Assessment of peer relationships in children with asthma

To Make and Keep Friends: The Role of Health Status in Adolescent Network Tie Formation and Persistence

Health status may shape network structure through network dynamics (tie formation and persistence) and direction (sent and received ties), net of typical network processes. We apply Separable Temporal Exponential Random Graph Models (STERGMs) to National Longitudinal Study of Adolescent to Adult Health survey data (n = 1,779) to differentiate how health status shapes network sent and received tie formation and persistence. Results indicate that networks are shaped by withdrawal of adolescents experiencing poor health, highlighting the importance of separating distinct and directed processes of friendship formation and persistence when considering how health relates to adolescent social life.

The Long-Term Impact of Childhood Disability on Mental Health Trajectories in Mid- to Late-Life

OBJECTIVES

We draw from the life course and stress process frameworks to examine how experiencing disability in early life influences mental health in adulthood.

METHODS

Data come from the Health and Retirement Study Cross-Wave Childhood Health and Family Aggregated Data file (2008-2018, n = 15,289). Childhood disability status is a retrospective self-report of whether respondents were disabled for six months or more because of a health problem before the age of 16 (n = 581). We used age-based growth curve models to construct trajectories of depressive symptoms by childhood disability status.

RESULTS

Respondents who experienced childhood disability exhibit more depressive symptoms at age 50 compared to those who did not experience this stressor. However, there is no difference in the growth of depressive symptoms with age between these groups, suggesting maintained inequality over the late adulthood life course.

DISCUSSION

Findings suggest that childhood disability has long-term implications for life course mental health.

Comprehensive Investigation of Factors Influencing University Students’ Academic Performance in Saudi Arabia

Academic success in undergraduate programs is indicative of potential achievements for graduates in their professional careers. The reasons for an outstanding performance are complex and influenced by several principles and factors. An example of this complexity is that success factors might change depending on the culture of students. The relationship of 32 factors with the reported academic performance (RAP) was investigated by using a survey distributed over four key universities in Saudi Arabia. A total of 3565 Saudi undergraduate students completed the survey. The examined factors included those related to upbringing, K-12 education, and structured and unstructured activities. Statistical results validate that many factors had a significant relationship with the RAP. Among those factors, paternal’s education level and work field, type of intermediate and high schools, and the attendance of prayers in mosques were significantly associated with the reported performance. This study provides important insights into the potential root causes of success so that they can be targeted by educators and policy makers in the effort to enhance education outcomes.

Attitudes of Non-Asthmatic Children Towards Their Asthmatic Peers: Influence of interactions with asthmatic relatives and peers

Objectives

This study aimed to examine non-asthmatic children's acceptance of and attitudes towards their asthmatic peers in Jordan.

Methods

This descriptive cross-sectional study was conducted between September 2015 and January 2016 among 1,812 non-asthmatic children aged 9-13 years old at 10 schools in Zarqa, Jordan. Arabic versions of the Peers Attitude Towards Children with Asthma scale and the Asthma Knowledge Test for Children were used to assess attitudes towards children with asthma and asthma-related knowledge, respectively.

Results

A total of 1,586 children participated in the study (response rate: 87.5%). Of these, 158 (10%) and 399 (25.2%) children reported a family history of asthma or knew at least one person with asthma, respectively. Although 50.3% stated that they would sit next to such children in the classroom, only 34.9% reported that they would be friends with an asthmatic child. However, 73.1% of the non-asthmatic children believed that asthmatic children were not pretending to be ill and 61.4% believed that such children were not ill due to their own carelessness. Female non-asthmatic children (P <0.001), those with a family history of asthma (P = 0.004) and those who knew other individuals with asthma (P <0.001) had significantly more positive attitudes towards and acceptance of their asthmatic peers. In addition, age was significantly related to attitude scores (P <0.001). However, there was no correlation between asthma-related knowledge and the children's attitudes towards peers with asthma (P = 0.611).

Conclusion

Previous interactions with asthmatic family members or peers were found to significantly influence non-asthmatic children's attitudes towards their asthmatic peers.

