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Perry TT, Marko A, Russell AF, Cooke AT, Bingemann TA, Ross KR, Young MC. How Schools Can Help Address Social Determinants of Health in Asthma Management. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:316-326. [PMID: 37839577 DOI: 10.1016/j.jaip.2023.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 10/02/2023] [Accepted: 10/02/2023] [Indexed: 10/17/2023]
Abstract
Schools are in a unique position to address social determinants of health (SDOHs) in pediatric asthma management because of their potential to provide resources and facilitate collaboration with health care providers and services for children at risk within their community. SDOHs include economic factors, educational attainment and health literacy, neighborhood factors and the built environment, social and community aspects including discrimination and racism, and health care access and quality. These factors have a significant impact on asthma health in children, and certain populations such as minoritzed populations and those living in high-poverty environments have been shown to be at greater risk for adverse effects of SDOHs on asthma outcomes. School-based asthma programs address several SDOHs including health literacy, the built environment, and health care quality and access and have been shown to improve asthma outcomes. Key components include connection between the school and the health care team, self-management education, and directly observed therapy. School nurses play a key role in directing and managing effective programs because they can evaluate and support a student's health while considering the effect of SDOHs at interpersonal, institutional, community, and policy levels.
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Affiliation(s)
- Tamara T Perry
- Division of Allergy and Immunology, College of Medicine, Arkansas Children's Research Institute, University of Arkansas for Medical Sciences, Little Rock, Ark
| | - Angela Marko
- Division of Pediatric Pulmonology and Sleep Medicine, UH Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, Ohio.
| | - Anne F Russell
- School of Nursing and Health Sciences, Spring Arbor University, Spring Arbor, Mich; Food Allergy and Anaphylaxis Michigan Association, Ann Arbor, Mich
| | - Abigail T Cooke
- Allergy and Asthma Specialists, Durango, Colo; Colorado State University-Pueblo: Graduate School of Nursing, Pueblo, Colo
| | - Theresa A Bingemann
- Departments of Allergy, Immunology and Rheumatology and Pediatric Allergy and Immunology, University of Rochester School of Medicine, Rochester, NY
| | - Kristie R Ross
- Division of Pediatric Pulmonology and Sleep Medicine, UH Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, Ohio
| | - Michael C Young
- Division of Allergy and Immunology, Boston Children's Hospital, Harvard Medical School, Boston, Mass
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2
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Pogge G, Fedele DA, Waters EA, Maki J, Hunleth JM, Prabhakaran S, Bowen DJ, Shepperd JA. Exploring Caregiver Interest in and Preferences for Interventions for Children With Risk of Asthma Exacerbation: Web-Based Survey. JMIR Form Res 2023; 7:e46341. [PMID: 37531188 PMCID: PMC10433025 DOI: 10.2196/46341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 06/14/2023] [Accepted: 06/15/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Maintaining control of asthma symptoms is the cornerstone of asthma treatment guidelines in the United States. However, suboptimal asthma control and asthma exacerbations among young people are common and are associated with many negative outcomes. Interventions to improve asthma control are needed. For such interventions to be successful, it is necessary to understand the types of interventions that are appealing to caregivers of children with different levels of risk of exacerbation. OBJECTIVE This study aimed to evaluate whether caregivers of children with high (vs low) risk of asthma exacerbation show different levels of interest in and preferences for potential intervention programs and delivery methods. METHODS We contracted with Ipsos to administer a web-based survey to caregivers of children with asthma who were residing in the United States. Caregivers (N=394) reported their interest (1=not at all; 3=a lot) in 9 possible intervention programs and 8 possible intervention delivery methods. Caregivers also indicated their preferences by selecting the 3 intervention programs and 3 delivery methods that "most" interested them. Finally, caregivers completed 2 open-ended questions asking what other resources might be useful for managing their children's asthma. We classified children as having a high risk of exacerbation if they had an exacerbation in the past 3 months (n=116) and a low risk of exacerbation if otherwise (n=278). RESULTS Caregivers reported higher levels of interest in all intervention programs and delivery methods if they cared for a child with a high risk rather than a low risk of exacerbation. However, regardless of the child's risk status, caregivers expressed the highest levels of interest in programs to increase their child's self-management skills, to help pay for asthma care, and to work with the school to manage asthma. Caregivers expressed the highest levels of interest in delivery methods that maintained personal control over accessing information (websites, videos, printed materials, and smartphone apps). Caregivers' preferences were consistent with their interests; programs and delivery methods that were rated as high in interest were also selected as one of the 3 that "most" interested them. Although most caregivers did not provide additional suggestions for the open-ended questions, a few caregivers suggested intervention programs and delivery methods that we had not included (eg, education about avoiding triggers and medication reminders). CONCLUSIONS Similar interests and preferences among caregivers of children with high and low risk of exacerbation suggest a broad need for support in managing childhood asthma. Providers could help caregivers by directing them toward resources that make asthma care more affordable and by helping their children with asthma self-management. Interventions that accommodate caregivers' concerns about having personal control over access to asthma information are likely to be more successful than interventions that do not.
