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Janus M, Reid-Westoby C, Pottruff M, Schneeweiss M, Hu G, Brownell M. Developmental health of Canadian kindergarten children with teacher-reported asthma between 2010 and 2015: A population-level cross-sectional study. Prev Med Rep 2024; 37:102525. [PMID: 38186657 PMCID: PMC10767499 DOI: 10.1016/j.pmedr.2023.102525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 11/17/2023] [Accepted: 11/21/2023] [Indexed: 01/09/2024] Open
Abstract
Asthma can impact children's quality of life. It is unclear how asthma is associated with the developmental health (i.e. a broad range of skills and abilities associated with growth and development) of young children at school entry. The goals of this cross-sectional, population-level study were to: (1) investigate the association between teacher-reported asthma and children's concurrent indicators of developmental health (developmental vulnerability); and (2) explore whether school absences and functional impairments modified this association. Participants were a Canadian population-based sample of 564 582 kindergarten children (Mage = 5.71 years, SD = 0.32, 51.3 % male) with data on the Early Development Instrument (EDI) collected between 2010 and 2015. Adjusted binary logistic regressions were conducted to address the objectives. From the sample, 958 (0.2 %) children were identified as having a diagnosis of asthma. These children were absent on average 9.4 days and 53.5 % had functional impairments (vs. 6.7 days absent and 15.9 % with functional impairments in children without asthma). After controlling for demographic characteristics, children with asthma had between 1.51 and 2.42 higher odds of being developmentally vulnerable. Only the presence of functional impairments modified this relationship and only for physical health and well-being. In this large, population-based sample of Canadian kindergarten children, few teachers reported knowledge of their students' asthma diagnosis. Among teacher-reported cases, asthma was a risk factor for developmental vulnerability in the domain of physical health and well-being only. Functional impairments may therefore be more detrimental for child development at school entry than asthma alone.
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Affiliation(s)
- Magdalena Janus
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario L8S 4K1, Canada
- Human Early Learning Partnership, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia V6T 1Z3, Canada
| | - Caroline Reid-Westoby
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario L8S 4K1, Canada
| | - Molly Pottruff
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario L8S 4K1, Canada
| | - Michelle Schneeweiss
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario L8P 1H6, Canada
| | - George Hu
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario L8P 1H6, Canada
| | - Marni Brownell
- Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba R3E 3P5, Canada
| | - Canadian Children's Health in Context Study Team
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario L8S 4K1, Canada
- Human Early Learning Partnership, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia V6T 1Z3, Canada
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario L8P 1H6, Canada
- Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba R3E 3P5, Canada
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2
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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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3
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Evans A, Farewell D, Demmler J, Bandyopadhyay A, Powell CVE, Paranjothy S. Association of asthma severity and educational attainment at age 6-7 years in a birth cohort: population-based record-linkage study. Thorax 2020; 76:116-125. [PMID: 33177228 PMCID: PMC7815901 DOI: 10.1136/thoraxjnl-2020-215422] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 09/01/2020] [Accepted: 10/09/2020] [Indexed: 12/05/2022]
Abstract
Background There is conflicting research about the association between asthma and poor educational attainment that may be due to asthma definitions. Our study creates seven categories of current chronic and acute asthma to investigate if there is an association for poorer educational attainment at age 6–7 years, and the role of respiratory infections and school absence. Methods This study used a population-based electronic cross-sectional birth cohort 1998–2005, in Wales, UK, using health and education administrative datasets. Current asthma or wheeze categories were developed using clinical management guidelines in general practice (GP) data, acute asthma was inpatient hospital admissions and respiratory infections were the count of GP visits, from birth to age 6–7 years. We used multilevel logistic regression grouped by schools to ascertain if asthma or wheeze was associated with not attaining the expected level in teacher assessment at Key Stage 1 (KS1) adjusting for sociodemographics, perinatal, other respiratory illness and school characteristics. We tested if absence from school was a mediator in this relationship using the difference method. Results There were 85 906 children in this population representative cohort with 7-year follow-up. In adjusted multilevel logistic regression, only asthma inpatient hospital admission was associated with increased risk for not attaining the expected level at KS1 (adjusted OR 1.14 95% CI (1.02 to 1.27)). Lower respiratory tract infection (LRTI) GP contacts remained an independent predictor for not attaining the expected level of education. Absence from school was a potential mediator of the association between hospital admission and educational attainment. Conclusions Clinicians and educators need to be aware that children who have inpatient hospital admissions for asthma or wheeze, or repeated LRTI, may require additional educational support for their educational outcomes.
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Affiliation(s)
- Annette Evans
- Division of Population Medicine, Cardiff University School of Medicine, Cardiff, UK
| | - Daniel Farewell
- Division of Population Medicine, Cardiff University School of Medicine, Cardiff, UK
| | - Joanne Demmler
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement, Data Science Building, School of Medicine, Swansea University, Swansea, UK
| | - Amrita Bandyopadhyay
- Administrative Data Research Wales, Swansea University Medical School, Swansea, UK
| | - Colin Victor Eric Powell
- Division of Population Medicine, Cardiff University School of Medicine, Cardiff, UK.,Department of Pediatric Emergency Medicine, Senior Attending Physician (Head of Research), Sidra Medicine, Education City, Al Rayyan, Qatar
| | - Shantini Paranjothy
- Division of Population Medicine, Cardiff University School of Medicine, Cardiff, UK.,Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement, Cardiff University College of Arts Humanities and Social Sciences, Cardiff, UK.,Centre for Improvement in Population Health through E-records Research, Institute of Life Science Medical School, Swansea University, Swansea, UK
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4
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Lundholm C, Brew BK, D'Onofrio BM, Osvald EC, Larsson H, Almqvist C. Asthma and subsequent school performance at age 15-16 years: A Swedish population-based sibling control study. Sci Rep 2020; 10:7661. [PMID: 32377014 PMCID: PMC7203156 DOI: 10.1038/s41598-020-64633-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 04/16/2020] [Indexed: 12/27/2022] Open
Abstract
Asthma may negatively affect children’s school performance, such as grades and exam results. Results from previous studies have shown varying results and may have suffered from confounding and other biases. We used a Swedish population-based cohort of 570,595 children with data on asthma (including severity and control) in Grades 7–8 and 9, school performance from Grade 9 (grade point sum, non-eligibility for upper secondary school and national test results) and measured confounders from national registers. We used sibling comparisons to account for unmeasured familial factors. Children with asthma and severe asthma performed slightly better in school than children without asthma when adjusting for measured confounders, but the associations were attenuated in sibling comparisons. In contrast, children with uncontrolled asthma performed slightly worse (e.g. Grade 9: βadj = −9.9; 95% CI −12.8 to −7.0; Cohen’s d = 0.16). This association remained for uncontrolled asthma in Grade 9 in sibling comparisons (Grade 9: β = −7.7 points; 95% CI −12.6 to −2.6; Cohen’s d = 0.12), but not for Grades 7–8. The attenuation of estimates when controlling for familial factors using sibling comparisons suggests that the differences were due to familial factors, rather than being causal. The remaining associations in sibling comparisons between uncontrolled asthma in Grade 9 and school performance are consistent with a causal association.
