Chris Argueta, Berenice Elizarraraz, Akira Féliz, Aarin Huffman, Clarence Sams,

Lilly Jimoh, Wanjiku Dyer, Tobenna Obi, Fatima Amin, Erva Tatlilioglu

summary

This case study investigated the implementation of community-based participatory research methods to identify the key drivers and areas for improvement in addressing pediatric asthma disparities in the South Los Angeles Service Planning Area (SPA 6).

Background and Introduction to Pediatric Asthma in South Los Angeles

South Los Angeles, specifically Service Planning Area 6 (SPA 6), is a predominantly Black and Latino community facing significant health disparities and socioeconomic challenges. Over the years, SPA 6 has struggled with persistent health disparities such as higher rates of chronic diseases, including asthma, diabetes, and hypertension, which are all further exacerbated by limited access to care. The area’s complex health landscape has been shaped by disparities arising from historical injustices and systemic racism. According to the Los Angeles County Health Survey 2017, SPA 6’s pediatric asthma prevalence has risen to 7.8%, surpassing the LA County average of 7.4% and ranking as the third highest among all SPAs.⁽¹⁾ This increase is particularly striking given that in 2003, SPA 6 had the second-lowest prevalence of asthma among children ages 0-17 at 5.9%, compared to the LA County average of 7.9%. ⁽¹⁾

The rise in pediatric asthma prevalence cannot be discussed without examining the historical context of systemic racism and environmental injustices. Practices such as redlining, beginning in the 1930s, institutionalized racial segregation and economic inequality by formalizing racial bias in lending practices that impact communities to this day. This historical neglect has resulted in the following, but not limited to:

• Environmental racism: SPA 6 continues to be disproportionately impacted by pollution due to its proximity to busy highways.
• Limited access to healthcare: a decrease in investment has led to a shortage of medical facilities and access to specialists in the area.
• Economic disparities: the creation of wealth gaps through historical racisms has affected families’ ability to afford preventative care and asthma management.

Anti-Black racism is also instrumental in shaping the current landscape of communities alike SPA 6. There are discriminatory practices in healthcare, education, and employment towards Black communities that create barriers to health equity. Similarly, xenophobia impacts immigrant communities, leading to reduced access to healthcare due to distrust, fear, and language barriers.

Despite these challenges, the community has demonstrated remarkable resilience. Local leaders, community organizations, and residents have worked tirelessly to advocate for improvements in healthcare, education, and social services, showcasing the strength and determination of SPA 6’s population.

As medical students at Charles R Drew University of Medicine and Science, one of four Historically Black Colleges and Universities (HBCUs) in the country, we had the opportunity to learn about the health challenges faced by communities in South Los Angeles. Our diverse group of 10 students, representing a variety of social and ethnic backgrounds, saw this project as an opportunity to help bridge the gap between medical education and community needs. We do so by applying our developing knowledge to explore the current disparities affecting SPA 6, particularly for the patients, families, and medical team impacted by pediatric asthma. By taking part in this community-based research, we sought to gain a robust understanding of health-related inequalities through collaboration with patients, their family members, community-based organizations, and healthcare workers. In addition, we sought to understand whether there was alignment in perspectives within the community regarding these disparities.

This research can serve as a valuable resource for healthcare providers, community-based organizations, and policymakers who are working to address the healthcare disparities surrounding pediatric asthma in communities such as SPA 6. Additionally, our research can serve as an example of the potential that physicians in training can have to elevate community health promotion through community-engaged research. We identified pediatric asthma as a crucial disparity, then synthesized published literature on pediatric asthma, and sought unique insight about this disparity from various community stakeholders. In doing so, our research offers a comprehensive overview of the challenges and opportunities in managing pediatric asthma in communities alike.

We highlight the key insights gained from the community, such as the importance of considering socioeconomic and environmental factors driven by systemic racism, with some examples being

• health education delivery,
• health literacy,
• air pollution,
• mold, and
• second-hand smoke.

We also emphasize key areas where our medical practice can improve in our service to diverse populations, such as addressing insurance barriers and improving access to specialized care.

