHIS data. For example, the findings of this paper are limited by the study’s design, which is confined to the specific years, which the original research was undertaken – 2011-2016. This means that the views explained in this paper may not apply to the sample population outside of this time framework.
The CHIS data used in this report provided useful information relating to risk factors predicting asthma among adult foreign-born African Americans in California. Here, it is important to point out that the relationships investigated in this report do not necessarily explain why this is so. Therefore, the findings highlighted are merely descriptive and fail to explain why such relationships are as described. Stated differently, the information represented in this paper is only indicative of the relationship between asthma (dependent variable) and its risk factors (tobacco use, alcohol use, education level, income level, and health insurance). Although some of these limitations largely reflect those of the CHIS data, it is important to consider the recommendations of Linneberg and Gonzalez-Quintela (2016), which suggest that no data is perfect. Therefore, it is up to the discretion of researchers to balance the pros and cons of each research data for the advancement of a study’s objective. The findings I present in this study are developed with this consideration in mind.
Recommendations
A key finding in this report is the lack of a significant relationship between the independent variables (tobacco use, alcohol use, education level, income level, and health insurance) and asthma status. As highlighted in the limitations section (above), this finding is generally descriptive. Future research should be undertaken to find out why these relationships are as described. For example, the research could be done to understand the issues surrounding causality. This analysis would help to provide a broader picture of the relationship between asthma and the independent variables within the wider framework of social and ecological issues affecting the health of foreign-born African Americans.
Future research should also extend the scope of the analysis outside California to investigate whether the findings reported in this paper remain true when a larger, sample of foreign-born African Americans are studied. This effort would help to understand some of the effects of having an unfocused data pool in the investigation of one research phenomenon. In other words, the CHIS data I used in this paper is not specifically focused on foreign-born African Americans as a sample population or asthma as a health issue. Therefore, undertaking a more focused review using data that specifically target foreign-born African Americans and asthma (as a health issue) would help to address some of these issues.
Lastly, future research should investigate the relationship between asthma status and the independent variables across an extended time frame. In this paper, the analysis was only confined to the asthma status of the sample population between 2011 and 2016. Since CHIS data are readily available, a larger sample cohort of foreign-born African Americans may be investigated pre-2011. This way, it would be possible to have a broader understanding of the effects of different risk factors in predicting asthma incidences among adult foreign-born African Americans.
Implications for Professional Practice and Social Change
Professional practice
The findings highlighted in this paper have a positive effect on community health promotion because they expand the body of knowledge regarding the health of minority populations in America. Particularly, the focus on foreign-born African Americans as a minority population in the U.S provides an important contribution to the overall analysis of the health of minority populations in the country because this demographic is rarely studied.
The use of the social-ecological model as the main theoretical framework in this study also has a significant implication for the use of the study’s findings because it has been used to improve community health outcomes. This competency emerges from the fact that the model examines person-environment interactions, which are critical components of public health studies. For example, by understanding the risk factors predicting asthma incidences among adult foreign-born African Americans, it would be easier for public health workers to improve the environments of the same population in support of expressions of individuals’ systems dispositions. Such initiatives could be implemented in different ways, such as community health promotion where public health workers identify high impact leverage points to manage asthma. Using the social-ecological model, health workers can also facilitate the successful implementation of health promotion programs. The social-ecological model would also help in combining person-focused and environmentally based health promotion programs to develop sound health initiatives for managing asthma. The knowledge gained, relative to the risk factors predicting asthma, could also provide a reliable body of knowledge to understand environmental factors affecting asthma management. Such information could be used to develop comprehensive asthma management programs. The same information is critical in understanding whether such programs will be sustainable, or not.