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Affiliation(s)
- Cecilia Lundholm
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
| | - Bronwyn K Brew
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,National Perinatal Epidemiology and Biostatistics Unit, Centre for Big Data Research in Health and School of Women and Children's Health, University of New South Wales, Sydney, Australia
| | - Brian M D'Onofrio
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
| | - Emma Caffrey Osvald
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Pediatric Allergy and Pulmonology Unit at Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Catarina Almqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Pediatric Allergy and Pulmonology Unit at Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
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5
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Pattemore PK, Liberty KA, Reid J. Changes in asthma severity in the first year of school and difficulty learning to read. J Asthma 2019; 57:799-809. [PMID: 31066318 DOI: 10.1080/02770903.2019.1609982] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: Asthma is a risk factor for poor early reading in children, for reasons that are unclear. This analysis examines the relationship between changes in asthma severity during the first year of school and being in the lowest quartile of reading achievement after 1 year of school.Methods: We used previously unreported data from our cohort study. Parent interviews and teacher questionnaires enquired about asthma and covariates of achievement at school entry (T1) and 12 months later (T2). Asthma severity scores at T1 and T2 showed that in 27 of 51 children with asthma, symptoms improved over the year, whereas in 24, symptoms persisted or worsened. Word and story reading were assessed at T1 and T2. We compared reading achievement at both timepoints between children with asthma and children who had no reported respiratory symptoms between birth and T2 (controls, N = 74), and between those with persistent versus improved symptoms.Results: More children with asthma than controls were in the lowest quartiles for reading. Further, significantly more children in the persistent group compared to the improved group were in the lowest quartiles for word reading (58 versus 30%, respectively) and story reading (54 versus 26%, respectively). School absences, increased behavior problems, stressful life events or parental mental health were not associated with the differences in either comparison. Logistic regression modeling identified persistent asthma as the most important variable associated with being in the lowest quartile of reading after 1 year in school.Conclusions: Active asthma symptoms during early school may influence early reading achievement.
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Affiliation(s)
| | - Kathleen A Liberty
- School of Health Sciences, College of Education, Health and Human Development, University of Canterbury, Christchurch, New Zealand
| | - James Reid
- Department of the Dean, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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6
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Wall-Wieler E, Roos LL, Lee JB, Urquia ML, Roos NP, Bruce S, Brownell M. Placement in Care in Early Childhood and School Readiness: A Retrospective Cohort Study. CHILD MALTREATMENT 2019; 24:66-75. [PMID: 30176734 DOI: 10.1177/1077559518796658] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The current study examined school readiness for children placed in care of child protection services before age 5. This association was assessed using a population-based cohort of children born in Manitoba, Canada, between 2000 and 2009 ( n = 53,477) and subcohorts of discordant siblings (one sibling taken into care, one sibling not taken into care; n = 809) and discordant cousins ( n = 517). In the population analysis, children placed in care were significantly less likely to be ready for school; this difference was not seen in the discordant sibling or cousin analysis. The findings suggested that differences in school readiness for children placed in care are a result of broader social factors affecting families, not placement into care.
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Affiliation(s)
| | - Leslie L Roos
- 1 Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- 2 Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada
| | - Janelle Boram Lee
- 1 Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Marcelo L Urquia
- 1 Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- 2 Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada
| | - Noralou P Roos
- 1 Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- 2 Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada
| | - Sharon Bruce
- 1 Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Marni Brownell
- 1 Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- 2 Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada
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7
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Peterson JW, Loeb S, Chamberlain LJ. The Intersection of Health and Education to Address School Readiness of All Children. Pediatrics 2018; 142:peds.2018-1126. [PMID: 30366953 DOI: 10.1542/peds.2018-1126] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/31/2018] [Indexed: 11/24/2022] Open
Abstract
Children who enter kindergarten healthy and ready to learn are more likely to succeed academically. Children at the highest risk for not being ready for school live in poverty and/or with chronic health conditions. High-quality early childhood education (ECE) programs can be used to help kids be ready for school; however, the United States lacks a comprehensive ECE system, with only half of 3- and 4-year-olds being enrolled in preschool, lagging behind 28 high-income countries. As addressing social determinants of health gains prominence in pediatric training and practice, there is increasing interest in addressing ECE disparities. Unfortunately, evidence is lacking for clinically based, early educational interventions. New interventions are being developed asynchronously in pediatrics and education, often without knowledge of the evidence base in the other's literature. In this State-of-the-Art Review, we synthesize the relevant work from the field of education (searchable through the Education Resources Information Center, also known as the "PubMed" of education), combining it with relevant literature in PubMed, to align the fields of pediatrics and education to promote this timely transdisciplinary work. First, we review the education literature to understand the current US achievement gap. Next, we provide an update on the impact of child health on school readiness and explore emerging solutions in education and pediatrics. Finally, we discuss next steps for future transdisciplinary work between the fields of education and pediatrics to improve the health and school readiness of young children.
