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Gibson-Scipio W, Dinaj V, Hall A, Kormelink A, Bruzzese JM, MacDonell KK. Anxiety, depression and global distress among African American young adults with uncontrolled asthma. J Asthma 2023; 60:1836-1842. [PMID: 36952598 PMCID: PMC10524604 DOI: 10.1080/02770903.2023.2193632] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/06/2023] [Accepted: 03/16/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND Anxiety and depression are mental health disorders that are often comorbid with asthma. Urban African American young adults with asthma often experience increased risk of anxiety and depression. OBJECTIVE To explore relationships between symptoms of psychological distress and asthma-related anxiety with asthma outcomes among urban African American young adults with poorly controlled persistent asthma. METHODS A secondary analysis of baseline data from a larger study of 141 African American young adults with uncontrolled persistent asthma was examined. Participants completed the Brief Symptom Inventory (BSI-18), Youth Asthma-related Anxiety Scale, Asthma Control Test (ACT), a daily diary to assess asthma symptoms; and number of asthma attacks. Spirometry assessed airway obstruction. Generalized linear models tested associations. RESULTS In multivariable models testing, higher somatization scores were significantly associated with lower ACT scores (adjusted β = -0.49; 95% CI = -0.69, -0.28; p < 0.01), and higher symptoms (adjusted β = 0.39; 95% CI = 0.14, 0.65; p < 0.01). After adding asthma-related anxiety to the model, the somatization subscale and asthma-related anxiety were significantly associated with ACT scores (adjusted β = -0.36; 95% CI = -0.57, -0.15; p < 0.01), (adjusted β = -0.32; 95% CI = -0.50, -0.14; p < 0.01), respectively. Asthma-related anxiety was also significantly associated with asthma attacks (adjusted β = 0.24; 95% CI = 0.05, 0.43; p < 0.05). CONCLUSION This study suggests, asthma-related anxiety may differ from general anxiety and be related to poorly controlled asthma among African American young adults.
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Affiliation(s)
| | - Veronica Dinaj
- Wayne State University School of Medicine, Detroit, MI, USA
| | - Amy Hall
- Wayne State University College of Nursing, Detroit, MI, USA
| | | | | | - Karen Kolmodin MacDonell
- Wayne State University College of Nursing, Detroit, MI, USA
- Wayne State University School of Medicine, Detroit, MI, USA
- Florida State University College of Medicine, Tallahassee, FL, USA
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2
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Clarke R, Heath G, Nagakumar P, Farrow C. Influence of parental anxiety and beliefs about medicines on feeding and exercise in children living with asthma. J Child Health Care 2023:13674935231171453. [PMID: 37122084 DOI: 10.1177/13674935231171453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
This study's primary objective was to establish differences in beliefs about medicines, levels of asthma-related anxiety and diet and exercise behaviours between parents of children with well controlled and poorly controlled asthma. Secondary objectives were to explore how asthma control might shape relationships between parental cognitions and parenting practices concerning paediatric asthma. Parents of children with asthma aged 10-16 years (N = 310) completed standardised questionnaires measuring beliefs about medicines, parental asthma-related anxiety, parenting attitudes towards child activity, parental feeding and asthma control. Parents of children with poorly controlled asthma reported significantly greater asthma medication necessity and concern, asthma-related anxiety, control of child activity, pressure to exercise and unhealthy feeding practices. Moderation analyses indicated that the relationship between parental concern about asthma medicine and parental control of child activity was strongest in children with poorly controlled asthma. Also, the relationship between parental asthma-related anxiety and use of food to regulate child emotion was only significant when asthma was poorly controlled. Parental beliefs about asthma medicines and asthma-related anxiety may indirectly influence asthma outcomes through unhealthy parenting practices around exercise and diet. Eliciting and understanding parents' perceptions of asthma medications and anxiety may facilitate personalised interventions to improve asthma control.