Developing web-based Triple P 'Positive Parenting Programme' for families of children with asthma

BACKGROUND

We examined the feasibility of self-directed Triple P 'Positive Parenting Programme' for optimizing parents' management of childhood asthma and behaviour.

METHODS

Eligible families were invited to access asthma-specific web-based Triple P as part of a preliminary randomized controlled study.

RESULTS

Initial study information and introductory website pages received considerable interest but intervention uptake was poor with high rates of attrition.

CONCLUSIONS

Although parents of children with asthma show willingness to access web-based parenting support, further work is necessary to develop engaging websites and determine barriers to uptake, and adherence to online parenting interventions with this population.

Asthma and adaptive functioning among homeless kindergarten-aged children in emergency housing

BACKGROUND

Children who experience homelessness have elevated rates of asthma, a risk factor for other problems. Purpose. Examine rates of asthma and its relation to health care use and adaptive functioning among young children staying in family emergency shelters.

METHODS

Children and caregivers (N = 138) completed assessments in shelters, including measurement of child cognitive functioning, parent report of child health care service utilization and asthma diagnosis, and teacher report of child school functioning.

RESULTS

Asthma diagnosis was reported for 21% of 4-to-6-year-old children, about twice the national and state prevalences. Children with asthma used more health care services and had worse peer relationships. Asthma did not relate to cognitive test performance or subsequent academic performance, or to other behavior problems in school.

CONCLUSIONS

High rates of asthma remain an important issue for children in emergency family housing, a context with high levels of child risk for toxic stress exposure and developmental problems.

Differences in sleep quality and health-related quality of life in young adults with allergies and asthma and their healthy peers

OBJECTIVE

The current study examined the relationship between sleep quality and health-related quality of life (HRQOL).

PARTICIPANTS

Participants were 501 undergraduate students with allergies (167), asthma + allergies (167), or with no history of a chronic illness (167) completed study measures from August 2011 to April 2012.

METHODS

The undergraduate students completed questionnaires online as part of a larger study of psychosocial adjustment of young adults.

RESULTS

Young adults with allergies and asthma + allergies reported significantly worse sleep quality and HRQOL than healthy peers. Additionally, those with allergies and asthma + allergies had significantly more sleep disturbances and used sleeping medication significantly more often in the previous month than healthy peers.

CONCLUSIONS

These results highlight concerns regarding quality of life and sleep problems in an often-overlooked population. Importantly, sleep difficulties can result in difficulties in daily living and impairment in academic functioning.

A comparison of friendship quality and social functioning among children with perinatally acquired HIV, children with persistent asthma, and healthy children of HIV-positive mothers

OBJECTIVE

To examine the friendships and social expectations of children with perinatally acquired HIV and compare them to children with moderate to severe persistent asthma and healthy children of HIV-positive mothers.

METHODS

70 children (ages 8-14 years) were recruited from pediatric allergy and immunology multidisciplinary clinics and hospital-based HIV-support programming. Children completed measures of friendship quality and interpersonal functioning. Caregivers completed a measure of child psychosocial functioning.

RESULTS

Children with asthma, not HIV, demonstrated poorer indicators of friendship and the most negative social expectations of the three groups. Children with HIV maintained best friendships and rated themselves as socially well-adjusted.

CONCLUSIONS

Comprehensive multidisciplinary services and ancillary supports may have buffered against stressors and facilitated positive psychosocial outcomes in children with HIV. Children with asthma displayed higher disease activity, possibly contributing to poorer outcomes. Results suggest a need to better understand the protective factors that enhance social functioning in children with HIV.

The effectiveness of psychosocial interventions designed to improve health-related quality of life (HRQOL) amongst asthmatic children and their families: a systematic review

PURPOSE

Asthmatic children are at risk of compromised health-related quality of life (HRQOL) compared with their healthy peers. This systematic review reports the range and effectiveness of psychosocial interventions designed to improve HRQOL amongst asthmatic children, adolescents, and their families.

