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Keenan K, Walton S, Mbayiwa K, Akande L, Cherian A, Ciaccio C, Tare I. Short Report: Exploring the Effect of Prenatal Fatty Acid Supplementation on Wheeze and Asthma in Black American Children. J Asthma Allergy 2024; 17:929-933. [PMID: 39355514 PMCID: PMC11444094 DOI: 10.2147/jaa.s474009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 09/18/2024] [Indexed: 10/03/2024] Open
Abstract
Background Black American children are at higher risk for developing asthma than White children. Identifying potential scalable preventive interventions that can reduce the racial disparities in asthma prevalence and associated morbidity and mortality are needed. We leveraged data from an RCT of prenatal supplementation with docosahexaenoic acid (DHA) in Black American women, to explore whether prenatal fatty acid supplementation is associated with offspring wheeze and asthma. Methods Data were from the Nutrition and Pregnancy Study (NAPS), a double-blind RCT of prenatal DHA supplementation in Black women targeting stress regulation during pregnancy. A subset of mothers (n = 83) completed a standardized questionnaire on offspring wheeze and asthma when children were between 0.5 and 5.5 years of age. DHA levels were measured from venous blood and reported as percent of total fatty acids. Results Of the 83 mothers providing data on child wheeze and asthma, 57 (68.7%) had been randomized to active DHA and 26 (31.3%) to placebo. Mothers and research staff were blind to group assignment. Comparison at the group assignment level yielded a relative reduction of 32% in the rate of wheeze or asthma among offspring of mothers assigned to active DHA compared to offspring of mothers assigned to placebo (OR = 1.6 [95% CI = 0.50-5.09], p = 0.426). DHA levels measured at 25-29 and 33-37 weeks of gestation differed as a function of offspring wheeze or asthma (t = 2.21, p = 0.015 and t = 2.54, p = 0.007, respectively). Conclusion These preliminary data suggest that increasing prenatal levels of DHA could be considered as a potential prevention for asthma in Black American children.
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Affiliation(s)
- Kate Keenan
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, IL, USA
| | - Sarah Walton
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, IL, USA
| | - Kimberley Mbayiwa
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, IL, USA
| | - Lara Akande
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, IL, USA
| | - Anna Cherian
- Department of Pediatrics, The University of Chicago, Chicago, IL, USA
| | - Christina Ciaccio
- Department of Pediatrics, The University of Chicago, Chicago, IL, USA
| | - Ilaria Tare
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, IL, USA
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2
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Khan JR, Lingam R, Owens L, Chen K, Shanthikumar S, Oo S, Schultz A, Widger J, Bakar KS, Jaffe A, Homaira N. Social deprivation and spatial clustering of childhood asthma in Australia. Glob Health Res Policy 2024; 9:22. [PMID: 38910250 PMCID: PMC11194868 DOI: 10.1186/s41256-024-00361-2] [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: 01/29/2024] [Accepted: 05/28/2024] [Indexed: 06/25/2024] Open
Abstract
BACKGROUND Asthma is the most common chronic respiratory illness among children in Australia. While childhood asthma prevalence varies by region, little is known about variations at the small geographic area level. Identifying small geographic area variations in asthma is critical for highlighting hotspots for targeted interventions. This study aimed to investigate small area-level variation, spatial clustering, and sociodemographic risk factors associated with childhood asthma prevalence in Australia. METHODS Data on self-reported (by parent/carer) asthma prevalence in children aged 0-14 years at statistical area level 2 (SA2, small geographic area) and selected sociodemographic features were extracted from the national Australian Household and Population Census 2021. A spatial cluster analysis was used to detect hotspots (i.e., areas and their neighbours with higher asthma prevalence than the entire study area average) of asthma prevalence. We also used a spatial Bayesian Poisson model to examine the relationship between sociodemographic features and asthma prevalence. All analyses were performed at the SA2 level. RESULTS Data were analysed from 4,621,716 children aged 0-14 years from 2,321 SA2s across the whole country. Overall, children's asthma prevalence was 6.27%, ranging from 0 to 16.5%, with significant hotspots of asthma prevalence in areas of greater socioeconomic disadvantage. Socioeconomically disadvantaged areas had significantly higher asthma prevalence than advantaged areas (prevalence ratio [PR] = 1.10, 95% credible interval [CrI] 1.06-1.14). Higher asthma prevalence was observed in areas with a higher proportion of Indigenous individuals (PR = 1.13, 95% CrI 1.10-1.17). CONCLUSIONS We identified significant geographic variation in asthma prevalence and sociodemographic predictors associated with the variation, which may help in designing targeted asthma management strategies and considerations for service enhancement for children in socially deprived areas.
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Affiliation(s)
- Jahidur Rahman Khan
- School of Clinical Medicine, University of New South Wales, Randwick, NSW, 2031, Australia.
| | - Raghu Lingam
- School of Clinical Medicine, University of New South Wales, Randwick, NSW, 2031, Australia
- Sydney Children's Hospital Network, Randwick, NSW, Australia
| | - Louisa Owens
- School of Clinical Medicine, University of New South Wales, Randwick, NSW, 2031, Australia
- Sydney Children's Hospital Network, Randwick, NSW, Australia
| | - Katherine Chen
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
- The Royal Children's Hospital, Melbourne, VIC, Australia
| | - Shivanthan Shanthikumar
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
- The Royal Children's Hospital, Melbourne, VIC, Australia
| | - Steve Oo
- Perth Children's Hospital, Perth, WA, Australia
| | - Andre Schultz
- Perth Children's Hospital, Perth, WA, Australia
- University of Western Australia, Perth, WA, Australia
| | - John Widger
- Women's and Children's Hospital, Adelaide, SA, Australia
| | - K Shuvo Bakar
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Adam Jaffe
- School of Clinical Medicine, University of New South Wales, Randwick, NSW, 2031, Australia
- Sydney Children's Hospital Network, Randwick, NSW, Australia
| | - Nusrat Homaira
- School of Clinical Medicine, University of New South Wales, Randwick, NSW, 2031, Australia
- Sydney Children's Hospital Network, Randwick, NSW, Australia
- James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh
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3
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Dapas M, Lee YL, Wentworth-Sheilds W, Im HK, Ober C, Schoettler N. Revealing polygenic pleiotropy using genetic risk scores for asthma. HGG ADVANCES 2023; 4:100233. [PMID: 37663543 PMCID: PMC10474095 DOI: 10.1016/j.xhgg.2023.100233] [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: 06/02/2023] [Accepted: 08/11/2023] [Indexed: 09/05/2023] Open
Abstract
In this study we examined how genetic risk for asthma associates with different features of the disease and with other medical conditions and traits. Using summary statistics from two multi-ancestry genome-wide association studies of asthma, we modeled polygenic risk scores (PRSs) and validated their predictive performance in the UK Biobank. We then performed phenome-wide association studies of the asthma PRSs with 371 heritable traits in the UK Biobank. We identified 228 total significant associations across a variety of organ systems, including associations that varied by PRS model, sex, age of asthma onset, ancestry, and human leukocyte antigen region alleles. Our results highlight pervasive pleiotropy between asthma and numerous other traits and conditions and elucidate pathways that contribute to asthma and its comorbidities.
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Affiliation(s)
- Matthew Dapas
- Department of Human Genetics, University of Chicago, Chicago, IL, USA
| | - Yu Lin Lee
- Department of Human Genetics, University of Chicago, Chicago, IL, USA
- Biological Sciences Collegiate Division, University of Chicago, Chicago, IL, USA
| | | | - Hae Kyung Im
- Section of Genetic Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Carole Ober
- Department of Human Genetics, University of Chicago, Chicago, IL, USA
| | - Nathan Schoettler
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA
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4
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Volerman A, Balachandran U, Zhu M, Akel M, Hull A, Siros M, Luna V, Xu I, Press VG. Evaluating inhaler education interventions for hospitalized children with asthma: A randomized controlled trial. Ann Allergy Asthma Immunol 2023; 131:217-223.e1. [PMID: 36870528 PMCID: PMC10440276 DOI: 10.1016/j.anai.2023.02.023] [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: 09/23/2022] [Revised: 02/09/2023] [Accepted: 02/23/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND Most children with asthma have poor inhaler technique, with detrimental morbidity effects. Guidelines recommend clinicians provide inhaler education at every opportunity, yet resources are limited. A low-cost, technology-based intervention-Virtual Teach-to-Goal (V-TTG)-was developed to deliver tailored inhaler technique education with high fidelity. OBJECTIVE To evaluate whether V-TTG leads to less inhaler misuse among children with asthma who are hospitalized vs brief intervention (BI, reading steps aloud). METHODS A single-center randomized controlled trial of V-TTG vs BI was conducted with 5-to-10-year-old children with asthma hospitalized between January 2019 and February 2020. Inhaler technique was assessed pre- and post-education using 12-step validated checklists (misuse: < 10 steps correct). RESULTS Among 70 children enrolled, mean age was 7.8 years (SD = 1.6). Most (86%) were Black. Most had an emergency department visit (94%) or hospitalization (90%) in the previous year. At baseline, nearly all children misused inhalers (96%). The proportion of children with inhaler misuse decreased significantly in V-TTG (100%→74%, P = .002) and BI (92%→69%, P = .04) groups, with no difference between groups at both time points (P = .2 and .9). On average, children performed 1.5 more steps correctly (SD = 2.0), with greater improvement with V-TTG (mean [SD] = 1.7 [1.6]) vs BI (mean [SD] = 1.4 [2.3]), though not significant (P = .6). Concerning pre and post technique, older children were significantly more likely than younger children to show more correct steps (mean change = 1.9 vs 1.1, P = .002). CONCLUSION A technology-based intervention for tailored inhaler education led to improved technique among children, similarly to reading steps aloud. Older children saw greater benefits. Future studies should evaluate the V-TTG intervention across diverse populations and disease severities to identify the greatest impact. CLINICAL TRIAL REGISTRATION NCT04373499.
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Affiliation(s)
- Anna Volerman
- Department of Medicine, University of Chicago, Chicago, Illinois; Department of Pediatrics, University of Chicago, Chicago, Illinois.
| | - Uma Balachandran
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Mengqi Zhu
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Mary Akel
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Ashley Hull
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Michelle Siros
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Viridiana Luna
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Isabella Xu
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Valerie G Press
- Department of Medicine, University of Chicago, Chicago, Illinois; Department of Pediatrics, University of Chicago, Chicago, Illinois
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5
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Abstract
Cross-sector partnerships are essential to ensure a safe and effective system of care for children, their caregivers, and communities. A "system of care" should have a well-defined population, vision, and measures shared by health care and community stakeholders, and an efficient modality for tracking progress toward better, more equitable outcomes. Effective partnerships could be clinically integrated, built atop coordinated awareness and assistance, and community-connected opportunities for networked learning. As opportunities for partnership continue to be uncovered, it will be vital to broadly assess their impact, using clinical and nonclinical metrics.