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Affiliation(s)
- Gabrielle Pogge
- Department of Psychology, University of Florida, Gainesville, FL, United States
| | - David A Fedele
- Department of Psychology, University of Florida, Gainesville, FL, United States
| | - Erika A Waters
- Division of Public Health Sciences, Washington University in St Louis, St Louis, MO, United States
| | - Julia Maki
- Division of Public Health Sciences, Washington University in St Louis, St Louis, MO, United States
| | - Jean M Hunleth
- Division of Public Health Sciences, Washington University in St Louis, St Louis, MO, United States
| | | | - Deborah J Bowen
- Department of Bioethics and Humanities, University of Washington, Seattle, WA, United States
| | - James A Shepperd
- Department of Psychology, University of Florida, Gainesville, FL, United States
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3
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Jefferson AA, Brown CC, Eyimina A, Goudie A, Rezaeiahari M, Perry TT, Tilford JM. Asthma Quality Measurement and Adverse Outcomes in Medicaid-Enrolled Children. Pediatrics 2023; 152:e2022059812. [PMID: 37497577 PMCID: PMC10389769 DOI: 10.1542/peds.2022-059812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/17/2023] [Indexed: 07/28/2023] Open
Abstract
OBJECTIVES To determine the association between the asthma medication ratio (AMR) quality measure and adverse outcomes among Medicaid-enrolled children with asthma in Arkansas, given concerns regarding the utility of the AMR in evaluating pediatric risk of asthma-related adverse events (AAEs). METHODS We used the Arkansas All-Payer Claims Database to identify Medicaid-enrolled children with asthma using a nonrestrictive case definition and additionally using the standard Healthcare Effectiveness Data and Information Set (HEDIS) persistent asthma definition. We assessed the AMR using the traditional dichotomous HEDIS AMR categorization and across 4 expanded AMR categories. Regression models assessed associations between AMR and AAE including hospitalization and emergency department utilization, with models conducted overall and by race and ethnicity. RESULTS Of the 22 788 children in the analysis, 9.0% had an AAE (6.7% asthma-related emergency department visits; 3.0% asthma-related hospitalizations). We found poor correlation between AMR and AAE, with higher rates of AAE (10.5%) among children with AMR ≥0.5 compared with AMR <0.5 (8.5%; P < .001), and similar patterns stratified by racial and ethnic subgroups. Expanded AMR categorization revealed notable differences in associations between AMR and AAEs, compared with traditional dichotomous categorization, with worse performance in Black children. CONCLUSIONS The AMR performed poorly in identifying risk of adverse outcomes among Medicaid-enrolled children with asthma. These findings underscore concerns of the utility of the AMR in population health management and reliance on restrictive HEDIS definitions. New population health frameworks incorporating broader considerations that accurately identify at-risk children are needed to improve equity in asthma management and outcomes.
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Affiliation(s)
- Akilah A. Jefferson
- Department of Pediatrics, Allergy & Immunology Division
- Arkansas Children’s Research Institute, Little Rock, Arkansas
| | - Clare C. Brown
- College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Arina Eyimina
- College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Anthony Goudie
- College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Mandana Rezaeiahari
- College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Tamara T. Perry
- Department of Pediatrics, Allergy & Immunology Division
- Arkansas Children’s Research Institute, Little Rock, Arkansas
| | - J. Mick Tilford
- College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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Fedele DA, Hollenbach J, Sinisterra M, LeFave E, Fishe J, Salloum RG, Bian J, Gurka MJ. Implementation of a pediatric asthma management program in rural primary care clinics. J Asthma 2023; 60:1080-1087. [PMID: 36194428 PMCID: PMC10115910 DOI: 10.1080/02770903.2022.2132954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 09/26/2022] [Accepted: 10/03/2022] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Rural communities experience a significant asthma burden. We pilot tested the implementation of Easy Breathing, a decision support program for improving primary care provider adherence to asthma guidelines in a rural community, and characterized asthma risk factors for enrollees. METHODS We implemented Easy Breathing in two rural primary care practices for two years. Patient demographics, exposure histories, asthma severity, asthma medications, and treatment plans were collected. Providers' adherence to guidelines included the frequency of children with persistent asthma who were prescribed guidelines-based therapy and the frequency of children with a written asthma treatment plan on file. Clinicians provided feedback on the feasibility and acceptability of Easy Breathing using a validated survey tool and through semi-structured interviews. RESULTS Two providers implemented the program. Enrollment included 518 children, of whom 135 (26%) had physician-confirmed asthma. After enrollment into Easy Breathing, 75% of children with asthma received a written asthma treatment plan All children with persistent asthma were prescribed an anti-inflammatory drug as part of their treatment plan. Providers (n = 2) rated Easy breathing as highly acceptable (M = 4.5), feasible (M = 4.5), and appropriate (M = 4.5). Qualitative feedback was positive, with suggestions to integrate the paper-based program into the electronic health record system for broader uptake. Enrollees with asthma were more likely to have a family history of asthma and endorse exposure to tobacco smoke and cockroaches. CONCLUSIONS Easy Breathing shows promise as a decision support system that can be implemented in rural, medically underserved communities via primary care.