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Affiliation(s)
- Rebecca Clarke
- School of Psychological Science, University of Bristol, Bristol, UK
| | - Gemma Heath
- School of Psychology, Aston University, Birmingham, UK
| | - Prasad Nagakumar
- Department of Paediatric Respiratory Medicine and Cystic Fibrosis, Birmingham Women's and Children's Hospital, Birmingham, UK
| | - Claire Farrow
- School of Psychology, Aston University, Birmingham, UK
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3
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Farver-Vestergaard I, Rubio-Rask S, Timm S, Christiansen CF, Hilberg O, Løkke A. Disease-Specific Anxiety in Chronic Obstructive Pulmonary Disease: Translation and Initial Validation of a Questionnaire. Front Psychol 2022; 13:907939. [PMID: 35865679 PMCID: PMC9294537 DOI: 10.3389/fpsyg.2022.907939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background Commonly applied measures of symptoms of anxiety are not sensitive to disease-specific anxiety in patients with chronic obstructive pulmonary disease (COPD). There is a need for validated instruments measuring COPD-specific anxiety. Therefore, we translated the COPD-Anxiety Questionnaire (CAF) into Danish (CAF-R-DK) and performed an initial validation of the psychometric properties in a sample of patients with COPD. Materials and Methods Translation procedures followed the World Health Organization guidelines. Participants with COPD completed questionnaires measuring COPD-specific anxiety (CAF-R-DK), general psychological distress (Hospital Anxiety and Depression Scale) as well as variables related to COPD (COPD Assessment Test; modified Medical Research Council dyspnea scale), quality of life (the 12-item Short Form survey, SF12), and socio-demography. Results A total of 260 patients with COPD (mean age: 65.0, 69% female) completed questionnaires. The Danish version of CAF-R-DK demonstrated acceptable Cronbach’s α values that were comparable with those of the original CAF. As expected, the CAF-R-DK showed positive correlations with convergent constructs (CAT; HADS) and negative correlations with discriminant constructs (SF-12). However, the results for specific subdomains of the CAF-R-DK indicated inconsistency in the underlying concept of disease-specific anxiety, which was also suggested based on the subsequent confirmatory and exploratory factor analyzes. Conclusion The CAF could serve as an important supplement to generic psychological distress screening of patients with COPD in somatic health care settings, and the questionnaire is now available in Danish. Translation into other languages is needed with the purpose of obtaining data for further testing the psychometric properties of the questionnaire.
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Affiliation(s)
| | | | - Signe Timm
- Research Unit, Lillebaelt Hospital, Kolding, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | | | - Ole Hilberg
- Department of Medicine, Lillebaelt Hospital, Vejle, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Anders Løkke
- Department of Medicine, Lillebaelt Hospital, Vejle, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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Castiblanco MR, Kingston S, Zhao Y, Céspedes A, Powell JS, Bruzzese JM. The Association of Mental Health, Asthma Control and Acute Care Visits Among Rural Adolescents with Poorly Controlled Asthma. J Sch Nurs 2022:10598405221085675. [PMID: 35300544 PMCID: PMC9827738 DOI: 10.1177/10598405221085675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Anxiety and depressive symptoms are associated with asthma-related acute care utilization. Few studies include rural adolescents. Asthma control may be the mechanism by which mental health affects acute care. This study explored associations between generalized anxiety, asthma-related anxiety, depressive symptoms, and acute care visits, and tested if asthma control mediates these associations among 197 rural adolescents with asthma. Data analysis included descriptive statistics and regression. Controlling for age, sex and race/ethnicity, asthma-related anxiety was associated with higher odds of acute care visits (OR = 2.09, 95% CI [1.42, 3.07]). Asthma control mediated this relationship: one unit increase in anxiety, on average, increased the odds of having any acute care visit by 5%. Generalized anxiety and depressive symptoms were not associated with acute care visits. Helping adolescents reduce their concerns regarding asthma while improving their self-management skill may potentially to reduce acute care among rural adolescents.