The Focus on Pediatric Asthma: Rationale and Project Objectives

Several compelling factors drive our focus on pediatric asthma in SPA 6. The 27.7% increase in asthma prevalence since 2003 represents the largest percentage rise among all SPAs, signaling an urgent need for intervention.⁽¹⁾ Complications from pediatric asthma can be severe, including emergency treatments, hospitalizations, permanent lung function decline, missed school days, poor sleep, and limited participation in activities.⁽²⁾ These complications are exacerbated by additional challenges faced in SPA 6. For example, the area has the highest percentage of children (15%) and adults (32.5%) reporting difficulty accessing medical care among all SPAs. (1)

Moreover, SPA 6 has the second-highest percentage (23.7%) of households with children regularly exposed to tobacco smoke, a known risk factor for asthma development and exacerbation. (1,2) The interplay between asthma and other respiratory conditions is also concerning. Research by the American Lung Association indicates that people with asthma are at higher risk of developing pneumonia due to lung damage or weakness caused by asthma. (2) This is particularly alarming given that SPA 6 has the highest pneumonia/influenza mortality rate (31.1 per 100,000) among all SPAs. (1)

Our project aims to explore the drivers and sentiments surrounding the rising pediatric asthma prevalence in SPA 6. After investigating the intertwining of environmental risks, such as air quality, with limited healthcare access, we sought to paint a comprehensive picture of the challenges faced by this community. Our goal was to highlight the importance of continued community-focused research and provide community-based recommendations to address this growing health concern. Through this project, we aspire to contribute to the development of targeted public health interventions and robust support systems that can mitigate these growing health disparities. By focusing on pediatric asthma, we hope to catalyze positive changes that will improve the overall health and well-being of children and families in SPA 6.

Research Study Methods

Study Design and Participants

This study employed a multi-stakeholder approach to investigate pediatric asthma prevalence in SPA 6 of Los Angeles County. We conducted focused video interviews with four distinct groups: patients and caregivers, healthcare providers, community-based organizations (CBOs), and policymakers. We intentionally sought out participants from these four distinct groups in an attempt to gain a well-rounded perspective of pediatric asthma. Methods for stakeholder selection were designed to allow for focused one-on-one interviews, ensuring that participants could provide in-depth, relevant insights into the pediatric asthma landscape in SPA 6.

Participant Selection

Patients and Caregivers: Eligible participants included primary caregivers of children aged 5 to 17 years with a known history of asthma residing in SPA 6 or from low socioeconomic status (SES) backgrounds. This age range was chosen to focus on school-aged children and adolescents with asthma who would be representative of the same age range and asthma diagnosis identified in the LA County Health Survey. ⁽¹⁾ 

Healthcare Providers: We recruited healthcare providers based on their specialized knowledge in pediatrics, pulmonology, or asthma management. Additionally, providers were selected for their personal or professional affiliations within SPA 6, ensuring familiarity with the unique health challenges of the area.

Community-Based Organizations and Policymakers: CBOs were identified and selected based on their proactive efforts in environmental and health initiatives specifically tailored to alleviate conditions such as asthma within marginalized communities like SPA. The CBO selection process involved a review of the organization’s track record with health advocacy and demonstration of community engagement with previous projects addressing the needs of communities alike SPA 6. Policymakers with influence over health and environmental policies affecting SPA 6 were also included in the study. It is important to recognize the role of policymakers with influence over health and environmental policies affecting SPA 6. Their inclusion is instrumental in bridging the gap between research outcomes and policy implementation based on outcomes.

Data Collection

Interviews were conducted and transcribed via Zoom and Microsoft Teams over three months from December 2023 to February 2024. Zoom and Microsoft Teams were used specifically to be accommodating to participants who may not have had the ability or additional time to conduct an in-person interview. Our stage of training in medicine was explained to all participants, along with a mention to participants on how the mission of our medical program entails helping serve our SPA 6 community and communities alike.

A semi-structured interview guide was developed, featuring open-ended questions in layman’s terms to reach all levels of health literacy, organized around key domains relevant to pediatric asthma in South Los Angeles. To ensure a diversity of curiosity in the interviews, all 10 medical students contributed questions of interest toward an interview guide covering themes such as community health challenges, environmental factors, healthcare access, and potential interventions. Each medical student was then assigned to interview a community stakeholder and accordingly tailor their questions to each interviewee’s occupation, experience and expertise. Interview durations ranged from 30 minutes to 1.5 hours, allowing for in-depth exploration of participants’ perspectives and experiences. This approach provided flexibility to delve into emerging topics while ensuring consistency across interviews. This multi-faceted approach, coupled with focused interview techniques, allowed us to gather comprehensive and targeted insights from various perspectives, providing a holistic understanding of the pediatric asthma landscape in SPA 6.