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Affiliation(s)
- David A. Fedele
- Department of Clinical & Health Psychology, University of Florida, Gainesville, FL
| | - Jessica Hollenbach
- Department of Pediatrics, Connecticut Children’s Medical Center, Hartsford, CT
| | - Manuela Sinisterra
- Department of Clinical & Health Psychology, University of Florida, Gainesville, FL
| | - Elizabeth LeFave
- Department of Pediatrics, University of Florida, Gainesville, FL
| | - Jennifer Fishe
- Department of Emergency Medicine, University of Florida, Jacksonville, FL
| | - Ramzi G. Salloum
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL
| | - Jiang Bian
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL
| | - Matthew J. Gurka
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL
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5
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Bozigar M, Lawson AB, Pearce JL, Svendsen ER, Vena JE. Using Bayesian time-stratified case-crossover models to examine associations between air pollution and "asthma seasons" in a low air pollution environment. PLoS One 2021; 16:e0260264. [PMID: 34879071 PMCID: PMC8654232 DOI: 10.1371/journal.pone.0260264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 11/05/2021] [Indexed: 11/18/2022] Open
Abstract
Many areas of the United States have air pollution levels typically below Environmental Protection Agency (EPA) regulatory limits. Most health effects studies of air pollution use meteorological (e.g., warm/cool) or astronomical (e.g., solstice/equinox) definitions of seasons despite evidence suggesting temporally-misaligned intra-annual periods of relative asthma burden (i.e., “asthma seasons”). We introduce asthma seasons to elucidate whether air pollutants are associated with seasonal differences in asthma emergency department (ED) visits in a low air pollution environment. Within a Bayesian time-stratified case-crossover framework, we quantify seasonal associations between highly resolved estimates of six criteria air pollutants, two weather variables, and asthma ED visits among 66,092 children ages 5–19 living in South Carolina (SC) census tracts from 2005 to 2014. Results show that coarse particulates (particulate matter <10 μm and >2.5 μm: PM10-2.5) and nitrogen oxides (NOx) may contribute to asthma ED visits across years, but are particularly implicated in the highest-burden fall asthma season. Fine particulate matter (<2.5 μm: PM2.5) is only associated in the lowest-burden summer asthma season. Relatively cool and dry conditions in the summer asthma season and increased temperatures in the spring and fall asthma seasons are associated with increased ED visit odds. Few significant associations in the medium-burden winter and medium-high-burden spring asthma seasons suggest other ED visit drivers (e.g., viral infections) for each, respectively. Across rural and urban areas characterized by generally low air pollution levels, there are acute health effects associated with particulate matter, but only in the summer and fall asthma seasons and differing by PM size.
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Affiliation(s)
- Matthew Bozigar
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, United States of America
- * E-mail:
| | - Andrew B. Lawson
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - John L. Pearce
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Erik R. Svendsen
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - John E. Vena
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, United States of America
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Canonica GW, Paggiaro P, Blasi F, Musarra A, Richeldi L, Rossi A, Papi A. Manifesto on the overuse of SABA in the management of asthma: new approaches and new strategies. Ther Adv Respir Dis 2021; 15:17534666211042534. [PMID: 34587829 PMCID: PMC8488406 DOI: 10.1177/17534666211042534] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The risks of overusing short-acting β2-agonists (SABA), including an
increase in asthma-related deaths, are many and well known. The Global
Initiative on Asthma (GINA) 2019 and 2020 updates recommend as-needed inhaled
corticosteroid (ICS)/formoterol as the preferred rescue medication in mild
asthma as monotherapy and also in moderate to severe asthma when the maintenance
and reliever therapy (MART) strategy is used. Using SABA for symptom relief,
however, was the standard of treatment for many years, and consequently this
practice persists, particularly in patients not taking ICS regularly. Here, we
examine the rationale for this shift from a long-standing recommendation for
as-needed SABA treatment to the use of as-needed ICS/formoterol and consider
clinical evidence on strategies for asthma treatment and patient management.
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Affiliation(s)
- Giorgio Walter Canonica
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Milan, Italy.,IRCCS Humanitas Research Hospital, Personalized Medicine, Asthma and Allergy, via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Pierluigi Paggiaro
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy
| | - Francesco Blasi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Respiratory Unit and Cystic Fibrosis Adult Center, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | | | - Luca Richeldi
- Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Rossi
- Pulmonary Unit, Azienda Ospedaliera Universitaria Integrata and University of Verona, Verona, Italy
| | - Alberto Papi
- Research Center on Asthma and COPD, Department of Translational Medicine, University of Ferrara, Ferrara, Italy
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7
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Johnson EE, MacGeorge C, Andrews A, King KL, Teufel RJ, Brinton DL, Kruis R, Hale KC, Ford D, Sterba KR. Nurse Perspectives Regarding Implementation of an Asthma Monitoring Mobile Health Application in the School Setting. Telemed J E Health 2021; 27:955-962. [PMID: 34152858 DOI: 10.1089/tmj.2021.0100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: School-based telehealth (SBTH) plays a valuable role in child asthma management, although nurses have concerns with caregiver engagement. Mobile technology (m-health) has potential to improve this engagement. Objective: We identified barriers and key desired features of an asthma m-health application as a supplement to an existing SBTH asthma program in rural settings. Methods: Multimethod design using school nurse surveys and interviews with school and SBTH personnel to describe processes related to implementation of an m-health application. Results: Nurses reported SBTH programs were an ideal setting to identify potential families for m-health. Benefits of caregiver education and engagement and barriers related to technology, smart phone data availability, and family buy-in were described. Desired application features included education on inhaler technique, asthma symptom, and medication adherence reports. Conclusions: The feedback identified from nurses can be incorporated into an asthma m-health program within an SBTH program to facilitate implementation.
