Pioneering Nurse Scientist Addresses Asthma-Related Disparities

    • June 17, 2014

In 2000, Kamal Eldeirawi, PhD, RN, a pioneering scientist with expertise in immigrant health, became director of a state-sponsored asthma project in Chicago. For the job, he drove to more than 40 of the city’s public schools, where he screened children for asthma and respiratory conditions, provided education to children with asthma and their families, and trained school teachers and staff on how to control the disease.

He gathered information from the parents of some of these children who lived in underserved parts of the city and worked closely with a mobile clinic, or “Asthma Van,” to facilitate the children’s access to affordable quality health care.

His forays throughout the city led to a deep understanding of the difficulties low-income parents—and immigrant parents in particular—experienced accessing adequate health care for their children. Many did not have enough money to send their children to a doctor or to the hospital. And some, especially immigrants, had difficulty communicating with school staff and health providers about their children’s conditions.

New immigrants, he observed, faced almost insurmountable challenges. Many lived in fear of deportation and in social isolation, without support from family and friends, and few had access to government-provided social support services. Asthma rates tended to vary significantly by race and ethnicity and across neighborhoods; the poor, he observed, were disproportionally affected by the disease.

“Asthma is a chronic condition that affects the entire family and requires quality and long-term health care and education,” Eldeirawi said. “Some of the children I identified as having asthma lacked access to proper health care, and that was a big problem.”

The experience resonated with Eldeirawi, an immigrant who was born in the Gaza Strip in Palestine, and spurred him to research immigrant health. “I was touched by those challenges, especially in newly arriving immigrant families,” he said. “As an immigrant myself, I have faced some of the same challenges that the families I worked with described to me. That really influenced my decision to pursue this line of research.”

Making a Difference

Eldeirawi’s interest in nursing dates back to his childhood, where he saw the profound impact of poverty and disadvantage on health in his own community. A career in nursing, he believed, would allow him to make a difference at both the individual and population-wide levels.

He earned his bachelor’s degree at Bethlehem University, located in the West Bank of Palestine, and moved to the United States to enroll in a master’s-level nursing program at Indiana University in Pennsylvania. In 2006, he earned his doctorate in public health from the University of Illinois at Chicago, where he wrote his dissertation on asthma in children of Mexican descent.

Now an assistant professor in the College of Nursing at the University of Illinois at Chicago, Eldeirawi is continuing his research into asthma, a condition that affects around 40 million people in the United States. About 12 percent of Mexican American children have asthma, and Eldeirawi is researching risk factors that contribute to the condition in this under-studied group.

Eldeirawi has studied individual-level factors linked with asthma including ear infections, antibiotic use in infancy, and exposure to animals and pets. He and his team found that repeated ear infections in infancy increased the risk of asthma in children. He also pioneered an area of research on the effect of immigration and acculturation on asthma and respiratory health in Mexican American children, documenting that asthma rates in these children increase with immigration and acculturation.

Immigration Status a Risk Factor

Mexican American children born in the United States were more than twice as likely to have asthma as Mexican American children born in Mexico, Eldeirawi’s team found. And the prevalence of asthma among Mexican American children born in Mexico was linked to the length of time they had spent—or level of acculturation—in the United States.

Immigration status seemed to affect other aspects of health too, he found in another study. Mexican American children born in the United States had lower levels of cancer-fighting antioxidants than Mexican American children born in Mexico.

There is something about migrating to and living in the United States, in other words, that contributes to asthma and possibly other health conditions in immigrant children, Eldeirawi’s findings suggest. “We’re not sure what it is,” he said, noting that possibilities include environmental exposures in U.S. cities, the American diet, or the stress of immigrating to a new country. “When Mexican Americans first come to this country, they have some protection against the risk of asthma. But that initial protection fades away as they spend more time living in the United States and adopting U.S. lifestyles.”

Eldeirawi wants to know why. Now a Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholar (2013-2016), he is linking his previously collected data on individual characteristics with data on neighborhood-level characteristics such as neighborhood deprivation and poverty, rates of violent crime, amount of green space, concentration of Mexican Americans, traffic-related pollution, and indicators of neighborhood physical disorder such as vacant or abandoned buildings, crumbling foundations, and broken windows.

He plans to examine the relationship between neighborhood environments and Mexican American children’s risk for asthma as well as other respiratory conditions and the interrelationships among these neighborhood factors and individual level characteristics such as immigration status, acculturation, or other factors. He and his team hope to release some early results within a year.

The findings have implications for identifying causes of asthma and defining effective, multi-level, culturally appropriate interventions as well as policies to prevent asthma and reduce asthma-related disparities in Mexican American children—and perhaps in other populations too.

“I want to uncover the causes of asthma and design studies to treat and prevent this disease, not only in the United States but globally as well,” he said.

Nearly 15 years after he first started chasing asthma in children throughout Chicago’s impoverished neighborhoods, Eldeirawi still has the same goal: to improve the health of underserved and immigrant children, eliminate asthma-related health disparities, and develop strategies to prevent asthma and its consequences. But now, he’s a lot closer to reaching it.