Ethical Considerations

No Institutional Review Board (IRB) approval was required. Verbal consent was obtained before participant interviews, with the study’s nature thoroughly explained to selected participants; pseudo-names for patients are used throughout the paper.

A Community-Engaged Approach Allowed for Community-Specific Recommendations

In addressing the rising prevalence of pediatric asthma in Service Planning Area (SPA) 6 of Los Angeles County, a community-engaged approach is crucial, as it has a patient-centered and community approach to address certain health disparities. Moreover, given the unique demographic composition of SPA 6, with its predominantly Hispanic and African American population, culturally tailored interventions are essential for effective asthma management and prevention.

Our research team spoke to local healthcare providers, community residents such as caregivers of pediatric patients, pediatricians, policymakers, and community-based organizations, to grow a more comprehensive framework on the multifaceted factors contributing to asthma disparities in SPA 6. By engaging community members in the interview component of our research, we were able to determine pertinent themes that can be used to create actionable plans. For example, lack of parental education, environmental triggers, and economic barriers, all of which ensured that our interventions are relevant and wanted within SPA 6.

This community-engaged framework allowed us to combine academic expertise with community wisdom, ultimately working towards reducing asthma-related health disparities and improving overall respiratory health in this vulnerable population. parental education, environmental triggers such as smog, and economic barriers.

Community Stakeholders Interviewed

Outcomes, Impacts, Challenges, and Future Directions from Multiple Perspectives Within SPA 6

The following interviews and discussions highlight a complex web of challenges in managing pediatric asthma within SPA 6. To address these issues effectively, solutions must be multifaceted and consider the perspectives of physicians, patients, and community-based organizations (CBOs).

Families Want Improved Emotional Support, Health Education, and Healthcare Access

The experience of managing pediatric asthma, as shared by patient James and his mother Linda, highlighted the multifaceted challenges faced by families in underserved communities. Difficulties in managing pediatric asthma illuminated a significant need for comprehensive guidance for families managing chronic diseases. Linda’s reliance on internet resources for asthma management underscores the gap in accessible and comprehensive healthcare support.

The following are simulated readings of the quoted paragraphs below. Click [Play] to begin, and [Pause] to stop at any time.

“We learned everything on the internet ourselves and tried to help our child that way.”

Linda recounted, reflecting on their determination despite the lack of formal guidance. The psychological toll on the family was evident when Linda shared:

“It was hard for us to see our child like that, but we tried to stand strong next to him; we had no other choice. It’s psychologically challenging to see your child like that; it hurts your heart, and you can’t do anything.”

Linda further expressed a poignant wish:

“We did not receive any guidance; we wish there were such an opportunity. It would have helped us a lot in this journey; we felt very alone. We learned everything and explained it to our child. We think there should be special guidance for children and families with chronic diseases.”

This project emphasizes the importance of comprehensive healthcare support and education for families dealing with pediatric asthma. It highlights the critical need for improved access to healthcare services, educational resources, and community support.

Our interview with Taylor, a 43-year-old foster mother of 8-year-old Cori with asthma, provided further valuable insights into the challenges and experiences of managing pediatric asthma in South LA’s SPA 6 region. Taylor’s candid reflection on managing asthma attacks exemplifies the emotional toll on caregivers:

“Well, they are pretty scary because I don’t know what to do. I just feel like, oh, my God, what if he stops breathing or what if I’m not doing something correctly? Or what if the medication stops working? Those are my worries. Because it’s so new to us, but I try to take charge and not to freak out and just give it to him.”

This quote highlights the constant fear and uncertainty caregivers face, while also demonstrating their resilience and determination. The interview also revealed how caregivers can gain new insights during such discussions, as evidenced by Taylor’s realization about school air quality:

“We may have, now that you mentioned, I am going to check with the school, see what their air conditioning looks like, if they have filtration, or how often they clean it.”

This exchange underscores the need for better communication of asthma-related policies and practices to affected families. The conversation touched on various aspects of asthma management in SPA 6, including environmental challenges like proximity to freeways and smog exposure, accessibility of medications, and the availability of asthma information for families. This comprehensive discussion served as a reminder of the complex interplay between healthcare, environment, and policy in managing pediatric asthma, particularly in underserved areas like SPA 6.