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Affiliation(s)
- Emily E Johnson
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Claire MacGeorge
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Annie Andrews
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Kathryn L King
- Center for Telehealth, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ronald J Teufel
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Daniel L Brinton
- College of Health Professions, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ryan Kruis
- Center for Telehealth, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Kathryn C Hale
- Center for Telehealth, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Dee Ford
- Center for Telehealth, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Kathryn R Sterba
- Department of Public Health, Medical University of South Carolina, Charleston, South Carolina, USA
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8
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Jabre NA, Keet CA, McCormack M, Peng R, Balcer-Whaley S, Matsui EC. Material Hardship and Indoor Allergen Exposure among Low-Income, Urban, Minority Children with Persistent Asthma. J Community Health 2021; 45:1017-1026. [PMID: 32377967 DOI: 10.1007/s10900-020-00822-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Traditional measures of socioeconomic status (SES) are associated with asthma morbidity, but their specific contributions are unclear. Increased exposure to indoor allergens among low SES children is an important consideration. Material hardship, a concept describing poor access to basic goods and services, may explain the relationship between low SES and indoor allergen exposure, and thereby, the increased risk of asthma morbidity. We sought to (i) describe the specific hardships experienced by low-Income, urban, minority children with asthma and indoor allergen sensitization and (ii) determine if material hardship is associated with indoor allergen exposure in this population. We conducted a cross-sectional analysis of children undergoing the baseline assessment for a clinical trial of home environmental modification. Participants were scored in five domains of material hardship. Domain scores were assigned based on caregiver responses to a questionnaire and were summed to generate a total material hardship score. Linear regression was used to examine the relationship between material hardship scores and bedroom floor concentrations of five common indoor allergens. Participants experienced high levels of material hardship in each of the five domains, with 33% not having access to a car, 35% not being able to pay utility bills, and 28% not being able to pay rent in the past year. Each one-point increase in material hardship was associated with an increase in cockroach allergen of 16.2% (95% CI 9.4%, 24.6%) and an increase in mouse allergen of 9.4% (95% CI 1.0%, 18.5%). After adjusting for traditional measures of SES, including household income, health insurance type, caregiver education, and caregiver employment status, the association between material hardship and cockroach allergen, but not mouse allergen, remained. These data suggest that a significant proportion of families of low-income, minority children with asthma may experience material hardship, and that they may be at greater risk of cockroach allergen exposure than their peers with similar income, but without material hardship.
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Affiliation(s)
- Nicholas A Jabre
- Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Corinne A Keet
- Division of Pediatric Allergy and Immunology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Meredith McCormack
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Roger Peng
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Susan Balcer-Whaley
- Division of Pediatric Allergy and Immunology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Elizabeth C Matsui
- Department of Population Health and Pediatrics, Dell Medical School, The University of Texas at Austin, 1701 Trinity St, Austin, TX, 78704, USA.
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9
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Bozigar M, Lawson AB, Pearce JL, King K, Svendsen ER. A Bayesian spatio-temporal analysis of neighborhood pediatric asthma emergency department visit disparities. Health Place 2020; 66:102426. [PMID: 33011491 DOI: 10.1016/j.healthplace.2020.102426] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/17/2020] [Accepted: 08/17/2020] [Indexed: 11/25/2022]
Abstract
Asthma disparities have complex, neighborhood-level drivers that are not well understood. Consequently, identifying particular contextual factors that contribute to disparities is a public health goal. We study pediatric asthma emergency department (ED) visit disparities and neighborhood factors associated with them in South Carolina (SC) census tracts from 1999 to 2015. Leveraging a Bayesian framework, we identify risk clusters, spatially-varying relationships, and risk percentile-specific associations. Clusters of high risk occur in both rural and urban census tracts with high probability, with neighborhood-specific associations suggesting unique risk factors for each locale. Bayesian methods can help clarify the neighborhood drivers of health disparities.
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Affiliation(s)
- Matthew Bozigar
- Division of Epidemiology, Department of Public Health Sciences, College of Graduate Studies, Medical University of South Carolina, Charleston, SC, United States.
| | - Andrew B Lawson
- Division of Biostatistics, Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, United States.
| | - John L Pearce
- Division of Environmental Health, Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, United States.
| | - Kathryn King
- Department of Pediatrics, College of Medicine, Medical University of South Carolina, Charleston, SC, United States; School-Based Health, Center for Telehealth, Medical University of South Carolina, Charleston, SC, United States.
| | - Erik R Svendsen
- Division of Environmental Health, Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, United States.