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Affiliation(s)
| | | | - Yihong Zhao
- Columbia University School of Nursing, New York, NY, USA
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Turi ER, Reigada LC, Liu J, Leonard SI, Bruzzese JM. Associations among anxiety, self-efficacy, and self-care in rural adolescents with poorly controlled asthma. Ann Allergy Asthma Immunol 2021; 127:661-666.e1. [PMID: 34547441 PMCID: PMC8627490 DOI: 10.1016/j.anai.2021.09.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 08/17/2021] [Accepted: 09/11/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Rural adolescents are vulnerable to asthma; good self-care can reduce morbidity. The subtypes of anxiety (eg, asthma-related, generalized) may have differential associations with asthma self-care. Low self-efficacy, a determinant of behavior, is associated with increased anxiety. Little is known regarding these relationships in rural adolescents. OBJECTIVE To evaluate whether anxiety symptoms are associated with asthma symptom prevention and management among rural adolescents and whether self-efficacy mediates these relationships. METHODS We used baseline data from 197 rural adolescents (mean age = 16 years; 69% girls; 62% Black) who were part of a trial that tested the effectiveness of a school-based asthma intervention. Adolescents completed the Youth Asthma-Related Anxiety Scale, Screen for Child Anxiety and Emotional Disorders, Asthma Management Self-efficacy Index, and Asthma Prevention and Management Indices. Linear regression was performed to test whether: (1) asthma-related and generalized anxiety had curvilinear relationships with self-care; (2) social and separation anxiety had linear relationships with self-care; and (3) self-efficacy mediated relationships. RESULTS Asthma-related anxiety had a significant curvilinear relationship with prevention (P = 0.001) and a linear association with management (P = .01). Generalized anxiety had a significant curvilinear association with management (P = .03), whereas social anxiety had a significant linear relationship with prevention (P = .04). Self-efficacy partially or fully mediated these relationships. CONCLUSION Anxiety symptoms were associated with asthma self-care among this sample of rural adolescents, with differing roles for prevention and management. Self-efficacy may be a mechanism to improve asthma self-care among rural adolescents with anxiety. With a lack of self-efficacy, asthma-related, generalized, or social anxiety may motivate adolescents to take steps to care for their asthma.
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Affiliation(s)
- Eleanor R Turi
- Office of Scholarship and Research, Columbia University School of Nursing, New York, New York
| | - Laura C Reigada
- Department of Psychology, Brooklyn College and The Graduate Center, The City University of New York, New York, New York
| | - Jianfang Liu
- Office of Scholarship and Research, Columbia University School of Nursing, New York, New York
| | - Sarah I Leonard
- Office of Scholarship and Research, Columbia University School of Nursing, New York, New York
| | - Jean-Marie Bruzzese
- Office of Scholarship and Research, Columbia University School of Nursing, New York, New York.
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Development of the Child- and Parent-Rated Scales of Food Allergy Anxiety (SOFAA). THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2021; 10:161-169.e6. [PMID: 34265450 DOI: 10.1016/j.jaip.2021.06.039] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/07/2021] [Accepted: 06/23/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Anxiety can be excessive and impairing in children with food allergy (FA). There is no accepted condition-specific measure of anxiety for this population. OBJECTIVE To evaluate the validity and reliability of new child- and parent-rated measures of FA-related anxiety in youth. METHODS Items for the Scale of Food Allergy Anxiety (SOFAA) were developed by a cognitive-behavioral therapist specializing in pediatric anxiety, in consultation with FA medical professionals and parents of children with FA. Dyads (n = 77) of children with FA (aged 8-18 years; 42.9% females) and their parents (95.5% females) completed full versions of the SOFAA (21 items; scored 0-4) via online survey. RESULTS The child-rated SOFFA-C mean score was 29.1 ± 18.3; the parent-rated SOFAA-P mean score was 33.9 ± 16.1. Higher scores indicate higher reported anxiety. Coefficient alphas were 0.94 and 0.92. Factor analyses and item-response theory analyses supported the creation of the 14-item SOFAA-C-brief and the 7-item SOFAA-P-brief, accounting for 93% and 79% of total variance, respectively. Correlations revealed strong convergence between child- and parent-report for both the full (r = 0.85) and brief (r = 0.79) versions. Correlations with a generic measure of child anxiety (Screen for Child Anxiety Related Disorders) and the Food Allergy Quality of Life Questionnaire ranged from moderate to strong, whereas those with a generic measure of child eating problems (About Your Child's Eating) were weak to moderate, supporting convergent and divergent validity. Scores of 48 dyads who completed SOFAAs at time 2 (mean, 16.0 days) appeared stable over time, supporting test-retest reliability. CONCLUSIONS The 21-item SOFAA-C and SOFAA-P are reliable and valid scales for measuring condition-specific anxiety in youth with FA. As shorter screening measures, the SOFAA-C-brief and the SOFAA-P-brief are also reliable and valid.
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Screening for Anxiety Disorders Among Schoolchildren with Asthma. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2020. [DOI: 10.2478/sjecr-2018-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
The aim of this study was to perform screening for anxiety disorders among children with asthma and to reveal factors associated with general anxiety disorder and its specific forms.