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Affiliation(s)
- Alexandra M S Corley
- Department of Pediatrics, University of Cincinnati College of Medicine, 3333 Burnet Avenue MLC 7035, Cincinnati, OH 45229, USA; Division of General & Community Pediatrics, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 7035, Cincinnati, OH 45229, USA.
| | - Adrienne W Henize
- Division of General & Community Pediatrics, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 7035, Cincinnati, OH 45229, USA
| | - Melissa D Klein
- Department of Pediatrics, University of Cincinnati College of Medicine, 3333 Burnet Avenue MLC 2011, Cincinnati, OH 45229, USA; Division of General & Community Pediatrics, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 2011, Cincinnati, OH 45229, USA; Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 2011, Cincinnati, OH 45229, USA
| | - Andrew F Beck
- Department of Pediatrics, University of Cincinnati College of Medicine, 3333 Burnet Avenue MLC 7035, Cincinnati, OH 45229, USA; Division of General & Community Pediatrics, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 7035, Cincinnati, OH 45229, USA; Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 7035, Cincinnati, OH 45229, USA
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Nanda A, Siles R, Park H, Louisias M, Ariue B, Castillo M, Anand MP, Nguyen AP, Jean T, Lopez M, Altisheh R, Pappalardo AA. Ensuring equitable access to guideline-based asthma care across the lifespan: Tips and future directions to the successful implementation of the new NAEPP 2020 guidelines, a Work Group Report of the AAAAI Asthma, Cough, Diagnosis, and Treatment Committee. J Allergy Clin Immunol 2023; 151:869-880. [PMID: 36720288 DOI: 10.1016/j.jaci.2023.01.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 01/08/2023] [Accepted: 01/19/2023] [Indexed: 01/29/2023]
Abstract
The most recent recommendations from the 2020 National Asthma Education and Prevention Program Update and Global Initiative for Asthma 2021 guide evidence-based clinical decision making. However, given the present state of health disparities by age, income, and race, the equitable implementation and dissemination of these guidelines will be unlikely without further guidance. This work group report reviews the current state of the new asthma guideline implementation; presents updated evidence-based therapeutic options with attention to specific patient populations; and addresses barriers to the implementation of these guidelines in minoritized, historically marginalized, and underresourced communities. Allergists and immunologists can use practical ways to accomplish the goals of improved asthma care access and advanced asthma care across the life span, with specific considerations to historically marginalized populations. Modifiable barriers to guideline implementation include financial barriers, environmental factors, and allergy subspecialty access and care coordination. Various programs to improve access to guideline-based asthma care include community programs, school-based asthma programs, and digital health solutions, with an emphasis on reducing disparities by race.
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Affiliation(s)
- Anil Nanda
- Asthma and Allergy Center, Lewisville-Flower Mound; Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas
| | - Roxana Siles
- Department of Allergy and Clinical Immunology, Respiratory Institute, Cleveland Clinic Foundation, Cleveland
| | - Henna Park
- Department of Pediatrics, University of Illinois Hospital, Chicago
| | - Margee Louisias
- Department of Medicine, Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Cleveland; Department of Immunology, Boston Children's Hospital, Boston; Harvard Medical School, Boston
| | - Barbara Ariue
- Department of Pediatrics, Division of Allergy/Immunology, Loma Linda Children's Hospital, Loma Linda
| | - Maria Castillo
- Department of Medical Education at Driscoll Children's Hospital, Corpus Christi
| | - Mahesh Padukudru Anand
- Department of Respiratory Medicine, JSS Medical College, JSS Academy of Higher Education and Research, Mysore
| | - Anh P Nguyen
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, School of Medicine, University of California Davis, Sacramento
| | - Tiffany Jean
- Division of Basic and Clinical Immunology, Department of Medicine, University of California Irvine, Orange
| | - Michael Lopez
- Division of Basic and Clinical Immunology, Department of Medicine, University of California Irvine, Orange
| | - Roula Altisheh
- Department of Allergy and Clinical Immunology, Respiratory Institute, Cleveland Clinic Foundation, Cleveland
| | - Andrea A Pappalardo
- Department of Pediatrics, Department of Medicine, University of Illinois at Chicago, Chicago
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7
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Pappalardo AA, Wang T, Martin MA. CHECK: Multi-level Real-World Pediatric Asthma Care Coordination: Results and Lessons Learned. J Asthma 2022; 60:1061-1071. [PMID: 36151882 DOI: 10.1080/02770903.2022.2129063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Because asthma health disparities in children remain common, innovative approaches to obtain asthma health equity are essential. Comprehensive care coordination programs may address the social determinants of health that influence these disparities. This analysis aims to ascertain if receipt of Coordination of Healthcare for Complex Kids (CHECK) program services was associated with changes in school absence, cost, healthcare utilization, and controller prescription in children with asthma. METHODS The CHECK program ran from December 1st, 2014 through August 31st, 2017. Engagement with Community Health Workers (CHW) was rolling and targeted based on risk level (low, medium or high determined by healthcare utilization). This analysis included school-aged children with asthma (n = 2,629) and sufficient Chicago Public Schools attendance data (n = 430). RESULTS Children engaged in CHECK were more likely to be female (p = 0.046) and to identify as Black and/or Hispanic/Latino than enrolled-only children. School absence was not different between the groups. Average total cost for engaged children was 21.3% more than enrolled-only children the first year (p = 0.027) but did not differ by the second year (p = 0.948). At baseline, 68.1% of the cohort had at least one ED visit 12-months prior to CHECK, this reduced to 49.5% post-1 and 41.9% post-2. Engaged children were 21% more likely to visit an ED (p = 0.010) and 40% more likely to have a controller. CONCLUSIONS CHECK program receipt was associated with reduced costs and improved healthcare utilization, and controller prescriptions. School attendance did not change. The CHECK model offers potential pathways to support low-income children with asthma.
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Affiliation(s)
- A A Pappalardo
- Department of Pediatrics, University of Illinois at Chicago, Chicago, IL.,Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - T Wang
- Institute of Research and Health Policy, University of Illinois at Chicago, Chicago, IL
| | - M A Martin
- Department of Pediatrics, University of Illinois at Chicago, Chicago, IL.,Institute of Research and Health Policy, University of Illinois at Chicago, Chicago, IL
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8
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Baptist A, Gibson-Scipio W, Carcone AI, Ghosh S, Jacques-Tiura AJ, Hall A, MacDonell KK. Asthma and technology in emerging African American adults (The ATHENA Project): Protocol for a trial using the Multiphase Optimization Strategy framework (Preprint). JMIR Res Protoc 2022; 11:e37946. [PMID: 35536642 PMCID: PMC9131162 DOI: 10.2196/37946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 03/16/2022] [Accepted: 03/23/2022] [Indexed: 11/25/2022] Open
Abstract
Background Asthma causes substantial morbidity and mortality in the United States, particularly among African American emerging adults (AAEAs; aged 18-30 years), but very few asthma programs have targeted this population. Interventions that provide education and address underlying motivation for managing asthma may be the most effective. However, intensive face-to-face interventions are often difficult to implement in this population. Objective The purpose of this study is to develop an effective mobile asthma management intervention to improve control among AAEAs. Methods We will assess the ability of multiple technologic components to assist and improve traditional asthma education. The first component is the Motivational Enhancement System for asthma management. It is a mobile 4-session intervention using supported self-regulation and motivational interviewing. Personalized content is based on each participant’s activity level, daily experiences, and goals. The second component is supportive accountability. It is administered by asthma nurses using targeted mobile support (Skype/voice calls) to provide education, promote self-efficacy, and overcome barriers through a motivational interviewing–based framework. The third component is SMS text messaging. It provides reminders for asthma education, medication adherence, and physical activity. The fourth component is physical activity tracking. It uses wearable technology to help meet user-defined physical activity goals. Using a multiphase optimization strategy (MOST) framework, we will test intervention components and combinations of components to identify the most effective mobile intervention. The MOST framework is an innovative, and cost- and time-effective framework that uses engineering principles to produce effective behavioral interventions. We will conduct a component selection experiment using a factorial research design to build an intervention that has been optimized for maximum efficacy, using a clinically significant improvement in asthma. Participants (N=180) will be randomized to 1 of 6 intervention arms. Participants will be recruited from multiple sites of the American Lung Association-Airway Clinical Research Centers network and ambulatory care clinics at the Detroit Medical Center. Data collections will occur at baseline, and 3, 6, and 12 months. Results At study completion, we will have an empirically supported optimized mobile asthma management intervention to improve asthma control for AAEAs. We hypothesize that postintervention (3, 6, and 12 months), participants with uncontrolled asthma will show a clinically significant improvement in asthma control. We also hypothesize that improvements in asthma management behaviors (including physical activity), quality of life, symptoms, adherence, and exacerbation (secondary outcomes) will be observed. Conclusions AAEAs are disproportionately impacted by asthma, but have been underrepresented in research. Mobile asthma management interventions may help improve asthma control and allow people to live healthier lives. During this project, we will use an innovative strategy to develop an optimized mobile asthma management intervention using the most effective combination of nurse-delivered asthma education, a smartphone app, and text messaging. International Registered Report Identifier (IRRID) PRR1-10.2196/37946
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Affiliation(s)
- Alan Baptist
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, United States
| | | | - April Idalski Carcone
- Department of Family Medicine and Public Health Sciences, School of Medicine, Wayne State University, Detroit, MI, United States
| | - Samiran Ghosh
- Department of Family Medicine and Public Health Sciences, School of Medicine, Wayne State University, Detroit, MI, United States
| | - Angela J Jacques-Tiura
- Department of Family Medicine and Public Health Sciences, School of Medicine, Wayne State University, Detroit, MI, United States
| | - Amy Hall
- College of Nursing, Wayne State University, Detroit, MI, United States
| | - Karen Kolmodin MacDonell
- Department of Family Medicine and Public Health Sciences, School of Medicine, Wayne State University, Detroit, MI, United States
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9
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Kelleher KJ, Erwin E. Building the neighborhood to improve health. Ann Allergy Asthma Immunol 2021; 128:3-4. [PMID: 34537358 DOI: 10.1016/j.anai.2021.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 09/07/2021] [Accepted: 09/11/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Kelly J Kelleher
- Community Health, Nationwide Children's Hospital, Columbus, Ohio.
| | - Elizabeth Erwin
- Community Health, Nationwide Children's Hospital, Columbus, Ohio
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10
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Senter JP, Smith BM, Prichett LM, Connor KA, Johnson SB. Pediatric Asthma Is Associated With Poorer 3-Year Academic Achievement in Urban Elementary and Middle-School Students. Acad Pediatr 2021; 21:1009-1017. [PMID: 33207219 DOI: 10.1016/j.acap.2020.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 11/09/2020] [Accepted: 11/11/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Asthma has been associated with worse academic performance in a single school year, yet this association may be magnified over time as students with asthma continue to fall behind. This study examined the relationship between asthma and standardized test performance aggregated across 3 school years, including whether performance varied by likelihood of having significant asthma. METHODS Data were from students in grades K-8 at 2 urban public schools in the Northeastern United States (2015-2018). Asthma was based on parent- and self-report and school health center records. Standardized test performance was assessed using Measures of Academic Progress (MAP) and Partnership for Assessment of Readiness for College and Careers (PARCC). Mixed effects linear and logistic regression models were used to evaluate the relationship between asthma and performance during 3 school years. RESULTS Any asthma was associated with worse MAP performance across the 3 academic years. Students with the most significant asthma demonstrated worse performance on MAP and PARCC. Aggregating across 3 school years, students scored 3.17 points worse on MAP reading (95% confidence interval [CI]: 0.7-5.63; P = .012) and 3.56 points worse on MAP mathematics (95% CI: 0.52-6.6; P = .022); they had 48.8% (95% CI: 1.9%-73.2%; P = .044) and 58.0% (95% CI: 21%-78%; P = .007) lower odds of proficiency on PARCC English/Language Arts and Mathematics, respectively compared to those without asthma. CONCLUSIONS The relationship between asthma and poorer academic achievement in 1 school year may be magnified over multiple years, particularly among those with more significant asthma. School-based asthma interventions may support academic growth and more equitable health outcomes.