METHOD

Data sources included The Cochrane Airways Group Trials Register of trials, PubMed database, and reference lists from review articles.

RESULTS

Eighteen studies of psychosocial interventions were identified. Interventions were designed to improve HRQOL amongst a range of psychosocial, health care, school-related and clinical outcomes, and were delivered in numerous settings and formats. Four studies reported that interventions were effective for significant improvements in child overall HRQOL scores. These include asthma education (n = 2), asthma education plus problem solving (n = 1), and art therapy (n = 1).

CONCLUSIONS

Most interventions focussed on the delivery of asthma education to children, with the purpose of improving knowledge about asthma and disease management. There is limited evidence to suggest that interventions currently available are effective for significantly improving HRQOL amongst asthmatic children, adolescents, and their families. Most interventions lacked a theoretical basis and did not focus on family functioning variables. Multi-component interventions that incorporate asthma education along with strategies to assist families with implementing behaviour change towards improved asthma management are required. Future interventions should also attempt to address the wider context of family functioning likely to contribute to the family's ability to engage in successful asthma management in order to improve HRQOL.

What about your friends? Exploring asthma-related peer interactions

PURPOSE

School-based asthma interventions have been shown to be effective, but many may not be sensitive to the influence of peer interactions in shaping asthma-related emotional experiences. This exploratory study describes associations between peer interactions and asthma-related emotional experiences, asthma control, and outcomes among elementary-aged children with asthma.

METHODS

Data come from the baseline assessment of a randomized trial evaluating the effect of a school-based asthma intervention. Univariate and multivariate statistics were completed to examine associations between peer interactions and asthma-related variables of interest.

RESULTS

Eight hundred and thirty-five caregiver and child interviews were used in the analysis. Both males and females were enrolled in this study, 31% had not well controlled or poorly controlled asthma and 44% reported taking asthma medications. Overall, 26% of children talked to friends about asthma. Females were significantly more likely to talk to friends about asthma (p < .05) and more likely to report that they were worried, concerned, or troubled about asthma (p < .01). Significant differences in emotional quality of life between males and females were also found. Children who reported talking to friends about asthma were more likely to report teasing about asthma (OR = 2.47; 95% CI 1.57, 3.89) and to report that friends help with their asthma (OR = 1.79; 95% CI 1.07, 3.01).

CONCLUSIONS

School-based asthma interventions should be sensitive to emotional-related outcomes associated with asthma and the influence of asthma-related peer interactions. Providing children with communication strategies for disclosure of asthma status to peers that result in more supportive interactions may be needed.

Suicide risk in adolescents with chronic illness: implications for primary care and specialty pediatric practice: a review

Suicide in adolescents is a global tragedy. Research-identified correlates of suicide in youth include depression, academic failure, loss of friends, social isolation, and substance abuse, among others. This review focuses on the potential link between chronic illness in adolescents and increased suicide risk. Research suggests that chronic illness is a risk factor for depression in adolescents that may induce suicide ideation and attempts; however, this risk may be increased even more in young adulthood if the underlying causes of depression are not resolved. This risk needs to be considered against the research data noting an increase in suicide attempts and completions, in each decade of life from adolescence into adulthood. Although more research is clearly needed, it can be concluded that suicide risks are seen in adolescents with chronic illness and all of these young people should be screened for depression and other risk factors for suicide on a regular basis.

Health and the structure of adolescent social networks

Much research has explored the role of social networks in promoting health through the provision of social support. However, little work has examined how social networks themselves may be structured by health. This article investigates the link between individuals' health and the characteristics of their social network positions. We first develop theoretical predictions for how health may influence the structure of adolescent networks. We then test these predictions using longitudinal analysis of the National Longitudinal Study of Adolescent Health (Add Health). We find important relationships between the health status of adolescents and the characteristics of the social network positions within which they are embedded. Overall we find that adolescents in poor health form smaller local networks and occupy less central global positions than their healthy peers. These results also have implications for social network research, expanding the scope of factors responsible for the network positions individuals occupy.

