RATIONALE:Adherencetoinhaledcorticosteroid (ICS) medication is known to be low overall, but tends to be lower among African-American patients when compared with white patients.OBJECTIVES:To understand thefactorsthat contribute to ICSadherenceamong African-American and whiteadultswithasthma.METHODS:Eligible individuals had a prior diagnosis ofasthma, one or more ICS prescriptions, and were members of a large health maintenance organization in southeast Michigan. Individuals were sent a survey that included questions about internalfactors(e.g., patient beliefs, knowledge, and motivation) and externalfactors(e.g., socioeconomic status, barriers to care, social support, and stressors) potentially related to ICSadherence.Adherencewas calculated using electronic prescription and fill data. Stepwise regression was used to identifyfactorsassociatedwithadherencebefore and after stratifying by race-ethnicity.MEASUREMENTS AND MAIN RESULTS:Surveys were returned by 1,006 (56.3%) of 1,787 eligible patients. Adjusting for internalfactors, but not externalfactors, diminished the relationship between race-ethnicity and ICSadherence. Among African-American patients, readiness to take ICS medication was the only internal or external factor significantlyassociatedwith ICSadherence; it explained 5.6% of the variance inadherence. Among white patients, perceived ICS necessity, ICS knowledge, doctors being perceived as the source ofasthmacontrol, and readiness to take medication were the internalfactorsassociatedwith ICSadherence; these accounted for 19.8% of the variance inadherence.CONCLUSIONS:Factorsassociatedwith ICSadherenceappear to differ between African-American and white patients, suggesting that group-specific approaches are needed to improveadherence.