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Affiliation(s)
- James P Senter
- Department of Pediatrics, Johns Hopkins University School of Medicine (JP Senter, BM Smith, LM Prichett, KA Connor, and SB Johnson), Baltimore, Md.
| | - Brandon M Smith
- Department of Pediatrics, Johns Hopkins University School of Medicine (JP Senter, BM Smith, LM Prichett, KA Connor, and SB Johnson), Baltimore, Md
| | - Laura M Prichett
- Department of Pediatrics, Johns Hopkins University School of Medicine (JP Senter, BM Smith, LM Prichett, KA Connor, and SB Johnson), Baltimore, Md
| | - Katherine A Connor
- Department of Pediatrics, Johns Hopkins University School of Medicine (JP Senter, BM Smith, LM Prichett, KA Connor, and SB Johnson), Baltimore, Md
| | - Sara B Johnson
- Department of Pediatrics, Johns Hopkins University School of Medicine (JP Senter, BM Smith, LM Prichett, KA Connor, and SB Johnson), Baltimore, Md; Department of Population, Family & Reproductive Health and Mental Health, Johns Hopkins Bloomberg School of Public Health (SB Johnson), Baltimore, Md
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11
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Martin MA, Caskey R, Glassgow AE, Pappalardo AA, Hsu LL, Jang J, Basu S, Minier M, Fox K, Voorhees BV. Trends in School Attendance for Low-Income Children with Chronic Health Conditions: Results from a Randomized Controlled Trial. THE JOURNAL OF SCHOOL HEALTH 2021; 91:187-194. [PMID: 33594692 DOI: 10.1111/josh.12989] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 03/16/2020] [Accepted: 11/19/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND In this study, we aimed to determine how school attendance changed over time for children on Medicaid with chronic health conditions enrolled in a comprehensive care coordination program called Coordinated HEalthcare for Complex Kids (CHECK). METHODS Medicaid beneficiaries from one managed care organization were randomized into 2 arms: CHECK program services or usual care. The final sample was 1322. RESULTS The mean age was 10.9 (SD = 3.7) years old and children were mostly non-Hispanic Black (62.6%) or Hispanic (34.9%). The median school attendance at baseline was 94.9% (IQR 88.9, 97.9); over one-fourth of children (28.4%) were chronically absent. School attendance was not associated with race/ethnicity, risk level, and health condition. In a model including a significant time/grade interaction, school attendance increased over time for children in pre-kindergarten (OR = 1.52, 95% CI: 1.38, 1.68; p < .001) and kindergarten to 5th grade (OR = 1.21, 95% CI: 1.17, 1.26; p < .001), and decreased for children in 6th to 8th grade (OR = 0.80, 95% CI: 0.77, 0.83; p < .001). No differences were seen in school attendance or chronic absenteeism associated with enrollment in the CHECK program. CONCLUSIONS School attendance improved for most of the low-income children with chronic health conditions in our cohort, except for children in middle school.
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Affiliation(s)
- Molly A Martin
- Associate Professor, , University of Illinois at Chicago, 840 S Wood St, Chicago, IL 60612
| | - Rachel Caskey
- Associate Professor, , University of Illinois at Chicago, 840 S Wood St, Chicago, IL 60612
| | - Anne Elizabeth Glassgow
- Research Assistant Professor, , University of Illinois at Chicago, 840 S Wood St, Chicago, IL 60612
| | - Andrea A Pappalardo
- Assistant Professor, , University of Illinois at Chicago, 840 S Wood St, Chicago, IL 60612
| | - Lewis L Hsu
- Associate Professor, , University of Illinois at Chicago, 840 S Wood St, Chicago, IL 60612
| | - Jiyeong Jang
- Graduate Student, , University of Illinois at Chicago, 1603 W Taylor St, Chicago, IL 60612
| | - Sanjib Basu
- Professor, , University of Illinois at Chicago, 1603 W Taylor St, Chicago, , IL 60612
| | - Mark Minier
- Community Pediatrician, Esperanza Health Center, 2001 S California Ave #100, Chicago, IL 60612
| | - Kenneth Fox
- Chief Health Officer, , Chicago Public Schools, 42 W Madison St, Chicago, IL 60612
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12
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Sutherland C, Greenlee AJ, Schneider D. Socioeconomic drivers of urban pest prevalence. PEOPLE AND NATURE 2020. [DOI: 10.1002/pan3.10096] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Chris Sutherland
- Department of Environmental Conservation University of Massachusetts Amherst MA USA
| | - Andrew J. Greenlee
- Department of Urban and Regional Planning University of Illinois at Urbana‐Champaign Urbana IL USA
| | - Daniel Schneider
- Department of Urban and Regional Planning University of Illinois at Urbana‐Champaign Urbana IL USA
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13
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Martin MA, Bisarini R, Roy A, Mosnaim G, Rosales G, Weinstein S, Walton SM. Implementation Lessons From a Randomized Trial Integrating Community Asthma Education for Children. J Ambul Care Manage 2020; 43:125-135. [PMID: 32073501 PMCID: PMC8329939 DOI: 10.1097/jac.0000000000000326] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study characterized and compared the implementation of clinically integrated community health workers (CHWs) to a certified asthma educator (AE-C) for low-income children with asthma. In the AE-C arm (N = 115), 51.3% completed at least one in-clinic education session. In the CHW arm (N = 108), 722 home visits were completed. The median number of visits was 7 (range, 0-17). Scheduled in-clinic asthma education may not be the optimal intervention for this patient population. CHW visit completion rates suggest that the schedule, location, and content of CHW asthma services better met patients' needs. Seven to 10 visits seemed to be the preferred CHW dose.
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Affiliation(s)
- Molly A Martin
- University of Illinois at Chicago (Drs Martin, Bisarini, Weinstein, and Walton and Ms Rosales); Erie Family Health Center, Chicago, Illinois (Dr Roy); and Northshore University Health System, Evanston, Illinois (Dr Mosnaim)
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14
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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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15
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Abstract
Severe asthma is broadly defined as asthma requiring a high level of therapy, usually high doses of inhaled corticosteroids, to bring under control. Children who remain symptomatic despite such treatment are a heterogeneous population, and bear a high burden of disease and require high resource utilization. Children with severe asthma require a comprehensive evaluation, careful consideration of alternative diagnoses and comorbid conditions, assessment of medication adherence and environmental conditions, and frequent disease monitoring.
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16
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Measuring Subcounty Differences in Population Health Using Hospital and Census-Derived Data Sets: The Missouri ZIP Health Rankings Project. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2019; 24:340-349. [PMID: 28492449 PMCID: PMC5704978 DOI: 10.1097/phh.0000000000000578] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
CONTEXT Measures of population health at the subcounty level are needed to identify areas for focused interventions and to support local health improvement activities. OBJECTIVE To extend the County Health Rankings population health measurement model to the ZIP code level using widely available hospital and census-derived data sources. DESIGN Retrospective administrative data study. SETTING Missouri. POPULATION Missouri FY 2012-2014 hospital inpatient, outpatient, and emergency department discharge encounters (N = 36 176 377) and 2015 Nielsen data. MAIN OUTCOME MEASURES ZIP code-level health factors and health outcomes indices. RESULTS Statistically significant measures of association were observed between the ZIP code-level population health indices and published County Health Rankings indices. Variation within counties was observed in both urban and rural areas. Substantial variation of the derived measures was observed at the ZIP code level with 20 (17.4%) Missouri counties having ZIP codes in both the top and bottom quintiles of health factors and health outcomes. Thirty of the 46 (65.2%) counties in the top 2 county quintiles had ZIP codes in the bottom 2 quintiles. CONCLUSIONS This proof-of-concept analysis suggests that readily available hospital and census-derived data can be used to create measures of population health at the subcounty level. These widely available data sources could be used to identify areas of potential need within counties, engage community stakeholders, and target interventions.
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17
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Pappalardo AA, Glassgow AE, Kumar HV, Martin MA. CHECK: a multi-level program to improve outcomes for urban children and youth with asthma. J Asthma 2019; 57:911-913. [PMID: 31046507 DOI: 10.1080/02770903.2019.1614616] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- A A Pappalardo
- Department of Pediatrics, University of Illinois at Chicago, Chicago, IL, USA.,Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - A E Glassgow
- Department of Pediatrics, University of Illinois at Chicago, Chicago, IL, USA
| | - H V Kumar
- Department of Pediatrics, University of Illinois at Chicago, Chicago, IL, USA
| | - M A Martin
- Department of Pediatrics, University of Illinois at Chicago, Chicago, IL, USA
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18
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Souza ECDO, Santos ESD, Rosa AM, Botelho C. Space-time scan for identification of risk areas for hospitalization of children due to asthma in Mato Grosso, Brazil. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2019; 22:e190019. [PMID: 30916143 DOI: 10.1590/1980-549720190019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 03/21/2018] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Asthma is the result of a complex interaction between genetic, environmental and socioeconomic factors. It represents a serious global public health problem. The goal of this study was to identify geographic areas for priority actions in order to control of asthma in children. METHOD Ecological study that space-time statistic Scan was used. Non-elective, short-stay (type 1) paid authorizations of hospitalizations were selected according to hospitalizations year and children place of residence. RESULTS In the two periods of the study, the high risk primary cluster was located in the region of Barra do Bugres (relative risk = 8.17, in the first period, and 10.37, in the second). The number of high-risk clusters increased from 8, in the period 2001-2004, to 9, in 2005-2012; while low-risk clusters decreased from 6, in the initial period, to 4, in the latest. The priority geographic areas for attention and intervention for children with asthma are the region around Barra do Bugres, which remained in the two periods with high risk primary clusters and the southwest border of the State that presented increase of the risk. Furthermore, there was an increase of 87% in the number of high risk counties and a reduction of 28% of the counties of protection. CONCLUSION In conclusion, the surroundings areas of Barra do Bugres and Porto Estrela and the east and northeast border of the state are priority for health care, once there was an increased risk of hospitalization of children due to asthma.