Olivia, mother of 12-year-old Nick, also provided unique insights into difficulties managing pediatric asthma in South LA. Diagnosed in 2018, Nick’s asthma symptoms worsened during a brief stay in Las Vegas, highlighting the impact of environmental factors on his condition. While Olivia feels comfortable managing her son’s asthma, she expressed significant frustration with the current inhaler system. She stated:

“I don’t think they (inhalers) are that good because it’s 200 pumps and once you’re out of that, like you have to wait a long time. You know, probably a month just to get a new one. So, I mean, that’s the only downfall I see.”

This limitation in medication availability poses a serious challenge to consistent asthma management. The interview also touched on other factors influencing Nick’s condition, including his weight, participation in soccer, and the crucial role of Medi-Cal in providing access to inhalers. The discussion highlighted the complex interplay between environmental conditions, healthcare access, and individual health factors in managing pediatric asthma, emphasizing the need for more comprehensive and accessible asthma care solutions.

The discussion also touched on other determinants of Nick’s health, including his weight, participation in soccer, and the crucial role of Medi-Cal in providing access to inhalers. These factors illustrate how an interplay of individual health, environmental conditions, and systemic healthcare policies influences pediatric asthma management. Addressing these issues requires a shift from placing responsibility solely on caregivers to advocating for institutional accountability, including insurance reforms, increased funding for healthcare infrastructure, and improved access to medication.

By framing these findings through a systemic lens, this project contributes to a broader discourse on healthcare equity and policy reform. Rather than focusing exclusively on parental education as a solution, these insights highlight the need for transformative change through community engagement, policy advocacy, and institutional accountability. Expanding Medicaid coverage, improving access to preventive care, and integrating asthma education into public school curricula are necessary steps toward dismantling the systemic inequities that perpetuate healthcare disparities in underserved communities. This project not only informs practical interventions but also can serve as a foundation for policy advocacy aimed at achieving long-term, structural change in pediatric asthma management.

Challenges and Future Directions for Patients

An identified challenge from a patient perspective is improving comprehensive healthcare coverage, access to specialty care, and health education for pediatric patients with asthma. As Linda expressed, the lack of guidance and support can leave families feeling alone and reliant on internet resources.

Future Directions

Healthcare Providers Face Significant Systemic Challenges in the Management of Asthma and Patient Education

Difficulties in the management of asthma were highlighted by several healthcare providers, including a pediatric pulmonologist at UCLA Health, who illuminated the significant challenges in managing asthma among young patients, particularly regarding medication accessibility and insurance barriers. She emphasized the critical need for age-appropriate medications, noting that many children are discharged on inhalers they cannot effectively use, stating:

“They were discharged on inhalers they can’t use because it’s like a dry powder inhaler for a 2-year-old, like on a flex-haler.
They have to follow commands and deep inhale, and it’s way different because there are only a few inhalers kids can use.”

This highlights the disconnect between prescribed treatments and the actual capabilities of young patients, which can compromise their asthma management.

Additionally, she pointed out that insurance companies often fail to consider age-specific needs when approving medications, leading to delays in care. For instance, while common inhalers like Proair are covered by most insurances, their usage requirements can be challenging for toddlers. Furthermore, she emphasized disparities in access to pediatric pulmonology care, as many families in SPA 6 face significant barriers due to the lack of nearby specialty clinics, including none specifically in SPA 6. The doctor’s insights underscore the urgent need for systemic changes to ensure that all children receive appropriate asthma care and support tailored to their developmental stages.

Additionally, a pediatrician and CDU College of Medicine faculty member highlighted the multifaceted challenges in managing pediatric asthma in South Los Angeles. These included complex environmental factors, care coordination, parental education, systemic barriers to healthcare access, medication availability and affordability, health literacy, and addressing biases and ethical issues. This pediatrician emphasized the critical role of parental engagement, stating:

“A lot of it is just frequent reminders to parents, but it’s vital they grasp their role in managing childhood asthma. Parental education and support are crucial for implementing treatment plans and recognizing early signs of exacerbations. With open communication and support, healthcare providers can empower parents to monitor and control their child’s asthma effectively.”