This was a cross-sectional study conducted among out-patients with asthma during routine visits to pediatricians. They were screened for anxiety disorders using SCARED self-reported questionnaire. Additional data were collected using specially designed questionnaire as well as the patient files. Statistical analysis was performed by the SPPS software using descriptive statistics and logistic regression.
Study population consisted mostly of schoolchildren (n=58), 8-12 years old, and adolescents (13-17 years) (n=13). Approximately 33.8% respondents were positive for general anxiety disorder. The most common were separation anxiety and social anxiety, recorded among 49.3% and 32.4% of patients, respectively. Generalized anxiety and panic/somatic disorder were recorded in the same percentage of patients (21.3%), while avoiding school was the least frequent (14.08%). Influence of numerous factors was tested, but only the following showed significant effects: peak expiratory flow test was associated with general anxiety disorder, patient’s age and gender with PD, and living place, asthma control according to GINA and age on GAD. Parent’s smoking was associated with SAD, age and patient’s weight status with SPH, and GINA asthma control with SA.
These findings suggest that anxiety disorders are common among children and adolescents with asthma. Various factors can be associated with general anxiety disorder and its specific forms, but some of them being preventable as avoiding smoking in the family.
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Dudeney J, Sharpe L, Jaffe A, Jones EB, Hunt C. Anxiety in youth with asthma: A meta-analysis. Pediatr Pulmonol 2017; 52:1121-1129. [PMID: 28749088 DOI: 10.1002/ppul.23689] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 02/19/2017] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Anxiety often presents comorbidly with asthma in youth under 18; however, prevalence rates are unclear. The aim of this review was to provide an up-to-date analysis of the literature investigating the prevalence of anxiety disorders, and comparisons of anxiety disorders and symptomatology in youth with asthma, compared to those without. METHODS A systematic search was conducted using the databases PsycINFO, MEDLINE, EMBASE, and CINAHL. RESULTS The search process produced 15 studies (n = 7443) reporting data on youth with asthma and anxiety disorders, 11 studies (n = 10 332) reporting data on youth with and without asthma and anxiety disorders, and 28 studies (n = 5848) reporting data on youth with and without asthma and anxiety symptomatology. Youth with asthma had an anxiety disorder prevalence rate of 22.7%. Youth with asthma also had a greater number of anxiety disorders, compared to those without asthma (d = 0.37, 95%CI: 0.24-0.50, P < 0.001), and higher levels of anxiety symptomatology than youth without asthma (d = 0.29, 95%CI: 0.19-0.39, P < 0.001). CONCLUSIONS Youth with asthma display a prevalence rate for anxiety disorders that is more than three times higher than the prevalence in healthy youth. For the specific anxiety disorders investigated, elevated prevalence rates for youth with asthma were also found. Future research needs to focus on the factors that mediate or predict the development and maintenance of anxiety in youth with asthma and the development of clinically efficacious treatments.
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Affiliation(s)
- Joanne Dudeney
- School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Louise Sharpe
- School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Adam Jaffe
- School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Department of Respiratory Medicine, Sydney Children's Hospital Randwick, Sydney, New South Wales, Australia
| | - Emma B Jones
- School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Caroline Hunt
- School of Psychology, University of Sydney, Sydney, New South Wales, Australia
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Thabrew H, McDowell H, Given K, Murrell K. Systematic Review of Screening Instruments for Psychosocial Problems in Children and Adolescents With Long-Term Physical Conditions. Glob Pediatr Health 2017; 4:2333794X17690314. [PMID: 28255576 PMCID: PMC5315369 DOI: 10.1177/2333794x17690314] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 12/27/2016] [Indexed: 01/03/2023] Open
Abstract
Children and adolescents with long-term physical conditions (LTPCs) are at greater risk of developing psychosocial problems. Screening for such problems may be undertaken using validated psychometric instruments to facilitate early intervention. A systematic review was undertaken to identify clinically utilized and psychometrically validated instruments for identifying depression, anxiety, behavior problems, substance use problems, family problems, and multiple problems in children and adolescents with LTPCs. Comprehensive searches of articles published in English between 1994 and 2014 were completed via Medline, Embase, PsycINFO, CINAHL, and Cochrane CENTRAL databases, and by examining reference lists of identified articles and previous related reviews. Forty-four potential screening instruments were identified, described, and evaluated against predetermined clinical and psychometric criteria. Despite limitations in the evidence regarding their clinical and psychometric validity in this population, a handful of instruments, available at varying cost, in multiple languages and formats, were identified to support targeted, but not universal, screening for psychosocial problems in children and adolescents with LTPCs.