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Affiliation(s)
| | - Emerson Soares Dos Santos
- Departamento de Geografia, Instituto de Ciências Humanas e Sociais, Universidade Federal de Mato Grosso - Cuiabá (MT), Brasil
| | - Antonia Maria Rosa
- Faculdade de Ciências da Saúde, Universidade do Estado de Mato Grosso - Cáceres (MT), Brasil
| | - Clóvis Botelho
- Faculdade de Medicina, Universidade Federal de Mato Grosso - Cuiabá (MT), Brasil
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19
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Arnetz BB, Arnetz J, Harkema JR, Morishita M, Slonager K, Sudan S, Jamil H. Neighborhood air pollution and household environmental health as it relates to respiratory health and healthcare utilization among elderly persons with asthma. J Asthma 2019; 57:28-39. [PMID: 30810414 DOI: 10.1080/02770903.2018.1545856] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Objective: The study investigated the associations between fine particulate matter (PM2.5; <2.5 μm in diameter), indoor environment, pulmonary function, and healthcare utilization in a vulnerable group of elderly persons with asthma. We hypothesized that environmental conditions were associated with adverse pulmonary health outcomes. Methods: The study involved elderly (n = 76; mean age 64.6 years; 48 women) vulnerable persons in Detroit, Michigan, USA, with physician-diagnosed asthma. Exposure variables included measured outdoor PM2.5, self-rated outdoor and household environmental pollutants. Outcome variables were self-rated and measured pulmonary function, and asthma-related healthcare utilization. Results: Mean ambient PM2.5 concentrations during the study was 14.14 ± (S.D. 6.36) µg/m3 during the summer and 14.20 (6.33) during the winter (p = 0.95). In multiple regression analyses, adjusting for age and gender, mean 6-month concentration of PM2.5 was related to shortness of breath (SHOB; standardized β = 0.26, p = 0.02) and inversely with self-rated respiratory health (SRRH; β = 0.28, p = 0.02). However, PM2.5 did not predict lung function (FEV1% predicted and FEV1/FVC). However, PM2.5 was related to use of asthma controller drugs (β = 0.38, p = 0.001). Participants' air pollution ratings predicted total healthcare utilization (β = 0.33, p = 0.01). Conclusions: In elderly persons with asthma, living near heavy industry and busy highways, objective and perceived environmental pollution relate to participants' respiratory health and healthcare utilization. Importantly, air pollution might increase use of asthma controller drugs containing corticosteroids with implication for elderly persons' risk to develop osteoporosis and cardiovascular disease.
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Affiliation(s)
- Bengt B Arnetz
- Department of Family Medicine, College of Human Medicine, Michigan State University, Grand Rapids, Michigan, USA.,Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Judy Arnetz
- Department of Family Medicine, College of Human Medicine, Michigan State University, Grand Rapids, Michigan, USA.,Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Jack R Harkema
- Department of Pathobiology and Diagnostic Investigation, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Masako Morishita
- Department of Family Medicine, College of Human Medicine, Michigan State University, Grand Rapids, Michigan, USA
| | - Kathleen Slonager
- Asthma and Allergy Foundation of America, Michigan Chapter, Franklin, MI, USA
| | - Sukhesh Sudan
- Department of Family Medicine, College of Human Medicine, Michigan State University, Grand Rapids, Michigan, USA
| | - Hikmet Jamil
- Department of Family Medicine, College of Human Medicine, Michigan State University, Grand Rapids, Michigan, USA
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20
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Beck AF, Riley CL, Taylor SC, Brokamp C, Kahn RS. Pervasive Income-Based Disparities In Inpatient Bed-Day Rates Across Conditions And Subspecialties. Health Aff (Millwood) 2019; 37:551-559. [PMID: 29608357 DOI: 10.1377/hlthaff.2017.1280] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Building a culture of health in hospitals means more than participating in community partnerships. It also requires an enhanced capacity to recognize and respond to disparities in utilization patterns across populations. We identified all pediatric hospitalizations at Cincinnati Children's Hospital Medical Center, in the period 2011-16. Each hospitalized child's address was geocoded, allowing us to calculate inpatient bed-day rates for each census tract in Hamilton County, Ohio, across all causes and for specific conditions and pediatric subspecialties. We then divided the census tracts into quintiles based on their underlying rates of child poverty and calculated bed-day rates per quintile. Poorer communities disproportionately bore the burden of pediatric hospital days. If children from all of the county's census tracts spent the same amount of time in the hospital each year as those from the most affluent tracts, approximately twenty-two child-years of hospitalization time would be prevented. Of particular note were "hot spots" in high-poverty census tracts neighboring the hospital, where bed-day rates were more than double the county average. Hospitals that address disparities would benefit from a more comprehensive understanding of the culture of health-a culture that is more cohesive inside the hospital and builds bridges into the community.
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Affiliation(s)
- Andrew F Beck
- Andrew F. Beck ( ) is an associate professor of pediatrics at the University of Cincinnati College of Medicine and Cincinnati Children's Hospital Medical Center, in Ohio
| | - Carley L Riley
- Carley L. Riley is an assistant professor of pediatrics at the University of Cincinnati College of Medicine and at Cincinnati Children's Hospital Medical Center
| | - Stuart C Taylor
- Stuart C. Taylor is a data analyst in the James M. Anderson Center for Health Systems Excellence at Cincinnati Children's Hospital Medical Center
| | - Cole Brokamp
- Cole Brokamp is an assistant professor of pediatrics at the University of Cincinnati College of Medicine and Cincinnati Children's Hospital Medical Center
| | - Robert S Kahn
- Robert S. Kahn is a professor of pediatrics at the University of Cincinnati College of Medicine and at Cincinnati Children's Hospital Medical Center
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21
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Volerman A, Kan K, Salem E, Prachand N, Warren CM, Sighoko D, Gupta RS. Disparities persist in asthma-related emergency department visits among Chicago children. Ann Allergy Asthma Immunol 2019; 122:417-419.e1. [PMID: 30684738 DOI: 10.1016/j.anai.2019.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 01/11/2019] [Accepted: 01/14/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Anna Volerman
- Departments of Medicine and Pediatrics, University of Chicago, Chicago, Illinois.
| | - Kristin Kan
- Northwestern University Feinberg School of Medicine, Stanley Manne Children's Research Institute, Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois
| | - Erica Salem
- Respiratory Health Association, Chicago, Illinois
| | - Nik Prachand
- Chicago Department of Public Health, Chicago, Illinois
| | - Chris M Warren
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, California
| | - Dominique Sighoko
- Northwestern University, Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois
| | - Ruchi S Gupta
- Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital, Science and Outcomes of Allergy and Asthma Research Program, Chicago, Illinois
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22
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Lovinsky-Desir S, Acosta LM, Rundle AG, Miller RL, Goldstein IF, Jacobson JS, Chillrud SN, Perzanowski MS. Air pollution, urgent asthma medical visits and the modifying effect of neighborhood asthma prevalence. Pediatr Res 2019; 85:36-42. [PMID: 30337671 PMCID: PMC6353679 DOI: 10.1038/s41390-018-0189-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 08/14/2018] [Accepted: 08/26/2018] [Indexed: 01/20/2023]
Abstract
BACKGROUND Social and environmental stressors may modify associations between environmental pollutants and asthma symptoms. We examined if neighborhood asthma prevalence (higher: HAPN vs. lower: LAPN), a surrogate for underlying risk factors for asthma, modified the relationship between pollutants and urgent asthma visits. METHODS Through zip code, home addresses were linked to New York City Community Air Survey's land use regression model for street-level, annual average nitrogen dioxide (NO2), particulate matter (PM2.5), elemental carbon (EC), summer average ozone (O3), winter average sulfur dioxide (SO2) concentrations. Poisson regression models were fit to estimate the association (prevalence ratio, PR) between pollutant exposures and seeking urgent asthma care. RESULTS All pollutants, except O3 were higher in HAPN than LAPN (P < 0.01). Neighborhood asthma prevalence modified the relationship between pollutants and urgent asthma (P-interaction < 0.01, for NO2 and SO3). Associations between pollutants and urgent asthma were observed only in LAPN (NO2: PR = 1.38, P = 0.01; SO3: PR = 1.85, P = 0.04). No association was observed between pollutants and urgent asthma among children in HAPN (P > 0.05). CONCLUSIONS Relationships between modeled street-level pollutants and urgent asthma were stronger in LAPN compared to HAPN. Social stressors that may be more prevalent in HAPN than LAPN, could play a greater role in asthma exacerbations in HAPN vs. pollutant exposure alone.
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Affiliation(s)
- Stephanie Lovinsky-Desir
- Division of Pediatric Pulmonology, Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
| | - Luis M Acosta
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Andrew G Rundle
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Rachel L Miller
- Division of Pulmonary, Allergy and Critical Care of Medicine, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Inge F Goldstein
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Judith S Jacobson
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Steven N Chillrud
- Lamont-Doherty Earth Observatory, Columbia University, New York, NY, USA
| | - Matthew S Perzanowski
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
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23
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Samuels-Kalow ME, Camargo CA. The Use of Geographic Data to Improve Asthma Care Delivery and Population Health. Clin Chest Med 2018; 40:209-225. [PMID: 30691713 DOI: 10.1016/j.ccm.2018.10.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The authors examine uses of geographic data to improve asthma care delivery and population health and describe potential practice changes and areas for future research.
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Affiliation(s)
- Margaret E Samuels-Kalow
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Zero Emerson Place Suite 104, Boston, MA 02114, USA.
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, 125 Nashua Street, Suite 920, Boston MA 02114, USA
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24
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Ross KR, Teague WG, Gaston BM. Life Cycle of Childhood Asthma: Prenatal, Infancy and Preschool, Childhood, and Adolescence. Clin Chest Med 2018; 40:125-147. [PMID: 30691707 DOI: 10.1016/j.ccm.2018.10.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Asthma is a heterogeneous developmental disorder influenced by complex interactions between genetic susceptibility and exposures. Wheezing in infancy and early childhood is highly prevalent, with a substantial minority of children progressing to established asthma by school age, most of whom are atopic. Adolescence is a time of remission of symptoms with persistent lung function deficits. The transition to asthma in adulthood is not well understood.
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Affiliation(s)
- Kristie R Ross
- Division of Pediatric Pulmonology, Allergy, Immunology and Sleep Medicine, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH 44106, USA.
| | - W Gerald Teague
- Pediatric Asthma Center of Excellence, Department of Pediatrics, University of Virginia School of Medicine, 409 Lane Road, Building MR4, Room 2112, PO Box 801349, Charlottesville, VA 22908, USA
| | - Benjamin M Gaston
- Division of Pediatric Pulmonology, Allergy, Immunology and Sleep Medicine, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Children's Lung Foundation, 2109 Adelbert Road, BRB 827, Cleveland, OH 44106, USA
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25
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Pappalardo AA, Paulson A, Bruscato R, Thomas L, Minier M, Martin MA. Chicago Public School nurses examine barriers to school asthma care coordination. Public Health Nurs 2018; 36:36-44. [PMID: 30569556 DOI: 10.1111/phn.12574] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 10/19/2018] [Accepted: 11/14/2018] [Indexed: 01/16/2023]
Abstract
OBJECTIVE/DESIGN Well documented asthma disparities in Chicago pose a continual challenge for the Chicago Public Schools (CPS). Coordinated Healthcare for Complex Kids (CHECK) is a health care demonstration project funded by a Centers for Medicare and Medicaid Services Health Care Innovation Award. A collaborative partnership was formed between CHECK and CPS. With CHECK support, CPS administered a survey to 160 nurses to understand the asthma problems nurses perceived and interest in intervention. RESULTS Seventy-five per cent (n = 120) completed the survey. While asthma was the top diagnosis managed by 95%, 72% reported gaps in asthma understanding. Appropriate communication between school nurses and providers occurred 33% of the time; 18% believed they received sufficient support to follow-up on deficient paperwork. The barriers mentioned were lack of medications (73%), time (67%), and communication with providers (61%). When asked their opinions on potential interventions, 78% of nurses supported web-based applications, 66% community health workers (CHW), and 66% stock albuterol in schools. CONCLUSIONS The greatest barriers for CPS nurses with asthma management are time and communication. Potential interventions such as web-based communication applications and CHW in schools were well received.