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Affiliation(s)
| | - Susanna Loeb
- Center for Education Policy Analysis, Graduate School of Education, Stanford University, Palo Alto, California
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8
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Bhagat D, Fagnano M, Halterman JS, Reznik M. Asthma symptoms, interactive physical play and behavioral and academic outcomes in urban children with persistent asthma. J Asthma 2018; 56:711-718. [PMID: 29969924 DOI: 10.1080/02770903.2018.1488978] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVES Asthma may lead to reduced participation in interactive physical play (IPP). Urban youth with asthma are also at risk for behavioral and academic difficulties. Exploring associations between asthma, IPP and socio-emotional and academic outcomes in children with asthma is important. Study objectives are to: (1) describe IPP participation among school children with persistent asthma; (2) determine if IPP varies with asthma severity (3) determine independent associations of both asthma severity and IPP with socio-emotional and academic outcomes. METHODS We analyzed data from children with persistent asthma enrolled in the SB-TEAM trial (Rochester, NY). Caregiver surveys assessed asthma severity, IPP participation (gym ≥3 days/week, running at recess, sports team participation), socio-emotional and academic outcomes. Bivariate and regression analyses assessed relationships between variables. RESULTS Of 324 children in the study (59% Black, 31% Hispanic, mean age 7.9), 53% participated in any IPP at school. Compared to those with mild persistent asthma, fewer children with moderate-severe asthma had no limitation in gym (44% vs. 58%, p < .01), and fewer ran at recess (29% vs. 42%, p < .01) or engaged in any IPP (48% vs. 58%, p = .046). Asthma severity was not associated with socio-emotional or academic outcomes. However, children participating in IPP had better positive peer social and task orientation skills, were less shy/anxious, and more likely to meet academic standards (all p < .05). Results were consistent in multivariable analyses. CONCLUSIONS Urban children with moderate-severe asthma partake in less IPP, which is associated with socio-emotional and academic outcomes. Further efforts are needed to optimize asthmatic children's participation in IPP.
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Affiliation(s)
- Dhristie Bhagat
- a School of Medicine and Dentistry , University of Rochester , Rochester , NY , USA
| | - Maria Fagnano
- b Department of Pediatrics , University of Rochester , Rochester , NY , USA
| | - Jill S Halterman
- b Department of Pediatrics , University of Rochester , Rochester , NY , USA
| | - Marina Reznik
- c Department of Pediatrics, Albert Einstein College of Medicine , Children's Hospital at Montefiore , Bronx NY , USA
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9
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Szefler SJ, Cloutier MM, Villarreal M, Hollenbach JP, Gleason M, Haas-Howard C, Vinick C, Calatroni A, Cicutto L, White M, Williams S, McGinn M, Langton C, Shocks D, Mitchell H, Stempel DA. Building Bridges for Asthma Care: Reducing school absence for inner-city children with health disparities. J Allergy Clin Immunol 2018; 143:746-754.e2. [PMID: 30055181 DOI: 10.1016/j.jaci.2018.05.041] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 05/16/2018] [Accepted: 05/25/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Children with asthma are at increased risk for experiencing health and educational disparities because of increased school absence. School nurses are well positioned to support asthma management and improve school attendance. OBJECTIVE We sought to implement and assess the effect of the Building Bridges for Asthma Care Program on improving school attendance and measures of asthma control. METHODS Children with asthma (age, 5-14 years) in the Denver Public School System (n = 240) and the Hartford Public School System (n = 223) were enrolled in the Building Bridges Program during the 2013-2014 and 2014-2015 school years and followed until the end of the second school year. The primary outcome was school absence, with secondary outcomes, including asthma control, measured based on Childhood Asthma Control Test or the Asthma Control Test scores and rescue inhaler use. RESULTS Participants experienced a 22% absolute decrease in school absenteeism, the number of children with an Asthma Control Test/Childhood Asthma Control Test score of less than the control threshold of 20 decreased from 42.7% to 28.8%, and bronchodilator use greater than 2 times per week decreased from 35.8% to 22.9% (all changes were significant, P < .01). CONCLUSIONS Children enrolled in the Building Bridges for Asthma Care Program experienced reduced school absence and improved asthma control.
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Affiliation(s)
- Stanley J Szefler
- Pediatric Asthma Research Program and the Breathing Institute, Children's Hospital Colorado, and the Section of Pediatric Pulmonary and Sleep Medicine, University of Colorado School of Medicine, Aurora, Colo.
| | - Michelle M Cloutier
- Pediatrics and Medicine, UCONN Health, and the Asthma Center, Connecticut Children's Medical Center, Hartford, Conn
| | | | - Jessica P Hollenbach
- Department of Pediatrics, University of Connecticut School of Medicine, and the Asthma Center, Connecticut Children's Medical Center, Hartford, Conn
| | - Melanie Gleason
- Building Bridges Asthma Program, Children's Hospital Colorado, and the Department of Pediatrics, Section of Pediatric Pulmonary Medicine, University of Colorado School of Medicine, Aurora, Colo
| | - Christy Haas-Howard
- Denver Public Schools, Nursing and Student Health Services, and the Colorado Department of Education, Asthma Grant Program, Denver, Colo
| | - Carol Vinick
- Building Bridges Coordinator, Asthma Center, and the Connecticut Children's Medical Center, Hartford, Conn
| | | | - Lisa Cicutto
- Community Outreach and Research, National Jewish Health, and the Clinical Science Program, University of Colorado Denver AMC, Denver, Colo
| | - Marty White
- Children's Hospital Colorado/Denver Public Schools, Denver, Colo
| | | | | | - Christine Langton
- Building Bridges Coordinator, Asthma Center, and the Connecticut Children's Medical Center, Hartford, Conn
| | - Donna Shocks
- Denver Public Schools, Nursing and Student Health Services, Denver, Colo
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10
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Gracy D, Fabian A, Basch CH, Scigliano M, MacLean SA, MacKenzie RK, Redlener IE. Missed opportunities: Do states require screening of children for health conditions that interfere with learning? PLoS One 2018; 13:e0190254. [PMID: 29342147 PMCID: PMC5771574 DOI: 10.1371/journal.pone.0190254] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 12/10/2017] [Indexed: 11/30/2022] Open
Abstract
METHODS Investigators reviewed websites of state departments of health and education, and legislation for all 50 states and DC. For states with mandated screenings and a required form, investigators applied structured analysis to assess HBL inclusion. RESULTS No state mandated that schools require screening for all 7 HBLs. Less than half (49%) required comprehensive school health examinations and only 12 states plus DC required a specific form. Of these, 12 of the forms required documentation of vision screening, 11 of hearing screening, and 12 of dental screening. Ten forms asked about asthma and 9 required documentation of lead testing. Seven asked about general well-being, emotional problems, or mental health. None addressed hunger. When including states without comprehensive school health examination requirements, the most commonly required HBL screenings were for vision (80% of states; includes DC), hearing (75% of states; includes DC) and dental (24% of state; includes DC). CONCLUSION The lack of state mandated requirements for regular student health screening represents a missed opportunity to identify children with HBLs. Without state mandates, accompanying comprehensive forms, and protocols, children continue to be at risk of untreated health conditions that can undermine their success in school.