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Bruzzese JM, Kingston S, Zhao Y, DiMeglio JS, Cespedes A, George M. Psychological Factors Influencing the Decision of Urban Adolescents With Undiagnosed Asthma to Obtain Medical Care. J Adolesc Health 2016; 59:543-548. [PMID: 27772661 PMCID: PMC5119912 DOI: 10.1016/j.jadohealth.2016.06.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 06/10/2016] [Accepted: 06/11/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE Adolescents are low users of medical care. Psychological factors and perceived reasons to not seek routine medical care may increase risk of nonuse by adolescents with undiagnosed asthma. This study tests if psychological factors were associated with seeing a medical provider for asthma-like symptoms; identifies adolescents' perceived reasons for not obtaining care; explores if psychological factors are associated with these perceptions; and explores if asthma severity moderates the relationships with psychological factors. METHODS We analyzed cross-sectional data from a baseline assessment of 349 urban, primarily ethnic minority adolescents with moderate to severe asthma-like symptoms but no asthma diagnosis who were enrolled in a controlled trial. RESULTS The odds of seeing a provider for their asthma-like symptoms were significantly higher for those with asthma-related anxiety (odds ratio [OR]: 1.644; 95% confidence interval [CI]: 1.242-2.176) and depressive symptoms (OR: 1.031; 95% CI: 1.004-1.059). The most commonly endorsed reason for noncare included a characterization of symptoms as not serious, past medical visits not diagnosed as asthma, fear of diagnosis, busy lifestyles, and not wanting medication. Psychological factors were not related to the number of reasons or to most of the commonly endorsed reasons. Adolescents with more asthma-related anxiety were less likely to characterize their breathing problems as serious (OR = .0583; 95% CI: .424-.802) and were more likely to report busy lifestyles (OR = 1.593; 95% CI: 1.122-2.261). CONCLUSIONS Adolescent-perceived reasons for noncare were not pragmatic, but instead highlighted denial. Asthma-related anxiety was the most robust psychological factor associated with the decision to seek medical care.
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Affiliation(s)
| | - Sharon Kingston
- Department of Psychology, Dickinson College, P.O. Box 1773, Carlisle, PA 17013,
| | - Yihong Zhao
- Department of Child and Adolescent Psychiatry, NYU School of Medicine, One Park Avenue, 7 FL, New York, NY 10016,
| | - John S. DiMeglio
- Department of Child and Adolescent Psychiatry, NYU School of Medicine, One Park Avenue, 7 FL, New York, NY 10016,
| | - Amarilis Cespedes
- Department of Child and Adolescent Psychiatry, NYU School of Medicine, One Park Avenue, 7 FL, New York, NY 10016,
| | - Maureen George
- Columbia University School of Nursing, Office of Scholarship and Research, 630 West 168th Street, New York, NY 10032,
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11
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Bruzzese JM, Reigada LC, Lamm A, Wang J, Li M, Zandieh SO, Klein RG. Association of Youth and Caregiver Anxiety and Asthma Care Among Urban Young Adolescents. Acad Pediatr 2016; 16:792-798. [PMID: 27049680 PMCID: PMC5047850 DOI: 10.1016/j.acap.2016.03.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Revised: 03/16/2016] [Accepted: 03/25/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To examine the association of adolescent asthma-related anxiety, social anxiety, separation anxiety, and caregiver asthma-related anxiety with asthma care by urban adolescents. METHODS Participants were 386 ethnic minority adolescents (mean age 12.8 years) with persistent asthma and their caregivers. Adolescents reported what they do to prevent asthma symptoms and to manage acute symptoms, and if they or their caregiver is responsible for their asthma care. Adolescents completed the Youth Asthma-Related Anxiety Scale, and the social and separation anxiety subscales of the Screen for Child Anxiety and Emotional Disorders (SCARED); caregivers completed the Parent Asthma-Related Anxiety Scale. Linearity of the associations was assessed by generalized additive models. When there was no evidence for nonlinearity, linear mixed effects models were used to evaluate the effects of the predictors. RESULTS Adolescent asthma-related anxiety had a strong curvilinear relationship with symptom prevention (P < .001). Adolescents took more prevention steps as their anxiety increased, with a plateau at moderate anxiety. There was a linear relationship of adolescent asthma-related anxiety to symptom management (β = 0.03, P = .021) and to asthma responsibility (β = 0.11, P = .015), and of caregiver asthma-related anxiety to adolescent symptom prevention (β = 0.04, P = .001). Adolescent social and separation anxiety had weak to no relationship with asthma care. Results remained consistent when controlling for each of the other anxieties. CONCLUSIONS Asthma-related anxiety plays an important, independent role in asthma care. When low, adolescents may benefit from increased support from caregivers and awareness of the consequences of uncontrolled asthma. When elevated, health providers should ensure the adolescents are not assuming responsibility for asthma care prematurely.
