Asthma is the most common chronic illness of childhood and one of the leading health problems of children worldwide. U.S. minority groups are disproportionately affected by the burden of asthma, as compared with non-minorities. Poor management of asthma is related to high morbidity, hospitalization and emergency visits. Studies have documented that minority Latino children, particularly Puerto Ricans, have the highest rates of asthma, are more likely to die because of their asthma, and are more likely to be under-treated for asthma, as compared with other children. Given the changing demographics of the United States, the asthma morbidity among children can be expected to increase and clinicians are destined to encounter more Latinos in their practices. Our study intends to give clinicians a better understanding of a set of beliefs, principles, and values about client involvement with Latinos, and to teach Latino clients skill-building techniques that helps to think critically and ask the "right questions", leading to the answers they need; and give clients a framework to create action plans and use their question-formulation skills in order to reduce the burden effects of asthma.

This asthma study uses a culturally adapted intervention designed to empower or activate patients/families to communicate better to the primary care physician (PCP) by establishing a communication linkage between the PCP, patients and the asthma counselor that will result in better child and adolescent care. The cultural adaptation involves training of providers to increase their competence about the patient's ethno-cultural practices about asthma. In Puerto Rico, this sample will be recruited from four clinics randomly selected from 17 clinics in the San Juan Metropolitan area. The sample will consist of 250 families/parents that have a child or adolescent that has a current doctor diagnose of Asthma (mild to severe) (100 control and 150 intervention group). The Research Core participants at the University of Puerto Rico clinics will benefit of 2 sessions (baseline, 4 months, and 8 months post baseline) of 45 minutes each that will focus on the Pediatric Asthma Intervention Project education session. These sessions will focus on empowering or activating families to communicate better to the primary care physician about their asthma management. Each study participant will only participate once through out the entire study project.

In summary this study focuses on in-depth information on the cultural beliefs and practices of Latino children with asthma and their caregivers, as well as their knowledge of and sensitivity to asthma that providers have about these beliefs.


Funding Acknowledgement

This work was supported by Grant : NIH MD00537-02 from UPR-CHA EXPORT EXPLORATORY CENTER .





To reduce Latino health disparities in asthma outcomes

To promote the career development of investigators in health disparities research

To empower patients/families to communicate better to the primary care physician (PCP) about asthma

To train clinicians in terms of cultural sensitivity and competence about Latino patients’ ethno-cultural practices about asthma.


Intervention Materials (available only in Spanish)

Proyecto CALMA: A Visual Aid to Learn about Asthma

Proyecto CALMA: Parent’s Manual

Proyecto CALMA: Asma Instructor’s Manual

Proyecto CALMA (brochures)

  • What you should know about Asthma
  • Asthma and Food Allergies
  • How to take care of Equipment used to treat Asthma
  • Control or Maintainance Medication for Asthma
  • Rescue Medication for Asthma




  • Canino, G. (2006). Respirando con CALMA: Un Programa sobre el Manejo de Asma para el Médico Primario “Nuevas Tendencias en el Manejo del Asma Bronquial”. Oral presentation, Medical Directors Academy, San Juan, Puerto Rico.

  • Canino, G. (2006). Reducing Asthma Health Disparities in Poor Puerto Rican Children: The effectivenes of a Culturrally Tailored Family Intervention. Oral presentation, UPR-CHA Export Center: Research Training Institute III, San Juan, Puerto Rico.

  • Vila, D. (2006) Individual Modifiable Factors as Predictors of Services Utilization in a Sample of Puerto Rican Children with Moderate or Severe Asthma. Oral presentation, UPR-CHA Export Center: Research Training Institute III, San Juan, Puerto Rico.

  • Martinez, K. & Acosta-Perez, E. (2006). The role of caregiver depression on pediatric bronchial asthma in a low-income. Puerto Rican sample UPR-CHA Export Center: Research Training Institute III Ruiz, L., Anderson, A., Quiñonez, A., Campos, A., Acosta-Pérez, E., Vila, D., & Canino, G. (March, 2007). Quality of life of children with asthma and their caregivers: Impact of an educational intervention in Puerto Rico. Poster, Annual Forum of Research and Education, San Juan, Puerto Rico.

  • Acosta Pérez, E., Canino, G., Vila, D. & Matías, L. (December, 2006). Conducting a randomized controlled clinical trial to test “CALMA”: A culturally appropriate family asthma management intervention. Oral presentation, Annual Symposium of the Research Centers in Minority Institutions (RCMI), San Juan, Puerto Rico.



    Child’s Demographics and Medical History

    • History of Allergies
    • History of Significant Asthma Attacks

    Asthma Knowledge

    Child’s Quality of Life

    Asthma Symptoms

    Treatment of Asthma

    • Prescribed Medication
    • Home Remedies
    • Treatment Plan
    • Adherence to Treatment
    • Health Beliefs

    Asthma Management

    • Judgment (Clark’s Measures of Self-Regulation)
    • Self-Efficacy for Accessing Physician
    • Asthma Triggers and Avoidance Techniques

    Health Care Utilization

    Barriers to Care

    Relationship with Provider

    • Communication
    • Perception of Patient Provider Communication

    Family Empowerment Scale - FES

    Parent’s Quality of Life

    Depression Scale (CES-D)