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Affiliation(s)
- Andrea A Pappalardo
- Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois.,Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Allison Paulson
- School of Public Health, University Chicago Medical Center, Chicago, Illinois
| | - Robin Bruscato
- Chicago Public Schools Nursing Administration, Chicago, Illinois
| | - Leretha Thomas
- Chicago Public Schools Nursing Administration, Chicago, Illinois
| | - Mark Minier
- Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois
| | - Molly A Martin
- Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois
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26
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Martin MA, Kapheim MG, Erwin K, Ignoffo S, McMahon K, OʼRourke A, Gerald LB, Barrett M, Press VG, Darabi H, Krishnan JA. Childhood Asthma Disparities in Chicago: Developing Approaches to Health Inequities. FAMILY & COMMUNITY HEALTH 2018; 41:135-145. [PMID: 29781915 PMCID: PMC5965690 DOI: 10.1097/fch.0000000000000187] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
We conducted a needs assessment to develop an evidence-based, locally tailored asthma care implementation plan for high-risk children with asthma in Chicago. Our team of health policy experts, clinicians, researchers, and designers included extensive stakeholder engagement (N = 162) in a mixed-methods community needs assessment. Results showed the lines of communication and collaboration across sectors were weak; caregivers were the only consistent force and could not always manage this burden. A series of recommendations for interventions and how to implement and measure them were generated. Cooperative, multidisciplinary efforts grounded in the community can target wicked problems such as asthma.
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Affiliation(s)
- Molly A Martin
- Department of Pediatrics (Dr Martin), College of Engineering (Dr Darabi), and University of Illinois Hospital & Health Sciences System Population Health Sciences Program (Dr Krishnan), University of Illinois at Chicago; Sinai Health System, Sinai Urban Health Institute, Chicago, Illinois (Ms Kapheim); Institute of Design, Illinois Institute of Technology, Chicago (Ms Erwin); Chicago Asthma Consortium, Chicago, Illinois (Ms Ignoffo); Respiratory Health Association, Chicago, Illinois (Mss McMahon, and O'Rourke); Department of Health Promotion Sciences, College of Public Health, University of Arizona, Tucson (Dr Gerald); Propeller Health, San Francisco, California (Dr Barrett); and Department of Medicine, University of Chicago, Illinois (Dr Press)
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27
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Volerman A, Dennin M, Vela M, Ignoffo S, Press VG. A qualitative study of parent perspectives on barriers, facilitators and expectations for school asthma care among urban, African-American children. J Asthma 2018; 56:1099-1109. [PMID: 30285497 DOI: 10.1080/02770903.2018.1520861] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objectives: Minority children experience the disproportionate burden of asthma and its consequences. Studies suggest ethnic groups may experience asthma differently with varied perceptions and expectations among parents of African-American and Latino children. Because parents coordinate asthma care with the school, where children spend a significant amount of their day, this study's goal was to determine parents' perspectives on school asthma management. Methods: Focus groups were conducted with parents of children with asthma at four urban schools whose student population is predominantly African-American. A semi-structured guide was utilized focusing on barriers, facilitators and expectations for asthma care at school. Grounded theory principles were applied in this study. Results: Twenty-two parents (91% females) representing 13 elementary and 10 middle school children with asthma (61% boys) participated in four focus groups. Most children (87%) had persistent asthma. The identified barriers to effective school-based asthma care included limited awareness of children with asthma by teachers/staff, communication issues (e.g. school/parent, within school), inadequate education and lack of management plans or systems in place. In contrast, the identified facilitators included steps that fostered education, communication and awareness, as supported by management plans and parent initiative. Parents described their expectations for increased communication and education about asthma, better systems for identifying children with asthma, and a trained asthma point person for school-based asthma care. Conclusions: Parents of children with asthma identified important barriers, facilitators and expectations that must be considered to advance school asthma management. Improved school-based asthma care could lead to better health and academic outcomes.
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Affiliation(s)
- Anna Volerman
- Department of Medicine, University of Chicago Medicine, Chicago, IL, USA.,Department of Pediatrics, University of Chicago Medicine, Chicago, IL, USA
| | - Margaret Dennin
- Pritzker School of Medicine, University of Chicago Medicine, Chicago, IL, USA
| | - Monica Vela
- Department of Medicine, University of Chicago Medicine, Chicago, IL, USA
| | | | - Valerie G Press
- Department of Medicine, University of Chicago Medicine, Chicago, IL, USA.,Department of Pediatrics, University of Chicago Medicine, Chicago, IL, USA
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Rodríguez EM, Kumar H, Bearman SK, von Buttlar AM, Sánchez-Johnsen L. Physician perceptions of children's coping with asthma are associated with children's psychosocial and disease functioning. FAMILIES, SYSTEMS & HEALTH : THE JOURNAL OF COLLABORATIVE FAMILY HEALTHCARE 2018; 36:327-337. [PMID: 29172629 PMCID: PMC6078809 DOI: 10.1037/fsh0000299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Low-income, ethnic minority children disproportionately face poor asthma control, and poorly controlled asthma is related to psychosocial difficulties. This study assessed physician reports of coping in child patients and examined associations between physician reports of child coping and parent and child reports of children's coping, psychosocial, and asthma outcomes (asthma-related stress, emotional and behavioral problems, asthma control, and school missed due to asthma). METHOD Physicians reported on coping in their patients (N = 67) ages 5-17 with asthma. Parents reported on child coping, asthma-related stress, emotional and behavioral problems, asthma control, and school missed due to asthma. Children ages 9-17 provided self-reports. RESULTS Physicians' reports of primary control coping (e.g., problem solving) and secondary control coping (e.g., cognitive restructuring) were not associated with parent ratings of corresponding coping strategies, but physician reports of disengagement coping (e.g., avoidance) were correlated with parent reports of disengagement and secondary control coping. Physician perceptions of higher child primary control, and lower disengagement, were correlated with less parent-reported stress, better asthma control, and for primary control, fewer partial days of school missed. Physician reports were not correlated with child reports of coping, but physician reports of disengagement were correlated with child-reported conduct problems. DISCUSSION Findings suggest that physician reports of child coping provide independent information from parent and child reports of coping, and could be leveraged to identify and intervene with patients who are at elevated risk for poor outcomes. (PsycINFO Database Record
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Affiliation(s)
- Erin M. Rodríguez
- Department of Educational Psychology, University of Texas at Austin, Austin, Texas
| | - Harsha Kumar
- Department of Pediatrics, Division of Pulmonary, Allergy and Sleep Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Sarah Kate Bearman
- Department of Educational Psychology, University of Texas at Austin, Austin, Texas
| | | | - Lisa Sánchez-Johnsen
- Department of Psychiatry and Surgery, University of Illinois at Chicago, Chicago, Illinois
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Martin MA, Press VG, Erwin K, Margellos-Anast H, Ignoffo S, McMahon KS, Mosnaim G, Ramsay J, Paik SM. Engaging end-users in intervention research study design. J Asthma 2018; 55:483-491. [PMID: 28699825 PMCID: PMC8350842 DOI: 10.1080/02770903.2017.1342256] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Coordinated Healthcare Interventions for Childhood Asthma Gaps in Outcomes (CHICAGO) Plan is a 3-arm multicenter pragmatic trial to evaluate asthma interventions in high-risk Chicago children presenting to emergency departments (ED) with asthma. A formative evaluation with end-users to provide input into the trial design and outcome instruments was conducted prior to trial initiation. METHODS A multi-level data gathering framework from the field of design and standard qualitative methods was employed. This included one focus group with asthma Community Health Workers (N = 8), two focus groups with caregivers of children with asthma (N = 9), in-home interviews with caregivers (N = 9), key informant interviews at six EDs and outpatient clinical sites (N = 19), and ED tours and observations (N = 6). Data were presented, discussed, and organized into themes. RESULTS Data indicated that changes to the study design and discharge tool were warranted. A key insight was that ED discharge protocols typically place patient education at a single inopportune time, as families are preparing to leave the ED. At this point in time, families are less receptive to education due to fatigue and a desire to expedite the discharge process. The trial design was modified to reposition the discharge asthma plan to occur at earlier "teachable moments." Delivery of the asthma discharge plan was assigned to study-employed ED coordinators instead of ED providers and staff. Other potential challenges to study recruitment and implementation were raised and addressed. CONCLUSIONS Engagement of end-users in the design phase of implementation research is critical to improve research feasibility and relevance.
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Affiliation(s)
- Molly A Martin
- University of Illinois at Chicago, Department of Pediatrics, 840 South Wood Street, M/C 856, Chicago, IL, 60612
| | - Valerie G Press
- University of Chicago, Department of Medicine, 5841 S Maryland Ave, Chicago, IL, 60637
| | - Kim Erwin
- Illinois Institute of Technology, Institute of Design, 565 W Adams St, Chicago, IL, 60661
| | - Helen Margellos-Anast
- Sinai Urban Health Institute, Sinai Health System, 1500 S Fairfield Ave, Chicago, IL, 60608
| | - Stacy Ignoffo
- Chicago Asthma Consortium, PO Box 31757, Chicago, IL, 60631
| | | | - Giselle Mosnaim
- NorthShore University Health System, NorthShore Research Institute, 1001 University Pl, Evanston, IL, 60201
| | - Jessica Ramsay
- Sinai Urban Health Institute, Sinai Health System, 1500 S Fairfield Ave, Chicago, IL, 60608
| | - S. Margaret Paik
- University of Chicago, Department of Pediatrics, 5841 S Maryland Ave, Chicago, IL, 60637
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Spatial variation of pneumonia hospitalization risk in Twin Cities metro area, Minnesota. Epidemiol Infect 2017; 145:3274-3283. [PMID: 29039282 DOI: 10.1017/s0950268817002291] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Fine resolution spatial variability in pneumonia hospitalization may identify correlates with socioeconomic, demographic and environmental factors. We performed a retrospective study within the Fairview Health System network of Minnesota. Patients 2 months of age and older hospitalized with pneumonia between 2011 and 2015 were geocoded to their census block group, and pneumonia hospitalization risk was analyzed in relation to socioeconomic, demographic and environmental factors. Spatial analyses were performed using Esri's ArcGIS software, and multivariate Poisson regression was used. Hospital encounters of 17 840 patients were included in the analysis. Multivariate Poisson regression identified several significant associations, including a 40% increased risk of pneumonia hospitalization among census block groups with large, compared with small, populations of ⩾65 years, a 56% increased risk among census block groups in the bottom (first) quartile of median household income compared to the top (fourth) quartile, a 44% higher risk in the fourth quartile of average nitrogen dioxide emissions compared with the first quartile, and a 47% higher risk in the fourth quartile of average annual solar insolation compared to the first quartile. After adjusting for income, moving from the first to the second quartile of the race/ethnic diversity index resulted in a 21% significantly increased risk of pneumonia hospitalization. In conclusion, the risk of pneumonia hospitalization at the census-block level is associated with age, income, race/ethnic diversity index, air quality, and solar insolation, and varies by region-specific factors. Identifying correlates using fine spatial analysis provides opportunities for targeted prevention and control.