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Affiliation(s)
- Delaney Gracy
- Children’s Health Fund, New York, NY, United States of America
| | - Anupa Fabian
- Children’s Health Fund, New York, NY, United States of America
| | - Corey Hannah Basch
- Department of Public Health, William Paterson University, New York, NY, United States of America
| | - Maria Scigliano
- Children’s Health Fund, New York, NY, United States of America
| | - Sarah A. MacLean
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | | | - Irwin E. Redlener
- Children’s Health Fund, New York, NY, United States of America
- Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, NY, United States of America
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11
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Chen F, Liaw Y, Hsu S, Nfor ON. Association between vascular rings and learning performance: A cross-sectional study. JOURNAL OF CLINICAL ULTRASOUND : JCU 2017; 45:556-560. [PMID: 28555926 PMCID: PMC5655769 DOI: 10.1002/jcu.22502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 03/28/2017] [Accepted: 04/27/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Chronic tracheal obstruction has been associated with learning deficits; hence, early surgical intervention has been suggested. AIM To evaluate the relationship between learning performance and vascular ring caused by an isolated aberrant right subclavian artery. METHODS Participants included 1,685 undergraduate students (ie, students of medical informatics and medical/public health students) in Central Taiwan. The diagnostic period was from 2005 to 2010. Vascular ring was diagnosed by two-dimensional echocardiographic screening and was validated by esophagogram. The reference group (medical students) was associated with higher learning performance, whereas the comparison group (students of medical informatics and public health) was associated with lower learning performance. Multiple logistic regression was used for analysis. RESULTS The prevalence of vascular ring among the reference and comparison groups was 0.48 and 2.03%, respectively. The odds ratio for the vascular ring was 4.90 (95% confidence interval: 1.30-18.40) after adjusting for potential confounders. CONCLUSIONS This study suggests that vascular ring can impact learning efficiency and advocates for larger dedicated studies. © 2017 The Authors Journal of Clinical Ultrasound Published by Wiley Periodicals, Inc. J Clin Ultrasound 45:556-560, 2017.
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Affiliation(s)
- Fong‐Lin Chen
- Division of Pediatric Cardiology, Department of Pediatrics, Chung Shan Medical University HospitalTaichung City40201Taiwan
- Institute of MedicineChung Shan Medical University HospitalTaichung City40201Taiwan
| | - Yung‐Po Liaw
- Department of Public Health and Institute of Public Health, Chung Shan MedicalUniversity HospitalTaichung City40201Taiwan
- Department of Family and Community MedicineChung Shan Medical University HospitalTaichung City40201Taiwan
| | - Shu‐Yi Hsu
- Department of Public Health and Institute of Public Health, Chung Shan MedicalUniversity HospitalTaichung City40201Taiwan
| | - Oswald Ndi Nfor
- Department of Public Health and Institute of Public Health, Chung Shan MedicalUniversity HospitalTaichung City40201Taiwan
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12
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Grytten J. The impact of education on dental health - Ways to measure causal effects. Community Dent Oral Epidemiol 2017; 45:485-495. [DOI: 10.1111/cdoe.12319] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 06/02/2017] [Indexed: 01/23/2023]
Affiliation(s)
- Jostein Grytten
- Department of Community Dentistry; University of Oslo; Oslo Norway
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13
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Irani F, Barbone JM, Beausoleil J, Gerald L. Is asthma associated with cognitive impairments? A meta-analytic review. J Clin Exp Neuropsychol 2017; 39:965-978. [PMID: 28325118 DOI: 10.1080/13803395.2017.1288802] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Asthma is a chronic disease with significant health burden and socioeconomic and racial/ethnic disparities related to diagnosis and treatment. Asthma primarily affects the lungs, but can impact brain function through direct and indirect mechanisms. Some studies have suggested that asthma negatively impacts cognition, while others have failed to identify asthma-related cognitive compromise. We aimed to conduct a meta-analysis of cognition in individuals with asthma compared to that in healthy controls. We also examined the impact of some key potential moderators. METHOD Data on cognitive outcome measures and sociodemographic, illness-related, and study-related variables were extracted from studies reporting cognitive test performance in individuals with asthma compared to that in controls. RESULTS There was no evidence of publication bias. A random-effects model examining differences in task performance between 2017 individuals with asthma and 2131 healthy controls showed significant effects in the small to medium range. Cognitive deficits associated with asthma were global, with strongest effects on broader measures involving academic achievement and executive functioning, but with additional impact on processing speed, global intellect, attention, visuospatial functioning, language, learning, and memory. Severity of asthma was a key moderator, with greatest cognitive deficits associated with severe asthma. Cognitive burden was also greatest in asthma patients who were younger, males, from low socioeconomic backgrounds, and from racial/ethnic minorities. Effects were independent of type of population (child versus adult), type of study (norm-referenced versus control-referenced), or reported use of oral or inhaled corticosteroid medications. CONCLUSIONS There is cognitive burden associated with asthma, particularly among vulnerable groups with severe asthma. This could be due to increased risk of intermittent cerebral hypoxia in severe asthma. The clinical need to assess cognition in individuals with asthma is underscored.