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10
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Bozigar M, Lawson A, Pearce J, King K, Svendsen E. A geographic identifier assignment algorithm with Bayesian variable selection to identify neighborhood factors associated with emergency department visit disparities for asthma. Int J Health Geogr 2020; 19:9. [PMID: 32188481 PMCID: PMC7081565 DOI: 10.1186/s12942-020-00203-7] [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: 12/18/2019] [Accepted: 03/04/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ecologic health studies often rely on outcomes from health service utilization data that are limited by relatively coarse spatial resolutions and missing geographic information, particularly neighborhood level identifiers. When fine-scale geographic data are missing, the ramifications and strategies for addressing them are not well researched or developed. This study illustrates a novel spatio-temporal framework that combines a geographic identifier assignment (i.e., geographic imputation) algorithm with predictive Bayesian variable selection to identify neighborhood factors associated with disparities in emergency department (ED) visits for asthma. METHODS ED visit records with missing fine-scale spatial identifiers (~ 20%) were geocoded using information from known, coarser, misaligned spatial units using an innovative geographic identifier assignment algorithm. We then employed systematic variable selection in a spatio-temporal Bayesian hierarchical model (BHM) predictive framework within the NIMBLE package in R. Our novel methodology is illustrated in an ecologic case study aimed at identifying neighborhood-level predictors of asthma ED visits in South Carolina, United States, from 1999 to 2015. The health outcome was annual ED visit counts in small areas (i.e., census tracts) with primary diagnoses of asthma (ICD9 codes 493.XX) among children ages 5 to 19 years. RESULTS We maintained 96% of ED visit records for this analysis. When the algorithm used areal proportions as probabilities for assignment, which addressed differential missingness of census tract identifiers in rural areas, variable selection consistently identified significant neighborhood-level predictors of asthma ED visit risk including pharmacy proximity, average household size, and carbon monoxide interactions. Contrasted with common solutions of removing geographically incomplete records or scaling up analyses, our methodology identified critical differences in parameters estimated, predictors selected, and inferences. We posit that the differences were attributable to improved data resolution, resulting in greater power and less bias. Importantly, without this methodology, we would have inaccurately identified predictors of risk for asthma ED visits, particularly in rural areas. CONCLUSIONS Our approach innovatively addressed several issues in ecologic health studies, including missing small-area geographic information, multiple correlated neighborhood covariates, and multiscale unmeasured confounding factors. Our methodology could be widely applied to other small-area studies, useful to a range of researchers throughout the world.
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Affiliation(s)
- Matthew Bozigar
- Division of Epidemiology, Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA.
| | - Andrew Lawson
- Division of Biostatistics, Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - John Pearce
- Division of Environmental Health, Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Kathryn King
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA.,School-Based Health, Center for Telehealth, Medical University of South Carolina, Charleston, SC, USA
| | - Erik Svendsen
- Division of Environmental Health, Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
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11
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Pate CA, Qin X, Bailey CM, Zahran HS. Cost barriers to asthma care by health insurance type among children with asthma. J Asthma 2019; 57:1103-1109. [PMID: 31343379 DOI: 10.1080/02770903.2019.1640730] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Objective: Children with asthma have ongoing health care needs and health insurance is a vital part of their health care access. Health care coverage may be associated with various cost barriers to asthma care. We examined cost barriers to receiving asthma care by health insurance type and coverage continuity among children with asthma using the 2012-2014 Child Asthma Call-back Survey (ACBS).Methods: The study sample included 3788 children under age 18 years with current asthma who had responses to the ACBS by adult proxy. Associations between cost barriers to asthma care and treatment were analyzed by demographic, health insurance coverage, and urban residence variables using multivariable logistic regression models.Results: Among insured children, more blacks reported a cost barrier to seeing a doctor (10.6% [5.9, 18.3]) compared with whites (2.9% [2.1, 4.0]) (p = 0.03). Adjusting for demographic factors (sex, age, and race), uninsured and having partial year coverage were associated with cost barrier to seeing a doctor (adjusted prevalence ratio aPR = 8.07 [4.78, 13.61] and aPR = 6.58 [3.78, 11.45], respectively) and affording medication (aPR = 8.35 [5.23, 13.34] and aPR = 4.93 [2.96, 8.19], respectively), compared with children who had full year coverage. Public insurance was associated with cost barrier to seeing a doctor (aPR = 4.43 [2.57, 7.62]), compared with private insurance.Conclusions: Having no health insurance, partial year coverage, and public insurance were associated with cost barriers to asthma care. Improving health insurance coverage may help strengthen access to and reduce cost barriers to asthma care.
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Affiliation(s)
- Cynthia A Pate
- 2M Research, LLC Contractor to Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Xiaoting Qin
- Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Cathy M Bailey
- Office of the Director, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Hatice S Zahran
- Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Perry TT, Halterman JS, Brown RH, Luo C, Randle SM, Hunter CR, Rettiganti M. Results of an asthma education program delivered via telemedicine in rural schools. Ann Allergy Asthma Immunol 2018; 120:401-408. [PMID: 29471032 DOI: 10.1016/j.anai.2018.02.013] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 01/19/2018] [Accepted: 02/12/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Asthma morbidity is high in low-income children living in rural US regions, yet few interventions have been designed to decrease the asthma burden in rural populations. OBJECTIVE To examine the effect of a school-based asthma education program delivered by telemedicine in children living in an impoverished rural region. METHODS We conducted a cluster randomized trial with rural children 7 to 14 years old by comparing a school-based telemedicine asthma education intervention with usual care. The intervention provided comprehensive asthma education by telemedicine to participants and provided evidence-based treatment recommendations to primary care providers. RESULTS Of the 393 enrolled children, median age was 9.6 years, 81% were African American, and 47% lived in households with an annual income less than $14,999. At enrollment, 88% of children reported uncontrolled asthma symptoms. At the end of the intervention, there were no statistically significant differences in reported symptom-free days (primary outcome) for the intervention or usual-care group. Participants in the intervention group reported significantly higher use of peak flow meters to monitor asthma and reported taking their asthma medications as prescribed more frequently compared with the usual-care group. There were no changes in other outcome measures, including quality of life, self-efficacy, asthma knowledge, or lung function, between groups. CONCLUSION Although there was some evidence of behavior change among intervention participants, these changes were inadequate to overcome the significant morbidity experienced by this highly symptomatic rural impoverished population. Future interventions should be designed with a multifaceted approach that considers caregiver engagement, distance barriers, and inadequate access to asthma providers in rural regions. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01167855.