This underscores the importance of ongoing support and tailored educational interventions. The challenges extend to systemic issues such as transportation difficulties, limited clinic hours, and socioeconomic disparities that disproportionately affect underserved communities. Addressing these complex issues requires a comprehensive approach involving improvements in healthcare infrastructure, enhanced patient education, and community engagement to ensure equitable and effective asthma management for all children in the area.

A Pediatric Physician Assistant (PA) provided further insights into various systemic difficulties of pediatric asthma management, centered around environmental factors, social determinants of health, and the often-overlooked role of nutrition. While acknowledging the potential benefits of a diet rich in vegetables, fruits, and seeds for children with asthma, she highlighted that current clinical practice primarily emphasizes symptom control through medication and environmental management. She stated:

“… So, we classify their asthma severity as either intermittent or mild, moderate, or severe, right? And then based on the classification, we follow asthma guidelines. So again, you can see that the focus is on management, right? As opposed to nutrition per se…”

This perspective underscores the disparity between symptom management and nutritional considerations in asthma care. Importantly, an improved diet can decrease obesity, a known risk factor for childhood asthma, and in children with asthma, obesity increases asthma severity and morbidity. Despite this connection, nutrition often receives less attention compared to factors like environmental or chemical exposures. The discussion also touched on promoting healthy eating habits in under-resourced areas, medication use, and the potential benefits of breastfeeding in asthma prevention. The PA observation that medicine tends to be more reactive than proactive highlights the need for a more holistic approach to patient care, integrating nutrition, lifestyle improvements, enhanced access to care, better air quality, and sound policy implementation to elevate the standard of care for pediatric asthma patients, particularly in underserved areas like SPA 6.

Healthcare providers play a crucial role in managing asthma, especially in communities with lower socioeconomic status, where economic barriers can significantly exacerbate health risks. A nurse at Torrance Memorial explored various aspects of asthma management, including the challenges posed by documentation barriers for health insurance, state funding issues, and the importance of educational initiatives. The nurse poignantly emphasized the need to identify and avoid triggers, stating:

“When it comes to patients who deal with asthma, the most important thing is to be able to identify triggers and then take steps to stay away from said triggers. Patients run into issues when they come across their triggers often, or they are ultimately not able to avoid them.”

This insight resonated deeply, highlighting how critical it is for patients to recognize their specific triggers to improve their quality of life. The conversation also shed light on the profound impact of environmental factors, particularly pollution, on respiratory health and underscored the necessity of robust electronic documentation systems to enhance patient care. Community outreach programs and the vital role of case managers in supporting asthma patients were discussed, alongside the inherent challenges in accurately diagnosing asthma and differentiating it from other respiratory conditions. Ultimately, this interview reinforced the complexity of asthma management and the urgent need for a comprehensive approach that integrates patient education, environmental awareness, and effective healthcare systems to foster better outcomes for those living with asthma.

Lastly, an Internal Medicine physician at UCLA Medical Center provided valuable insights into systemic challenges and opportunities in managing pediatric asthma, particularly in underserved areas like SPA 6. He emphasized the critical importance of health education and proper medication adherence, illustrating this with a tragic case involving a young relative of a patient who relied solely on short-acting medication for their severe asthma, leading to an unfortunate fatal outcome. He stated:

“She was underestimating how severe this was and was only taking the albuterol and totally relying on that, and had a bad attack. It didn’t do the job, and she ended up passing away. So I think it has been a challenge.”

This heartbreaking example underscores the need for comprehensive patient education, especially regarding long-acting medications, as he noted:

“I think human beings in general just don’t like to take medicine every day if they feel good.”

Additionally, he raised concerns about the potential underestimation of asthma prevalence in SPA 6 due to limited access to care and formal diagnoses, drawing a parallel with autism rates. He emphasized the necessity for children in these areas to receive proper care, stating:

“One thing is to make sure that they’re actually seeing these kids and seeing doctors that are attuned to the diagnosis of this, because, for example, autism rates, if you look at straight diagnosis, they are much higher in affluent areas, but likely because the parents are very diligent about going to get their kids evaluated.”

This observation highlights the importance of improving access to care and ensuring physicians in SPA 6 are attuned to diagnosing asthma in pediatric patients. Furthermore, he discussed the role physicians can play as patient advocates by addressing environmental risk factors for asthma through communication with landlords and involving social workers to enhance living conditions, which can sometimes be more impactful than prescriptions alone.