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Affiliation(s)
- Jean-Marie Bruzzese
- Department of Child and Adolescent Psychiatry, NYU School of Medicine, One Park Avenue, 7 FL, New York, NY 10016, USA
| | - Laura C. Reigada
- Department of Psychology, Brooklyn College of the City University of New York, 2900 Bedford Avenue, Brooklyn, NY 11210, USA
| | - Alexandra Lamm
- Department of Child and Adolescent Psychiatry, NYU School of Medicine, One Park Avenue, 7 FL, New York, NY 10016, USA
| | - Jing Wang
- Department of Child and Adolescent Psychiatry, NYU School of Medicine, One Park Avenue, 7 FL, New York, NY 10016, USA
| | - Meng Li
- Department of Child and Adolescent Psychiatry, NYU School of Medicine, One Park Avenue, 7 FL, New York, NY 10016, USA
| | - Stephanie O. Zandieh
- Department of Pediatrics, NYU School of Medicine, 550 First Avenue, New York, NY 10016, USA
| | - Rachel G. Klein
- Department of Child and Adolescent Psychiatry, NYU School of Medicine, One Park Avenue, 7 FL, New York, NY 10016, USA
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Jay M, Wijetunga NA, Stepney C, Dorsey K, Chua DM, Bruzzese JM. The Relationship between Asthma and Obesity in Urban Early Adolescents. PEDIATRIC ALLERGY, IMMUNOLOGY, AND PULMONOLOGY 2012; 25:159-167. [PMID: 22970423 PMCID: PMC3429276 DOI: 10.1089/ped.2012.0145] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Accepted: 06/10/2012] [Indexed: 12/21/2022]
Abstract
Asthma and obesity, which have reached epidemic proportions, impact urban youth to a great extent. Findings are inconsistent regarding their relationship; no studies have considered asthma management. We explored the association of obesity and asthma-related morbidity, asthma-related health care utilization, and asthma management in urban adolescents with uncontrolled asthma. We classified 373 early adolescents (mean age=12.8 years; 82% Hispanic or Black) from New York City public middle schools into 4 weight categories: normal (body mass index [BMI]<85th percentile); overweight (85th percentile≤BMI<95th percentile); obese (95th percentile≤BMI<97th percentile); and very obese (BMI≥97th percentile). We compared sample obesity prevalence to national estimates, and tested whether weight categories predicted caregiver reported asthma outcomes, adjusting for age and race/ethnicity. Obesity prevalence was 37%, with 28% of the sample being very obese; both rates were significantly higher than national estimates. We found no significant differences in asthma-related health care utilization or asthma management between weight categories, and a few differences in asthma-related morbidity. Relative to normal weight and obese youth, overweight youth had higher odds of never having any days with asthma-related activity limitations. They also had higher odds of never having asthma-related school absences compared with obese youth. Overweight youth with asthma-related activity limitations had more days with limitations compared with normal weight youth. Overweight, but not obese youth, missed more school due to asthma than normal weight youth. Overweight and obesity prevalence was very high in urban, Hispanic, and Black adolescents with uncontrolled asthma, but not strongly associated with asthma-related morbidity, asthma-related health care utilization, or asthma management practices.
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Affiliation(s)
- Melanie Jay
- Division of General Internal Medicine, New York University School of Medicine, New York, New York
| | - N. Ari Wijetunga
- Albert Einstein College of Medicine, Yeshiva University, Bronx, New York
| | - Cesalie Stepney
- Department of Psychology, Rutgers University, New Brunswick, New Jersey
| | - Karen Dorsey
- Department of Pediatrics, School of Medicine, Yale University, New Haven, Connecticut
| | - Danica Marie Chua
- Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York, New York
| | - Jean-Marie Bruzzese
- Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York, New York
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