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Affiliation(s)
- Farzin Irani
- a Department of Psychology , West Chester University of Pennsylvania , West Chester , PA , USA
| | - Jordan Mark Barbone
- a Department of Psychology , West Chester University of Pennsylvania , West Chester , PA , USA
| | - Janet Beausoleil
- b Division of Allergy and Immunology , The Children's Hospital of Philadelphia , Philadelphia , PA , USA
| | - Lynn Gerald
- c Mel and Enid Zuckerman College of Public Health , University of Arizona , Tucson , AZ , USA.,d Asthma and Airways Disease Research Center , University of Arizona , Tucson , AZ , USA
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Early physical health conditions and school readiness skills in a prospective birth cohort of U.S. children. Soc Sci Med 2015; 142:145-53. [PMID: 26310590 DOI: 10.1016/j.socscimed.2015.08.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 08/12/2015] [Accepted: 08/14/2015] [Indexed: 02/02/2023]
Abstract
RATIONALE Extant research identifies associations between early physical health disparities and impaired functioning in adulthood, but limited research examines the emergence of these associations in the early years of children's lives. OBJECTIVE This study draws on data from the Early Childhood Longitudinal Study Birth Cohort (ECLS-B; N = 5900) to assess whether a host of early health indicators measured from birth to age five are associated with children's cognitive and behavioral skills at age five. RESULTS After adjusting for child and family characteristics, results revealed that children's neonatal risks (prematurity or low birth weight) and reports of poor health and hospitalizations were associated with lower cognitive skills, and neonatal risks and poor health predicted lower behavioral functioning at age five. Some of the association between neonatal risks and school readiness skills were indirect, functioning through children's poor health and hospitalization. Analyses further found that associations between early physical health and children's school readiness skills were consistent across subgroups defined by family income and child race/ethnicity, suggesting generalizability of results. CONCLUSIONS Findings emphasize the need for more interdisciplinary research, practice, and policy related to optimizing child well-being across domains of physical health and development in the early years of life.
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Cutuli JJ, Herbers JE, Lafavor TL, Ahumada SM, Masten AS, Oberg CN. Asthma and adaptive functioning among homeless kindergarten-aged children in emergency housing. J Health Care Poor Underserved 2014; 25:717-30. [PMID: 24858881 PMCID: PMC4498570 DOI: 10.1353/hpu.2014.0099] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
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.
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Delmas MC, Guignon N, Leynaert B, Annesi-Maesano I, Com-Ruelle L, Gonzalez L, Fuhrman C. [Prevalence and control of asthma in young children in France]. Rev Mal Respir 2012; 29:688-96. [PMID: 22682595 DOI: 10.1016/j.rmr.2011.11.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Accepted: 11/30/2011] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Few data on regional variations in asthma prevalence are available in France. METHODS The study was carried out during the academic year 2005-2006 in a random sample of around 20,000 children in the last year of nursery school. The lifetime prevalence of asthma and the preceding year prevalences of asthma-like symptoms and treatment for wheezing or asthma attacks were estimated by region. RESULTS Overall, the lifetime prevalence of asthma was 9.8 % and the past-year prevalence of wheezing was 10.7 %. An increasing trend in prevalence was observed from Eastern to Western France and in overseas territories. The regional variations in past-year prevalence of wheezing remained when adjusting for gender, family structure and the number of siblings. Among children who had wheezed or received a treatment in the past year, 42 % had experienced frequent or severe symptoms. CONCLUSION Large regional variations in asthma prevalence among young children in France exist.
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Affiliation(s)
- M-C Delmas
- Départment des maladies chroniques, Institut de veille sanitaire, 12 rue du Val d'Osne, Saint-Maurice cedex, France.
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Akinbami LJ, Sullivan SD, Campbell JD, Grundmeier RW, Hartert TV, Lee TA, Smith RA. Asthma outcomes: healthcare utilization and costs. J Allergy Clin Immunol 2012; 129:S49-64. [PMID: 22386509 PMCID: PMC4277846 DOI: 10.1016/j.jaci.2011.12.984] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Accepted: 12/23/2011] [Indexed: 11/23/2022]
Abstract
BACKGROUND Measures of healthcare utilization and indirect impact of asthma morbidity are used to assess clinical interventions and estimate cost. OBJECTIVE National Institutes of Health institutes and other federal agencies convened an expert group to propose standardized measurement, collection, analysis, and reporting of healthcare utilization and cost outcomes in future asthma studies. METHODS We used comprehensive literature reviews and expert opinion to compile a list of asthma healthcare utilization outcomes that we classified as core (required in future studies), supplemental (used according to study aims and standardized), and emerging (requiring validation and standardization). We also have identified methodology to assign cost to these outcomes. This work was discussed at an National Institutes of Health-organized workshop in March 2010 and finalized in September 2011. RESULTS We identified 3 ways to promote comparability across clinical trials for measures of healthcare utilization, resource use, and cost: (1) specify the study perspective (patient, clinician, payer, and society); (2) standardize the measurement period (ideally 12 months); and (3) use standard units to measure healthcare utilization and other asthma-related events. CONCLUSIONS Large clinical trials and observational studies should collect and report detailed information on healthcare utilization, intervention resources, and indirect impact of asthma, so that costs can be calculated and cost-effectiveness analyses can be conducted across several studies. Additional research is needed to develop standard, validated survey instruments for collection of provider-reported and participant-reported data regarding asthma-related health care.
