Not well examined is the role that culture, acculturation, and illness representations (the way the parent interprets health and illness which influences how he/she manages the child's asthma) may play in parents' asthma treatment decisions and ultimately, children's asthma control. Parental illness representations may account for the differences in the use of complementary and alternative medicine (CAM), 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 diagnosis of asthma and medication adherence.