Positive Social Change
The findings of this paper are also useful in creating a positive social change by supporting health improvements in immigrant communities. As highlighted in earlier sections of this chapter, they are critical in understanding immigrant health outcomes and providing a platform for undertaking further research on foreign-born African immigrants as a minority health group in the United States. At a policy level, the findings of this study could help policymakers to improve decision-making processes affecting asthma risk factors such as housing or access to health insurance. At an individual level, the findings of this paper could help to sensitize people to embrace health-promoting behaviors that allow them to manage asthma as a common respiratory health condition. Such recommendations could cover the willingness of a person to remove themselves from an environment that would be detrimental to their overall health or encourage them to refrain from engaging in risky health behaviors that exacerbate the condition. This way, they will better understand how to exclude themselves from environments that are not conducive to their health.
Conclusion
In this study, I sought to examine the risk factors predicting asthma among foreign-born African Americans in California. The findings I developed seem to be fundamentally different from those of previous researchers who have highlighted a strong relationship between the risk factors examined in this report and asthma. This departure in conventional findings accentuates the importance of understanding the community health outcomes of different immigrant groups, selectively. Based on this understanding, environmental and social issues concerning immigrant populations seem to affect their health outcomes and they need to be explored separately as well (this is the basis for the recommendations). The need to explore the specifics of community health behavior is an approach that should be further entrenched in healthcare practice because different populations have unique health characteristics that should be exclusively explored. Increased support for genetic and genomic services in healthcare practice is one approach that appreciates individual and societal differences in health care outcomes. The same should be encouraged in the management of asthma.
References
Coogan, P. F., Castro-Webb, N., Yu, J., O’Connor, G. T., Palmer, J. R., & Rosenberg, L. (2015). Active and passive smoking and the incidence of asthma in the black women’s health study. American Journal of Respiratory and Critical Care Medicine, 191(2), 168-176.
Gong, T., Lundholm, C., Rejnö, G., Mood, C., Långström, N., & Almqvist, C. (2014). Parental socioeconomic status, childhood asthma and medication use – A population-based study. PLoS ONE, 9(9), 21-28.
Imami, L., Tobin, E. T., Kane, H. S., Saleh, D. J., Lupro, T. H., & Slatcher, R. B. (2015). Effects of socioeconomic status on maternal and child positive behaviors in daily life among youth with asthma. Journal of Pediatric Psychology, 40(1), 55-65.
Iqbal, S., Oraka, E., Chew, G. L., & Flanders, W. D. (2014). Association between birthplace and current asthma: The role of environment and acculturation. American Journal of Public Health, 104(1), 175-182.
Lee, E., Lee, S. H., Kwon, J. W., Kim, Y. H., Yoon, J., Cho, H. J., … Hong, S. J. (2017). Persistent asthma phenotype related with late-onset, high atopy, and low socioeconomic status in school-aged Korean children. BMC Pulmonary Medicine, 17(1), 45.
Lenney, W., Bush, A., Fitzgerald, D. A., Fletcher, M., Ostrem, A., Pedersen, S., … Zar, H. J. (2018). Improving the global diagnosis and management of asthma in children. Thorax, 73(7), 662-669.
Linneberg, A., & Gonzalez-Quintela, A. (2016). The unsolved relationship of alcohol and asthma. International Archives of Allergy Immunology, 171(1), 155-157.
Li, Z., Leite, W., Thompson, L., Gross, H. E., Shenkman, E., Reeve, B. B., … Huang, I.-C. (2017). Determinants of longitudinal health-related quality of life change in children with asthma from low-income families: A report from the PROMIS® pediatric asthma study. Clinical and Experimental Allergy: Journal of the British Society for Allergy and Clinical Immunology, 47(3), 383-394.
Mirabelli, M. C., Beavers, S. F., Shepler, S. H., & Chatterjee, A. B. (2015). Age at asthma onset and asthma self-management education among adults in the United States. The Journal of Asthma: Official Journal of the Association for the Care of Asthma, 52(9), 974-980.
Rosser, F.J., Forno, E., Cooper, P. J., & Celedón, J. C. (2014). Asthma in Hispanics. An 8-year update. American Journal of Respiratory and Critical Care Medicine, 189(11), 1316-1327.
Silverberg, J. I., Simpson, E. L., Durkin, H. G., & Joks, R. (2013). Prevalence of allergic disease in foreign-born American children. JAMA Pediatrics, 167(6), 554-560.