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Affiliation(s)
- Lara J Akinbami
- National Center for Health Statistics, Center for Disease Control and Prevention, Hyattsville, MD, USA
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Montes G, Lotyczewski BS, Halterman JS, Hightower AD. School readiness among children with behavior problems at entrance into kindergarten: results from a US national study. Eur J Pediatr 2012; 171:541-8. [PMID: 22016261 DOI: 10.1007/s00431-011-1605-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Accepted: 10/05/2011] [Indexed: 11/30/2022]
Abstract
The impact of behavior problems on kindergarten readiness is not known. Our objective was to estimate the association between behavior problems and kindergarten readiness on a US national sample. In the US educational system, kindergarten is a natural point of entry into formal schooling at age 5 because fewer than half of the children enter kindergarten with prior formal preschool education. Parents of 1,200 children who were scheduled to enter kindergarten for the first time and were members of the Harris Interactive online national panel were surveyed. We defined behavior problems as an affirmative response to the question, "Has your child ever had behavior problems?" We validated this against attention deficit hyperactivity disorder diagnosis, scores on a reliable socioemotional scale, and child's receipt of early intervention services. We used linear, tobit, and logistic regression analyses to estimate the association between having behavior problems and scores in reliable scales of motor, play, speech and language, and school skills and an overall kindergarten readiness indicator. The sample included 176 children with behavior problems for a national prevalence of 14% (confidence interval, 11.5-17.5). Children with behavior problems were more likely to be male and live in households with lower income and parental education. We found that children with behavior problems entered kindergarten with lower speech and language, motor, play, and school skills, even after controlling for demographics and region. Delays were 0.6-1 SD below scores of comparable children without behavior problems. Parents of children with behavior problems were 5.2 times more likely to report their child was not ready for kindergarten. Childhood behavior problems are associated with substantial delays in motor, language, play, school, and socioemotional skills before entrance into kindergarten. Early screening and intervention is recommended.
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Abstract
OBJECTIVES To outline the prevalence and disparities of asthma among school-aged urban minority youth, causal pathways through which poorly controlled asthma adversely affects academic achievement, and proven or promising approaches for schools to address these problems. METHODS Literature review. RESULTS Asthma is the most common chronic disease affecting youth in the United States; almost 10 million youth under 18 (14%) have received a diagnosis and 6.8 million (9%) have active asthma. Average annual prevalence estimates were approximately 45% higher for Black versus White children (12.8% vs. 8.8%), as were average annual estimates of asthma attacks (8.4% vs. 5.8%). Urban minority youth have highly elevated prevalence of poorly controlled asthma as evidenced by overuse of emergency departments and under-use of efficacious medications. Poorly controlled asthma has functional consequences on cognition, connectedness with school, and absenteeism. Exemplary asthma programs include management and support systems, school health and mental health services, asthma education, healthy school environments, physical education and activity, and coordination of school, family, and community efforts. CONCLUSIONS Asthma and, more importantly, poorly controlled asthma are highly and disproportionately prevalent among school-aged urban minority youth, has a negative impact on academic achievement through its effects on cognition, school connectedness, and absenteeism, and effective practices are available for schools to address this problem. To reduce the adverse effects of poorly controlled asthma on learning, a multifaceted approach to asthma control and prevention in which schools can and must play a central role is essential.
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Affiliation(s)
- Charles E Basch
- Department of Health and Behavior Studies, Teachers College, Columbia University, 525 West 120th Street, New York, NY 10027, USA.
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Fagnano M, Bayer AL, Isensee CA, Hernandez T, Halterman JS. Nocturnal asthma symptoms and poor sleep quality among urban school children with asthma. Acad Pediatr 2011; 11:493-9. [PMID: 21816697 PMCID: PMC3481184 DOI: 10.1016/j.acap.2011.05.006] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Revised: 05/13/2011] [Accepted: 05/16/2011] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of this study was to describe nocturnal asthma symptoms among urban children with asthma and assess the burden of sleep difficulties between children with varying levels of nocturnal symptoms. METHODS We analyzed baseline data from 287 urban children with persistent asthma (aged 4-10 years) enrolled in the School-Based Asthma Therapy trial; Rochester, New York. Caregivers reported on nocturnal asthma symptoms (number of nights/2 weeks with wheezing or coughing), parent quality of life (Juniper's Pediatric Asthma Caregivers Quality of Life Questionnaire), and sleep quality by using the validated Children's Sleep Habits Questionnaire. We used bivariate and multivariate statistics to compare nocturnal asthma symptoms with sleep quality/quantity and quality of life. RESULTS Most children (mean age, 7.5 years) were black (62%); 74% had Medicaid. Forty-one percent of children had intermittent nocturnal asthma symptoms, 23% mild persistent, and 36% moderate to severe. Children's average total sleep quality score was 51 (range, 33-99) which is above the clinically significant cutoff of 41, indicating pervasive sleep disturbances among this population. Sleep scores were worse for children with more nocturnal asthma symptoms compared with those with milder symptoms on total score, as well as several subscales, including night wakings, parasomnias, and sleep disordered breathing (all P < .03). Parents of children with more nocturnal asthma symptoms reported their child having fewer nights with enough sleep in the past week (P = .018) and worse parent quality of life (P < .001). CONCLUSIONS Nocturnal asthma symptoms are prevalent in this population and are associated with poor sleep quality and worse parent quality of life. These findings have potential implications for understanding the disease burden of pediatric asthma.
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Affiliation(s)
- Maria Fagnano
- Department of Pediatrics and the Strong Children's Research Center, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA.
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21
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Liberty KA, Pattemore P, Reid J, Tarren-Sweeney M. Beginning school with asthma independently predicts low achievement in a prospective cohort of children. Chest 2010; 138:1349-55. [PMID: 20558555 DOI: 10.1378/chest.10-0543] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Concerns about the achievement of children with asthma and respiratory conditions are especially important in New Zealand, which has one of the world's highest rates of childhood asthma. The present study evaluated whether entering school with asthma was associated with low achievement after the first year. METHODS A child cohort was recruited to a prospective study at time of first enrollment into randomly selected schools in Christchurch. Parent interviews covered demographics and respiratory status. Physician reports were sought for children with asthma, and all respiratory information was clinically reviewed. The children's achievement in reading and math was individually assessed at school entry and reassessed after 12 months. Schools reported absences. Intelligence subtests were administered. RESULTS Two hundred ninety-eight children were recruited, including 55 (18.5%) with current asthma. At 1-year follow-up, retention was 93.7%. Children who entered school with asthma were more likely to be ≥ 6 months behind other participants in reading words (P = .023) and books (P = .026), but not in math (P = .167) at the end of the first year of school. Achievement was not related to asthma severity. Entering school with asthma reliably predicted low reading achievement independent of other known covariates of low achievement (high absenteeism, minority status, male gender, single-parent family, poor academic skills at school entry, and low socioeconomic status). CONCLUSIONS Entering school with asthma was a significant predictor of low achievement in reading at 12-month follow-up, independent of asthma severity, high absenteeism, or other covariates of low achievement.
