1. Noreen Clark, PhD Molly Gong, MD Melissa Valerio, MPH Sijian Wang, BS Xihong Lin, PhD William Bria, MD Timothy Johnson, MD University of Michigan School of Public Health Women’s Self- Management of Asthma

2. Background Approximately 9.6 million women had asthma in 2001 compared to an estimated 5 million men (CDC, 2002). Asthma disproportionately affects boys and women. Increases in the rate of asthma in women begin in adolescence (references)

3. Purpose To examine demographic factors and symptoms associated with asthma self-management in women with asthma.

4. Study Participants 652 women 18 years and older Physician diagnosis Attending University of Michigan Asthma & Airways Clinic and University of Michigan Health System

5. Data collection Telephone interview Demographics Asthma symptoms Health care utilization Gender-related management Peak flow meter use

6. Data Analyses Logistic regression and Odds Ratios (OR) or Relative Risk (RR) were computed.

7. Demographics: Age

8. Demographics: Education

9. Demographics: Income

10. Demographics: Race/Ethnicity

11. Findings

12. Asthma Severity Classified by NAEPP criteria, Guidelines and Diagnosis and Treatment of Asthma, 1997 Percent of Women Mild intermittent52% Mild persistent15% Moderate persistent18% Severe persistent15%

13. Demographics and Persistent Asthma ORP-value Low income1.76.026 Less education1.68.003 Unemployed1.71.002 Race0.546.0073 Marriage1.095.5773  Women of minority, low income, less education, and unemployed were more likely to have persistent asthma

14. PFM use and Persistent Asthma  Results from logistic regression indicated that women with persistent asthma used more peak flow meters (OR=1.48, p=.03)

15. Management Behavior and Persistent Asthma  Results from Poisson regression type-3 test indicated that women with more severe asthma were more likely to adopt management techniques (p=.0001).  However, women’s beliefs about self- management and confidence in management behavior were not associated with their disease severity (p>.05)

16. Demographics and Frequency of Using The Management Techniques  Lower education level and unemployment were associated with more use of management techniques. RRP-value Married1.0103.6830 Low income1.0658.0810 Race0.9480.1041 Education0.9204.0014 unemployed1.0999.0003

17. Demographics and Believes of The Management Techniques  Lower education level was associated with higher level of belief in the management techniques. RRP-value Married1.0163.3740 Low income0.9996.9887 Race0.9923.7524 Education0.9546.0141 unemployed0.9680.937

18. Demographics and Confidence of Using the Management Techniques  Lower education level and unemployment were associated with higher level of confidence in using the management techniques. RRP-value Married1.0245.1930 Low income0.9823.5278 Race0.9577.0766 Education0.9480.0058 unemployed1.0411.0413

19. Hormone Related Findings  49% women currently menstruate. Among those, 16% noticed symptoms worsening during the week prior to the period, 97% women reported at least one PMS symptom.  36% women reported they were bothered by symptoms of asthma during sexual activity.

20. Menstruation and Health Care Use RRP-value hospitalization 1.420.02 ED visits1.04>.05 Unscheduled visits1.01>.05 Scheduled visits1.29.0056 Follow-up visits1.06>.05  Women who menstruate had significantly more hospitalizations and scheduled doctor visits.

21. PMS and Asthma Health Care Use RRP-value hospitalization 4.95.0007 ED visits1.79.025 Unscheduled visits2.01.002 Scheduled visits1.23.38 Follow-up visits1.81.007  Women who reported PMS Symptoms had more hospitalizations, ED visits, unscheduled doctor visits and doctor visits to follow-up an asthma episode

22. With Problems during Sexual Activity and Health Care Use RRP-value hospitalization 1.42.006 ED visits1.51.0001 Unscheduled visits1.46.0001 Scheduled visits1.23.0045 Follow-up visits1.32.0001  Women who reported asthma related problems during sexual activity had significantly more health care use.

23. Study Limitations The study sample includes a number of women with high levels of education and income and an average age of 51 years.

24. Conclusions  Health care use maybe associated with sex and gender related management problems for women with asthma.  Severity of asthma is associated with use of more management techniques including peak flow meter usage.