A controlled, longitudinal study of the social functioning of youth with sickle cell disease

OBJECTIVE

To assess the peer relationships of adolescents with sickle cell disease (SCD) and demographically similar comparison peers who did not have a chronic illness 2 years after an initial evaluation. As a result of ongoing medical challenges associated with SCD and the psychological demands of adolescence, we hypothesized that children with SCD would be viewed by peers as more sensitive and isolated, they would have fewer friends, and they would be less well liked than comparison peers.

PATIENTS AND METHODS

At follow-up, peer (n = 2067) and teacher (n = 120) reports of social functioning were obtained for 60 children with SCD and 66 comparison peers. Social reputation (What is the child like?) and social acceptance (Is the child liked?) were evaluated cross-sectionally and longitudinally at the 2-year follow-up (ages 10-17).

RESULTS

Relative to comparison peers, children with SCD were perceived as less aggressive by peers and teachers. No significant differences were found between groups on measures of friendship or social acceptance. Results of longitudinal analyses indicated that teacher-reported levels of sensitive and isolated behavior increased over time for comparison peers but remained stable for children with SCD.

CONCLUSIONS

In general, the social functioning of children with SCD remained stable over time and was not suggestive of emergent social dysfunction. Findings are discussed within a developmental psychopathology framework, possible protective effect of SCD for youth from high-risk environments, and implications regarding pain management for these youth.

Friendships and social interactions of school-aged children with migraine

We set out to evaluate the friendships and social behaviour of school-aged children with migraine. Concern exists regarding the impact of paediatric migraine on daily activities and quality of life. We hypothesized that children with migraine would have fewer friends and be identified as more socially sensitive and isolated than comparison peers. Sixty-nine children with migraine participated in a school-based study of social functioning. A comparison sample without migraine included classmates matched for gender, race and age. Children with migraine had fewer friends at school; however, this effect was limited to those in elementary school. Behavioural difficulties were not found. Middle-school students with migraine were identified by peers as displaying higher levels of leadership and popularity than comparison peers. Concern may be warranted about the social functioning of pre-adolescent children with migraine; however, older children with migraine may function as well as or better than their peers.

Negative peer perceptions of obese children in the classroom environment

OBJECTIVE

It is asserted that the more immediate and observable consequences of pediatric obesity are psychosocial in nature. This study examines the peer relations of clinically referred obese youth compared to demographically comparable nonoverweight peers within the classroom environment.

METHODS AND PROCEDURES

Peer-, teacher-, and self-reports of behavioral reputation (Revised Class Play (RCP)), and peer reports of social acceptance, nonsocial attributes (attractiveness, athleticism, academic competence), and health interference (school absence, illness, fatigue) were obtained regarding 90 obese youth (BMI > 95th percentile; 8-16 years, 57% girls, 50% African American) and 76 nonoverweight demographically similar comparison classmates.

RESULTS

Relative to comparison peers, obese children were nominated significantly less often as a best friend and rated lower in peer acceptance, although the two groups did not differ in the number of reciprocated friendships. Obese youth were described by peer, teacher, and self-report as more socially withdrawn and by peers as displaying less leadership and greater aggressive-disruptive behavior. Peers also described obese youth as less physically attractive, less athletic, more sick, tired, and absent from school. Being seen as less attractive and less athletic by peers helped to explain differences in obese and nonoverweight youth's levels of peer acceptance.

DISCUSSION

Clinically referred obese youth are characterized by peer relations that differ from those of nonoverweight youth. The peer environment provides a rich context to understand the social consequences of pediatric obesity as well as factors that could be targeted in intervention to promote more positive health and psychosocial outcomes.