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Affiliation(s)
- Kathleen A Liberty
- Health Sciences Centre, University of Canterbury, Christchurch, New Zealand.
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Cutuli JJ, Herbers JE, Rinaldi M, Masten AS, Oberg CN. Asthma and behavior in homeless 4- to 7-year-olds. Pediatrics 2010; 125:145-51. [PMID: 19969617 DOI: 10.1542/peds.2009-0103] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Low-income, urban, ethnic minority children have higher rates of asthma, more severe symptoms, and more management issues, as well as high risk for academic and behavior problems. This study focused on asthma reported in young children who resided in a family emergency homeless shelter. Asthma rates were considered along with their relation to hospitalization and emergency department use and behavior that is important for school success, including cognitive function, conduct, and academic functioning. METHODS A total of 104 children (age 4.0-7.5 years) and parents were recruited while residing in an urban emergency homeless shelter for families. Children had no previously identified developmental delays and spoke English proficiently. Parents reported whether the child experienced asthma, as well as emergency department use and hospitalization. Parents and teachers completed measures of child inattention/hyperactivity and behavior problems. Cognitive function of children was directly assessed. RESULTS Asthma was reported for 27.9% of children, approximately 3 times the national average. Children with asthma had been hospitalized more often, showed higher levels of inattention/hyperactivity and behavior problems, and evidenced lower academic functioning. CONCLUSIONS Young children in homeless family emergency shelters have high rates of asthma and related problems that could lead to higher hospitalization rates, more behavioral problems, and lower academic functioning at school. Screening and treatment of children who stay in emergency family shelters may be particularly important for reducing risks associated with asthma in highly mobile, low-income families.
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Affiliation(s)
- J J Cutuli
- Institute of Child Development, University of Minnesota, Minneapolis, Minnesota 55455, USA.
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MURDOCK KARLAKLEIN, ROBINSON ELIZABETHM, ADAMS SUEK, BERZ JENNIFER, ROLLOCK MICHAELJ. Family–school connections and internalizing problems among children living with asthma in urban, low-income neighborhoods. J Child Health Care 2009; 13:275-94. [PMID: 19713409 PMCID: PMC3480735 DOI: 10.1177/1367493509336682] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Children with asthma living in urban environments are at risk for experiencing internalizing problems and difficulties at school due to social context and health-related stressors. Parent confidence and participation in the school and children's attitudes about school were explored in association with children's depressed mood and school anxiety. Forty-five parent-child dyads were recruited from urban community health centers. Most participants were members of ethnic minority groups. Hierarchical multiple regression analyses revealed that higher levels of parent confidence in the school were associated with fewer symptoms of school anxiety in children. Children's attitudes toward school moderated the relation between parent participation in the school and children's depressed mood. Specifically, lower levels of parent participation were associated with higher levels of depressed mood only for children with the least positive school attitudes. Although preliminary, these results suggest the importance of attending to family-school connections to optimize the school-related psychological functioning of children living with asthma in urban environments.
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Affiliation(s)
- KARLA KLEIN MURDOCK
- Associate Professor, Department of Psychology, Washington and Lee University, Lexington, VA, USA
| | - ELIZABETH M. ROBINSON
- Postbaccalaureate Fellow, Prevention Research Branch, Eunice Kennedy Shriver National Institute for Child Health and Human Development, Bethesda, MD, USA
| | - SUE K. ADAMS
- Assistant Professor, Department of Human Development and Family Studies, University of Rhode Island, Kingston, RI, USA
| | - JENNIFER BERZ
- Family and Child Clinician, Brookline Community Mental Health Center, Boston, MA, USA
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Conn KM, Hernandez T, Puthoor P, Fagnano M, Halterman JS. Screen time use among urban children with asthma. Acad Pediatr 2009; 9:60-3. [PMID: 19329093 PMCID: PMC2663806 DOI: 10.1016/j.acap.2008.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2008] [Revised: 09/26/2008] [Accepted: 10/06/2008] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe screen time use and factors related to screen time among urban children with persistent asthma. METHODS We analyzed data for 224 children (aged 3 to 10 years) with persistent asthma. Parents reported on children's asthma severity, screen time use, and family practices regarding screen time. We asked parents: "On weekdays [and weekends] on average, over a 24-hour period, how many hours of screen time does your child have?" Parents also reported activity limitation due to asthma, and activities their child engaged in during times of activity limitation. RESULTS Most children were male (58%), black (65%), and had Medicaid (74%); average screen time was 3.4 hours per day. Most parents (74%) reported that their child had >2 hours of screen time per day, and one-third were concerned that their child had too much screen time. Many children (63%) engaged in screen time activities during activity limitation due to asthma. Children who needed to slow down or stop normal activity due to asthma had more screen time compared with children who didn't need to slow down (3.51 hours vs 2.44 hours, P = .02). Additionally, children who engaged in screen time activities during times of physical limitation had more screen time compared with children who engaged in other activities (3.67 hours vs 2.99 hours, P = .01). CONCLUSIONS We found that urban children with asthma, particularly those with activity limitation, have excessive use of screen time. Strategies are needed to avoid activity limitation by improving asthma care and to empower families with alternative strategies to avoid excess screen time.
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Affiliation(s)
- Kelly M Conn
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Strong Memorial Hospital,601 Elmwood Ave., Rochester, NY 14642, USA.
