Disparities in Adolescent Controller Medication Adherence, Treatment Barriers, and Asthma Control

Background: Disparities in asthma persist despite advances in interventions. Adherence and self-management behaviors are critical yet challenging during adolescence. Treatment barriers include individual factors as well as structural and social determinants of health.

Objective: To determine differences in controller medication adherence, asthma control, and treatment barriers by race, income, and insurance and whether racial disparities persist when controlling for income and insurance. Associations between adherence, barriers, and control were also examined.

Methods: Adolescents completed measures of treatment barriers and asthma control. Controller medication adherence was measured electronically. Descriptive statistics, means comparisons, and analyses of covariance were conducted.

Results: One hundred twenty-five adolescents participated (M = 14.55, SD = 2.01, 37.6% Black or African American, 55.2% White). Black or African American adolescents had significantly lower adherence than White adolescents, t(105) = 2.79, p = .006, Cohen's d = .55. This difference was not significant when controlling for income and insurance (p > .05). There was a significant difference in asthma control, F(1,86) = 4.07, p = .047, η  = .045, where Black or African American adolescents had better asthma control scores than White adolescents. Feeling tired of living with asthma was the most common barrier among all adolescents (62.4%). More Black or African American adolescents endorsed difficulty getting to the pharmacy than White adolescents, X (1, N = 116) = 4.86, p = .027.

Conclusions: Racial disparities in asthma may be partially driven by income, insurance, and pharmacy access. Asthma burnout may be important to address for all adolescents with asthma.