Challenges and Future Directions for Healthcare Providers

A significant challenge faced by physicians in SPA 6 is knowing how to become more attuned to the diagnosis of asthma in pediatric patients, especially given the limited access to care in the area. Meticulous physician training in asthma disease is therefore integral and needed in SPA 6. As a UCLA internal medicine physician mentioned, the potential underestimation of asthma prevalence due to limited access to care is a serious concern.

Future Directions

Community-Based Organizations Are Making Continued Efforts to Address This Disparity

Pediatric asthma does not appear to be a silent issue, as community-based programs such as Healthy African American Families (HAAF) are making proactive efforts to address such disparities (for additional info see HAAF Project – PMC). HAAF highlighted the critical role community-based organizations play in addressing asthma in underserved areas like SPA 6. She emphasized the importance of community-driven research and education initiatives, stating:

“It’s more partner-driven, meaning everyone has a voice at the table from the initial start of a thought, and the idea, and they’re engaged all the way throughout a project to the end of the project.”

This quote underscores the empowering nature of involving the community in health initiatives, fostering a sense of ownership and collaboration. HAAF focuses on tailored support to meet the unique needs of these communities, offering workshops to raise awareness about asthma triggers and management while advocating for improved environmental conditions and healthcare resources. In 2018, HAAF implemented an asthma education program across 25 charter schools to equip children with essential knowledge about inhaler usage, which is vital for reducing exacerbations in socioeconomically disadvantaged communities. Her insights reflect a broader understanding that effective asthma management requires genuine collaboration between communities and researchers to address health disparities, ultimately enhancing self-efficacy among asthma patients and leading to better health outcomes.

Additionally, a District Manager from the South Coast Air Quality Management District (AQMD) provided valuable efforts from their end, including insights into the environmental determinants of air quality in South Los Angeles, particularly regarding asthma management. Alatorre emphasized the significant impact of vehicle emissions on children’s asthma, especially in areas with heavy traffic, such as routes near the 710 freeway. To combat this issue, the AQMD has implemented various incentive programs aimed at reducing emissions, including the “Replace Your Ride” initiative, which encourages the adoption of cleaner vehicles. In discussing additional programs aimed at prevention and reducing asthma exacerbations, he noted:

“Actually, it’s a very good program for schools; we are replacing HEPA filters inside classrooms, especially in SPA 6 communities, when there’s a lot of pollution. So at least when the kids are inside the classroom, they’re breathing cleaner air.”

This initiative highlights the AQMD’s commitment to improving air quality in educational settings, ensuring that children have a healthier environment while learning. Additionally, Alatorre’s insights broaden the discussion to include everyday sources of pollution and their direct linkage to health outcomes like asthma, suggesting new avenues for research into these impacts. Overall, his emphasis on community initiatives and cleaner technologies reflects a multifaceted strategy to enhance air quality and address asthma in underserved areas like South Los Angeles.

Challenges and Future Directions for Community-Based Organizations

Community-based organizations are faced with the challenge of currently requiring more funding to significantly enhance the distribution of health educational resources and programs in underserved areas like SPA 6. As HAAF emphasized, community-driven initiatives are crucial for addressing health disparities.

Future Directions

By addressing these challenges through collaborative, multi-faceted strategies, it is possible to significantly improve the lives of children with asthma and their families in SPA 6.

There is Optimism in Addressing and Closing the Pediatric Asthma Disparity in SPA 6

Our research on pediatric asthma prevalence in Service Planning Area (SPA) 6, South Los Angeles, revealed critical insights into how socioeconomic and environmental factors intertwine to exacerbate health disparities in this underserved community. For example, despite ongoing efforts to reduce emissions in Southern California, regions like SPA 6 remain highly vulnerable due to persistent smog and pollution, particularly in areas with heavy traffic, such as the vicinity of the 710 freeway (3). The connection between air pollution and increased asthma rates underscores the need for stringent environmental regulations and proactive measures to protect vulnerable populations. The role of community-based organizations like HAAF has now been highlighted as essential in this context. These organizations not only provide critical education on asthma management but also play a pivotal role in empowering communities by addressing the social determinants of health that contribute to asthma exacerbations. (4) The educational programs implemented by HAAF, such as those focusing on proper inhaler use, are particularly valuable in reducing emergency department visits and improving long-term health outcomes in communities where healthcare access is often limited.

