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Asampana Asosega K, Adebanji AO, Aidoo EN, Owusu-Dabo E. Application of Hierarchical/Multilevel Models and Quality of Reporting (2010-2020): A Systematic Review. ScientificWorldJournal 2024; 2024:4658333. [PMID: 38495479 PMCID: PMC10942821 DOI: 10.1155/2024/4658333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 02/14/2024] [Accepted: 02/24/2024] [Indexed: 03/19/2024] Open
Abstract
Introduction Multilevel models have gained immense popularity across almost every discipline due to the presence of hierarchy in most data and phenomena. In this paper, we present a systematic review on the adoption and application of multilevel models and the important information reported on the results generated from the use of these models. Methods The review was performed by searching Google Scholar for original research articles on the application of multilevel models published between 2010 and 2020. The search strategy involved topics such as "multilevel models," "hierarchical linear models," and "mixed models with hierarchy." The search placed more emphasis on the application of hierarchical models in any discipline but excluded software methodological development and related articles. Results A total of 121 articles were initially obtained from the search results. However, 65 articles met the inclusion criteria for the review. Out of the 65 articles reviewed, 46.2% were related to health/epidemiology, 15.4% to education and psychology, and 16.9% to social life. The majority of the articles (78.5%) were two-level models, and most of these studies modelled univariate responses. However, the few that modelled more than one response modelled them separately. Moreover, 83.1% were cross-sectional design, and 9.2% and 6.2% were longitudinal and repeated measures, respectively. Moreover, a little over half (55.4%) of articles reported on the intraclass correlation measure, and all articles indicated the response variable distribution where most (47.7%) were normally distributed. Only 58.5% of articles reported on the estimation methods used as Bayesian (20%) and MLE (18.5%). Again, model validation measures and statistical software were reported in 70.8% and 90.8% articles, respectively. Conclusion There is an increase in the utilization of multilevel modelling in the last decade, which could be attributed to the presence of clustered and hierarchically correlated data structures. There is a need for improvement in the area of measurement and reporting on the intraclass correlation, parameter estimation, and variable selection measures to further improve the quality of the application of multilevel models. The integration of spatial effects into multilevel models is very limited and needs to be explored in the future.
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Affiliation(s)
- Killian Asampana Asosega
- Department of Statistics and Actuarial Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Department of Mathematics and Statistics, University of Energy and Natural Resources, Sunyani, Ghana
| | - Atinuke Olusola Adebanji
- Department of Statistics and Actuarial Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Eric Nimako Aidoo
- Department of Statistics and Actuarial Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Ellis Owusu-Dabo
- Department of Global and International Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Perry TT, Grant TL, Dantzer JA, Udemgba C, Jefferson AA. Impact of socioeconomic factors on allergic diseases. J Allergy Clin Immunol 2024; 153:368-377. [PMID: 37967769 PMCID: PMC10922531 DOI: 10.1016/j.jaci.2023.10.025] [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: 08/23/2023] [Revised: 10/13/2023] [Accepted: 10/25/2023] [Indexed: 11/17/2023]
Abstract
Allergic and immunologic conditions, including asthma, food allergy, atopic dermatitis, and allergic rhinitis, are among the most common chronic conditions in children and adolescents that often last into adulthood. Although rare, inborn errors of immunity are life-altering and potentially fatal if unrecognized or untreated. Thus, allergic and immunologic conditions are both medical and public health issues that are profoundly affected by socioeconomic factors. Recently, studies have highlighted societal issues to evaluate factors at multiple levels that contribute to health inequities and the potential steps toward closing those gaps. Socioeconomic disparities can influence all aspects of care, including health care access and quality, diagnosis, management, education, and disease prevalence and outcomes. Ongoing research, engagement, and deliberate investment of resources by relevant stakeholders and advocacy approaches are needed to identify and address the impact of socioeconomics on health care disparities and outcomes among patients with allergic and immunologic diseases.
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Affiliation(s)
- Tamara T Perry
- University of Arkansas for Medical Sciences, Little Rock, Ark; Arkansas Children's Research Institute, Little Rock, Ark.
| | - Torie L Grant
- Johns Hopkins University School of Medicine, Baltimore, Md
| | | | - Chioma Udemgba
- National Institute of Allergic and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Akilah A Jefferson
- University of Arkansas for Medical Sciences, Little Rock, Ark; Arkansas Children's Research Institute, Little Rock, Ark
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3
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Aris IM, Perng W, Dabelea D, Padula AM, Alshawabkeh A, Vélez-Vega CM, Aschner JL, Camargo CA, Sussman TJ, Dunlop AL, Elliott AJ, Ferrara A, Joseph CLM, Singh AM, Breton CV, Hartert T, Cacho F, Karagas MR, Lester BM, Kelly NR, Ganiban JM, Chu SH, O’Connor TG, Fry RC, Norman G, Trasande L, Restrepo B, Gold DR, James P, Oken E. Neighborhood Opportunity and Vulnerability and Incident Asthma Among Children. JAMA Pediatr 2023; 177:1055-1064. [PMID: 37639269 PMCID: PMC10463174 DOI: 10.1001/jamapediatrics.2023.3133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 06/29/2023] [Indexed: 08/29/2023]
Abstract
Background The extent to which physical and social attributes of neighborhoods play a role in childhood asthma remains understudied. Objective To examine associations of neighborhood-level opportunity and social vulnerability measures with childhood asthma incidence. Design, Setting, and Participants This cohort study used data from children in 46 cohorts participating in the Environmental Influences on Child Health Outcomes (ECHO) Program between January 1, 1995, and August 31, 2022. Participant inclusion required at least 1 geocoded residential address from birth and parent or caregiver report of a physician's diagnosis of asthma. Participants were followed up to the date of asthma diagnosis, date of last visit or loss to follow-up, or age 20 years. Exposures Census tract-level Child Opportunity Index (COI) and Social Vulnerability Index (SVI) at birth, infancy, or early childhood, grouped into very low (<20th percentile), low (20th to <40th percentile), moderate (40th to <60th percentile), high (60th to <80th percentile), or very high (≥80th percentile) COI or SVI. Main Outcomes and Measures The main outcome was parent or caregiver report of a physician's diagnosis of childhood asthma (yes or no). Poisson regression models estimated asthma incidence rate ratios (IRRs) associated with COI and SVI scores at each life stage. Results The study included 10 516 children (median age at follow-up, 9.1 years [IQR, 7.0-11.6 years]; 52.2% male), of whom 20.6% lived in neighborhoods with very high COI and very low SVI. The overall asthma incidence rate was 23.3 cases per 1000 child-years (median age at asthma diagnosis, 6.6 years [IQR, 4.1-9.9 years]). High and very high (vs very low) COI at birth, infancy, or early childhood were associated with lower subsequent asthma incidence independent of sociodemographic characteristics, parental asthma history, and parity. For example, compared with very low COI, the adjusted IRR for asthma was 0.87 (95% CI, 0.75-1.00) for high COI at birth and 0.83 (95% CI, 0.71-0.98) for very high COI at birth. These associations appeared to be attributable to the health and environmental and the social and economic domains of the COI. The SVI during early life was not significantly associated with asthma incidence. For example, compared with a very high SVI, the adjusted IRR for asthma was 0.88 (95% CI, 0.75-1.02) for low SVI at birth and 0.89 (95% CI, 0.76-1.03) for very low SVI at birth. Conclusions In this cohort study, high and very high neighborhood opportunity during early life compared with very low neighborhood opportunity were associated with lower childhood asthma incidence. These findings suggest the need for future studies examining whether investing in health and environmental or social and economic resources in early life would promote health equity in pediatric asthma.
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Affiliation(s)
- Izzuddin M. Aris
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Wei Perng
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora
| | - Dana Dabelea
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora
| | - Amy M. Padula
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco
| | - Akram Alshawabkeh
- Department of Civil and Environmental Engineering, Northeastern University, Boston, Massachusetts
| | - Carmen M. Vélez-Vega
- University of Puerto Rico (UPR) Graduate School of Public Health, UPR Medical Sciences Campus, San Juan, Puerto Rico
| | - Judy L. Aschner
- Department of Pediatrics, Hackensack Meridian School of Medicine, Nutley, New Jersey
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York
| | - Carlos A. Camargo
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Medicine, Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Tamara J. Sussman
- Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York
| | - Anne L. Dunlop
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia
| | - Amy J. Elliott
- Avera Research Institute, Sioux Falls, South Dakota
- Department of Pediatrics, University of South Dakota School of Medicine, Sioux Falls
| | - Assiamira Ferrara
- Division of Research, Kaiser Permanente Northern California, Oakland
| | | | - Anne Marie Singh
- Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, University of Wisconsin–Madison
| | - Carrie V. Breton
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles
| | - Tina Hartert
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ferdinand Cacho
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Margaret R. Karagas
- Department of Epidemiology, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - Barry M. Lester
- Department of Pediatrics, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Nichole R. Kelly
- Department of Counseling Psychology and Human Services, Prevention Science Institute, University of Oregon, Eugene
| | - Jody M. Ganiban
- Department of Psychological and Brain Sciences, George Washington University, Washington, DC
| | - Su H. Chu
- Department of Medicine, Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Rebecca C. Fry
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, The University of North Carolina, Chapel Hill
| | - Gwendolyn Norman
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Wayne State University, Detroit, Michigan
| | - Leonardo Trasande
- Department of Pediatrics, Grossman School of Medicine, New York University, New York
| | - Bibiana Restrepo
- Department of Pediatrics, School of Medicine, University of California, Davis, Sacramento
| | - Diane R. Gold
- Department of Medicine, Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Peter James
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Emily Oken
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
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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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Adinkrah E, Najand B, Young-Brinn A. Parental Education and Adolescents' Asthma: The Role of Ethnicity. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020267. [PMID: 36832395 PMCID: PMC9955909 DOI: 10.3390/children10020267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/20/2023] [Accepted: 01/29/2023] [Indexed: 02/04/2023]
Abstract
While high parental education is associated with better health, this association may be weaker for ethnic minority than for ethnic majority families. It is unknown whether the association between parental education and adolescents' asthma also varies by ethnicity. AIM To study the association between parental education and adolescents' asthma overall and by ethnicity. METHODS The current study used data from the Population Assessment of Tobacco and Health (PATH)-Adolescents study. All participants were 12 to 17-year-old non-smokers (n = 8652). The outcome of interest was adolescents' asthma. The predictor of interest was baseline parental education, the covariates were age, sex, and number of parents present at baseline, and the moderator was ethnicity. RESULTS According to logistic regression analyses, higher parental education was predictive of adolescents' asthma; however, this association was weaker for Latino than non-Latino adolescents (OR 1.771; CI 1.282-2.446). We did not find a significant difference in the effect of parental education on asthma of White and African American adolescents. Our stratified models also showed that higher parental education was associated with lower asthma for non-Latino but not for Latino adolescents. CONCLUSION The effect of high parental education on adolescents' asthma prevalence differs between Latino and non-Latino families, with Latino families showing weaker protective effects of parental education on adolescents' asthma. Future research should test the role of exposure to environmental pollutants, neighborhood quality, and prevalence of smoking in social network members as well as other contextual factors at home, in school, and in the neighborhood that may increase prevalence of asthma in Latino adolescents regardless of their parental education. Given that these potential causes are multi-level, potential causes of such disparities should be tested in future multi-level research.