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Identification of students with asthma in Chicago schools: Missing the mark. Ann Allergy Asthma Immunol 2017; 118:739-740. [PMID: 28479193 DOI: 10.1016/j.anai.2017.04.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 04/01/2017] [Accepted: 04/04/2017] [Indexed: 11/21/2022]
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McRoy L, Rust G, Xu J. Factors Associated with Asthma ED Visit Rates among Medicaid-enrolled Children: A Structural Equation Modeling Approach. AIMS MEDICAL SCIENCE 2017; 4:71-82. [PMID: 30519630 PMCID: PMC6277032 DOI: 10.3934/medsci.2017.1.71] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Asthma is one of the leading causes of emergency department visits and school absenteeism among school-aged children in the United States, but there is significant local-area variation in emergency department visit rates, as well as significant differences across racial-ethnic groups. ANALYSIS We first calculated emergency department (ED) visit rates among Medicaid-enrolled children age 5-12 with asthma using a multi-state dataset. We then performed exploratory factor analysis using over 226 variables to assess whether they clustered around three county-level conceptual factors (socioeconomic status, healthcare capacity, and air quality) thought to be associated with variation in asthma ED visit rates. Measured variables (including ED visit rate as the outcome of interest) were then standardized and tested in a simple conceptual model through confirmatory factor analysis. RESULTS County-level (contextual) variables did cluster around factors declared a priori in the conceptual model. Structural equation models connecting the ED visit rates to socioeconomic status, air quality, and healthcare system professional capacity factors (consistent with our conceptual framework) converged on a solution and achieved a reasonable goodness of fit on confirmatory factor analysis. CONCLUSION Confirmatory factor analysis offers an approach for quantitatively testing conceptual models of local-area variation and racial disparities in asthma-related emergency department use.
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Affiliation(s)
- Luceta McRoy
- Southern Adventist University, Department of Business, Collegedale, TN 37363
| | - George Rust
- Center for Medicine and Public Health, Florida State University College of Medicine, 1115 W. Call Street, Tallahassee, FL 32304
| | - Junjun Xu
- National Center for Primary Care, Morehouse School of Medicine Atlanta, GA 30310
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Landrine H, Corral I, Lee JGL, Efird JT, Hall MB, Bess JJ. Residential Segregation and Racial Cancer Disparities: A Systematic Review. J Racial Ethn Health Disparities 2016; 4:1195-1205. [PMID: 28039602 DOI: 10.1007/s40615-016-0326-9] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 12/08/2016] [Accepted: 12/12/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND This paper provides the first review of empirical studies of segregation and black-white cancer disparities. METHODS We searched all years of PubMed (through May 2016) using these terms: racial segregation, residential segregation, neighborhood racial composition (first terms) and (second terms) cancer incidence, mortality, survival, stage at diagnosis, screening. The 17 (of 668) articles that measured both segregation and a cancer outcome were retained. RESULTS Segregation contributed significantly to cancer and to racial cancer disparities in 70% of analyses, even after controlling for socioeconomic status and health insurance. Residing in segregated African-American areas was associated with higher odds of later-stage diagnosis of breast and lung cancers, higher mortality rates and lower survival rates from breast and lung cancers, and higher cumulative cancer risks associated with exposure to ambient air toxics. There were no studies of many types of cancer (e.g., cervical). Studies differed in their measure of segregation, and 40% used an invalid measure. Possible mediators of the segregation effect usually were not tested. CONCLUSIONS Empirical analysis of segregation and racial cancer disparities is a recent area of research. The literature is limited to 17 studies that focused primarily on breast cancer. Studies differed in their measure of segregation, yet segregation nonetheless contributed to cancer and to racial cancer disparities in 70% of analyses. This suggests the need for further research that uses valid measures of segregation, examines a variety of types of cancers, and explores the variables that may mediate the segregation effect.
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Affiliation(s)
- Hope Landrine
- Center for Health Disparities, Brody School of Medicine, East Carolina University, 1800 W. 5th Street, Medical Pavilion Suite 6, Greenville, NC, 27858, USA.
| | - Irma Corral
- Department of Psychiatry and Behavioral Medicine, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Joseph G L Lee
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, NC, USA
| | - Jimmy T Efird
- Department of Cardiovascular Sciences and Center for Health Disparities, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Marla B Hall
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Jukelia J Bess
- Center for Health Disparities, Brody School of Medicine, East Carolina University, 1800 W. 5th Street, Medical Pavilion Suite 6, Greenville, NC, 27858, USA
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Ramsay J, Schwindt T, Nguyen T, Margellos-Anast H. Translating a Proven Pediatric Healthy Homes Asthma Intervention to Adults. Health Promot Pract 2016; 19:222-232. [PMID: 27794073 DOI: 10.1177/1524839916675118] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Asthma is a serious public health concern, disproportionately affecting urban, minority populations. Chicago's West and Southwest sides are among the most burdened by asthma and environmental conditions that exacerbate asthma. Home-based, community health worker (CHW)-led interventions have repeatedly demonstrated effectiveness in addressing pediatric asthma. However, evidence of such interventions among adults is limited. Helping Chicago's Westside Adults Breathe and Thrive is a longitudinal cohort study that assesses the effectiveness of a CHW-led asthma and healthy homes intervention for adults. One of the first of its kind, the program aims to improve asthma control and quality of life among adults with poorly controlled asthma. This article provides a framework for implementing the intervention from start to finish. CHWs make five or six home visits over the course of 12 months, providing comprehensive and individualized asthma education to study participants. They work closely with participants to conduct home environmental assessments, collaboratively developing techniques to eliminate or avoid asthma triggers. They also assist with smoking cessation, comorbidities, and health system navigation. Between December 1, 2013, and August 31, 2015, 202 participants enrolled in the program. This article reports on successes, challenges, and recommendations from the program's first 21 months of operation.
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Beck AF, Huang B, Chundur R, Kahn RS. Housing code violation density associated with emergency department and hospital use by children with asthma. Health Aff (Millwood) 2016; 33:1993-2002. [PMID: 25367995 DOI: 10.1377/hlthaff.2014.0496] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Local agencies that enforce housing policies can partner with the health care system to target pediatric asthma care. These agencies retain data that can be used to pinpoint potential clusters of high asthma morbidity. We sought to assess whether the density of housing code violations in census tracts-the in-tract asthma-relevant violations (such as the presence of mold or cockroaches) divided by the number of housing units-was associated with population-level asthma morbidity and could be used to predict a hospitalized patient's risk of subsequent morbidity. We found that increased density in housing code violations was associated with population-level morbidity independent of poverty, and that the density explained 22 percent of the variation in rates of asthma-related emergency department visits and hospitalizations. Children who had been hospitalized for asthma had 1.84 greater odds of a revisit to the emergency department or a rehospitalization within twelve months if they lived in the highest quartile of housing code violation tracts, compared to those living in the lowest quartile. Integrating housing and health data could highlight at-risk areas and patients for targeted interventions.
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Affiliation(s)
- Andrew F Beck
- Andrew F. Beck is an assistant professor of pediatrics at Cincinnati Children's Hospital Medical Center, in Ohio
| | - Bin Huang
- Bin Huang is an associate professor of pediatrics at Cincinnati Children's Hospital Medical Center
| | - Raj Chundur
- Raj Chundur is the CAGIS administrator of the Cincinnati Area Geographic Information System, in Hamilton County, Ohio
| | - Robert S Kahn
- Robert S. Kahn is a professor of pediatrics at Cincinnati Children's Hospital Medical Center
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Real FJ, Beck AF, Spaulding JR, Sucharew H, Klein MD. Impact of a Neighborhood-Based Curriculum on the Helpfulness of Pediatric Residents’ Anticipatory Guidance to Impoverished Families. Matern Child Health J 2016; 20:2261-2267. [DOI: 10.1007/s10995-016-2133-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Baptist AP, Islam N, Joseph CLM. Technology-Based Interventions for Asthma-Can They Help Decrease Health Disparities? THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2016; 4:1135-1142. [PMID: 27286777 DOI: 10.1016/j.jaip.2016.04.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 04/20/2016] [Accepted: 04/29/2016] [Indexed: 12/31/2022]
Abstract
Asthma is a condition that has consistently demonstrated significant health outcome inequalities for minority populations. One approach used for care of patients with asthma is the incorporation of technology for behavioral modification, symptom monitoring, education, and/or treatment decision making. Whether such technological interventions can improve the care of black and inner-city patients is unknown. We reviewed all randomized controlled trial technological interventions from 2000 to 2015 performed in minority populations. A total of 16 articles met inclusion and exclusion criteria; all but 1 was performed in a childhood or adolescent age group. The interventions used MPEG audio layer-3 players, text messaging, computer/Web-based systems, video games, and interactive voice response. Many used tailored content and/or a specific behavior theory. Although the interventions were based on technology, most required additional special staffing. Subject user satisfaction was positive, and improvements were noted in asthma knowledge, medication adherence, asthma symptoms, and quality of life. Unfortunately, health care utilization (emergency department visits and/or hospitalizations) was typically not improved by the interventions. Although no single intervention modality was vastly superior, the computer-based interventions appeared to have the most positive results. In summary, technology-based interventions have a high level of user satisfaction among minority and urban/low-income individuals with asthma, and can improve asthma outcomes. Further large-scale studies are needed to assess whether such interventions can decrease health disparities in asthma.
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Affiliation(s)
- Alan P Baptist
- Division of Allergy and Clinical Immunology, University of Michigan, Ann Arbor, Mich.
| | - Nishat Islam
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Mich
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Beck AF, Huang B, Ryan PH, Sandel MT, Chen C, Kahn RS. Areas with High Rates of Police-Reported Violent Crime Have Higher Rates of Childhood Asthma Morbidity. J Pediatr 2016; 173:175-182.e1. [PMID: 26960918 PMCID: PMC4884512 DOI: 10.1016/j.jpeds.2016.02.018] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 12/31/2015] [Accepted: 02/02/2016] [Indexed: 01/02/2023]
Abstract
OBJECTIVES To assess whether population-level violent (and all) crime rates were associated with population-level child asthma utilization rates and predictive of patient-level risk of asthma reutilization after a hospitalization. STUDY DESIGN A retrospective cohort study of 4638 pediatric asthma-related emergency department visits and hospitalizations between 2011 and 2013 was completed. For population-level analyses, census tract asthma utilization rates were calculated by dividing the number of utilization events within a tract by the child population. For patient-level analyses, hospitalized patients (n = 981) were followed until time of first asthma-related reutilization. The primary predictor was the census tract rate of violent crime as recorded by the police; the all crime (violent plus nonviolent) rate was also assessed. RESULTS Census tract-level violent and all crime rates were significantly correlated with asthma utilization rates (both P < .0001). The violent crime rate explained 35% of the population-level asthma utilization variance and remained associated with increased utilization after adjustment for census tract poverty, unemployment, substandard housing, and traffic exposure (P = .002). The all crime rate explained 28% of the variance and was similarly associated with increased utilization after adjustment (P = .02). Hospitalized children trended toward being more likely to reutilize if they lived in higher violent (P = .1) and all crime areas (P = .01). After adjustment, neither relationship was significant. CONCLUSIONS Crime data could help facilitate early identification of potentially toxic stressors relevant to the control of asthma for populations and patients.