Moreover, our research illuminated the pervasive challenges in healthcare access and the broader implications of social determinants for pediatric asthma management. Interviews with medical doctors, such as a Pediatrician at Kaiser Permanente and an Internist at UCLA Medical Center, revealed systemic barriers that continue to impede effective asthma care. These include limited clinic hours, transportation difficulties, and the affordability of medications, all of which disproportionately affect low-income families in SPA 6. These barriers underscore the critical need for a comprehensive approach to healthcare that not only focuses on medical treatment but also addresses the underlying social and economic factors contributing to health disparities. Furthermore, the issue of under-diagnosis in these communities suggests that the true prevalence of pediatric asthma may be higher than reported, particularly in areas with limited access to healthcare. This insight is vital as it emphasizes the need for improved diagnostic services and more proactive healthcare interventions in underserved areas.

The lessons learned from our research highlight the importance of integrating healthcare with policy advocacy and community engagement. Effective asthma management in communities like SPA 6 requires a multifaceted approach that includes stricter environmental policies to reduce exposure to pollutants, better access to healthcare services, and ongoing community education to empower families to manage asthma effectively. However, reflecting on the research process, it is important to critically evaluate whether power imbalances between researchers and community members were sufficiently addressed and whether the project incorporated cultural humility and systemic accountability throughout its implementation. To ensure systemic accountability and cultural humility, future iterations of the project should prioritize community leadership in decision-making. This can include engaging community leaders as co-researchers, ensuring they have equal influence over project design, implementation, and evaluation. Feedback mechanisms should be formalized to allow community members and partners to voice concerns and provide input throughout the research process.

Specific strategies to make the project more community-led and explicitly anti-oppressive include recruiting community members to leadership roles to ensure the research reflects their priorities, establishing continuous feedback mechanisms like surveys and town hall meetings, and addressing systemic issues such as housing quality and pollution through collaboration with policymakers. Tailoring educational programs to the cultural and linguistic needs of SPA 6 residents with trusted local organizations can further enhance participation and impact. Additionally, integrating nutritional counseling into asthma management could be an underutilized strategy that may offer significant benefits, especially in terms of reducing inflammation and improving overall respiratory health. The insights gained from interviews with healthcare providers and community leaders suggest this as a valuable addition to asthma management strategies.

Finally, this project underscores the critical need for continued research and investment in community-based solutions to address the rising prevalence of pediatric asthma in SPA 6. The sharp increase in asthma rates between 2003 and 2017, along with the associated increase in pneumonia/influenza mortality rates, indicates a pressing need for targeted interventions that address the specific needs of this community. (1) The interviews conducted with families, healthcare providers, and community leaders provide a comprehensive understanding of the challenges faced by residents of SPA 6 and offer valuable insights into potential solutions. For example, the partnership between community-based organizations and local schools has shown promise in improving asthma management through education and early intervention. By building on these insights and continuing to engage with the community, stakeholders can develop more effective strategies to reduce asthma-related health disparities and improve the overall quality of life for children living in SPA 6.

AI and Predictive Models Have Potential to Improve SPA 6 Asthma Management

As medical students at CDU, our research on pediatric asthma in SPA 6 revealed significant disparities and challenges in managing this condition. We recognized the need for more efficient and accurate methods to predict and manage asthma exacerbations, particularly in underserved communities. Given that the field of medicine is moving towards the use of AI to develop solutions in healthcare, this led us to explore recent advancements in healthcare technology, specifically the application of Artificial Intelligence (AI) in asthma care. Given the high prevalence of asthma in SPA 6 and the need for improved management strategies, we believe that integrating AI and predictive models could significantly enhance asthma care in our community, addressing some of the key challenges we observed during our study.

The future of medicine is moving towards the use of AI to create solutions in healthcare. AI predictive models can facilitate analyzing patient data to predict asthma exacerbations, personalize treatment plans, and improve medication adherence to enhance disease management. By investigating factors like environmental triggers and patient history, these models can provide valuable information that can lead to improving patient outcomes, creating timely interventions, and reducing hospital visits. Although a potential pitfall of the use of AI predictive models can be biases in the data, which can lead to inequity. To limit the bias of AI predictive models, it would be beneficial to have such models intentionally focused on being trained with diverse communities. Additionally, community input when designing or implementing the models that will be used will be of great assistance, as it may also serve as an opportunity to educate underserved communities on how AI can be used to improve outcomes pertinent to their health. Moreover, there may also be a role for AI predictive models in shortening the pre-approval time for specific prescriptions based on asthma severity risk. Potential models may be able to better identify risk for pediatric patients and potentially be utilized to expedite insurance pre-approval processes for medications, particularly for specific age groups.