Peer victimization in children with attention-deficit hyperactivity disorder

This study examined the correlation of peer victimization to psychosocial adjustment in a sample of children diagnosed with attention-deficit hyperactivity disorder (ADHD). A total of 303 files of youth who received a psycho-educational assessment were reviewed; of these, 116 had an ADHD diagnosis. The data collected included the Child Behavior Checklist (which includes items assessing peer victimization), Conner's Parent Rating Scale, Revised Children's Manifest Anxiety Scale and Children's Depression Inventory. Peer victimization was positively correlated with parent reports of anxiety, depression, social problems, delinquent behavior and aggressive behavior. Children with a comorbid psychiatric diagnosis with ADHD reported higher rates of peer victimization than those without a comorbid diagnosis. Children diagnosed with ADHD along with a comorbid externalizing psychiatric diagnosis experienced higher rates of peer victimization than those with a comorbid internalizing psychiatric diagnosis. The implications of this study concerning peer victimization and psychosocial adjustment in children with ADHD are discussed.

Peer relationships and emotional well-being of children with sickle cell disease: a controlled replication

We completed a replication study examining the social and emotional functioning of children with sickle cell disease (SCD) who have not had an overt stroke and a group of demographically similar comparison classmates based upon data from multiple informants. Relative to comparison peers, children with SCD were described by teachers as more prosocial and less aggressive. Peers described them as having fewer friends, less athletic, ill more often, and missing more school. No group differences were identified for emotional well-being. Effect size analyses indicated that this study replicated a number of findings from our previous study of children with SCD (Noll et al., 1996). Findings from both studies suggest relative psychological hardiness among children with SCD who have not had an overt stroke.

The role of coping strategies in quality of life of adolescents with asthma

This study aimed to determine which coping strategies are associated with better quality of life (QOL) in adolescents with asthma. Furthermore, because coping can mediate the effects of health stressors on QOL, this study also examined the indirect effect of asthma severity on QOL via coping. Between January and May 2003, 553 Dutch adolescents with asthma (aged 12-16 years) completed questionnaires assessing coping strategies, symptom severity, overall QOL and positive QOL domain (positive effects of asthma domain). The relations between symptom severity, coping strategies and QOL were tested with structural equation modelling (SEM). Symptom severity affected overall and positive QOL, both directly and indirectly via coping. The coping strategies restricted lifestyle and worrying about asthma were associated with poorer overall QOL. The use of the coping strategies restricted lifestyle, positive reappraisal, and information seeking was related to increased scores on the positive QOL domain, whereas hiding asthma was related to lower scores on the positive QOL domain. The findings of this study suggest that coping mediates the effect of symptoms of asthma on QOL among adolescents with asthma. Several suggestions for interventions to improve asthma-specific QOL are discussed.

Children's asthma, internalizing problems, and social functioning: an urban perspective

PROBLEM

Asthma may serve as a risk factor for higher levels of psychosocial problems in urban school-aged children.

METHOD

Interview data were collected from 48 children (27 with asthma and 21 without asthma) and their mothers.

FINDINGS

Asthma did not function as a risk factor for psychosocial problems in this sample. Children with more symptoms of depression and anxiety experienced poorer social functioning, regardless of their health status.

CONCLUSION

These results highlight the importance of examining co-occurring difficulties in psychosocial development among urban children in order to design interventions that minimize the impact of such challenges.

Schools' capacity to help low-income, minority children to manage asthma

This article describes the challenges and strengths of asthma management in 14 low-income, predominantly African American urban elementary schools serving more than 5,000 students. Asthma prevalence was 24.5%. Teachers, school principals, parents, and children described how asthma was managed at school. Data from classmates of students with asthma showed that they had moderate to high levels of information about the disease. Data from teachers indicated the great need for practical instruction on how they might effectively support a child with asthma in the classroom and on the playground. Principals raised concerns about expectations for the functioning of school staff and implementation of school policies especially related to asthma emergencies. Parents reported a range of problems their children face at school. Data from children with asthma showed that 75% believed asthma affected their school work. Findings from this study should be useful to school personnel, health providers, and others who assist children and their families to manage asthma at school. Data suggest that making school nursing services available is warranted, given the impact of asthma on the school community.

Effects of a self-management asthma educational program in Taiwan based on PRECEDE-PROCEED model for parents with asthmatic children

This study was conducted to evaluate the comparative effectiveness of two different asthma educational programs. One was self-management asthma education based on the PRECEDE-PROCEED model to change the influential factors based on a previous need assessment study in Taiwan. The other consisted of regular outpatient asthma education. The purposes were: 1) to compare differences in the asthma knowledge, self-efficacy, perceived effectiveness, children's cooperation, doctor-patient communication, and self-management behaviors in the experimental and control groups before education, and 2 weeks, 3 months, and 6 months after education; and 2) to compare differences in drug use, medication utilization, asthma severity, signs/symptoms of asthma, school absenteeism, and exercise ability before education, and 2 weeks, 3 months, and 6 months after education. Parents of asthmatic children were recruited from among outpatients of Chang Gung Children's Hospital, Taoyuan, Taiwan. They were grouped by registration number: those with even numbers were assigned to the experimental group, and those with odd numbers were assigned to the control group. Measurements were collected four times from all parents by means of a questionnaire and chart review. The General Linear Model: Repeat Measurement was used to compare variance differences. The following results were found. 1) Asthma knowledge, self-efficacy, perceived effectiveness, children's cooperation, and self-management behaviors significantly improved after the self-management asthma educational program based on PRECEDE-PROCEED. Except for perceived effectiveness, all variables still had good effectiveness after 6 months of follow-up. The experimental group was better than the control group in knowledge, children's cooperation, and self-management behaviors at the 3-month follow up, as well as in knowledge and children's cooperation at the 6-month follow-up. 2) In both the experimental and control groups, the educational program had a good impact on the health outcome. The average degree of drug use was reduced from 2.7 to 2.1. The number of visits was reduced from 4.75 to 3.55 per half year in the experimental group, and from 5.8 to 3.48 in the control group. The severity of asthma was reduced from 2.7 to 2.1. The signs/symptoms of asthma decreased, school absenteeism was reduced, and exercise ability improved after education at the 6-month follow-up in both groups. From the results of this study, the theory-based educational program had a good effect on self-management behaviors. From the repeat measurement analysis, we can understand the changing trend of the determinants, behaviors, and outcome indicators. The trend indicated that educational effects were sustained for at least 3 months, with some for 6 months. In order to maintain the educational effects, further specific series of educational programs can be designed based on the patterns of self-management behavior stages every 6 months. The effects of health outcomes may show significant differences using longer follow-up times in future clinical trials.

Social, emotional, and behavioral functioning of children with hemophilia

This study examines the social, emotional, and behavioral functioning of children with hemophilia. Data were collected in the homes and schools of 40 boys with hemophilia and 40 comparison boys of the same race and age. Data on social, emotional, and behavioral functioning were collected from teachers, classmates, parents, and the participants. Children with hemophilia scored comparably with comparison peers in all areas of social functioning but reported more difficulties with emotional well-being, including more depressive symptomatology and lower self-perceptions. Parent report also indicated more difficulties with emotional well-being. Parents did not report significant differences in externalizing behavior problems. In conclusion, children with hemophilia were not found to be at increased risk of social or behavioral difficulties. However, both children with hemophilia and their parents identified more difficulties with emotional well-being. Nevertheless, approximately all mean scores for both groups remained within the normal range.

A controlled longitudinal study of the social functioning of children who completed treatment of cancer

BACKGROUND

A follow-up assessment of social functioning was performed for children with cancer after completion of treatment. It was hypothesized that children who completed cancer treatment (CCT) would have more social problems than their peers who were not chronically ill (COMP) and that greater treatment intensity would be predictive of increasing social difficulties over time.

PATIENTS AND METHODS

Peer, teacher, and self-reports of social functioning were obtained from 69 CCTs and 77 COMPs. Social reputation and social acceptance were evaluated cross-sectionally and longitudinally.

RESULTS

Relative to COMPs, CCTs described themselves as more prosocial, were perceived by teachers as less aggressive, and were seen by peers as more sick, more tired, and as missing more school. Longitudinal analyses indicated that self-reported prosocial scores were significantly more stable over time for CCTs relative to COMPs. Children who received more intense treatment were perceived by peers as more prosocial and less aggressive, but as having fewer best friends 2 years after treatment ended.

CONCLUSIONS

CCTs had minimal impact on their social functioning as a result of their experience with cancer for those children who have returned to school. These results suggest that routine interventions with regard to social functioning after treatment ends may not be warranted for most CCTs when an integrated program of psychosocial services coordinated by mental health professionals has been provided during treatment. However, children who have undergone especially intense treatment may be at some risk for social problems.

Psychosocial factors associated with levels of metabolic control in youth with type 1 diabetes

This study sought to determine the relationship between Youth Self Report (YSR) scores for behavior problems, YSR scores for social competence, and metabolic control in children and adolescents with Type 1 diabetes. Using a cross sectional design, 234 individuals between 11 and 18 years old were given the YSR at regular clinic appointments; glycosylated hemoglobin (GHb) was also measured. More than 50% of subjects showed GHb levels above 9%; the normal GHb level is 4.2% to 5.8%. Individuals reporting a greater number of behavior problems, though not in the pathological range on the aggression, delinquent behaviors, and attention problems subscales of the YSR, were more than twice as likely to have GHb levels above 9%. Using logistic regression the externalizing scale (aggression and delinquent behaviors combined) predicted elevated GHb at 2.41, p =.003. Youth in this study were middle-class and were receiving subspecialty care. Yet, over half of them had GHb levels above the recommended 9%. The psychological health of youth should be monitored at regular intervals. Longitudinal studies are needed to determine whether aggression, delinquent behaviors, and attention problems in children and adolescents with Type 1 diabetes result later in depression and elevated levels of GHb in these same individuals or whether these elevations are transient. Interviews could be supplemented with instruments such as the YSR and care given for those with a higher number of self-reported problems.

Effect of peer led programme for asthma education in adolescents: cluster randomised controlled trial

OBJECTIVE

To determine the effect of a peer led programme for asthma education on quality of life and related morbidity in adolescents with asthma.

DESIGN

Cluster randomised controlled trial.

SETTING

Six high schools in rural Australia.

PARTICIPANTS

272 students with recent wheeze, recruited from a cohort of 1515 students from two school years (mean age 12.5 and 15.5 years); 251 (92.3%) completed the study.

INTERVENTION

A structured education programme for peers comprising three steps (the "Triple A Program").

MAIN OUTCOME MEASURES

Quality of life, school absenteeism, asthma attacks, and lung function.

RESULTS

When adjusted for year and sex, mean total quality of life scores showed significant improvement in the intervention than control group. Clinically important improvement in quality of life (>0.5 units) occurred in 25% of students with asthma in the intervention group compared with 12% in the control group (P=0.01). The number needed to treat was 8 (95% confidence interval 4.5 to 35.7). The effect of the intervention was greatest in students in year 10 and in females. Significant improvements occurred in the activities domain (41% v 28%) and in the emotions domain (39% v 19%) in males in the intervention group. School absenteeism significantly decreased in the intervention group only. Asthma attacks at school increased in the control group only.

CONCLUSION

The triple A programme leads to a clinically relevant improvement in quality of life and related morbidity in students with asthma. Wider dissemination of this programme in schools could play an important part in reducing the burden of asthma in adolescents.

The company they keep: the influence of peer relationships on adjustment to cystic fibrosis during adolescence

A grounded theory approach was used to explore the influence of peer relationships on adjustment to cystic fibrosis (CF) in 15 adolescents. Discovering the course was the core category that captured the influence of peers on adjustment to CF. Four subcategories were identified: (1) losing ground, (2) being out of the loop, (3) finding a new company of friends, (4) fighting a never-ending battle. The downward progression of CF and increasing social interactions with peers with CF during hospitalization helped them learn CF was a lifelong disease with relentless demands. Interventions should focus on strategies for promoting peer support, a positive attitude, and hope to create a sense of belonging, social competence, and well-being.

Behavioural/emotional symptoms among 8-9-year-old children with somatic symptoms or illnesses as reported by their teacher

The aim of this study was to assess children's behavioural/emotional symptoms at school and to compare these symptoms of somatically healthy children with those of children with somatic illnesses or symptoms. The Rutter Teacher Questionnaire (RB2) was used for measuring psychiatric symptoms in 5813 children aged 8-9 years. The parents reported the somatic symptoms and illnesses of their children during the previous 12 months. One hundred and sixty one children had a marked or serious chronic illness, 292 had a mild chronic illness, and 92 had one or several symptoms. The findings suggest that boys with a marked or serious chronic somatic illness are prone to manifest psychiatric symptoms in their interactions with peers and teachers at school and that boys with a mild chronic illness have less psychiatric symptoms than healthy boys.

Stressors and concerns in teen asthma

Adolescents are uniquely susceptible to poor outcome with asthma because of their desire for autonomy, denial of disease, preference for immediate gain rather than prophylaxis, restricted ability to control their psychosocial and physical environment, and difficult transition to health care. Tobacco smoking as well as related drug abuse and passive exposure to tobacco is a major obstacle to managing adolescent asthma, together with atopy and psychosocial problems. Recent investigations indicate that adolescents are uniquely susceptible to tobacco industry promotions and logos because of these developmental characteristics. By understanding adolescent development, behavior and peer group impact, with its spectrum from early to late adolescence, clinicians can target their educational interventions more successfully in asthma. Health care provision for the adolescent with asthma requires a multidisciplinary team spearheaded by a primary care provider with the expert guidance of an allergist, outreach nurse, mental health worker, and social service representative. This care must be negotiated with an appropriate educational plan on the basis of NHLBI guidelines to be successful. Medications should be prescribed no more than twice a day, whenever possible, in conjunction with an action plan on the basis of peak flow readings to warn the adolescent when to use more medication and when to call the clinician. The plan should empower adolescents by recognizing their need for autonomy with self-management, enabling them to have a safe and comfortable lifestyle, and being physically and mentally at ease with their peers, family, school, and work environments.

Social, emotional, and behavioral functioning of children with cancer

OBJECTIVE

It was hypothesized that children with cancer would have more social problems and difficulties with emotional well-being than case control, same race/gender, similarly aged classmates.

STUDY DESIGN

Using a case controlled design, children with any type of cancer requiring chemotherapy except brain tumors (n = 76), currently receiving chemotherapy, ages 8 to 15, were compared with case control classroom peers (n = 76). Peer relationships, emotional well-being, and behavior were evaluated based on peer, teacher, parent, and self-report, and were compared using analysis of variance and structural equation modeling.

RESULTS

Relative to case controls, children with cancer were perceived by teachers as being more sociable; by teachers and peers as being less aggressive; and by peers as having greater social acceptance. Measures of depression, anxiety, loneliness, and self-concept showed no significant differences, except children with cancer reported significantly lower satisfaction with current athletic competence. There were also no significant differences in mother or father perceptions of behavioral problems, emotional well-being, or social functioning. Scores on all standardized measures were in the normal range for both groups. Comparisons of the correlation matrices of children with cancer and to the correlation matrix of the comparison children using structural equation modeling suggested they were not significantly different.

CONCLUSIONS

Children with cancer currently receiving chemotherapy were remarkably similar to case controls on measures of emotional well-being and better on several dimensions of social functioning. These findings are not supportive of disability/stress models of childhood chronic illness and suggest considerable psychologic hardiness.

Management of chronic medical conditions in children and adolescents

The care of children and adolescents with chronic medical conditions is an area of great interest for primary care physicians. With longer lives and more "mainstreaming" of care, the primary care physician often finds an increased role in the management of children and adolescents with chronic conditions such as mental retardation, Down syndrome, and diabetes mellitus. This article discusses familiarity with the most common chronic conditions and common pitfalls of management.