Luis Zayas
Faculty spotlight
Luis E. Zayas
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 Luis E. Zayas |
Do you have a question for Zayas regarding his research or areas of expertise?
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Question:
You are co-investigator on a unique ASU study involving Mexican mothers of children with asthma. Can you share some details about this?
Answer:
This is a qualitative study led by Dr. Kim Arcoleo, assistant research professor in ASU's College of Nursing & Health Innovation, that seeks to obtain the perspective of Mexican and Puerto Rican mothers regarding their experience of living with a child with asthma, their understanding of the nature of the disease, their beliefs and attitudes about asthma treatment, and their experiences with the healthcare system.
The study aims to gain a better understanding of how acculturation influences mothers’ asthma illness representations and asthma management strategies, and to identify successful strategies for overcoming barriers (such as healthcare system, social, cultural, and economic barriers) to providing optimal asthma healthcare for their children.
A total of 60 in-depth interviews will be conducted among a sample of Mexican and Puerto Rican parents of children ages 5-17 who have asthma. Thirty interviews will be conducted with Mexican parents in Phoenix, and another 30 interviews will be conducted with Puerto Rican parents in Bronx, N.Y.
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Question:
Why do you feel this research is especially important?
Answer:
Asthma prevalence among Latino children has been increasing. Individuals of Mexican and Puerto Rican origin constitute 73% of the Latino population in the U.S. Asthma disproportionately affects Puerto Rican children. Puerto Rican children exhibit the highest rates of asthma prevalence and mortality among all ethnic groups while Mexican children have the lowest rates.
Genetic, environmental, healthcare system and provider factors cannot totally explain the difference in outcomes between these two groups. Perhaps of critical importance, but not well examined, is the role that culture, acculturation, and illness representations may play in parents’ asthma treatment decisions – i.e., the way the parent interprets health and illness which influences how he/she manages the child’s asthma. Parental illness representations may account for the differences in the use of complementary and alternative medicine, inhaled or oral corticosteroids, and leukotriene antagonists that have been observed between Puerto Rican and Mexican families.
Acculturation may also play a role in asthma health outcomes. Less-acculturated Mexican families, even if they have known risk factors for poor health outcomes, have better outcomes than more acculturated families. Emerging evidence suggests that acculturation has opposite effects for Puerto Rican versus Mexican children with asthma. U.S. birthplace and higher acculturation among Mexican children is associated with greater risk for asthma and wheezing, while higher acculturation may be protective for Puerto Rican children in terms of both diagnosis of asthma and medication adherence.
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Question:
What’s the most exciting and/or interesting part of this project?
Answer:
There has been a shift in approaches to studying health and illness behavior from disease-oriented medical models to integrated bio-psycho-social models. The factors leading to asthma health disparities between Mexican and Puerto Rican children are complex, yet little research has been conducted that integrates, in one explanatory model, the multitude of factors that can lead to these disparities among Latino children.
Illness representations and the associated treatment decisions (complementary and alternative medicine, and controller medication use) are two factors requiring additional scrutiny. Because parents are the gatekeepers for their children’s healthcare and ultimately make the final treatment decisions, it is parents’ representation of their children’s illness that influences parents’ treatment decisions and children’s asthma health outcomes. This knowledge could help improve parental management of children’s asthma.
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Question:
What are some of the ways culture plays a role in how different populations seek health care for chronic medical conditions (particularly Hispanic and African-American cultures)?
Answer:
Culture can play a role in health care seeking behaviors in a variety of ways. In general, beliefs about the structure and function of the body and about the causes and nature of ill health can influence if and when one seeks health care and whether one seeks care from the popular (lay non-specialist), folk (non-professional specialist), or professional (legally sanctioned, bio-medical) health care sector.
If illness is believed to derive from individual, natural, social or supernatural causes, then health care or health care advice will be sought from one’s self, relative, neighbor, pharmacist, pastor, physician, herbalist, counselor or curandero, among other care providers.
Seeking health care for chronic conditions is somewhat different than for an acute condition in that patients, once diagnosed by a medical care provider, are informed about the life-long nature of their illness and required to follow a regularly a prescribed disease management plan and preventive care visits for the rest of their lives.
Culture may still influence how patients follow or incorporate the care management plan into their lifestyle and cope with the illness. This can include offering a phenomenological rationale for developing the illness, providing the symbolic content for deriving new meaning or purpose in life, or prescribing complementary and alternative medicine treatments, which may in turn influence when, where and how to seek care for their chronic condition.
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Question:
How much impact can cultural influences have in managing and coping with chronic medical conditions issues? Can you share a few examples?
Answer:
It can have a significant impact. If the culture specifies that illness results at times from an imbalance in body temperature or emotions, or from the clogging of certain ‘tubes’ connected to organs, then its therapies should work to restore the balance or unclog the passages.
For example, if asthma is deemed a ‘cold’ illness, or if attacks are believed to be triggered by stress or excess phlegm, then its treatment may include ‘hot’ therapies (physically or symbolically) that can restore the balance in body temperature, or behavioral strategies to remain calm to restore emotional balance, or therapies that can clear out phlegm blocking the respiratory channels.
The same logic applies whether treatment is sought in the popular, folk or professional health care sector, and may impact on adherence to prescribed treatments. Biomedical therapies may be viewed through these culturally informed illness models.
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Question:
You’re also about to begin a study to learn how adults of Mexican background in Maricopa County, Arizona – who recently were screened and diagnosed with T2 diabetes mellitus – seek health care, manage and cope with their illness in the community. Can you tell us more about this?
Answer:
People of Mexican background in Maricopa County have high rates of diabetes and an undue burden of diabetes-related complications. It is important for those who are diagnosed to receive and follow a physician prescribed care management plan at the time of or soon after their diagnosis.
However, we know little about the challenges that this population faces in getting the care they need and in implementing their care management plan, how long it takes them, and how they learn to adequately take care of their diabetes. Besides learning to monitor their insulin regularly, diabetes care requires lifestyle adjustments involving dietary prescriptions and physical activity.
Well-established socio-cultural patterns impacting particularly on dietary practices, physical activities, and social support may challenge or facilitate these lifestyle adjustments. This study aims to better understand how those people who are recently diagnosed with diabetes respond to their diagnosis, what their perceptions of diabetes and of developing the illness are, when and how they initiate medical care for diabetes, how they manage their diabetes, and the social, economic and cultural resources that they bring to bear (or lack) in managing and coping with the illness.
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Question:
How might this study help to improve the health status and health care of the people in this population?
Answer:
The goal of this study is to better understand and learn from their experiences dealing with diabetes in the context of their daily live in order to develop, in collaboration with various community stakeholders, culturally informed, community-based strategies that facilitate prompt medical care and proper self-management of diabetes for adults of Mexican background who recently found out that they had diabetes and who are just learning to manage and cope with this illness.
The results from this study will inform subsequent studies for testing, evaluating and implementing interventions.
Short bio:
ASU Assistant Professor Luis E. Zayas is a socio-cultural anthropologist in the School of Social Work with a concentration in medical anthropology.
His published research has appeared in the Annals of Family Medicine, Health Education Research, Journal of the National Medical Association, Diabetes Educator, Journal of Asthma, Ethnicity and Disease, and Journal of Immigrant & Minority Health.
Dr. Zayas received a Ph.D. in Socio-Cultural Anthropology from the University of Chicago. Before joining ASU, he held teaching and research positions at Washington University in St. Louis; University at Buffalo, the State University of New York; and Lake Forest College in Lake Forest, IL.