Community-Based Recommendations to Improve Pediatric Asthma Disparities in SPA 6

Environmental Factors

Healthcare Access and Education

Preventive Measures

Future Research Directions

To further inform effective interventions, additional research is needed to explore the specific factors contributing to asthma disparities in low-income communities. Comparative analyses across different regions can help identify systemic trends and inform policy decisions. Community-based participatory research can also provide valuable insights into the lived experiences of individuals with asthma and their families. By addressing these key areas, we can work towards reducing the burden of asthma and improving the health and well-being of children in vulnerable communities.

We Need to Uplift All Those Involved in Addressing Pediatric Asthma in SPA 6

Our research on pediatric asthma in Service Planning Area 6 (SPA 6) of Los Angeles County exemplifies key principles of community psychology in practice. By employing community-engaged methods, the study embodies the field’s core values of collaboration, empowerment, and an ecological perspective. The community-engaged approach aligns closely with community psychology’s emphasis on collaborative engagement, involving community members, researchers, and stakeholders as equal partners. It recognizes and leverages the unique knowledge and capabilities of community members while focusing on prevention by identifying key drivers and areas for improvement to reduce the future burden of asthma. Additionally, it considers multiple levels of influence on health outcomes, reflecting an ecological approach.

The findings from this study have the potential to influence local health policies, demonstrating community psychology’s commitment to translating research into actionable change. This aligns with the field’s focus on systems-level interventions that advocate for changes in healthcare delivery, environmental regulations, and resource allocation. Moreover, the study fosters community capacity building by encouraging engagement and collective action among diverse stakeholders.

A crucial aspect of this study is its exploration of the significant mental health impact on caregivers, physicians, and healthcare providers in SPA 6. This focus aligns with community psychology’s holistic approach to well-being and social justice. Caregivers of children with asthma often experience heightened stress levels and an increased risk of depression and anxiety, which can diminish their capacity for effective asthma management. These challenges create a cyclical problem that exacerbates both the caregiver’s mental health and the child’s asthma outcomes. This interplay exemplifies the systemic nature of health issues that community psychology seeks to address. Most importantly, we hope to provide a sense of optimism to the SPA 6 community, particularly the caregivers of pediatric asthma patients, who often feel isolated and unheard. Our research aimed to amplify their voices while also bringing to light the varying efforts and compassion felt by those providing care on an individual and community level.

This is particularly important as healthcare providers in SPA 6 face unique psychological challenges as well. They are at risk for burnout due to high patient loads and limited resources, alongside experiencing compassion fatigue from the emotional toll of treating chronic conditions in vulnerable populations. Additionally, they may suffer from moral distress arising from their inability to provide optimal care due to systemic constraints. These issues reflect community psychology’s concern with the well-being of all community members, including those in helping professions.

The diverse community of SPA 6 presents additional psychological stressors for healthcare providers. Acculturative stress can arise as they navigate cultural differences in health beliefs and practices, while communication anxiety may stem from language barriers and potential misunderstandings. Implicit bias can also affect care quality and patient trust, further complicating interactions between providers and patients. Addressing these challenges aligns with community psychology’s emphasis on cultural competence and social justice.

To combat these mental health challenges, community psychologists can advocate for and implement various strategies. Establishing support systems such as peer support groups for caregivers and providers can foster a sense of community and shared experience. Providing stress management resources like mindfulness training and resilience-building programs can help mitigate burnout and improve coping skills. Enhancing cultural competency through training will empower providers to work effectively across cultures, while accessible, culturally appropriate mental health services will ensure that all stakeholders receive the support they need.

By recognizing and addressing the psychological toll on caregivers, physicians, and providers, this study embodies community psychology’s commitment to holistic, systemic change. It demonstrates how attending to the mental health of all stakeholders can enhance overall care quality and improve outcomes for children with asthma in SPA 6 while advancing broader goals of health equity and community well-being.

acknowledgement

College of Medicine, Charles R. Drew University of Medicine & Science, Medicine and Society Faculty

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