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Affiliation(s)
- Edward Adinkrah
- Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90059, USA
- Marginalization-Related Diminished Returns Center, Los Angeles, CA 90059, USA
- Correspondence:
| | - Babak Najand
- Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90059, USA
| | - Angela Young-Brinn
- Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90059, USA
- Marginalization-Related Diminished Returns Center, Los Angeles, CA 90059, USA
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6
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Cushing AM, Khan MA, Kysh L, Brakefield WS, Ammar N, Liberman DB, Wilson J, Shaban-Nejad A, Espinoza J. Geospatial data in pediatric asthma in the United States: a scoping review protocol. JBI Evid Synth 2022; 20:2790-2798. [PMID: 36081367 PMCID: PMC9669090 DOI: 10.11124/jbies-21-00284] [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] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The objective of this scoping review is to identify and describe the literature on the use of geospatial data in pediatric asthma research. INTRODUCTION Asthma is one of the most common pediatric chronic diseases in the United States, disproportionately affecting low-income patients. Asthma exacerbations may be triggered by local environmental factors, such as air pollution or exposure to indoor allergens. Geographic information systems are increasingly recognized as tools that use geospatial data to enhance understanding of the link between environmental exposure, social determinants of health, and clinical outcomes. Geospatial data in pediatric asthma may help inform risk factors for asthma severity, and guide targeted clinical and social interventions. INCLUSION CRITERIA This review will consider studies that utilize geospatial data in the evaluation of pediatric patients with asthma, ages 2 to 18 years, in the United States. Mixed samples of adults and children will also be considered. Geospatial data will include any external non-clinical geographic-based data source that uses a patient's environment or context. METHODS The following databases will be searched: PubMed, Embase, Cochrane CENTRAL, CINAHL, ERIC, Web of Science, and IEEE. Gray literature will be searched in DBLP, the US Environmental Protection Agency, Google Scholar, Google search, and a hand search of recent abstracts from relevant conferences. Articles published in English, Spanish, and French from 2010 to the present will be included. Study screening and selection will be performed independently by 2 reviewers. Data extraction will be performed by a trained research team member following pilot testing.
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Affiliation(s)
- Anna M. Cushing
- Division of Emergency and Transport Medicine, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Masrur A. Khan
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Lynn Kysh
- Institute for Nursing and Interprofessional Research, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Whitney S. Brakefield
- Bredesen Center for Data Science and Engineering, University of Tennessee, Knoxville, TN, United States
- Oak Ridge National Laboratory Center for Biomedical Informatics, Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Nariman Ammar
- Oak Ridge National Laboratory Center for Biomedical Informatics, Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Danica B. Liberman
- Division of Emergency and Transport Medicine, Children's Hospital Los Angeles, Los Angeles, CA, United States
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - John Wilson
- Spatial Sciences Institute, Dornsife College of Letters, Arts and Sciences, University of Southern California, Los Angeles, CA, United States
| | - Arash Shaban-Nejad
- Oak Ridge National Laboratory Center for Biomedical Informatics, Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Juan Espinoza
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
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7
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Gill I, Shah A, Lee EK, Sommer R, Ross K, Bole A, Freedman D. Community Interventions for Childhood Asthma ED Visits and Hospitalizations: A Systematic Review. Pediatrics 2022; 150:189494. [PMID: 36102121 DOI: 10.1542/peds.2021-054825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/12/2022] [Indexed: 11/24/2022] Open
Abstract
UNLABELLED A systematic review of interventions in community environments found significant reductions in childhood asthma exacerbations leading to emergency department visits and hospitalizations. BACKGROUND AND OBJECTIVES Structural and social determinants of childhood asthma inequities manifest within geographic communities that are often segregated. Childhood asthma disproportionately affects Black, Hispanic, and low-income populations. Community interventions have the potential to improve inequities in emergency healthcare. This systematic review was conducted to assess the effectiveness of childhood asthma community interventions and provide a conceptual model to inform implementation of future community interventions. METHODS Publications from PubMed, ScienceDirect, CINAHL, Cochrane Library, Web of Science, and hand searched references were examined from 2010 to 2021. Community intervention studies among children with asthma were included. Main outcomes were emergency department visits and hospitalizations. Community interventions exclusively focusing on schools or hospitals were excluded. Two reviewers independently assessed eligibility for final inclusion. Emergency healthcare findings were extracted in addition to co-benefits (eg, fewer missed school days and caregiver workdays). RESULTS Out of 1856 records, 26 publications met the inclusion criteria. Community interventions were categorized by care coordination (n = 8), policy and environmental changes (eg, smoke-free legislature, traffic reduction models, and green housing) (n = 8), home-based (n = 6), and community-based health services (n = 4). Selected studies indicated that community interventions significantly reduced childhood asthma emergency department visits and hospitalizations through increased caregiver self-efficacy, home environmental trigger reduction, and increased access to healthcare. Because of heterogeneity among studies, we were unable to conduct a meta-analysis. CONCLUSIONS Findings show significant associations between community interventions and the reduction of emergency healthcare, suggesting a protective effect for severe cases of childhood asthma.
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Affiliation(s)
- India Gill
- Mary Ann Swetland Center for Environmental Health, Department of Population and Quantitative Health Sciences
| | - Aashna Shah
- Mary Ann Swetland Center for Environmental Health, Department of Population and Quantitative Health Sciences.,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Eun Kyung Lee
- Mary Ann Swetland Center for Environmental Health, Department of Population and Quantitative Health Sciences.,Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts
| | - Rachael Sommer
- Mary Ann Swetland Center for Environmental Health, Department of Population and Quantitative Health Sciences
| | - Kristie Ross
- Division of Pediatric Pulmonology, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, Ohio.,Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Aparna Bole
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio.,Division of General Academic Pediatrics, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, Ohio
| | - Darcy Freedman
- Mary Ann Swetland Center for Environmental Health, Department of Population and Quantitative Health Sciences
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8
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Cardet JC, Chang KL, Rooks BJ, Carroll JK, Celedón JC, Coyne-Beasley T, Cui J, Ericson B, Forth VE, Fagan M, Fuhlbrigge AL, Hernandez PA, Kruse J, Louisias M, Maher NE, Manning B, Pace WD, Phipatanakul W, Rodriguez-Louis J, Shields JB, Israel E, Wisnivesky JP. Socioeconomic status associates with worse asthma morbidity among Black and Latinx adults. J Allergy Clin Immunol 2022; 150:841-849.e4. [PMID: 35597370 PMCID: PMC9724153 DOI: 10.1016/j.jaci.2022.04.030] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 03/11/2022] [Accepted: 04/21/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Asthma disproportionately affects African American/Black (AA/B) and Hispanic/Latinx (H/L) patients and individuals with low socioeconomic status (SES), but the relationship between SES and asthma morbidity within these racial/ethnic groups is inadequately understood. OBJECTIVE To determine the relationship between SES and asthma morbidity among AA/B and H/L adults with moderate to severe asthma using multidomain SES frameworks and mediation analyses. METHODS We analyzed enrollment data from the PeRson EmPowered Asthma RElief randomized trial, evaluating inhaled corticosteroid supplementation to rescue therapy. We tested for direct and indirect relationships between SES and asthma morbidity using structural equation models. For SES, we used a latent variable defined by poverty, education, and unemployment. For asthma morbidity, we used self-reported asthma exacerbations in the year before enrollment (corticosteroid bursts, emergency room/urgent care visits, or hospitalizations), and Asthma Control Test scores. We tested for mediation via health literacy, perceived stress, and self-reported discrimination. All models adjusted for age, sex, body mass index, ethnicity, and comorbidities. RESULTS Among 990 AA/B and H/L adults, low SES (latent variable) was directly associated with hospitalizations (β = 0.24) and worse Asthma Control Test scores (β = 0.20). Stress partially mediated the relationship between SES and increased emergency room/urgent care visits and worse asthma control (β = 0.03 and = 0.05, respectively). Individual SES domains were directly associated with asthma morbidity. Stress mediated indirect associations between low educational attainment and unemployment with worse asthma control (β = 0.05 and = 0.06, respectively). CONCLUSIONS Lower SES is directly, and indirectly through stress, associated with asthma morbidity among AA/B and H/L adults. Identification of stressors and relevant management strategies may lessen asthma-related morbidity among these populations.
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Affiliation(s)
- Juan Carlos Cardet
- Division of Allergy and Immunology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, Fla
| | - Ku-Lang Chang
- Department of Community Health and Family Medicine, University of Florida College of Medicine, Gainesville, Fla
| | - Benjamin J Rooks
- Department of Community Health and Family Medicine, University of Florida College of Medicine, Gainesville, Fla
| | - Jennifer K Carroll
- American Academy of Family Physicians, National Research Network, Leawood, Kan; CU Anschutz Department of Family Medicine, University of Colorado, Aurora, Colo
| | - Juan Carlos Celedón
- Division of Pediatric Pulmonary Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pa
| | - Tamera Coyne-Beasley
- Department of Medicine, University of Alabama at Birmingham, Children's of Alabama, Birmingham
| | - Jing Cui
- Divisions of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Boston, Mass
| | - Brianna Ericson
- Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Mass
| | - Victoria E Forth
- Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Mass
| | | | - Anne L Fuhlbrigge
- Department of Medicine, Pulmonary Science and Critical Care Medicine, University of Colorado School of Medicine, Aurora, Colo
| | - Paulina Arias Hernandez
- Divisions of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Boston, Mass
| | - Jean Kruse
- Divisions of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Boston, Mass
| | - Margee Louisias
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass
| | - Nancy E Maher
- Divisions of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Boston, Mass
| | - Brian Manning
- American Academy of Family Physicians, National Research Network, Leawood, Kan
| | - Wilson D Pace
- American Academy of Family Physicians, National Research Network, Leawood, Kan; DARTNet Institute, Aurora, Colo
| | | | | | - Joel B Shields
- American Academy of Family Physicians, National Research Network, Leawood, Kan
| | - Elliot Israel
- Divisions of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Boston, Mass; Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass.
| | - Juan P Wisnivesky
- Divisions of General Internal Medicine and Pulmonary and Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
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9
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Hartley K, Ryan PH, Gillespie GL, Perazzo J, Wright JM, Rice GE, Donovan GH, Gernes R, Hershey GKK, LeMasters G, Brokamp C. Residential greenness, asthma, and lung function among children at high risk of allergic sensitization: a prospective cohort study. Environ Health 2022; 21:52. [PMID: 35549707 PMCID: PMC9097404 DOI: 10.1186/s12940-022-00864-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 05/05/2022] [Indexed: 05/10/2023]
Abstract
BACKGROUND While benefits of greenness to health have been reported, findings specific to child respiratory health are inconsistent. METHODS We utilized a prospective birth cohort followed from birth to age 7 years (n = 617). Residential surrounding greenness was quantified via Normalized Difference Vegetation Index (NDVI) within 200, 400, and 800 m distances from geocoded home addresses at birth, age 7 years, and across childhood. Respiratory health outcomes were assessed at age 7 years, including asthma and lung function [percent predicted forced expiratory volume in the first second (%FEV1), percent predicted forced vital capacity (%FVC), and percent predicted ratio of forced expiratory volume in the first second to forced vital capacity (%FEV1/FVC)]. We assessed associations using linear and logistic regression models adjusted for community deprivation, household income, and traffic-related air pollution. We tested for effect measure modification by atopic status. RESULTS We noted evidence of positive confounding as inverse associations were attenuated upon adjustment in the multivariable models. We found evidence of effect measure modification of NDVI and asthma within 400 m at age 7 years by atopic status (p = 0.04), whereby children sensitized to common allergens were more likely to develop asthma as exposure to greenness increased (OR = 1.3, 95% CI: 0.9, 2.0) versus children not sensitized to common allergens (OR = 0.8, 95% CI: 0.5, 1.2). We found consistently positive associations between NDVI and %FEV1 and %FVC which similarly evidenced positive confounding upon adjustment. In the adjusted regression models, NDVI at 7 years of age was associated with %FEV1 (200 m: β = 2.1, 95% CI: 0.1, 3.3; 400 m: β = 1.6, 95% CI: 0.3, 2.9) and %FVC (200 m: β = 1.8, 95% CI: 0.7, 3.0; 400 m: β = 1.6, 95% CI: 0.3, 2.8; 800 m: β = 1.5, 95% CI: 0.1, 2.8). Adjusted results for %FEV1/FVC were non-significant except exposure at birth in the 400 m buffer (β = 0.81, 95% CI: 0.1, 1.5). We found no evidence of effect measure modification of NDVI by atopic status for objective measures of lung function. CONCLUSION Sensitivity to allergens may modify the effect of greenness on risk for asthma in children but greenness is likely beneficial for concurrent lung function regardless of allergic status.
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Affiliation(s)
- Kim Hartley
- Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229 USA
- College of Nursing, University of Cincinnati, 3110 Vine St, Cincinnati, OH 45219 USA
| | - Patrick H. Ryan
- Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229 USA
- College of Medicine, University of Cincinnati, 3230 Eden Ave, Cincinnati, OH 45267 USA
| | - Gordon L. Gillespie
- College of Nursing, University of Cincinnati, 3110 Vine St, Cincinnati, OH 45219 USA
| | - Joseph Perazzo
- College of Nursing, University of Cincinnati, 3110 Vine St, Cincinnati, OH 45219 USA
| | - J. Michael Wright
- Toxic Effects Assessment Branch (Cincinnati), Chemical and Pollutant Assessment Division, Center for Public Health and Environmental Assessment (CPHEA), Office of Research and Development, U.S. Environmental Protection Agency, 26 West M.L. King Drive, Cincinnati, OH 45268 USA
| | - Glenn E. Rice
- Toxic Effects Assessment Branch (Cincinnati), Chemical and Pollutant Assessment Division, Center for Public Health and Environmental Assessment (CPHEA), Office of Research and Development, U.S. Environmental Protection Agency, 26 West M.L. King Drive, Cincinnati, OH 45268 USA
| | - Geoffrey H. Donovan
- USDA Forest Service, PNW Research Station, 1220 SW 3rd Ave, Portland, OR 97204 USA
| | - Rebecca Gernes
- Association of Schools and Programs of Public Health (ASPPH), Environmental Health Research Participant, 2014-2016, 1900 M St NW #710, DC 20036 Washington, USA
| | - Gurjit K. Khurana Hershey
- Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229 USA
- College of Medicine, University of Cincinnati, 3230 Eden Ave, Cincinnati, OH 45267 USA
| | - Grace LeMasters
- College of Medicine, University of Cincinnati, 3230 Eden Ave, Cincinnati, OH 45267 USA
| | - Cole Brokamp
- Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229 USA
- College of Medicine, University of Cincinnati, 3230 Eden Ave, Cincinnati, OH 45267 USA
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10
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Teoh L, Chang AB. Bird's eye overview of asthma in children. Indian J Med Res 2021; 154:8-11. [PMID: 34782523 PMCID: PMC8715702 DOI: 10.4103/ijmr.ijmr_931_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Laurel Teoh
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory; Faculty of Medicine, The University of Queensland; Department of Paediatrics, Caboolture Hospital, Caboolture, Queensland 4510, Australia
| | - Anne B Chang
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory; Department of Respiratory & Sleep Medicine, Queensland Children's Hospital; Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Australia
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11
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Rabito FA, Werthmann D, He H, Madkour AS, Arroyave WD, Sever ML, LaVeist TA. Cockroach exposure and perceived stress interact to predict clinical outcomes in childhood asthma. BMC Pulm Med 2021; 21:83. [PMID: 33706736 PMCID: PMC7953637 DOI: 10.1186/s12890-021-01447-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 02/23/2021] [Indexed: 11/17/2022] Open
Abstract
Background Nonpharmacologic interventions for asthma management rely on identification and mitigation of important asthma triggers. Cockroach exposure is strongly associated with asthma morbidity. It is also associated with stress, another risk factor for asthma. Despite high prevalence of both in vulnerable populations, the impact of joint exposure has not been examined. Methods Participants included 173 children with asthma in New Orleans, Louisiana. Cockroach exposure was based on visual inspection using standard protocols. Caregiver stress was measured using Cohen’s 4-item Perceived Stress Scale. Outcomes included unscheduled clinic or emergency department (ED) visits, hospitalization, and pulmonary function. Multivariable logistic regression was performed to assess independent effects of the exposure on the outcome and effect modification was examined in stratified analysis based on stress. Path analysis to explore the mediation effect by stress was performed using a probit link with parameters based on Bayes’ method with non-informative priors. Results Adjusting for stress and other covariates, cockroach exposure was associated with unscheduled clinic/ED visits (aOR = 6.2; 95% CI 1.8, 21.7). Positive associations were also found for hospitalization and FEV1 < 80%. High stress modified the relationship with unscheduled clinic/ED visits (high aOR = 7.7 95% CI 1.0, 60.2, versus normal aOR = 4.1 95% CI 0.8, 21.9). Path models identified direct and indirect effects (p = 0.05) indicating that a majority of the total effect on unscheduled clinic/ED visits is attributed directly to cockroach exposure. Conclusion The strong association between cockroach exposure and asthma morbidity is not due to uncontrolled confounding by stress. The combination of cockroach exposure and high stress, common in urban homes, are modifiable factors associated with poor asthma outcomes.
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Affiliation(s)
- Felicia A Rabito
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 2016, New Orleans, LA, 70112, USA.
| | - Derek Werthmann
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 2016, New Orleans, LA, 70112, USA
| | - Hua He
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 2016, New Orleans, LA, 70112, USA
| | - Aubrey S Madkour
- Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 2016, New Orleans, LA, 70112, USA
| | - Whitney D Arroyave
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 2016, New Orleans, LA, 70112, USA
| | - Michelle L Sever
- PPD Government and Public Health Services , 3900 Paramount Parkway, Morrisville, NC, 27560, USA
| | - Thomas A LaVeist
- Department of Health Policy and Management, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 2016, New Orleans, LA, 70112, USA
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12
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Kakar R, Combs R, Ali N, Muvuka B, Porter J. Enhancing the design and utilization of asthma action plans through community-based participatory research in an urban African American community. PATIENT EDUCATION AND COUNSELING 2021; 104:276-281. [PMID: 32921519 DOI: 10.1016/j.pec.2020.08.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 04/17/2020] [Accepted: 08/20/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Across the U.S., large inequities in asthma prevalence and outcomes persist, disproportionately affecting low-income, minoritized children. West Louisville is particularly impacted by these inequities due to a complex interplay of socioeconomic, historical, and industrial processes. Additionally, low health literacy and mistrust in healthcare exacerbate poor asthma self-management. OBJECTIVE To engage community members and health professionals to address childhood asthma management in a marginalized community experiencing significant health inequities. PATIENT INVOLVEMENT Although prior asthma knowledge was not required, the majority of our community advisory council (CAC) members either had asthma or cared for children/grandchildren with asthma. Through facilitated decision-making using the Boot Camp Translation approach, the CAC chose to focus on improving asthma self-management in their community through enhancing the design and utilization of asthma action plans (AAPs). METHODS Upon adding inhaler images to a user-friendly AAP, the CAC developed and implemented a provider incentive program and a health communication campaign to promote the Tool's utilization. Evaluation of the intervention consisted of a short questionnaire measuring relevant patient demographics and campaign knowledge, and phone interviews with providers to gather feedback on the incentive and Tool design. RESULTS Over the short two-month intervention, a total of 8 practices with 28 providers used 153 Tools to provide asthma self-management counseling. The majority of providers preferred the enhanced Tool to other AAPs they had used. Inhaler images facilitating improved communication regarding asthma medications. DISCUSSION Using a participatory approach, a community preferred intervention targeting barriers to effective asthma control increased provider utilization and community awareness of AAPs and bridged a communication gap between patients and providers. PRACTICAL VALUE Leveraging community members' (including patients/caregivers) and health professionals' expertise led to the development of an enhanced patient-education tool and an effective provider incentive program with the potential to improve childhood asthma management in marginalized populations.
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Affiliation(s)
- Rishtya Kakar
- Department of Health Promotion and Behavioral Sciences, University of Louisville School of Public Health and Information Sciences, Louisville, KY, USA.
| | - Ryan Combs
- Department of Health Promotion and Behavioral Sciences, University of Louisville School of Public Health and Information Sciences, Louisville, KY, USA.
| | - Nida Ali
- Department of Health Promotion and Behavioral Sciences, University of Louisville School of Public Health and Information Sciences, Louisville, KY, USA.
| | - Baraka Muvuka
- Department of Health Promotion and Behavioral Sciences, University of Louisville School of Public Health and Information Sciences, Louisville, KY, USA.
| | - Jennifer Porter
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY, USA.
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13
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Teoh L, Chatfield MD, Acworth JP, McCallum GB, Chang AB. Determinants of cough and caregivers' quality of life in pediatric asthma exacerbations. Pediatr Pulmonol 2021; 56:371-377. [PMID: 33179390 DOI: 10.1002/ppul.25168] [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: 07/13/2020] [Revised: 10/26/2020] [Accepted: 11/03/2020] [Indexed: 01/26/2023]
Abstract
OBJECTIVES In hospitalized and nonhospitalized children with asthma exacerbations, we evaluated the determinants of (a) prolonged cough on day-14 and (b) asthma quality of life (QoL) questionnaires for parents (PACQLQ) on day-21. We hypothesized that children with more severe acute asthma are more likely to have prolonged cough and/or poorer PACQLQ during the recovery phase. DESIGN Prospective cohort study performed during 2009-2011. METHODOLOGY Two hundred and forty-four children aged 2-16 years presenting with acute asthma to the Emergency Departments of two hospitals were recruited. Clinical history, examination, baseline asthma severity, and acute asthma severity on presentation were documented. Validated daily cough diaries and weekly PACQLQ were recorded for 14 and 21 days, respectively. RESULTS 34.4% and 32.2% of children who returned the daytime and nighttime cough diaries respectively had a prolonged cough. Those on regular inhaled corticosteroids (ICS) were significantly more likely to have a daytime or nighttime cough score of ≥1 on day-14 (odds ratio [ORadjusted ] = 4.70, 95% confidence interval [CI] 1.65, 13.35, p = .004 and ORadjusted = 2.65, 95% CI 1.05, 6.69, p = .040, respectively). PACQLQ on day-21 was significantly poorer in younger children (mean difference [MD] = -0.04 per year, 95% CI -0.08, -0.01, p = .016), those on ICS (MD = -0.31, 95% CI -0.52, -0.09, p = .005), leukotriene antagonists (MD = -0.42, 95% CI -0.83, -0.02, p = .040) and in those who had an unplanned visit for asthma on day-21 (MD = -1.20, 95% CI -1.61, -0.78, p = .0001). CONCLUSIONS Post an acute asthma exacerbation, children on regular ICS were more likely to have prolonged cough and poorer QoL. While this may be reflective of asthma severity or control, its association deserves further evaluation.
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Affiliation(s)
- Laurel Teoh
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Mark D Chatfield
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Jason P Acworth
- Department of Emergency Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Gabrielle B McCallum
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Anne B Chang
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Department of Respiratory and Sleep Medicine, Queensland Children's Hospital and Centre for Children's Health Research, Queensland University of Technology, Brisbane, Queensland, Australia
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14
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Sullivan PW, Ghushchyan VH, Skoner DP, LeCocq J, Park S, Zeiger RS. Complications and Health Care Resource Utilization Associated with Systemic Corticosteroids in Children and Adolescents with Persistent Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 9:1541-1551.e9. [PMID: 33290914 PMCID: PMC8393544 DOI: 10.1016/j.jaip.2020.11.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 10/22/2020] [Accepted: 11/20/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND: Limited comparative data are available on the impact of systemic corticosteroid (SCS) use in children and adolescents. OBJECTIVE: To determine if asthmatic children and adolescents treated with SCS have a higher likelihood of developing complications versus those not receiving SCS and to examine health care resource utilization (HCRU) in this population. METHODS: A retrospective study of data from children and adolescents with persistent asthma retrieved from the MarketScan database, a large US health claims data set, for the period 2000 to 2017 was performed. Propensity score matching was used to pair patients in the SCS and control cohorts. For complications, SCS subgroups (≥4 or 1-3 annual prescriptions) were compared with asthmatic controls without SCS using logistic regression, and for HCRU, cohorts were compared using negative binomial regression. RESULTS: A total of 67,081 patients were included (SCS: 23,898; control: 43,183). The odds of having a complication were 2.9 (95% confidence interval [CI], 2.5-3.2; P < .001) and 1.6 (95% CI, 1.6-1.7; P < .001) times higher in the ≥4 and 1 to 3 SCS groups, respectively, in the first year of follow-up versus controls. For asthma-related hospitalizations, the incidence rate ratio (IRR) was 6.9 (95% CI, 5.6-8.6) and 3.1 (95% CI, 2.8-3.4) times greater in the ≥4 SCS and 1 to 3 SCS groups, respectively, versus controls; for asthma-related emergency department visits, IRR was 5.0 (95% CI, 4.4-5.6) and 2.9 (95% CI, 2.7-3.0) times greater, respectively, versus controls (all P < .01). CONCLUSION: Children and adolescents receiving SCS for persistent asthma have an increased risk of developing complications and have greater HCRU in the first year of follow-up versus those without SCS exposure.
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Affiliation(s)
- Patrick W Sullivan
- Department of Pharmacy Practice, Regis University School of Pharmacy, Denver, Colo.
| | - Vahram H Ghushchyan
- Center for Pharmaceutical Outcomes Research, University of Colorado, Aurora, Colo; American University of Armenia, Yerevan, Armenia
| | - David P Skoner
- Department of Pediatrics, West Virginia University, Morgantown, WV
| | - Jason LeCocq
- Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Siyeon Park
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, Md
| | - Robert S Zeiger
- Department of Allergy, Kaiser Permanente, Southern California Region, San Diego, Calif
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15
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Bozigar M, Lawson AB, Pearce JL, King K, Svendsen ER. A Bayesian spatio-temporal analysis of neighborhood pediatric asthma emergency department visit disparities. Health Place 2020; 66:102426. [PMID: 33011491 DOI: 10.1016/j.healthplace.2020.102426] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/17/2020] [Accepted: 08/17/2020] [Indexed: 11/25/2022]
Abstract
Asthma disparities have complex, neighborhood-level drivers that are not well understood. Consequently, identifying particular contextual factors that contribute to disparities is a public health goal. We study pediatric asthma emergency department (ED) visit disparities and neighborhood factors associated with them in South Carolina (SC) census tracts from 1999 to 2015. Leveraging a Bayesian framework, we identify risk clusters, spatially-varying relationships, and risk percentile-specific associations. Clusters of high risk occur in both rural and urban census tracts with high probability, with neighborhood-specific associations suggesting unique risk factors for each locale. Bayesian methods can help clarify the neighborhood drivers of health disparities.
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Affiliation(s)
- Matthew Bozigar
- Division of Epidemiology, Department of Public Health Sciences, College of Graduate Studies, Medical University of South Carolina, Charleston, SC, United States.
| | - Andrew B Lawson
- Division of Biostatistics, Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, United States.
| | - John L Pearce
- Division of Environmental Health, Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, United States.
| | - Kathryn King
- Department of Pediatrics, College of Medicine, Medical University of South Carolina, Charleston, SC, United States; School-Based Health, Center for Telehealth, Medical University of South Carolina, Charleston, SC, United States.
| | - Erik R Svendsen
- Division of Environmental Health, Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, United States.
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16
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Combined Effect of Race/Ethnicity and Type of Insurance on Reuse of Urgent Hospital-Based Services in Children Discharged with Asthma. CHILDREN-BASEL 2020; 7:children7090107. [PMID: 32825507 PMCID: PMC7552762 DOI: 10.3390/children7090107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 08/17/2020] [Accepted: 08/19/2020] [Indexed: 11/17/2022]
Abstract
Asthma is a leading cause of health disparity in children. This study explores the joint effect of race/ethnicity and insurance type on risk for reuse of urgent services within a year of hospitalization. Data were collected from 604 children hospitalized with asthma between 2012 and 2015 and stratified with respect to combination of patients’ insurance status (public vs. private) and race/ethnicity (white vs. nonwhite). Highest rates for at least one emergency department (ED) revisit (49.5%, 95% CI 42.5, 56.5) and for average revisits (1.03, 95% CI 0.83, 1.22) were recorded in nonwhite children with public insurance. Adjusted models revealed higher chance for ED reuse in white as well as nonwhite children covered by public insurance. Hospitalization rate was not dependent on the combination of social determinants, but on the number of post-discharge ED revisits. The combined effect of race/ethnicity and health insurance are associated with post-discharge utilization of ED services, but not with hospital readmission.
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Argentieri MA, Seddighzadeh B, Noveroske Philbrick S, Balboni T, Shields A. A Roadmap for conducting psychosocial research in epidemiological studies: perspectives of cohort study principal investigators. BMJ Open 2020; 10:e037235. [PMID: 32723742 PMCID: PMC7389745 DOI: 10.1136/bmjopen-2020-037235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Psychosocial adversity disproportionately affects racial/ethnic and socioeconomic minorities in the USA, and therefore understanding the mechanisms through which psychosocial stress and resilience influence human health can provide meaningful insights into addressing US health disparities. Despite this promise, psychosocial factors are infrequently and unsystematically collected in the US prospective cohort studies. METHODS We sought to understand prospective cohort principal investigators' (PIs') attitudes regarding the importance of psychosocial influences on disease aetiology, in order to identify barriers and opportunities for greater inclusion of these domains in high-quality epidemiological research. One-hour, semi-structured qualitative interviews were conducted with 20 PIs representing 24 US prospective cohort studies funded by the National Institutes of Health (NIH), collectively capturing health data on 1.25 of every 100 American adults. A hypothesis-free, grounded theory approach was used to analyse and interpret interview data. RESULTS Most cohort PIs view psychosocial factors as an important research area to further our understanding of disease aetiology and agree that this research will be crucial for future public health innovations. Virtually all PIs emphasised that future psychosocial research will need to elucidate biological and behavioural mechanisms in order to be taken seriously by the epidemiological community more broadly. A lack of pertinent funding mechanisms and a lack of consensus on optimal scales and measures of psychosocial factors were identified as additional barriers to advancing psychosocial research. CONCLUSIONS Our interviews emphasised the need for: (1) high-quality, longitudinal studies that investigate biological mechanisms and pathways through which psychosocial factors influence health, (2) effort among epidemiological cohorts to broaden and harmonise the measures they use across cohorts, to facilitate replication of results and (3) the need for targeted funding opportunities from NIH and other grant-making institutions to study these domains.
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Affiliation(s)
- M Austin Argentieri
- Harvard/MGH Center for Genomics, Vulnerable Populations, and Health Disparities, Massachusetts General Hospital, Boston, Massachusetts, USA
- School of Anthropology and Museum Ethnography, University of Oxford, Oxford, Oxfordshire, UK
| | - Bobak Seddighzadeh
- Harvard/MGH Center for Genomics, Vulnerable Populations, and Health Disparities, Massachusetts General Hospital, Boston, Massachusetts, USA
- University of Nevada, Las Vegas School of Medicine, Las Vegas, Nevada, USA
| | - Sarah Noveroske Philbrick
- Kirksville College of Osteopathic Medicine, A.T. Still University of Health Sciences, Kirksville, Missouri, USA
| | - Tracy Balboni
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Alexandra Shields
- Harvard/MGH Center for Genomics, Vulnerable Populations, and Health Disparities, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Singh SK, Gupta J, Sharma H, Pedgaonkar SP, Gupta N. Socio-economic Correlates and Spatial Heterogeneity in the Prevalence of Asthma among Young Women in India. BMC Pulm Med 2020; 20:190. [PMID: 32664897 PMCID: PMC7362630 DOI: 10.1186/s12890-020-1124-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 03/27/2020] [Indexed: 01/01/2023] Open
Abstract
Background Asthma is one of the leading causes of disease burden when measured in terms of disability adjusted life years, despite low prevalence of self-reported cases among young women. This paper deals with the meso-scale correlates and spatial heterogeneity in the prevalence of self-reported Asthma across 640 districts in India, using a nationally representative sample of 699,686 women aged 15–49 years from all 36 States/UTs under NFHS-4 (2015–16). Methods Analytical methods used in this paper include multivariate logistic regression to examine the adjusted effects of various independent variables on self-reported Asthma and poor-rich ratios (PRR) and concentration index (CI) to understand the economic inequalities in the prevalence of Asthma. For the spatial analysis in the prevalence of Asthma, univariate and bivariate local Moran’s I statistic have been computed in addition to measure of spatial autocorrelation and auto regression using spatial error and spatial lag models. Results Results highlight that women’s education was an important marker to the prevalence of Asthma. Smoking tobacco in any form among women were significantly more likely to suffer from Asthma. The prevalence of Asthma was further aggravated among women from the households without a separate room for kitchen, as well as those using unclean fuel for cooking. The poor-rich ratio in the prevalence of Asthma across various States/UTs in India depict inherent inequality. An analysis of spatial clustering in the prevalence of Asthma based on spatial autocorrelation portrays that Moran’s I values were significant for improved source of drinking water, clean fuel used for cooking, and household environment. When spatial weights are taken into consideration, the autoregression model noticeably becomes stronger in predicting the prevalence of Asthma. Conclusions Any programmatic effort to curb the prevalence of Asthma through vertical interventions may hinge around the use of clean fuel, poverty, and lifestyle of subjects, irrespective of urban-rural place of their residence, environmental and ecological factors.
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Affiliation(s)
- Shri Kant Singh
- Department of Mathematical Demography & Statistics, International Institute for Population Sciences, Govandi Station Road, Deonar, Mumbai, 400088, India
| | - Jitendra Gupta
- Department of Mathematical Demography & Statistics, International Institute for Population Sciences, Govandi Station Road, Deonar, Mumbai, 400088, India.
| | - Himani Sharma
- Department of Mathematical Demography & Statistics, International Institute for Population Sciences, Govandi Station Road, Deonar, Mumbai, 400088, India
| | - Sarang P Pedgaonkar
- Department of Population Policies & Programmes, International Institute for Population Sciences, Govandi Station Road, Deonar, Mumbai, 400088, India
| | - Nidhi Gupta
- International Institute for Population Sciences, Govandi Station Road, Deonar, Mumbai, 400088, India
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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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DePriest KN, Shields TM, Curriero FC. Returning to our roots: The use of geospatial data for nurse-led community research. Res Nurs Health 2019; 42:467-475. [PMID: 31599459 DOI: 10.1002/nur.21984] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 09/23/2019] [Indexed: 12/22/2022]
Abstract
In the early 20th century, public health nurse, Lillian Wald, addressed the social determinants of health (SDOH) through her work in New York City and her advocacy to improve policy in workplace conditions, education, recreation, and housing. In the early 21st century, addressing the SDOH is a renewed priority and provides nurse researchers with an opportunity to return to our roots. The purpose of this methods paper is to examine how the incorporation of geospatial data and spatial methodologies in community research can enhance the analyses of the complex relationships between social determinants and health. Geospatial technologies, software for mapping and working with geospatial data, statistical methods, and unique considerations are discussed. An exemplar for using geospatial data is presented regarding associations between neighborhood greenspace, neighborhood violence, and children's asthma control. This innovative use of geospatial data illustrates a new frontier in investigating nontraditional connections between the environment and SDOH outcomes.
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Affiliation(s)
- Kelli N DePriest
- School of Nursing, Johns Hopkins University, Baltimore, Maryland
| | - Timothy M Shields
- Department of Epidemiology, Spatial Science for Public Health Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Frank C Curriero
- Department of Epidemiology, Spatial Science for Public Health Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Kinghorn B, Fretts AM, O'Leary RA, Karr CJ, Rosenfeld M, Best LG. Socioeconomic and Environmental Risk Factors for Pediatric Asthma in an American Indian Community. Acad Pediatr 2019; 19:631-637. [PMID: 31103883 DOI: 10.1016/j.acap.2019.05.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 04/22/2019] [Accepted: 05/11/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND American Indian (AI)/Alaska Native children have increased asthma prevalence, morbidity, and mortality compared to non-Hispanic white children. Our study sought to examine environmental and socioeconomic factors of asthma among children in an AI community. METHODS This case-control study included children with physician-diagnosed asthma and age-matched controls, ages 6 through 17 years, in an AI community. Diagnosis and clinical characteristics were obtained from medical record review. Home visits included interviews regarding sociodemographic and household environmental exposures, physical exams, spirometry, and asthma control questionnaires (cases only). RESULTS Among the 108 asthma cases and 215 controls, 64% had an annual household income of <$25,000. Children with asthma had significantly higher odds of living in a multi-unit dwelling (odds ratio [OR], 2.3; 95% confidence interval [CI], 1.2-4.4) or in residences with rodent or insect infestation (OR, 2.1; 95% CI, 1.1-3.8) and were less likely to live in homes with more than 8 occupants (OR, 0.5; 95% CI, 0.3-0.9). Also, there was a trend for lower caregiver education level, unmarried caregiver marital status, and annual household income level of <$25,000 in univariate analysis. However, after adjustment for socioeconomic status and household environmental factors, these estimates were not significant. Nearly half of cases had poorly controlled asthma and reported persistent cough, wheeze, and dyspnea, yet only 24% reported using a controller medication. CONCLUSIONS In this low-income AI community, we identified several social and environmental determinants of asthma, which were mediated by socioeconomic status and other household environmental factors, suggesting a complex interplay between socioeconomic status and environmental exposures. Furthermore, many children with asthma reported poor asthma control.
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Affiliation(s)
- BreAnna Kinghorn
- Seattle Children's Hospital (B Kinghorn, AM Fretts, CJ Karr, and M Rosenfeld), University of Washington, Seattle; Missouri Breaks Industries Research Inc. (RA O'Leary and LG Best), Eagle Butte, SD; Turtle Mountain Community College (LG Best), Belcourt, ND.
| | - Amanda M Fretts
- Seattle Children's Hospital (B Kinghorn, AM Fretts, CJ Karr, and M Rosenfeld), University of Washington, Seattle; Missouri Breaks Industries Research Inc. (RA O'Leary and LG Best), Eagle Butte, SD; Turtle Mountain Community College (LG Best), Belcourt, ND
| | - Rae A O'Leary
- Seattle Children's Hospital (B Kinghorn, AM Fretts, CJ Karr, and M Rosenfeld), University of Washington, Seattle; Missouri Breaks Industries Research Inc. (RA O'Leary and LG Best), Eagle Butte, SD; Turtle Mountain Community College (LG Best), Belcourt, ND
| | - Catherine J Karr
- Seattle Children's Hospital (B Kinghorn, AM Fretts, CJ Karr, and M Rosenfeld), University of Washington, Seattle; Missouri Breaks Industries Research Inc. (RA O'Leary and LG Best), Eagle Butte, SD; Turtle Mountain Community College (LG Best), Belcourt, ND
| | - Margaret Rosenfeld
- Seattle Children's Hospital (B Kinghorn, AM Fretts, CJ Karr, and M Rosenfeld), University of Washington, Seattle; Missouri Breaks Industries Research Inc. (RA O'Leary and LG Best), Eagle Butte, SD; Turtle Mountain Community College (LG Best), Belcourt, ND
| | - Lyle G Best
- Seattle Children's Hospital (B Kinghorn, AM Fretts, CJ Karr, and M Rosenfeld), University of Washington, Seattle; Missouri Breaks Industries Research Inc. (RA O'Leary and LG Best), Eagle Butte, SD; Turtle Mountain Community College (LG Best), Belcourt, ND
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22
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Bruzzese JM, Kingston S, Falletta KA, Bruzelius E, Poghosyan L. Individual and Neighborhood Factors Associated with Undiagnosed Asthma in a Large Cohort of Urban Adolescents. J Urban Health 2019; 96:252-261. [PMID: 30645702 PMCID: PMC6458186 DOI: 10.1007/s11524-018-00340-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Undiagnosed asthma adds to the burden of asthma and is an especially significant public health concern among urban adolescents. While much is known about individual-level demographic and neighborhood-level factors that characterize those with diagnosed asthma, limited data exist regarding these factors and undiagnosed asthma. This observational study evaluated associations between undiagnosed asthma and individual and neighborhood factors among a large cohort of urban adolescents. We analyzed data from 10,295 New York City adolescents who reported on asthma symptoms and diagnosis; a subset (n = 6220) provided addresses that we were able to geocode into US Census tracts. Multivariable regression models estimated associations between undiagnosed asthma status and individual-level variables. Hierarchical linear modeling estimated associations between undiagnosed asthma status and neighborhood-level variables. Undiagnosed asthma prevalence was 20.2%. Females had higher odds of being undiagnosed (adjusted odds ratio (AOR) = 1.25; 95% confidence interval (CI) = 1.13-1.37). Compared to White, non-Hispanic adolescents, Asian-Americans had higher risk of being undiagnosed (AOR = 1.41; 95% CI = 1.01-1.95); Latinos (AOR = 0.67; 95% CI = 0.45-0.83); and African-Americans/Blacks (AOR = 0.66; 95% CI = 0.52-0.87) had lower risk; Latinos and African-Americans/Blacks did not differ significantly. Living in a neighborhood with a lower concentration of Latinos relative to White non-Latinos was associated with lower risk of being undiagnosed (AOR = 0.66; CI = 0.43-0.95). Living in a neighborhood with health care provider shortages was associated with lower risk of being undiagnosed (AOR = 0.80; 95% CI =0.69-0.93). Public health campaigns to educate adolescents and their caregivers about undiagnosed asthma, as well as education for health care providers to screen adolescent patients for asthma, are warranted.
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Affiliation(s)
- Jean-Marie Bruzzese
- Columbia University School of Nursing, 630 West 168th Street, Mail Code 6, New York, NY, 10032, USA.
| | - Sharon Kingston
- Psychology Department, Dickinson College, P.O. Box 1773, Carlisle, PA, 17013, USA
| | - Katherine A Falletta
- Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY, 10032, USA
| | - Emilie Bruzelius
- Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY, 10032, USA
| | - Lusine Poghosyan
- Columbia University School of Nursing, 630 West 168th Street, Mail Code 6, New York, NY, 10032, USA
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23
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Oliveira MAD. Epidemiology of asthma: it is necessary to expand our concepts. ACTA ACUST UNITED AC 2019; 44:341-342. [PMID: 30517331 PMCID: PMC6467589 DOI: 10.1590/s1806-37562018000050004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Maria Alenita de Oliveira
- . Centro Universitário de João Pessoa - UNIPÊ - João Pessoa (PB) Brasil.,. Universidade Federal da Paraíba - UFPB - João Pessoa (PB) Brasil
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24
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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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25
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Sandifer PA, Walker AH. Enhancing Disaster Resilience by Reducing Stress-Associated Health Impacts. Front Public Health 2018; 6:373. [PMID: 30627528 PMCID: PMC6309156 DOI: 10.3389/fpubh.2018.00373] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 12/06/2018] [Indexed: 12/19/2022] Open
Abstract
Disasters are a recurring fact of life, and major incidents can have both immediate and long-lasting negative effects on the health and well-being of people, communities, and economies. A primary goal of many disaster preparedness, response, and recovery plans is to reduce the likelihood and severity of disaster impacts through increased resilience of individuals and communities. Unfortunately, most plans do not address directly major drivers of long-term disaster impacts on humans-that is, acute, chronic, and cumulative stress-and therefore do less to enhance resilience than they could. Stress has been shown to lead to or exacerbate ailments ranging from mental illness, domestic violence, substance abuse, post-traumatic stress disorders, and suicide to cardiovascular disease, respiratory problems, and other infirmities. Individuals, groups, communities, organizations, and social ties are all vulnerable to stress. Based on a targeted review of what we considered to be key literature about disasters, resilience, and disaster-associated stress effects, we recommend eight actions to improve resiliency through inclusion of stress alleviation in disaster planning: (1) Improve existing disaster behavioral and physical health programs to better address, leverage, and coordinate resources for stress reduction, relief, and treatment in disaster planning and response. (2) Emphasize pre- and post-disaster collection of relevant biomarker and other health-related data to provide a baseline of health status against which disaster impacts could be assessed, and continued monitoring of these indicators to evaluate recovery. (3) Enhance capacity of science and public health early-responders. (4) Use natural infrastructure to minimize disaster damage. (5) Expand the geography of disaster response and relief to better incorporate the displacement of affected people. (6) Utilize nature-based treatment to alleviate pre- and post-disaster stress effects on health. (7) Review disaster laws, policies, and regulations to identify opportunities to strengthen public health preparedness and responses including for stress-related impacts, better engage affected communities, and enhance provision of health services. (8) With community participation, develop and institute equitable processes pre-disaster for dealing with damage assessments, litigation, payments, and housing.
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Affiliation(s)
- Paul A. Sandifer
- Center for Coastal Environmental and Human Health, School of Sciences and Mathematics, College of Charleston, Charleston, SC, United States
- Center for Oceans and Human Health, University of South Carolina, Columbia, SC, United States
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26
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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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27
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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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28
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Lewis TC, Metitiri EE, Mentz GB, Ren X, Goldsmith AM, Eder BN, Wicklund KE, Walsh MP, Comstock AT, Ricci JM, Brennan SR, Washington GL, Owens KB, Mukherjee B, Robins TG, Batterman SA, Hershenson MB. Impact of community respiratory viral infections in urban children with asthma. Ann Allergy Asthma Immunol 2018; 122:175-183.e2. [PMID: 30385348 PMCID: PMC6360098 DOI: 10.1016/j.anai.2018.10.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 10/13/2018] [Accepted: 10/21/2018] [Indexed: 12/13/2022]
Abstract
Background Upper respiratory tract viral infections cause asthma exacerbations in children. However, the impact of natural colds on children with asthma in the community, particularly in the high-risk urban environment, is less well defined. Objective We hypothesized that children with high-symptom upper respiratory viral infections have reduced airway function and greater respiratory tract inflammation than children with virus-positive low-symptom illnesses or virus-negative upper respiratory tract symptoms. Methods We studied 53 children with asthma from Detroit, Michigan, during scheduled surveillance periods and self-reported respiratory illnesses for 1 year. Symptom score, spirometry, fraction of exhaled nitric oxide (FeNO), and nasal aspirate biomarkers, and viral nucleic acid and rhinovirus (RV) copy number were assessed. Results Of 658 aspirates collected, 22.9% of surveillance samples and 33.7% of respiratory illnesses were virus-positive. Compared with the virus-negative asymptomatic condition, children with severe colds (symptom score ≥5) showed reduced forced expiratory flow at 25% to 75% of the pulmonary volume (FEF25%-75%), higher nasal messenger RNA expression of C-X-C motif chemokine ligand (CXCL)-10 and melanoma differentiation-associated protein 5, and higher protein abundance of CXCL8, CXCL10 and C-C motif chemokine ligands (CCL)-2, CCL4, CCL20, and CCL24. Children with mild (symptom score, 1-4) and asymptomatic infections showed normal airway function and fewer biomarker elevations. Virus-negative cold-like illnesses demonstrated increased FeNO, minimal biomarker elevation, and normal airflow. The RV copy number was associated with nasal chemokine levels but not symptom score. Conclusion Urban children with asthma with high-symptom respiratory viral infections have reduced FEF25%-75% and more elevations of nasal biomarkers than children with mild or symptomatic infections, or virus-negative illnesses.
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Affiliation(s)
- Toby C Lewis
- Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan; Department of Environmental Health Sciences, University of Michigan School of Public Health; University of Michigan, Ann Arbor, Michigan; Department of Health Behavior/Health Education, University of Michigan School of Public Health; University of Michigan, Ann Arbor, Michigan
| | - Ediri E Metitiri
- Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan
| | - Graciela B Mentz
- Department of Health Behavior/Health Education, University of Michigan School of Public Health; University of Michigan, Ann Arbor, Michigan
| | - Xiaodan Ren
- Department of Environmental Health Sciences, University of Michigan School of Public Health; University of Michigan, Ann Arbor, Michigan
| | - Adam M Goldsmith
- Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan
| | - Breanna N Eder
- Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan
| | - Kyra E Wicklund
- Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan; Department of Epidemiology, University of Michigan School of Public Health; University of Michigan, Ann Arbor, Michigan
| | - Megan P Walsh
- Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan; Department of Epidemiology, University of Michigan School of Public Health; University of Michigan, Ann Arbor, Michigan
| | - Adam T Comstock
- Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan
| | - Jeannette M Ricci
- Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan
| | - Sean R Brennan
- Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan
| | - Ginger L Washington
- Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan
| | - Kendall B Owens
- Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan
| | - Bhramar Mukherjee
- Department of Biostatistics, University of Michigan School of Public Health; University of Michigan, Ann Arbor, Michigan
| | - Thomas G Robins
- Department of Environmental Health Sciences, University of Michigan School of Public Health; University of Michigan, Ann Arbor, Michigan
| | - Stuart A Batterman
- Department of Environmental Health Sciences, University of Michigan School of Public Health; University of Michigan, Ann Arbor, Michigan
| | - Marc B Hershenson
- Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan; Department of Molecular and Integrative Physiology, University of Michigan Medical School, Ann Arbor, Michigan.
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29
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DePriest K, Butz A, Gross D. Investigating the relationships among neighborhood factors and asthma control in African American children: A study protocol. Res Nurs Health 2018; 41:428-439. [PMID: 30168586 DOI: 10.1002/nur.21901] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 07/22/2018] [Indexed: 11/11/2022]
Abstract
Over 2 million children in the US have uncontrolled asthma. African American children are disproportionately affected with a risk of dying from asthma that is 7.6 times higher than non-Hispanic White children. Racial disparities in childhood asthma are partially attributed to differential exposures to poverty; unsafe and stressful neighborhoods; and unhealthy physical environments. This paper describes the protocol for an ongoing National Institutes of Health/National Institute of Nursing Research-funded descriptive, cross-sectional study to investigate two neighborhood factors that may influence children's asthma. Building on an existing dataset, this study examines associations among neighborhood greenspace, neighborhood safety, and level of asthma control while controlling for indoor asthma triggers in an urban sample of predominantly low-income, African American children with persistent asthma. Two new variables are added to the dataset: availability of neighborhood greenspace and neighborhood violent crime rate. Greenspace is being accessed using geographic information systems and measured using the normalized difference vegetation index. Neighborhood violent crime rate is calculated using geocoded, point locations for crimes downloaded from the city police department. It is hypothesized that parents living in unsafe neighborhoods are likely to keep their children indoors, thereby increasing their children's exposure to indoor asthma triggers and limiting the potential benefits of neighborhood greenspace. The biggest challenges thus far are related to limited variability in greenspace and violent crime rates. Progress to date and strategies to address these challenges are discussed. Results have the potential to inform interventions to improve asthmatic children's health and influence public health policy.
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Affiliation(s)
- Kelli DePriest
- School of Nursing, The Johns Hopkins University, School of Medicine, Baltimore, Maryland
| | - Arlene Butz
- School of Nursing, The Johns Hopkins University, School of Medicine, Baltimore, Maryland.,General Pediatric and Adolescent Medicine, The Johns Hopkins University, School of Medicine, Baltimore, Maryland
| | - Deborah Gross
- School of Nursing, The Johns Hopkins University, School of Medicine, Baltimore, Maryland
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30
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Sullivan PW, Ghushchyan V, Kavati A, Navaratnam P, Friedman HS, Ortiz B. Health Disparities Among Children with Asthma in the United States by Place of Residence. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 7:148-155. [PMID: 29782937 DOI: 10.1016/j.jaip.2018.05.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 04/08/2018] [Accepted: 05/03/2018] [Indexed: 10/16/2022]
Abstract
BACKGROUND Children residing in poor-urban areas may have greater asthma morbidity. It is unclear whether this is due to individual characteristics such as race and ethnicity or place of residence. OBJECTIVE Assess indicators of control and treatment by residence. METHODS This was a cross-sectional analysis of children (aged 1-17 years) in the 2000-2014 Medical Expenditure Panel Survey (MEPS). Indicators of poor control included use of more than 3 canisters of short-acting beta agonist (SABA) in 3 months, asthma attack, and emergency department (ED) or inpatient (IP) visit during the year. Treatment measures included use of controller medications and a ratio of controller-to-total prescriptions of 0.7 or more. RESULTS There were 15,052 children with asthma in the MEPS 2000-2014 data, reflecting 8.4 million children in 2014. After controlling for covariates, children with asthma residing in poor-urban areas had lower odds of using controller medications (odds ratio [OR] = 0.77), having a controller-to-total ratio of 0.7 or more (OR = 0.75), and reporting an asthma attack (OR = 0.75) and higher odds of having an ED/IP visit (OR = 1.3) compared with those living elsewhere. Black race and Hispanic ethnicity were associated with greater odds of excessive SABA use (OR = 2.11) and ED/IP visits (OR = 2.03) and lower odds of controller-to-total ratio of 0.07 or more (OR = 0.50). CONCLUSIONS Poor-urban residence may be independently associated with asthma control and treatment even after controlling for individual characteristics such as race and ethnicity. Future research is needed to understand the sources of these geographic health disparities to more successfully target public health interventions.
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Affiliation(s)
| | - Vahram Ghushchyan
- University of Colorado, Denver, Colo; American University of Armenia, Yerevan, Armenia
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31
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Teoh L, Mackay IM, Van Asperen PP, Acworth JP, Hurwitz M, Upham JW, Siew WH, Wang CYT, Sloots TP, Neeman T, Chang AB. Presence of atopy increases the risk of asthma relapse. Arch Dis Child 2018; 103:346-351. [PMID: 29021189 DOI: 10.1136/archdischild-2017-312982] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 08/16/2017] [Accepted: 09/11/2017] [Indexed: 01/31/2023]
Abstract
OBJECTIVES To describe the point prevalence of respiratory viruses/atypical bacteria using PCR and evaluate the impact of respiratory viruses/atypical bacteria and atopy on acute severity and clinical recovery in children with hospitalised and non-hospitalised asthma exacerbations. DESIGN This was a prospective study performed during 2009-2011. SETTING The study was performed in the emergency departments of two hospitals. PATIENTS 244 children aged 2-16 years presenting with acute asthma to the emergency departments were recruited. A nasopharyngeal aspirate and allergen skin prick test were performed. MAIN OUTCOME MEASURES The outcomes were divided into (1) acute severity outcomes (Australian National Asthma Council assessment, hospitalisation, Functional Severity Scale, Acute Asthma Score, asthma quality of life questionnaires for parents (PACQLQ) on presentation, asthma diary scores (ADS) on presentation and length of hospitalisation) and (2) recovery outcomes (PACQLQ for 21 days, ADS for 14 days and representation for asthma for 21 days). RESULTS PCR for viruses/atypical bacteria was positive in 81.7% of children (75.1% human rhinovirus, codetection in 14.2%). Mycoplasma pneumoniae and Chlamydophila pneumoniae were rarely detected. The presence of micro-organisms had little impact on acute asthma or recovery outcomes. Children with atopy were significantly more likely to relapse and represent for medical care by day 14 (OR 1.11, 95% CI 1.00 to 1.23). CONCLUSIONS The presence of any viruses is associated with asthma exacerbations but does not appear to influence asthma recovery. In contrast, atopy is associated with asthma relapse. M. pneumoniae and C. pneumoniae are rare triggers of acute asthma in young children.
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Affiliation(s)
- Laurel Teoh
- Department of Paediatrics and Child Health, Centenary Hospital for Women and Children, Canberra, Australian Capital Territory, Australia.,Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Ian M Mackay
- Queensland Paediatric Infectious Diseases Laboratory, The University of Queensland, Brisbane, Queensland, Australia.,Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Peter P Van Asperen
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney Children's Hospitals Network, Westmead, New South Wales, Australia.,Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Jason P Acworth
- Emergency Medicine Department, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
| | - Mark Hurwitz
- Department of Respiratory and Sleep Medicine, The Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - John W Upham
- School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Weng Hou Siew
- Queensland Paediatric Infectious Diseases Laboratory, The University of Queensland, Brisbane, Queensland, Australia
| | - Claire Y T Wang
- Queensland Paediatric Infectious Diseases Laboratory, The University of Queensland, Brisbane, Queensland, Australia.,Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Theo P Sloots
- Queensland Paediatric Infectious Diseases Laboratory, The University of Queensland, Brisbane, Queensland, Australia.,Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Teresa Neeman
- Statistical Consulting Unit, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Anne B Chang
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia.,Respiratory and Sleep Medicine Department, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
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Kranjac AW, Kimbro RT, Denney JT, Osiecki KM, Moffett BS, Lopez KN. Comprehensive Neighborhood Portraits and Child Asthma Disparities. Matern Child Health J 2018; 21:1552-1562. [PMID: 28181157 DOI: 10.1007/s10995-017-2286-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objectives Previous research has established links between child, family, and neighborhood disadvantages and child asthma. We add to this literature by first characterizing neighborhoods in Houston, TX by demographic, economic, and air quality characteristics to establish differences in pediatric asthma diagnoses across neighborhoods. Second, we identify the relative risk of social, economic, and environmental risk factors for child asthma diagnoses. Methods We geocoded and linked electronic pediatric medical records to neighborhood-level social and economic indicators. Using latent profile modeling techniques, we identified Advantaged, Middle-class, and Disadvantaged neighborhoods. We then used a modified version of the Blinder-Oaxaca regression decomposition method to examine differences in asthma diagnoses across children in these different neighborhoods. Results Both compositional (the characteristics of the children and the ambient air quality in the neighborhood) and associational (the relationship between child and air quality characteristics and asthma) differences within the distinctive neighborhood contexts influence asthma outcomes. For example, unequal exposure to PM2.5 and O3 among children in Disadvantaged and Middle-class neighborhoods contribute to asthma diagnosis disparities within these contexts. For children in Disadvantaged and Advantaged neighborhoods, associational differences between racial/ethnic and socioeconomic characteristics and asthma diagnoses explain a significant proportion of the gap. Conclusions for Practice Our results provide evidence that differential exposure to pollution and protective factors associated with non-Hispanic White children and children from affluent families contribute to asthma disparities between neighborhoods. Future researchers should consider social and racial inequalities as more proximate drivers, not merely as associated, with asthma disparities in children.
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Affiliation(s)
- Ashley W Kranjac
- Department of Sociology, Kinder Institute Urban Health Program, Rice University, 6500 Main Street #1020, Houston, TX, 77030, USA.
| | - Rachel T Kimbro
- Department of Sociology, Kinder Institute Urban Health Program, Rice University, 6500 Main Street #1020, Houston, TX, 77030, USA
| | - Justin T Denney
- Department of Sociology, Kinder Institute Urban Health Program, Rice University, 6500 Main Street #1020, Houston, TX, 77030, USA
| | - Kristin M Osiecki
- Department of Public Health, University of Illinois- Springfield, Springfield, IL, USA
| | - Brady S Moffett
- Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Keila N Lopez
- Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
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Malecki KMC, Schultz AA, Bergmans RS. Neighborhood Perceptions and Cumulative Impacts of Low Level Chronic Exposure to Fine Particular Matter (PM 2.5) on Cardiopulmonary Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E84. [PMID: 29316641 PMCID: PMC5800183 DOI: 10.3390/ijerph15010084] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 12/20/2017] [Accepted: 12/29/2017] [Indexed: 11/25/2022]
Abstract
Adverse perceptions of neighborhood safety, aesthetics and quality including access to resources can induce stress and may make individuals more sensitive to cardiopulmonary effects of air pollution exposure. Few studies have examined neighborhood perceptions as important and modifiable non-chemical stressors of the built environment that may exacerbate effects of air pollution on cardiopulmonary health outcomes, particularly among general population based cohorts. This study examined associations between low-level chronic exposure to fine particulate matter (PM2.5) and cardiopulmonary health, and the potential mediating or modifying effects of adverse neighborhood perceptions. Using data from the Survey of the Health of Wisconsin (SHOW), 2230 non-asthmatic adults age 21-74 were included in the analyses. The overall goals of this study were to assess if individuals who experience stress from neighborhood environments in which they live were more sensitive to low levels of fine particular matter (PM2.5 μg/m³). Demographic predictors of air pollution exposure included younger age, non-White race, lower education and middle class income. After adjustments, objective lung function measures (FEV1 and FEV1 to FVC ratio) were the only cardiopulmonary health indicators significantly associated with chronic three-year annual averages of PM2.5. Among all non-asthmatics, a ten unit increase in estimated three year annual average PM2.5 exposure was significantly associated with lower forced expiratory volume (L) in one second FEV1 (β = -0.40 μg/L; 95% CI -0.45, -0.06). Among all individuals, adverse perceptions of the neighborhood built environment did not appear to statistically moderate or mediate associations. However, stratified analysis did reveal significant associations between PM2.5 and lung function (FEV1) only among individuals with negative perceptions and increased reports of neighborhood stressors. These findings included individuals who felt their neighborhoods were poorly maintained (β = -0.82; 95% CI -1.35, -0.28), experienced stress from crime (β = -0.45; 95% CI -0.94, 0.04) or reported neighborhood is not well maintained (β = -1.13, CI -2.04, -0.24). These significant associations were similar for FEV1 to FVC ratio. Multi-pronged approaches addressing both neighborhood built environment aesthetics and air pollution regulation may be necessary to protect vulnerable and susceptible individuals and reduce persistent inequalities.
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Affiliation(s)
- Kristen M C Malecki
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, 610 N. Walnut Street, Madison, WI 53726, USA.
| | - Amy A Schultz
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, 610 N. Walnut Street, Madison, WI 53726, USA.
| | - Rachel S Bergmans
- Department of Psychiatry, School of Medicine, University of Michigan, Ann Arbor, MI 48109, USA.
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Beck AF, Huang B, Wheeler K, Lawson NR, Kahn RS, Riley CL. The Child Opportunity Index and Disparities in Pediatric Asthma Hospitalizations Across One Ohio Metropolitan Area, 2011-2013. J Pediatr 2017; 190:200-206.e1. [PMID: 29144247 PMCID: PMC5708858 DOI: 10.1016/j.jpeds.2017.08.007] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 06/30/2017] [Accepted: 08/03/2017] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To determine whether the Child Opportunity Index (COI), a nationally available measure of relative educational, health/environmental, and social/economic opportunity across census tracts within metropolitan areas, is associated with population- and patient-level asthma morbidity. STUDY DESIGN This population-based retrospective cohort study was conducted between 2011 and 2013 in a southwest Ohio county. Participants included all children aged 1-16 years with hospitalizations or emergency department visits for asthma or wheezing at a major pediatric hospital. Patients were identified using discharge diagnosis codes and geocoded to their home census tract. The primary population-level outcome was census tract asthma hospitalization rate. The primary patient-level outcome was rehospitalization within 12 months of the index hospitalization. Census tract opportunity was characterized using the COI and its educational, health/environmental, and social/economic domains. RESULTS Across 222 in-county census tracts, there were 2539 geocoded hospitalizations. The median asthma-related hospitalization rate was 5.0 per 1000 children per year (IQR, 1.9-8.9). Median hospitalization rates in very low, low, moderate, high, and very high opportunity tracts were 9.1, 7.6, 4.6, 2.1, and 1.8 per 1000, respectively (P < .0001). The social/economic domain had the most variables significantly associated with the outcome at the population level. The adjusted patient-level analyses showed that the COI was not significantly associated with a patient's risk of rehospitalization within 12 months. CONCLUSIONS The COI was associated with population-level asthma morbidity. The details provided by the COI may inform interventions aimed at increasing opportunity and reducing morbidity across regions.
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Affiliation(s)
- Andrew F. Beck
- Division of General and Community Pediatrics, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A,Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Bin Huang
- Division of Biostatistics and Epidemiology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | | | - Nikki R. Lawson
- University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Robert S. Kahn
- Division of General and Community Pediatrics, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Carley L. Riley
- Division of Critical Care Medicine, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
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Louisias M, Phipatanakul W. Managing Asthma in Low-Income, Underrepresented Minority, and Other Disadvantaged Pediatric Populations: Closing the Gap. Curr Allergy Asthma Rep 2017; 17:68. [PMID: 28914405 DOI: 10.1007/s11882-017-0734-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE OF REVIEW In this article, we review current understanding of the epidemiology and etiology of disparities in asthma. We also highlight current and emerging literature on solutions to tackle disparities while underscoring gaps and pressing future directions. RECENT FINDINGS Tailored, multicomponent approaches including the home, school, and clinician-based interventions show great promise. Managing asthma in disadvantaged populations can be challenging as they tend to have disproportionately worse outcomes due to a multitude of factors. However, multifaceted, innovative interventions that are sustainable and scalable are key to improving outcomes.
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Affiliation(s)
- Margee Louisias
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA, USA.,Division of Allergy and Immunology, Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Wanda Phipatanakul
- Division of Allergy and Immunology, Boston Children's Hospital, Boston, MA, USA. .,Harvard Medical School, Boston, MA, USA. .,Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA.
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Ghosh A, Millett C, Subramanian S, Pramanik S. Neighborhood heterogeneity in health and well-being among the elderly in India – Evidence from Study on global AGEing and adult health (SAGE). Health Place 2017; 47:100-107. [DOI: 10.1016/j.healthplace.2017.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Revised: 03/18/2017] [Accepted: 08/01/2017] [Indexed: 01/08/2023]
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Miller GE, Borders AE, Crockett AH, Ross KM, Qadir S, Keenan-Devlin L, Leigh AK, Ham P, Ma J, Arevalo JM, Ernst LM, Cole SW. Maternal socioeconomic disadvantage is associated with transcriptional indications of greater immune activation and slower tissue maturation in placental biopsies and newborn cord blood. Brain Behav Immun 2017; 64:276-284. [PMID: 28434870 PMCID: PMC5493326 DOI: 10.1016/j.bbi.2017.04.014] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 04/17/2017] [Accepted: 04/18/2017] [Indexed: 12/13/2022] Open
Abstract
Children from economically disadvantaged families experience worse cognitive, psychiatric, and medical outcomes compared to more affluent youth. Preclinical models suggest some of the adverse influence of disadvantage could be transmitted during gestation via maternal immune activation, but this hypothesis has not been tested in humans. It also remains unclear whether prenatal interventions can mitigate such effects. To fill these gaps, we conducted two studies. Study 1 characterized the socioeconomic conditions of 79 women during pregnancy. At delivery, placenta biopsies and umbilical blood were collected for transcriptional profiling. Maternal disadvantage was associated with a transcriptional profile indicative of higher immune activation and slower fetal maturation, particularly in pathways related to brain, heart, and immune development. Cord blood cells of disadvantaged newborns also showed indications of immaturity, as reflected in down-regulation of pathways that coordinate myeloid cell development. These associations were independent of fetal sex, and characteristics of mothers (age, race, adiposity, diabetes, pre-eclampsia) and babies (delivery method, gestational age). Study 2 performed the same transcriptional analyses in specimens from 20 women participating in CenteringPregnancy, a group-based psychosocial intervention, and 20 women in traditional prenatal care. In both placenta biopsies and cord blood, women in CenteringPregnancy showed up-regulation of transcripts found in Study 1 to be most down-regulated in conjunction with disadvantage. Collectively, these results suggest socioeconomic disparities in placental biology are evident at birth, and provide clues about the mechanistic origins of health disparities. They also suggest the possibility that psychosocial interventions could have mitigating influences.
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Affiliation(s)
- Gregory E. Miller
- Department of Psychology and Institute for Policy Research, Northwestern University, Evanston IL
| | - Ann E. Borders
- Department of Obstetrics & Gynecology, NorthShore University Health System, University of Chicago Pritzker School of Medicine, Evanston IL
| | - Amy H. Crockett
- Department of Obstetrics & Gynecology, Greenville Hospital System University Medical Center, