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Brew BK, Caffrey Osvald E, Gong T, Hedman AM, Holmberg K, Larsson H, Ludvigsson JF, Mubanga M, Smew AI, Almqvist C. Pediatric asthma and non-allergic comorbidities: a review of current risk and proposed mechanisms. Clin Exp Allergy 2022; 52:1035-1047. [PMID: 35861116 PMCID: PMC9541883 DOI: 10.1111/cea.14207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 06/16/2022] [Accepted: 06/27/2022] [Indexed: 11/30/2022]
Abstract
It is increasingly recognized that children with asthma are at a higher risk of other non‐allergic concurrent diseases than the non‐asthma population. A plethora of recent research has reported on these comorbidities and progress has been made in understanding the mechanisms for comorbidity. The goal of this review was to assess the most recent evidence (2016–2021) on the extent of common comorbidities (obesity, depression and anxiety, neurodevelopmental disorders, sleep disorders and autoimmune diseases) and the latest mechanistic research, highlighting knowledge gaps requiring further investigation. We found that the majority of recent studies from around the world demonstrate that children with asthma are at an increased risk of having at least one of the studied comorbidities. A range of potential mechanisms were identified including common early life risk factors, common genetic factors, causal relationships, asthma medication and embryologic origins. Studies varied in their selection of population, asthma definition and outcome definitions. Next, steps in future studies should include using objective measures of asthma, such as lung function and immunological data, as well as investigating asthma phenotypes and endotypes. Larger complex genetic analyses are needed, including genome‐wide association studies, gene expression–functional as well as pathway analyses or Mendelian randomization techniques; and identification of gene–environment interactions, such as epi‐genetic studies or twin analyses, including omics and early life exposure data. Importantly, research should have relevance to clinical and public health translation including clinical practice, asthma management guidelines and intervention studies aimed at reducing comorbidities.
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Affiliation(s)
- Bronwyn K Brew
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Sweden.,National Perinatal Epidemiology and Statistics Unit, Centre for Big Data Research in Health and School of Clinical Medicine, University of New South Wales, Australia
| | - Emma Caffrey Osvald
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Sweden.,Pediatric Allergy and Pulmonology Unit, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Sweden
| | - Tong Gong
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Sweden
| | - Anna M Hedman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Sweden
| | - Kirsten Holmberg
- Child Health and Parenting (CHAP), Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Sweden.,School of Medical Sciences, Örebro University, Sweden
| | - Jonas F Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Sweden.,Department of Pediatrics, Orebro University Hospital, Orebro, Sweden
| | - Mwenya Mubanga
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Sweden
| | - Awad I Smew
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Sweden
| | - Catarina Almqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Sweden.,Pediatric Allergy and Pulmonology Unit, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Sweden
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2
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Sherrey J, Biggs S, Dorrian J, Martin J, Gold M, Kennedy D, Lushington K. Allergic disease, sleep problems and psychological distress in children recruited from the general community. Ann Allergy Asthma Immunol 2022; 129:366-372. [PMID: 35598883 DOI: 10.1016/j.anai.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 05/04/2022] [Accepted: 05/06/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND It is unclear which allergic disease is most strongly related to which sleep problem and whether sleep problems may mediate the association between allergic disease and psychological distress. There is also a need for more community-based studies using non-referred samples. OBJECTIVE To examine the association between individual allergic diseases and sleep problems and test whether the association between allergic disease and psychological distress is mediated through sleep problems. METHODS Parents of 1449 Australian children aged 6-10y recruited from the general community completed measures of sleep problems (Pediatric Sleep Survey Instrument), psychological distress (Strengths and Difficulties Questionnaire), and frequency of allergic disease. RESULTS Sleep and psychological distress scores were in the normal range. After controlling for co-existing allergic diseases: allergic rhinitis was associated with sleep routine problems, morning tiredness, night arousals, sleep disordered breathing and restless sleep; asthma with sleep routine problems, sleep disordered breathing and restless sleep; and eczema with restless sleep. Path analyses revealed that sleep problems mediated the association between asthma and allergic rhinitis but not eczema with psychological distress. CONCLUSION In this non-referred community sample, the frequency of sleep problems and psychological distress was lower than that typically reported in children referred to specialized centres. However, allergic rhinitis was associated with a broad range of sleep problems and to a lesser extent in children with asthma and least in children with eczema. Path analysis revealed that the association between allergic disease and psychological distress was mediated through sleep problems highlighting the importance of assessing sleep health in children with allergic disease.
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Affiliation(s)
- Jade Sherrey
- University of South Australia, Justice and Society Unit, Adelaide, Australia
| | - Sarah Biggs
- Murdoch Children's Research Institute, Melbourne, Australia
| | - Jillian Dorrian
- University of South Australia, Justice and Society Unit, Adelaide, Australia
| | | | | | | | - Kurt Lushington
- University of South Australia, Justice and Society Unit, Adelaide, Australia.
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3
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Perazzo D, Moore R, Kasparian NA, Rodts M, Horowitz-Kraus T, Crosby L, Turpin B, Beck AF, Hutton J. Chronic pediatric diseases and risk for reading difficulties: a narrative review with recommendations. Pediatr Res 2022; 92:966-978. [PMID: 35121848 PMCID: PMC9586865 DOI: 10.1038/s41390-022-01934-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 11/02/2021] [Accepted: 12/13/2021] [Indexed: 12/03/2022]
Abstract
Literacy is a major social determinant of health, rooted in skills that develop during early childhood. Children arriving at kindergarten unprepared to learn to read are more likely to have low reading proficiency thereafter. General and health literacy are highly correlated, affecting understanding of health conditions, treatment adherence, and transition to self-care and adult healthcare services. The American Academy of Pediatrics (AAP) recommends literacy and school readiness promotion during well-visits and neurodevelopmental surveillance is emphasized across primary and subspecialty care. While genetic and environmental risk factors for reading difficulties are well-established, risks related to complex and chronic medical conditions are less appreciated and under-researched. This review applies an eco-bio-developmental framework to explore literacy across five complex chronic conditions affecting millions of children worldwide: asthma, cancer, congenital heart disease, epilepsy, and sickle cell disease. In each, integration of an efficient reading brain network may be impacted by direct factors, such as ischemia, anesthesia, and/or medications, and also indirect factors, such as altered parent-child routines, hospital stays, and missed school. By integrating literacy into care management plans for affected children, pediatric primary care and specialty providers are poised to identify risks early, target guidance and interventions, and improve academic and health outcomes. IMPACT: While genetic and environmental risk factors for reading difficulties are well-established, risks related to complex and/or chronic medical conditions such as asthma, cancer, congenital heart disease, epilepsy, and sickle cell disease are substantial, less appreciated, and under-researched. General and health literacy are highly correlated, with implications for the understanding one's health condition, treatment adherence, and transitioning to self-care, which is especially important for children with complex and/or chronic illness. Pediatric primary care and specialty providers are poised to integrate reading and literacy into care management plans for children with complex and/or chronic illness, including early screening, guidance, support, and interventions.
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Affiliation(s)
- Donna Perazzo
- grid.24827.3b0000 0001 2179 9593Reading and Literacy Discovery Center, Cincinnati Children’s Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH USA
| | - Ryan Moore
- grid.24827.3b0000 0001 2179 9593The Heart Institute, Cincinnati Children’s Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH USA
| | - Nadine A. Kasparian
- grid.24827.3b0000 0001 2179 9593The Heart Institute, Cincinnati Children’s Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH USA ,grid.24827.3b0000 0001 2179 9593Center for Heart Disease and Mental Health, Heart Institute and Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH USA
| | - Megan Rodts
- grid.24827.3b0000 0001 2179 9593The Heart Institute, Cincinnati Children’s Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH USA
| | - Tzipi Horowitz-Kraus
- grid.24827.3b0000 0001 2179 9593Reading and Literacy Discovery Center, Cincinnati Children’s Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH USA ,grid.24827.3b0000 0001 2179 9593Division of General and Community Pediatrics, Cincinnati Children’s Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH USA ,grid.6451.60000000121102151Educational Neuroimaging Center, Faculty of Education in Science and Technology and Faculty of Biomedical Engineering, Technion, Haifa, Israel
| | - Lori Crosby
- grid.24827.3b0000 0001 2179 9593Center for Clinical and Translational Science and Training and Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH USA
| | - Brian Turpin
- grid.24827.3b0000 0001 2179 9593Division of Oncology, Cincinnati Children’s Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH USA
| | - Andrew F. Beck
- grid.24827.3b0000 0001 2179 9593Division of General and Community Pediatrics, Cincinnati Children’s Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH USA ,grid.24827.3b0000 0001 2179 9593Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH USA
| | - John Hutton
- Reading and Literacy Discovery Center, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA. .,Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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4
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Mitchell RJ, McMaugh A, Homaira N, Lystad RP, Badgery-Parker T, Cameron CM. The impact of childhood asthma on academic performance: A matched population-based cohort study. Clin Exp Allergy 2021; 52:286-296. [PMID: 34564913 DOI: 10.1111/cea.14022] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/25/2021] [Accepted: 09/22/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND There is inconclusive evidence of the effect of asthma on the academic performance of young people. This study aims to compare scholastic performance and high school completion of young people hospitalized with asthma compared to matched peers not hospitalized with asthma. METHOD A population-based matched case-comparison cohort study of young people aged ≤18 years hospitalized for asthma during 2005-2018 in New South Wales, Australia using linked birth, health, education and mortality records. The comparison cohort was matched on age, gender and residential postcode. Generalized linear mixed-modelling examined risk of school performance below the national minimum standard (NMS) and generalized linear regression examined risk of not completing high school for young people hospitalized with asthma compared to matched peers. RESULTS Young males hospitalized with asthma had a 13% and 15% higher risk of not achieving the NMS for numeracy (95%CI 1.04-1.22) and reading (95%CI 1.07-1.23), respectively, compared to peers. Young males hospitalized with asthma had a 51% (95%CI 1.22-1.86) higher risk of not completing year 10, and around a 20% higher risk of not completing year 11 (ARR: 1.25; 95%CI 1.15-1.36) or year 12 (ARR: 1.27; 95%CI 1.17-1.39) compared to peers. Young females hospitalized with asthma showed no difference in achieving numeracy or reading NMSs, but did have a 21% higher risk of not completing year 11 (95%CI 1.09-1.36) and a 33% higher risk of not completing year 12 (95%CI 1.19-1.49) compared to peers. CONCLUSIONS Educational attainment is worse for young people hospitalized with asthma compared to matched peers. Early intervention and strategies for better management of asthma symptoms may enhance academic performance for students.
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Affiliation(s)
- Rebecca J Mitchell
- Faculty of Medicine, Health and Human Sciences, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Anne McMaugh
- The Macquarie School of Education, Macquarie University, Sydney, New South Wales, Australia
| | - Nusrat Homaira
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.,Respiratory Department, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Reidar P Lystad
- Faculty of Medicine, Health and Human Sciences, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Tim Badgery-Parker
- Faculty of Medicine, Health and Human Sciences, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Cate M Cameron
- Jamieson Trauma Institute, Royal Brisbane & Women's Hospital, Metro North Hospital and Health Services District, Brisbane, Queensland, Australia.,Centre for Healthcare Transformation, Australian Centre for Health Services Innovation (AusHSI), Queensland University of Technology (QUT), Brisbane, Queensland, Australia
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5
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Senter JP, Smith BM, Prichett LM, Connor KA, Johnson SB. Pediatric Asthma Is Associated With Poorer 3-Year Academic Achievement in Urban Elementary and Middle-School Students. Acad Pediatr 2021; 21:1009-1017. [PMID: 33207219 DOI: 10.1016/j.acap.2020.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 11/09/2020] [Accepted: 11/11/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Asthma has been associated with worse academic performance in a single school year, yet this association may be magnified over time as students with asthma continue to fall behind. This study examined the relationship between asthma and standardized test performance aggregated across 3 school years, including whether performance varied by likelihood of having significant asthma. METHODS Data were from students in grades K-8 at 2 urban public schools in the Northeastern United States (2015-2018). Asthma was based on parent- and self-report and school health center records. Standardized test performance was assessed using Measures of Academic Progress (MAP) and Partnership for Assessment of Readiness for College and Careers (PARCC). Mixed effects linear and logistic regression models were used to evaluate the relationship between asthma and performance during 3 school years. RESULTS Any asthma was associated with worse MAP performance across the 3 academic years. Students with the most significant asthma demonstrated worse performance on MAP and PARCC. Aggregating across 3 school years, students scored 3.17 points worse on MAP reading (95% confidence interval [CI]: 0.7-5.63; P = .012) and 3.56 points worse on MAP mathematics (95% CI: 0.52-6.6; P = .022); they had 48.8% (95% CI: 1.9%-73.2%; P = .044) and 58.0% (95% CI: 21%-78%; P = .007) lower odds of proficiency on PARCC English/Language Arts and Mathematics, respectively compared to those without asthma. CONCLUSIONS The relationship between asthma and poorer academic achievement in 1 school year may be magnified over multiple years, particularly among those with more significant asthma. School-based asthma interventions may support academic growth and more equitable health outcomes.
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Affiliation(s)
- James P Senter
- Department of Pediatrics, Johns Hopkins University School of Medicine (JP Senter, BM Smith, LM Prichett, KA Connor, and SB Johnson), Baltimore, Md.
| | - Brandon M Smith
- Department of Pediatrics, Johns Hopkins University School of Medicine (JP Senter, BM Smith, LM Prichett, KA Connor, and SB Johnson), Baltimore, Md
| | - Laura M Prichett
- Department of Pediatrics, Johns Hopkins University School of Medicine (JP Senter, BM Smith, LM Prichett, KA Connor, and SB Johnson), Baltimore, Md
| | - Katherine A Connor
- Department of Pediatrics, Johns Hopkins University School of Medicine (JP Senter, BM Smith, LM Prichett, KA Connor, and SB Johnson), Baltimore, Md
| | - Sara B Johnson
- Department of Pediatrics, Johns Hopkins University School of Medicine (JP Senter, BM Smith, LM Prichett, KA Connor, and SB Johnson), Baltimore, Md; Department of Population, Family & Reproductive Health and Mental Health, Johns Hopkins Bloomberg School of Public Health (SB Johnson), Baltimore, Md
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6
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Davis CM, Apter AJ, Casillas A, Foggs MB, Louisias M, Morris EC, Nanda A, Nelson MR, Ogbogu PU, Walker-McGill CL, Wang J, Perry TT. Health disparities in allergic and immunologic conditions in racial and ethnic underserved populations: A Work Group Report of the AAAAI Committee on the Underserved. J Allergy Clin Immunol 2021; 147:1579-1593. [PMID: 33713767 DOI: 10.1016/j.jaci.2021.02.034] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 02/13/2021] [Accepted: 02/18/2021] [Indexed: 12/18/2022]
Abstract
Health disparities are health differences linked with economic, social, and environmental disadvantage. They adversely affect groups that have systematically experienced greater social or economic obstacles to health. Renewed efforts are needed to reduced health disparities in the United States, highlighted by the disparate impact on racial minorities during the coronavirus pandemic. Institutional or systemic patterns of racism are promoted and legitimated through accepted societal standards, and organizational processes within the field of medicine, and contribute to health disparities. Herein, we review current evidence regarding health disparities in allergic rhinitis, asthma, atopic dermatitis, food allergy, drug allergy, and primary immune deficiency disease in racial and ethnic underserved populations. Best practices to address these disparities involve addressing social determinants of health and adopting policies to improve access to specialty care and treatment for the underserved through telemedicine and community partnerships, cross-cultural provider training to reduce implicit bias, inclusion of underserved patients in research, implementation of culturally competent patient education, and recruitment and training of health care providers from underserved communities. Addressing health disparities requires a multilevel approach involving patients, health providers, local agencies, professional societies, and national governmental agencies.
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Affiliation(s)
- Carla M Davis
- Baylor College of Medicine, Houston, Tex; Texas Children's Hospital Food Allergy Program, Texas Children's Hospital, Houston, Tex.
| | - Andrea J Apter
- Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pa
| | - Adrian Casillas
- Texas Tech Health Sciences Center, Sierra Providence Medical Partners, El Paso, Tex
| | - Michael B Foggs
- Advocate Medical Group, Advocate Aurora Health Clinic, Chicago, Ill
| | - Margee Louisias
- Boston Children's Hospital, Harvard Medical School, Brigham and Women's Hospital, Boston, Mass
| | | | - Anil Nanda
- Asthma and Allergy Center, Lewisville, Tex; Asthma and Allergy Center, Flower Mound, Tex; University of Texas Southwestern Medical Center, Dallas, Tex
| | - Michael R Nelson
- Allergy-Immunology Service, Walter Reed National Military Medical Center, Bethesda, Md
| | - Princess U Ogbogu
- Case Western Reserve University-Rainbow Babies and Children/UH Cleveland Medical Center, Cleveland, Ohio
| | - Cheryl Lynn Walker-McGill
- Carolina Complete Health, Charlotte, NC; Wingate University Graduate School of Business, Charlotte, NC
| | - Julie Wang
- Elliot and Roslyn Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Tamara T Perry
- University of Arkansas for Medical Sciences, Little Rock, Ark; Arkansas Children's Research Institute, Little Rock, Ark
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7
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Wolock ER, Queen AH, Rodríguez GM, Weisz JR. Chronic Illness and Internalizing Symptomatology in a Transdiagnostic Clinical Sample of Youth. J Pediatr Psychol 2020; 45:633-642. [PMID: 32386417 DOI: 10.1093/jpepsy/jsaa028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 03/04/2020] [Accepted: 04/07/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE In research with community samples, children with chronic physical illnesses have shown elevated anxiety and depressive symptoms, compared to healthy peers. Less is known about whether physical illnesses are associated with elevated internalizing symptoms even among children referred for mental health treatment-a pattern that would indicate distinctive treatment needs among physically ill children receiving mental health care. We investigated the relationship between chronic physical illness and internalizing symptomatology among children enrolling in outpatient mental health treatment. METHOD A total of 262 treatment-seeking children ages 7-15 and their caregivers completed a demographic questionnaire, Child Behavior Checklist, and Youth Self-Report during a pre-treatment assessment. Physical illnesses were identified through caregiver report. RESULTS There was no overall association between the presence/absence of chronic physical illness and parent- or child-reported symptoms. However, number of chronic physical illnesses was related to parent- and child-reported affective symptoms. Children with two or more chronic physical illnesses had more severe depressive symptoms than those with fewer physical illnesses. CONCLUSION Having multiple chronic illnesses may elevate children's risk of depression symptomatology, even in comparison to other children seeking mental health care. This suggests a need to identify factors that may exacerbate depression symptoms in physically ill children who are initiating therapy and to determine whether different or more intensive services may be helpful for this group. The findings suggest the potential utility of screening for depression in youth with chronic physical illnesses, as well as addressing mental and physical health concerns during treatment.
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Affiliation(s)
- Elizabeth R Wolock
- Department of Psychology, Harvard University.,Department of Psychology, Tufts University
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8
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Rubens SL, Feldman DB, Soliemannjad RR, Sung A, Gudiño OG. Hope, Daytime Sleepiness, and Academic Outcomes in Low-Income, Latinx Youth. CHILD & YOUTH CARE FORUM 2020. [DOI: 10.1007/s10566-020-09553-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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9
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Seegan PL, Martin SR, Boergers J, Kopel SJ, Bruzzese JM, Koinis-Mitchell D. Internalizing symptoms and sleep outcomes in urban children with and without asthma. J Clin Sleep Med 2020; 16:207-217. [PMID: 31992399 DOI: 10.5664/jcsm.8168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES This study examines associations between internalizing symptoms and sleep in a sample of urban children with and without asthma, whether asthma status moderates these associations, and whether associations differ by ethnic group. METHODS Participants were Latino, African American (AA), and non-Latino white (NLW) urban 7- to 9-year-olds with (n = 259) and without (n = 122) persistent asthma. Teacher-reported internalizing symptoms (anxiety, depressive, and somatic) were assessed using the Behavioral Assessment System for Children-2. Sleep duration, variability in sleep duration, and sleep onset latency were assessed with actigraphy. RESULTS Depressive symptoms were associated with variability in sleep duration and shorter sleep onset latency; somatic symptoms were associated with variability in sleep duration. In Latino children, depressive symptoms were associated with shorter sleep onset latency. In AA children, anxiety, depressive, and somatic symptoms were associated with variability in sleep duration; somatic symptoms were related to variability in sleep duration in NLW children. The association between internalizing symptoms and sleep outcomes did not differ by asthma status. However, asthma status was a significant moderator when examining these associations by ethnic group: among AA children, depressive symptoms were significantly related to variability in sleep duration only in children with asthma, whereas in NLW children, somatic symptoms were related to variability in sleep duration only in children without asthma. CONCLUSIONS Targeting specific internalizing symptoms and sleep outcomes may be beneficial in the development of interventions tailored for urban children with and without asthma from specific ethnic groups.
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Affiliation(s)
- Paige L Seegan
- Bradley/Hasbro Children's Research Center, The Warren Alpert Medical School of Brown University Providence, Rhode Island
| | - Sarah R Martin
- Department of Pediatrics, University of California, Los Angeles, California
| | - Julie Boergers
- Bradley/Hasbro Children's Research Center, The Warren Alpert Medical School of Brown University Providence, Rhode Island
| | - Sheryl J Kopel
- Bradley/Hasbro Children's Research Center, The Warren Alpert Medical School of Brown University Providence, Rhode Island
| | - Jean-Marie Bruzzese
- Office of Scholarship and Research, Columbia University School of Nursing, New York, New York
| | - Daphne Koinis-Mitchell
- Bradley/Hasbro Children's Research Center, The Warren Alpert Medical School of Brown University Providence, Rhode Island
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10
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Koinis-Mitchell D, Boergers J, Kopel SJ, McQuaid EL, Farrow ML, LeBourgeois M. Racial and ethnic disparities in sleep outcomes among urban children with and without asthma. Sleep Health 2019; 5:532-538. [PMID: 31708438 PMCID: PMC11108584 DOI: 10.1016/j.sleh.2019.08.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 08/12/2019] [Accepted: 08/14/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Suboptimal sleep has been documented in at-risk groups such as urban minority children, particularly those with asthma. It is therefore critical to examine differences in sleep outcomes across specific racial and ethnic groups and to identify factors that contribute to such variations in sleep outcomes to inform tailored interventions to improve sleep health. OBJECTIVES The objectives were to examine racial/ethnic differences in sleep outcomes among urban children with and without asthma and to evaluate the extent to which asthma status and aspects of sleep hygiene and the sleep environment contribute to racial/ethnic differences in sleep outcomes in this sample. METHODS Two hundred and sixteen African American, Latino, or non-Latino white (NLW) urban children, ages 7-9 years, with (n = 216) and without asthma (n = 130) and their primary caregivers were included. Objective sleep duration and efficiency were assessed via actigraphy. Asthma status was assessed by a study clinician. Caregiver-reported sleep hygiene and exposure to noise were assessed using a questionnaire. RESULTS Minority children in the sample had, on average, shorter sleep duration compared to NLW children during the monitoring period (mean difference Latino vs NLW = -22.10, SE = 5.02; mean difference AA vs NLW = -18.69, SE = 5.28) Additionally, several racial/ethnic group differences in sleep outcomes emerged and were dependent on whether or not children had asthma. Specifically, Latinos had lower mean number of awakenings compared to NLWs but only among control participants with no asthma. Furthermore, specific aspects of sleep hygiene and exposure to nighttime noise in the home and neighborhood contributed to racial/ethnic differences in sleep outcomes. CONCLUSION Considering urban stressors and asthma status when treating pediatric populations is important, as factors related to urban stress and asthma management may influence sleep hygiene practices and sleep outcomes.
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Affiliation(s)
- Daphne Koinis-Mitchell
- Alpert Medical School, Brown University, Providence, RI; Bradley/Hasbro Children's Research Center, Providence, RI; Department of Pediatrics, Hasbro Children's Hospital/Rhode Island Hospital, Providence, RI.
| | - Julie Boergers
- Alpert Medical School, Brown University, Providence, RI; Bradley/Hasbro Children's Research Center, Providence, RI; Department of Pediatrics, Hasbro Children's Hospital/Rhode Island Hospital, Providence, RI
| | - Sheryl J Kopel
- Alpert Medical School, Brown University, Providence, RI; Bradley/Hasbro Children's Research Center, Providence, RI
| | - Elizabeth L McQuaid
- Alpert Medical School, Brown University, Providence, RI; Bradley/Hasbro Children's Research Center, Providence, RI; Department of Pediatrics, Hasbro Children's Hospital/Rhode Island Hospital, Providence, RI
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11
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Ramasami J, Fehr KK. JPP Student Journal Club Commentary: Sleep in Youth With Chronic Health Conditions: Expanding Models to Understand Complexity in Youth With Comorbid Conditions. J Pediatr Psychol 2019; 43:955-957. [PMID: 30085230 DOI: 10.1093/jpepsy/jsy060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 07/10/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Karla K Fehr
- Department of Psychology, Southern Illinois University
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12
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Koinis-Mitchell D, Kopel SJ, Farrow ML, McQuaid EL, Nassau JH. Asthma and academic performance in urban children. Ann Allergy Asthma Immunol 2019; 122:471-477. [PMID: 30872028 PMCID: PMC6538301 DOI: 10.1016/j.anai.2019.02.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 02/25/2019] [Accepted: 02/28/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Urban minority children experience high levels of asthma morbidity. Poor school performance can be an indicator that asthma is in poor control. Little attention has been paid to examining real-time links between asthma and academic performance, particularly in high-risk groups. OBJECTIVE Examine 1) academic performance across a range of indicators in a group of urban children with asthma and urban children without chronic illness and ethnic differences in these associations, and 2) associations between asthma and academic performance in the group of urban children with asthma and ethnic differences in these associations. METHODS Two hundred sixteen black/African American (33%), Latino (46%), and non-Latino white (21%) urban children, ages 7 to 9 years completed a clinic- and home-based protocol that assessed asthma and allergy status, objective measurements of lung function, and academic functioning. RESULTS Analyses revealed that children with asthma experienced a higher number of school absences when compared with healthy controls. Greater disparities in academic outcomes emerged when examining ethnic differences within the groups of children with and without asthma. Poor academic outcomes were observed in Latino children with asthma. Furthermore, a strong correspondence of poor asthma outcomes and decrements in academic performance were seen in the full sample, and these associations emerged across ethnic groups. CONCLUSION Asthma activity contributes to poorer academic outcomes across a range of indicators, and urban minority children with asthma, particularly Latino children, may be at heightened risk for poorer academic performance. School management guidelines for asthma need to be consistently implemented and tailored for school staff, caregivers, and students with asthma to address challenges of managing asthma within the urban school setting.
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Affiliation(s)
- Daphne Koinis-Mitchell
- Bradley/Hasbro Children's Research Center, Providence, Rhode Island; Alpert Medical School, Brown University, Providence, Rhode Island; Department of Child Psychiatry and Pediatrics, Hasbro Children's Hospital/Rhode Island Hospital, Providence, Rhode Island.
| | - Sheryl J Kopel
- Bradley/Hasbro Children's Research Center, Providence, Rhode Island; Alpert Medical School, Brown University, Providence, Rhode Island
| | - Michael L Farrow
- Bradley/Hasbro Children's Research Center, Providence, Rhode Island
| | - Elizabeth L McQuaid
- Bradley/Hasbro Children's Research Center, Providence, Rhode Island; Alpert Medical School, Brown University, Providence, Rhode Island; Department of Child Psychiatry and Pediatrics, Hasbro Children's Hospital/Rhode Island Hospital, Providence, Rhode Island
| | - Jack H Nassau
- Bradley/Hasbro Children's Research Center, Providence, Rhode Island; Alpert Medical School, Brown University, Providence, Rhode Island
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