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Affiliation(s)
- Andrew F. Beck
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Bin Huang
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Patrick H. Ryan
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Megan T. Sandel
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts, U.S.A
| | - Chen Chen
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Robert S. Kahn
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
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Warren CM, Dyer A, Blumenstock J, Gupta RS. Leveraging Mobile Technology in a School-Based Participatory Asthma Intervention: Findings From the Student Media-Based Asthma Research Team (SMART) Study. AMERICAN JOURNAL OF HEALTH EDUCATION 2016. [DOI: 10.1080/19325037.2015.1133337] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
| | - Ashley Dyer
- Northwestern University Feinberg School of Medicine
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Jones MN, Brown CM, Widener MJ, Sucharew HJ, Beck AF. Area-Level Socioeconomic Factors Are Associated With Noncompletion of Pediatric Preventive Services. J Prim Care Community Health 2016; 7:143-8. [PMID: 26883436 DOI: 10.1177/2150131916632361] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We examined 4872 infants born consecutively, 2011-2012, and seen at 3 primary care centers to determine whether area-based socioeconomic measures were associated with noncompletion of common preventive services within the first 15 months. Addresses were geocoded and linked to census tract poverty, adult educational attainment, and household vehicle ownership rates. The quartile of patients in the highest poverty (adjusted odds ratio [aOR] 1.25; 95% confidence interval [CI] 1.01-1.54) and lowest vehicle ownership tracts (aOR 1.32; 95% CI 1.07-1.63) had significantly increased odds of service noncompletion. There were significant spatial clusters of low completion in Cincinnati's urban core. These findings have implications for preventive service delivery.
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Affiliation(s)
- Margaret N Jones
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Courtney M Brown
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Heidi J Sucharew
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Andrew F Beck
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Erwin K, Martin MA, Flippin T, Norell S, Shadlyn A, Yang J, Falco P, Rivera J, Ignoffo S, Kumar R, Margellos-Anast H, McDermott M, McMahon K, Mosnaim G, Nyenhuis SM, Press VG, Ramsay JE, Soyemi K, Thompson TM, Krishnan JA. Engaging stakeholders to design a comparative effectiveness trial in children with uncontrolled asthma. J Comp Eff Res 2015; 5:17-30. [PMID: 26690579 DOI: 10.2217/cer.15.52] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM To present the methods and outcomes of stakeholder engagement in the development of interventions for children presenting to the emergency department (ED) for uncontrolled asthma. METHODS We engaged stakeholders (caregivers, physicians, nurses, administrators) from six EDs in a three-phase process to: define design requirements; prototype and refine; and evaluate. RESULTS Interviews among 28 stakeholders yielded themes regarding in-home asthma management practices and ED discharge experiences. Quantitative and qualitative evaluation showed strong preference for the new discharge tool over current tools. CONCLUSION Engaging end-users in contextual inquiry resulted in CAPE (CHICAGO Action Plan after ED discharge), a new stakeholder-balanced discharge tool, which is being tested in a multicenter comparative effectiveness trial.
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Affiliation(s)
- Kim Erwin
- IIT Institute of Design, 350 N LaSalle, Chicago, IL 60654, USA
| | - Molly A Martin
- University of Illinois at Chicago, 1200 W Harrison St Chicago, IL 60607, USA
| | - Tara Flippin
- IIT Institute of Design, 350 N LaSalle, Chicago, IL 60654, USA
| | - Sarah Norell
- IIT Institute of Design, 350 N LaSalle, Chicago, IL 60654, USA
| | - Ariana Shadlyn
- IIT Institute of Design, 350 N LaSalle, Chicago, IL 60654, USA
| | - Jie Yang
- IIT Institute of Design, 350 N LaSalle, Chicago, IL 60654, USA
| | - Paula Falco
- IIT Institute of Design, 350 N LaSalle, Chicago, IL 60654, USA
| | - Jaime Rivera
- IIT Institute of Design, 350 N LaSalle, Chicago, IL 60654, USA
| | - Stacy Ignoffo
- Chicago Asthma Consortium, PO Box 31757, Chicago, IL 60631, USA
| | - Rajesh Kumar
- Ann & Robert H Lurie Children's Hospital of Chicago, 225 E Chicago Ave., Chicago, IL 60611, USA
| | | | | | - Kate McMahon
- Respiratory Health Association, 1440 W Washington Blvd, Chicago, IL 60607, USA
| | - Giselle Mosnaim
- Rush University Medical Center, 1653 W Congress Pkwy, Chicago, IL 60612, USA
| | | | - Valerie G Press
- University of Chicago, 5801 S Ellis Ave., Chicago, IL 60637, USA
| | - Jessica E Ramsay
- Sinai Health System, California Avenue, 15th Street, Chicago, IL 60608, USA
| | - Kenneth Soyemi
- John H Stroger Jr Hospital of Cook County, 1901 W Harrison St Chicago, IL 60612, USA
| | - Trevonne M Thompson
- University of Illinois at Chicago, 1200 W Harrison St Chicago, IL 60607, USA
| | - Jerry A Krishnan
- University of Illinois at Chicago, 1200 W Harrison St Chicago, IL 60607, USA.,University of Illinois Hospital & Health Sciences System, 1740 W Taylor St Chicago, IL 60612, USA
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Beck AF, Florin TA, Campanella S, Shah SS. Geographic Variation in Hospitalization for Lower Respiratory Tract Infections Across One County. JAMA Pediatr 2015; 169:846-54. [PMID: 26192102 PMCID: PMC4786371 DOI: 10.1001/jamapediatrics.2015.1148] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
IMPORTANCE Bronchiolitis and pneumonia are leading causes of pediatric hospitalizations. Identifying geographic patterns in hospitalization rates across small geographic areas could be particularly relevant to targeted patient-level and population-level health care. OBJECTIVE To determine whether lower respiratory tract infection hospitalization rates varied geographically across a single county and whether such variability was associated with socioeconomic conditions. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional, population-based study of children hospitalized at one institution for lower respiratory tract infections between January 1, 2010, and December 31, 2013. The setting was Cincinnati Children's Hospital Medical Center, a large, academic, stand-alone pediatric facility located in Hamilton County, Ohio. During the study period, 99.6% of in-county children hospitalized for lower respiratory tract infections were admitted to Cincinnati Children's Hospital Medical Center. Participants were children younger than 2 years who were hospitalized with bronchiolitis and children younger than 18 years who were hospitalized with pneumonia. Patients were identified using discharge diagnosis codes and then geocoded to their home census tract. EXPOSURES Primary exposures, linked to each geocoded patient, included census tract-level socioeconomic measures obtained from the 2008 to 2012 American Community Survey (eg, adult educational attainment, unemployment, and poverty). Patient-level variables examined included demographics, presence of a complex chronic condition, length of stay, and cost. MAIN OUTCOMES AND MEASURES We calculated bronchiolitis and pneumonia hospitalization rates for Hamilton County and for each of 222 in-county census tracts. Associations between hospitalization rate quintiles and underlying socioeconomic conditions were assessed using the Kruskal-Wallis test. Geographic clustering was assessed using the Getis-Ord Gi* statistic. RESULTS There were 1495 bronchiolitis hospitalizations and 1231 pneumonia hospitalizations during the study period. The county rates were 17.5 (range across census tracts, 0-71.4) hospitalizations per 1000 children per year for bronchiolitis and 1.6 (range across census tracts, 0-4.3) hospitalizations per 1000 children per year for pneumonia. There was significant variation in the median hospitalization rates by census tract quintile for bronchiolitis (32.8, 20.8, 14.0, 10.4, and 5.1 per 1000) and for pneumonia (3.3, 2.1, 1.4, 0.9, and 0.3 per 1000). There were also significant, graded differences in socioeconomic measures by hospitalization rate quintile. Hot spots were localized to inner-city, impoverished neighborhoods. CONCLUSIONS AND RELEVANCE Bronchiolitis and pneumonia hospitalization rates varied considerably in ways that were related to underlying socioeconomic conditions. Clinical and public health interventions, targeted accordingly, could improve patient-level and population-level management of acute conditions at a reduced cost.
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Affiliation(s)
- Andrew F Beck
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Todd A Florin
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Suzanne Campanella
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio2currently a student at Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Samir S Shah
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Keet CA, McCormack MC, Pollack CE, Peng RD, McGowan E, Matsui EC. Neighborhood poverty, urban residence, race/ethnicity, and asthma: Rethinking the inner-city asthma epidemic. J Allergy Clin Immunol 2015; 135:655-62. [PMID: 25617226 PMCID: PMC4391373 DOI: 10.1016/j.jaci.2014.11.022] [Citation(s) in RCA: 149] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Revised: 10/09/2014] [Accepted: 11/13/2014] [Indexed: 01/28/2023]
Abstract
BACKGROUND Although it is thought that inner-city areas have a high burden of asthma, the prevalence of asthma in inner cities across the United States is not known. OBJECTIVE We sought to estimate the prevalence of current asthma in US children living in inner-city and non-inner-city areas and to examine whether urban residence, poverty, or race/ethnicity are the main drivers of asthma disparities. METHODS The National Health Interview Survey 2009-2011 was linked by census tract to data from the US Census and the National Center for Health Statistics. Multivariate logistic regression models adjusted for sex; age; race/ethnicity; residence in an urban, suburban, medium metro, or small metro/rural area; poverty; and birth outside the United States, with current asthma and asthma morbidity as outcome variables. Inner-city areas were defined as urban areas with 20% or more of households at below the poverty line. RESULTS We included 23,065 children living in 5,853 census tracts. The prevalence of current asthma was 12.9% in inner-city and 10.6% in non-inner-city areas, but this difference was not significant after adjusting for race/ethnicity, region, age, and sex. In fully adjusted models black race, Puerto Rican ethnicity, and lower household income but not residence in poor or urban areas were independent risk factors for current asthma. Household poverty increased the risk of asthma among non-Hispanics and Puerto Ricans but not among other Hispanics. Associations with asthma morbidity were very similar to those with prevalent asthma. CONCLUSIONS Although the prevalence of asthma is high in some inner-city areas, this is largely explained by demographic factors and not by living in an urban neighborhood.