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Affiliation(s)
- Tamara T Perry
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas; Arkansas Children's Research Institute, Little Rock, Arkansas.
| | - Jill S Halterman
- Department of Pediatrics, University of Rochester Medical Center, Rochester, New York
| | - Rita H Brown
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas; Arkansas Children's Research Institute, Little Rock, Arkansas
| | - Chunqiao Luo
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas; Arkansas Children's Research Institute, Little Rock, Arkansas
| | | | | | - Mallikarjuna Rettiganti
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas; Arkansas Children's Research Institute, Little Rock, Arkansas
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Estrada RD, Ownby DR. Rural Asthma: Current Understanding of Prevalence, Patterns, and Interventions for Children and Adolescents. Curr Allergy Asthma Rep 2017; 17:37. [PMID: 28484946 PMCID: PMC6533905 DOI: 10.1007/s11882-017-0704-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE OF REVIEW Asthma is the most common chronic illness of children and adolescents in the USA. While asthma has been understood to disproportionately affect urban dwellers, recent investigations have revealed rural pediatric asthma prevalence to be very similar to urban and to be more closely correlated with socioeconomic and environmental factors than geographic location or population density. RECENT FINDINGS Rural children experience factors unique to location that impact asthma development and outcomes, including housing quality, cigarette smoke exposure, and small/large-scale farming. Additionally, there are challenging barriers to appropriate asthma care that frequently are more severe for those living in rural areas, including insurance status, lack of primary care providers and pulmonary specialists, knowledge deficits (both patient and provider), and a lack of culturally tailored asthma interventions. Interventions designed to address rural pediatric asthma disparities are more likely to be successful when targeted to specific challenges, such as the use of school-based services or telemedicine to mitigate asthma care access issues. Continued research on understanding the complex interaction of specific rural environmental factors with host factors can inform future interventions designed to mitigate asthma disparities.
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Affiliation(s)
| | - Dennis R Ownby
- Allergy & Immunology, Augusta University, Augusta, GA, USA
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14
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Patel MR, Song PXK, Sanders G, Nelson B, Kaltsas E, Thomas LJ, Janevic MR, Hafeez K, Wang W, Wilkin M, Johnson TR, Brown RW. A randomized clinical trial of a culturally responsive intervention for African American women with asthma. Ann Allergy Asthma Immunol 2016; 118:212-219. [PMID: 28034579 DOI: 10.1016/j.anai.2016.11.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 10/27/2016] [Accepted: 11/17/2016] [Indexed: 01/18/2023]
Abstract
BACKGROUND Few interventions have focused on the difficulties that African American women face when managing asthma. OBJECTIVE To evaluate a telephone-based self-regulation intervention that emphasized African American women's management of asthma in a series of 6 sessions. METHODS A total of 422 African American women with persistent asthma were randomly assigned to either an intervention or control group receiving usual care. Behavioral factors, symptoms and asthma control, asthma-related quality of life, and health care use at baseline and 2 years after baseline were assessed. Generalized estimating equations were used to assess the long-term effect of the intervention on outcomes. RESULTS Compared with the control group, those who completed the full intervention (6 sessions) had significant gains in self-regulation of their asthma (B estimate, 0.73; 95% CI, 0.17-1.30; P < .01), noticing changes to their asthma during their menstrual cycle (B estimate, 1.42; 95% CI, 0.69-2.15; P < .001), and when having premenstrual syndrome (B estimate, 1.70; 95% CI, 0.67-2.72; P < .001). They also had significant reductions in daytime symptoms (B estimate, -0.15; 95% CI, -0.27 to -0.03; P < .01), asthma-related hospitalization (B estimate, 0.51; 95% CI, 0.00-1.02; P < .05), and improved asthma control (B estimate, 1.34; 95% CI, 0.57-2.12; P < .001). However, neither grouped changed over time in outcomes. CONCLUSION Despite high comorbidity, African American women who completed a culturally responsive self-management program had improvements in asthma outcomes compared with the control group. Future work should address significant comorbidities and psychosocial issues alongside asthma management to improve asthma outcomes in the long term. TRIAL REGISTRATION clinicaltrials.gov Identifier NCT01117805.
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Affiliation(s)
- Minal R Patel
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, Michigan.
| | - Peter X K Song
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Georgiana Sanders
- Department Allergy and Immunology, University of Michigan, Ann Arbor, Michigan
| | - Belinda Nelson
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, Michigan
| | - Elena Kaltsas
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, Michigan
| | - Lara J Thomas
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, Michigan
| | - Mary R Janevic
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, Michigan
| | - Kausar Hafeez
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, Michigan
| | - Wen Wang
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Margaret Wilkin
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, Michigan
| | - Timothy R Johnson
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
| | - Randall W Brown
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, Michigan
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15
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Comparison of asthma prevalence and morbidity among rural and nonrural youth. Ann Allergy Asthma Immunol 2016; 117:193-194.e1. [PMID: 27287876 DOI: 10.1016/j.anai.2016.05.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 04/29/2016] [Accepted: 05/23/2016] [Indexed: 11/23/2022]
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López Tiro JJ, Contreras EAC, del Pozo MER, Gómez Vera J, Larenas Linnemann D. Real life study of three years omalizumab in patients with difficult-to-control asthma. Allergol Immunopathol (Madr) 2015; 43:120-6. [PMID: 24780091 DOI: 10.1016/j.aller.2013.11.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 11/10/2013] [Accepted: 11/14/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND Even though there are multiple options for the treatment of asthma, there still exists a fair group of patients with difficult-to-control asthma. We describe for the first time the real-world effects of three-year omalizumab treatment on patients with difficult-to-control asthma, seen in a social security hospital in a Latin American country. METHODS Difficult-to-control asthmatic patients from the out-patient clinic of a regional hospital were recruited to receive a three-year omalizumab course. Efficacy parameters were asthma control test (ACT) score; FEV1; daily beclomethasone maintenance dose; and unplanned visits for asthma exacerbations (emergency room (ER), hospitalisations, intensive care). RESULTS 52 patients were recruited, 47 completed the three-year treatment (42 female, 15-67 years, mean age 43.5). Comparing efficacy parameters of the year before omalizumab with the 3rd year of omalizumab: mean ACT improved from 12.4 to 20.5, mean FEV1 from 66.3% (standard deviation (SD) 19.1%) to 88.4% (SD 16.2%) of predicted, while mean beclomethasone dose reduced from 1750 to 766 mcg/day and there was a significant reduction in patients experiencing ER visits (from 95% to 19%, p<0.0001), hospitalisation (38% to 2%, p<0.0001) and intensive care (4% to 0, NS). Five patients discontinued omalizumab, two because of an adverse event (anaphylaxis, severe headache, both resolved without sequelae). CONCLUSION Omalizumab improved most clinical parameters of Mexican patients with difficult-to-control asthma. Especially the rates of ER visits and hospitalisation were significantly reduced, thus reducing costs. Omalizumab was generally well tolerated.
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Affiliation(s)
- J Jesús López Tiro
- Department of Allergy and Clinical Immunology, H.R. Lic. Adolfo López Mateos, ISSSTE, Mexico City, Mexico.
| | | | - M Elena Ramírez del Pozo
- Department of Allergy and Clinical Immunology, H.R. Lic. Adolfo López Mateos, ISSSTE, Mexico City, Mexico
| | - J Gómez Vera
- Department of Allergy and Clinical Immunology, H.R. Lic. Adolfo López Mateos, ISSSTE, Mexico City, Mexico
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Social disadvantage and asthma control in children. Paediatr Respir Rev 2014; 15:256-62; quiz 262-3. [PMID: 24928775 PMCID: PMC4146695 DOI: 10.1016/j.prrv.2014.04.017] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 04/29/2014] [Indexed: 12/22/2022]
Abstract
This review discusses various aspects of social disadvantage and their association with poor asthma control, including socioeconomic status, exposure to psychosocial stress and violence, minority affiliation, environmental concerns such as allergens and pollution, and poverty in rural settings. Each of these elements has been linked with worsened asthma outcomes in children. Known and hypothesized mechanisms behind these associations are described in an effort to further understand the complex entity of poorly controlled asthma among socially deprived children. Intervention studies to improve asthma outcomes in these vulnerable populations are also described.
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Coleman AT, Rettiganti M, Bai S, Brown RH, Perry TT. Mouse and cockroach exposure in rural Arkansas Delta region homes. Ann Allergy Asthma Immunol 2014; 112:256-60. [PMID: 24491312 DOI: 10.1016/j.anai.2014.01.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 01/03/2014] [Accepted: 01/04/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Home characteristics and aeroallergen exposure in rural US children with asthma are poorly described. OBJECTIVE To examine the relationship between cockroach and mouse allergen concentrations and home characteristics of children with asthma in the rural Arkansas Delta. METHODS The home environments of rural children with asthma were examined using home environment questionnaire and home inspection. Bedroom and kitchen dust was analyzed for cockroach and mouse allergen concentrations. RESULTS The median age of participants was 9 years, and 84% were African American. Most participants (78%) resided in single-family homes. Evidence of cockroaches was detected in 13% of homes and evidence of rodents was detected in 23% of homes. Detectable Bla g 1 was found in 58% of kitchens and 43% of bedrooms, Bla g 2 was detected in 37% of kitchens and 28% of bedrooms, and Mus m 1 was found in 81% of kitchens and 97% of bedrooms. Evidence of cockroaches in any room was associated with Bla g 1 concentrations of ≥2 U/g (odds ratio 21.71, 95% confidence interval 4.26-118.39) and Bla g 2 concentrations of ≥2 U/g (odds ratio 21.90 95% confidence interval 4.30-138.91). Multifamily vs single-family dwellings were more likely to have Bla g 2 concentrations of ≥2 U/g (odds ratio 3.52, 95% confidence interval 1.0-11.82). Home characteristics were not associated with Mus m 1. CONCLUSION Mouse and cockroach allergens were detected in most rural homes; however, concentrations were relatively low compared with those previously reported in inner-city homes. Few home characteristics predicted allergen concentrations. Further studies are needed to establish clinically relevant associations that might place rural children with asthma at risk for poor clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT00590304.
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Affiliation(s)
- Amaziah T Coleman
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Mallikarjuna Rettiganti
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas; Arkansas Children's Hospital Research Institute, Little Rock, Arkansas
| | - Shasha Bai
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, Ohio
| | - Rita H Brown
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Tamara T Perry
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas; Arkansas Children's Hospital Research Institute, Little Rock, Arkansas.
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Horner SD, Brown A. Evaluating the effect of an asthma self-management intervention for rural families. J Asthma 2013; 51:168-77. [PMID: 24188732 DOI: 10.3109/02770903.2013.855785] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To present outcomes of an asthma self-management educational intervention delivered to children (grades 2-5) at school and to parents in a home visit. METHODS The intervention effectiveness was tested in a 12-month longitudinal study with randomization by elementary schools into treatment and attention-control groups with 183 children who had a diagnosis of asthma. Data were collected at four time points. Change over time was examined with linear mixed models. RESULTS Quality of life (QOL), hospitalizations, and emergency department visits improved significantly for all the children. African American and Mexican American children had worse asthma-related QOL than did White children. Asthma management behaviors, asthma self-efficacy, and coping likewise improved with girls improving significantly more than the boys. Significant improvements in inhaler skill and asthma severity were seen in the treatment group children when compared to the control group. Treatment group parents showed significant improvements in home asthma management and self-efficacy. CONCLUSIONS The improvement in inhaler skill is an important finding for practitioners as this is a behavior that can be addressed in the clinical setting. The reduction in the treatment group's asthma severity scores may reflect the improvement in medication delivery as their inhaler skill improved. The differential improvement between boys and girls points to the need for testing other formats in asthma education that can address different learning styles. The individualized parent asthma education enabled the intervener to incorporate neighborhood and home environmental information thereby allowing for tailoring of parental instruction.
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Affiliation(s)
- Sharon D Horner
- School of Nursing, The University of Texas at Austin , Austin, TX , USA
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Abstract
In the past, cockroach allergen exposure assessment mainly focused on settled dust in homes in low-income urban cities in the United States. That choice was not wrong; without measureable levels of cockroach allergen, it is difficult to show associations with any home characteristics, much less with health outcomes (e.g., allergy, asthma). However, recent studies in other suburban areas, schools, and other countries have elucidated the importance of cockroach allergen in these environments too. In addition, characterizing the underlying factors that give rise to cockroach allergen exposure (or protect against it) can lead to more targeted public health interventions. This review discusses different approaches to sampling indoor environments, interprets recent asthma and allergy studies, compares cockroach allergen levels from past studies with those of recent studies, and describes strategies for decreasing exposures.
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Okelo SO, Eakin MN, Patino CM, Teodoro AP, Bilderback AL, Thompson DA, Loiaza-Martinez A, Rand CS, Thyne S, Diette GB, Riekert KA. The Pediatric Asthma Control and Communication Instrument asthma questionnaire: for use in diverse children of all ages. J Allergy Clin Immunol 2013; 132:55-62. [PMID: 23434285 DOI: 10.1016/j.jaci.2013.01.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Revised: 12/22/2012] [Accepted: 01/03/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND National Institutes of Health asthma guidelines recommend questionnaires to assess asthma control, but these questionnaires are not useable across the entire pediatric age spectrum and have not been validated among significant numbers of minority or Spanish-speaking children. OBJECTIVE We sought to evaluate a questionnaire designed to assess asthma control across a broad age range of minority and Spanish-speaking children cared for in an outpatient setting. METHODS Between July 1, 2007, and September 30, 2010, we collected information using the Pediatric Asthma Control and Communication Instrument (PACCI), the Asthma Control Test (ACT; or the childhood ACT for children 4-11 years old), the Pediatric Asthma Caregiver Quality of Life Questionnaire, and lung function and clinicians' ratings of asthma status among a population of children presenting for routine asthma specialist care. The PACCI measure of asthma control was validated by evaluating accuracy, internal reliability, and concurrent, discriminative, and known-groups validity. RESULTS We collected information on 265 English- and 52 Spanish-speaking children (mean age, 8.2 years; 58% male; 44% African American). Across all age groups and in both languages, PACCI control showed good internal reliability and strong concurrent, discriminative, and known-groups validity with ACT and Pediatric Asthma Caregiver Quality of Life Questionnaire scores and clinicians' ratings of asthma control. The accuracy of the PACCI in classifying children with uncontrolled asthma was good (area under the curve, 0.83; 95% CI, 0.79-0.88). CONCLUSIONS The PACCI accurately measures asthma control in English- and Spanish-speaking children. The PACCI should be useful to clinicians to assess and classify asthma according to National Institutes of Health asthma guidelines.
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Affiliation(s)
- Sande O Okelo
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA.
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