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Learning Difficulties Among Children Separated From a Parent. ACTA ACUST UNITED AC 2008; 8:163-8. [DOI: 10.1016/j.ambp.2008.02.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2007] [Revised: 01/30/2008] [Accepted: 02/06/2008] [Indexed: 11/20/2022]
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Moonie S, Sterling DA, Figgs LW, Castro M. The relationship between school absence, academic performance, and asthma status. THE JOURNAL OF SCHOOL HEALTH 2008; 78:140-148. [PMID: 18307609 DOI: 10.1111/j.1746-1561.2007.00276.x] [Citation(s) in RCA: 124] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND Children with asthma experience more absenteeism from school compared with their nonasthma peers. Excessive absenteeism is related to lower student grades, psychological, social, and educational adjustment. Less is known about the relationship between the presence of asthma and the academic achievement in school-aged children. Since students with asthma miss more days from school, this may negatively impact their academic achievement. The goal of this study was to investigate the relationships between absenteeism, presence of asthma, and asthma severity level with standardized test level performance in a predominantly African American urban school district. METHODS A cross-sectional analysis was conducted of 3812 students (aged 8-17 years) who took the Missouri Assessment Program (MAP) standardized test during the 2002-2003 academic year. RESULTS After adjustment for covariates, a significant inverse relationship was found between absenteeism and test level performance on the MAP standardized test in all children (F = 203.9, p < .001). There was no overall difference in test level achievement between those with and without asthma (p = .12). Though not statistically different, those with persistent asthma showed a modestly increased likelihood of scoring below Nearing Proficient compared with those with mild intermittent asthma (adjusted odds ratio = 1.93, 95% confidence intervals = 0.93-4.01, p = .08). CONCLUSIONS A negative impact of absenteeism on standardized test level achievement was demonstrated in children from an urban African American school district. Children with asthma perform the same academically as their nonasthma peers. However, those with persistent asthma show a trend of performing worse on MAP standardized test scores and have more absence days compared with other students. More research is warranted on the effects of persistent asthma on academic achievement.
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Affiliation(s)
- Sheniz Moonie
- Department of Environmental and Occupational Health, Division of Epidemiology and Biostatistics, University of Nevada, Las Vegas, School of Public Health, 4505 Maryland Parkway Box 453064, Las Vegas, NV 89154-3064, USA.
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Richardson JW. From Risk to Resilience: Promoting School–Health Partnerships for Children. ACTA ACUST UNITED AC 2008. [DOI: 10.1177/105678790801700103] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Across the globe, educational and health practitioners wrestle daily with the paradoxes of risk and resilience. Though the causes of risk are generally outside the control of professionals, manifestations of disadvantage directly affect service delivery and the realizing of accountability benchmarks. This article proposes a shift in attention from risk to resilience as being empowering and proactive for students and those vested in maximizing their potential. Given that resilience has been deemed an ecological phenomenon, the ecology of human development framework posited by Uri Bronfenbrenner (1979) was applied to advance the rationale for resiliency partnerships between schools and school-based health clinics.
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Stingone JA, Claudio L. Asthma and enrollment in special education among urban schoolchildren. Am J Public Health 2006; 96:1593-8. [PMID: 16873740 PMCID: PMC1551960 DOI: 10.2105/ajph.2005.075887] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2006] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We assessed whether asthma is associated with urban children's use of special education services. METHODS We conducted a cross-sectional study in 24 randomly selected New York City public elementary schools using a parent-report questionnaire focusing on sociodemographic characteristics, special education enrollment, asthma diagnosis and symptoms, school absences, and use of health care services. RESULTS Thirty-four percent of children enrolled in special education had been diagnosed with asthma, compared with 19% of children in the general student population. After control for sociodemographic factors, children with asthma were 60% more likely than children without asthma to be enrolled in special education (odds ratio [OR] = 1.62; 95% confidence interval [CI] = 1.22, 2.16). Asthmatic children in special education were significantly more likely to be from low-income families and to have been hospitalized in the previous 12 months than asthmatic children in general education. CONCLUSIONS Inadequate asthma control may contribute to a greater risk of asthmatic children residing in urban areas being placed in special education. School health programs should consider targeting low-income urban children with asthma at risk for enrollment in special education through increased asthma interventions and medical support services.
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Affiliation(s)
- Jeanette A Stingone
- Department of Community and Preventive Medicine, Mount Sinai School of Medicine, New York, NY, USA
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Le Louarn A, Schweitzer B. [Relationship between asthma or asthma-related symptoms and school problems among French children attending kindergarden]. Rev Epidemiol Sante Publique 2004; 52:29-38. [PMID: 15107691 DOI: 10.1016/s0398-7620(04)99020-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND The impact of chronic respiratory symptoms on school performance has been studied less than its impact on children's health. Our survey explored the relationship between chronic respiratory symptoms and school problems among children attending kindergarten. It assessed the impact of school absenteeism, sport practise in a club and health care access for school problems among pupils with chronic respiratory symptoms. METHODS A population-based study was carried out by school physicians on a representative sample of pupils attending third-year kindergarten, in Alsace - France. Assessments included school problems, sociodemographic and health care access characteristics. Health conditions, notably chronic respiratory symptoms, were asked to include the pupils in one of the three study groups: physician-diagnosed asthma, asthma-related symptoms not associated with diagnosed asthma, and without current health problems (controls). Logistic regression was used to compare the odds ratio of school problems for the three study groups, overall and stratified by income. RESULTS The 2,632 included pupils aged 5 to 6 Years, were assigned to the three groups according to their respiratory status: 179 with diagnosed asthma, 176 with asthma related symptoms and 2,277 healthy pupils. Diagnosed asthma was not linked with school problems. The overall association between asthma related symptoms and school problems was significant (OR=1.5, 95% CI: 1.0-2.2). After adjustment, this association persisted among pupils whose mother's education level was intermediary (technical or vocational diploma) (OR=2.3, 95% CI: 1.2-4.6). Among the diagnosed asthma group, pupils practising a sport in a club had less school problems than those not taking part in sports (ORadjusted=0.2, 95% CI: 0.03-0.8). CONCLUSION In our study, asthmatic children were not at higher risk of school problems. So developing programs preventing school problems which focus on asthmatic children is not needed. Among the pupils having a mother with an intermediary education level, asthma-related symptoms were associated with school problems. It is important to identify unknown asthmatics to institute to treatment for their respiratory symptoms in order to prevent the consequences of the functional impact of asthma on their scholarship.
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Affiliation(s)
- A Le Louarn
- Mission de Promotion de la Santé en Faveur des Elèves, Inspection Académique du Bas-Rhin, 65, avenue de la Forêt-Noire, 67083 Strasbourg Cedex.
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