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Affiliation(s)
- Corinne A. Keet
- Johns Hopkins University School of Medicine, Division of Pediatric Allergy and Immunology
| | - Meredith C. McCormack
- Johns Hopkins University School of Medicine, Division of Pulmonary and Critical Care Medicine, Baltimore, MD
| | - Craig E. Pollack
- Johns Hopkins University School of Medicine, Division of General Internal Medicine, Baltimore, MD
| | - Roger D. Peng
- Johns Hopkins Bloomberg School of Public Health, Department of Biostatistics, Baltimore, MD
| | - Emily McGowan
- Johns Hopkins University School of Medicine, Division of Allergy and Clinical Immunology, and Graduate Student, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Elizabeth C. Matsui
- Johns Hopkins University 24 School of Medicine, Division of Pediatric Allergy and Immunology, Baltimore, MD
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Abstract
The inner city has long been recognized as an area of high asthma morbidity and mortality. A wide range of factors interact to create this environment. These factors include well-recognized asthma risk factors that are not specific to the inner city, the structure and delivery of health care, the location and function of the urban environment, and social inequities. In this article, these facets are reviewed, and successful and unsuccessful interventions are discussed, to understand what is needed to solve this problem.
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Affiliation(s)
- Peter J Gergen
- Allergy, Asthma, Airway Biology Branch (AAABB), MD, USA.
| | - Alkis Togias
- Allergy, Asthma, Airway Biology Branch (AAABB), MD, USA
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Landrine H, Corral I. Advancing research on racial-ethnic health disparities: improving measurement equivalence in studies with diverse samples. Front Public Health 2014; 2:282. [PMID: 25566524 PMCID: PMC4273553 DOI: 10.3389/fpubh.2014.00282] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 12/04/2014] [Indexed: 11/24/2022] Open
Abstract
To conduct meaningful, epidemiologic research on racial-ethnic health disparities, racial-ethnic samples must be rendered equivalent on other social status and contextual variables via statistical controls of those extraneous factors. The racial-ethnic groups must also be equally familiar with and have similar responses to the methods and measures used to collect health data, must have equal opportunity to participate in the research, and must be equally representative of their respective populations. In the absence of such measurement equivalence, studies of racial-ethnic health disparities are confounded by a plethora of unmeasured, uncontrolled correlates of race-ethnicity. Those correlates render the samples, methods, and measures incomparable across racial-ethnic groups, and diminish the ability to attribute health differences discovered to race-ethnicity vs. to its correlates. This paper reviews the non-equivalent yet normative samples, methodologies and measures used in epidemiologic studies of racial-ethnic health disparities, and provides concrete suggestions for improving sample, method, and scalar measurement equivalence.
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Affiliation(s)
- Hope Landrine
- Center for Health Disparities, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Irma Corral
- Department of Psychiatry and Behavioral Medicine, Brody School of Medicine, East Carolina University, Greenville, NC, USA
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Rivkina V, Tapke DE, Cardenas LD, Harvey-Gintoft B, Whyte SA, Gupta RS. Identifying barriers to chronic disease reporting in Chicago Public Schools: a mixed-methods approach. BMC Public Health 2014; 14:1250. [PMID: 25481628 PMCID: PMC4265490 DOI: 10.1186/1471-2458-14-1250] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 12/02/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic disease among school-aged children is a public health concern, particularly for asthma and food allergy. In Chicago Public Schools (CPS), rates of asthma and food allergy among students are underreported. The aim of this study was to determine the barriers to chronic disease reporting as experienced by CPS parents and school nurses. METHODS A mixed-methods approach included focus groups and key informant interviews with parents and school nurses, and a cross-sectional survey was completed by parents. Qualitative data analysis was performed and survey data were analyzed to determine the significant demographic and knowledge variables associated with successfully completing the reporting process. RESULTS The three main barriers identified were 1) a lack of parental process knowledge; 2) limited communication from schools; and 3) insufficient availability of school nurses. Parents were significantly more likely to successfully complete the reporting process if they knew about special accommodations for chronic diseases, understood the need for physician verification, and/or knew the school nurse. CONCLUSIONS These findings suggest that increasing parental knowledge of the reporting process will allow schools to better identify and manage their students' chronic conditions. A parent-focused intervention informed by these results has been completed.
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Affiliation(s)
| | | | | | | | | | - Ruchi S Gupta
- Center for Community Health, Northwestern University, Feinberg School of Medicine, 750 North Lake Shore Drive, Suite 670, Chicago, IL 60611, USA.
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Camacho-Rivera M, Kawachi I, Bennett GG, Subramanian SV. Associations of neighborhood concentrated poverty, neighborhood racial/ethnic composition, and indoor allergen exposures: a cross-sectional analysis of los angeles households, 2006-2008. J Urban Health 2014; 91:661-76. [PMID: 24771244 PMCID: PMC4134442 DOI: 10.1007/s11524-014-9872-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Although racial/ethnic, socioeconomic, and neighborhood factors have been linked to asthma, and the association between indoor allergens and asthma is well documented, few studies have examined the relationship between these factors and indoor allergens. We examined the frequency of reported indoor allergens and differences by racial/ethnic, socioeconomic, and neighborhood characteristics among a diverse sample of Los Angeles households. Multilevel logistic regression models were used to analyze the data from 723 households from wave 2 of the Los Angeles Family and Neighborhood Survey. The reported presence of rats, mice, cockroaches, mold, pets, and tobacco smoke were the primary outcomes of interest. Hispanic and Asian households had a nearly threefold increase in the odds of reporting cockroaches compared to non-Hispanic Whites (OR, 2.85; 95 % CI 1.38-5.88 and OR, 2.62; 95 % CI 1.02-6.73, respectively) even after adjusting for socioeconomic factors. Primary caregivers who had obtained a high school degree were significantly less likely to report the presence of mice and cockroaches compared to primary caregivers with less than a high school degree (OR, 0.19; 95 % CI 0.08-0.46 and OR, 0.39; 95 % CI 0.23-0.68, respectively). Primary caregivers with more than a high school degree were also less likely to report the presence of rats, mice, and cockroaches within their households, compared to those with less than a high school degree. Compared to renters, home owners were less likely to report the presence of mice, cockroaches, and mold within their households. At the neighborhood level, households located within neighborhoods of high concentrated poverty (where the average poverty rate is at least 50 %) were more likely to report the presence of mice and cockroaches compared to households in low concentrated poverty neighborhoods (average poverty rate is 10 % or less), after adjusting for individual race/ethnicity and socioeconomic characteristics. Our study found evidence in support of neighborhood-level racial/ethnic and socioeconomic influences on indoor allergen exposure, above and beyond individual factors. Future studies should continue to explore individual and neighborhood-level racial/ethnic and socioeconomic differences in household allergen exposures across diverse contexts.
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Affiliation(s)
- Marlene Camacho-Rivera
- Department of Population Health, North Shore-Long Island Jewish Health System, Great Neck, NY, USA
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Chang M, Kelvin EA. Differing asthma prevalence by gross national index of country of birth among New York City residents. Allergy 2014; 69:494-500. [PMID: 24475906 DOI: 10.1111/all.12367] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/25/2013] [Indexed: 12/27/2022]
Abstract
BACKGROUND The hygiene hypothesis suggests that higher exposure to infectious agents may be one reason for regional differences in asthma. This would suggest that immigrants from less developed countries, where infections are more common, to highly developed countries will have lower risk of asthma compared with natives, as has been found in a number of studies. We expand the research on immigrants to look at the level of development in country of origin as a predictor of asthma in New York City residents. METHODS Data came from the 2009 cross-sectional Community Health Survey. We used logistic regression to assess the relationship of country of birth and the gross national income (GNI), an indicator of the level of development, of country of birth with asthma among immigrants and US-born New York City residents. RESULTS Those who were foreign born had lower odds of having asthma compared with those US born (OR = 0.43, P < 0.001). There was a dose relationship between GNI and asthma with decreasing odds of having asthma associated with lower GNI in country of birth (low GNI country: OR = 0.26, P = 0.014; middle GNI country: OR = 0.36, P < 0.001; and high GNI country = reference). CONCLUSIONS These findings lend support to the hygiene hypothesis in that the odds of having asthma among New York City residents was lowest among people born in the least developed countries, as indicated by GNI, where infections are likely the most common.
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Affiliation(s)
- M. Chang
- Epidemiology & Biostatistics Program; CUNY School of Public Health; Hunter College; New York NY USA
| | - E. A. Kelvin
- Epidemiology & Biostatistics Program; CUNY School of Public Health; Hunter College; New York NY USA
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Abstract
The Student Asthma Research Team (START) program was designed to enable students to explore socio-ecological factors contributing to asthma through the use of Photovoice, a technique that gathers both photographs and personal experiences from participants. The photographs taken by and commentary from student participants were integrated into public service announcements (PSAs) intended to increase community asthma awareness and catalyze behavior change. This article evaluates the effectiveness of these student-directed PSAs at improving asthma awareness among peers and community members. Pre-PSA, immediate post-PSA, and 4 month post-PSA follow-up assessments were conducted to evaluate changes in community members' asthma knowledge and behavior. The student-directed PSAs were found to significantly increase asthma knowledge among community members, irrespective of age, gender, or race. Increased knowledge persisted through the 4-month post-PSA follow-up. Of the thirty-six participants who were successfully contacted for the follow-up survey, nearly 40 % reported meaningful behavior-change in response to the PSAs. Photovoice and media production techniques were effective in engaging adolescent students--an under-served and often disenfranchised population--in asthma health education through the development and dissemination of PSAs. The extension of participatory techniques such as Photovoice to include the creation of student-directed PSAs holds promise for engaging adolescents in public health initiatives within their communities.
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Speck AL, Nelson B, Jefferson SO, Baptist AP. Young, African American adults with asthma: what matters to them? Ann Allergy Asthma Immunol 2013; 112:35-9. [PMID: 24331391 DOI: 10.1016/j.anai.2013.10.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 10/09/2013] [Accepted: 10/21/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Asthma is a common chronic condition that shows significant health disparities among minority populations. Little research has focused on the management needs and preferences of young African American adults with asthma, a population undergoing dramatic life changes as they transition from adolescence to adulthood. OBJECTIVE To understand the experiences and perspectives of young African American adults managing their asthma. METHODS Focus groups were conducted with African American adults (n = 34) 18 to 30 years old with a physician diagnosis of asthma. Focus group sessions were audiotaped, transcribed verbatim, and coded using constant comparative analysis. RESULTS Six major domains were identified and some of the salient themes included changes in asthma management needs with the onset of adulthood, career limitations owing to asthma, childcare interference with asthma regimen adherence, and difficulties with medication cost owing to lapses in insurance coverage. Participants also reported feeling discouraged when interacting with physicians as it related to their asthma care; yet ageism and racism were not perceived. Despite poor medication regimen compliance, participants were overwhelmingly interested in participating in asthma self-management programs and had strong preferences that such programs be tailored specifically to young adults with special consideration of the cultural experience of young African Americans with asthma. CONCLUSION Young African American adults have specific barriers to optimal asthma care and distinctive ideas for self-management programs. It is important for the asthma care provider to identify and address these population- and age-specific barriers to improve asthma outcomes and decrease health care disparities.
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Affiliation(s)
- Aimee L Speck
- Division of Allergy and Clinical Immunology, University of Michigan, Ann Arbor, Michigan.
| | - Belinda Nelson
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - S Olivia Jefferson
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Alan P Baptist
- Division of Allergy and Clinical Immunology, University of Michigan, Ann Arbor, Michigan; Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan
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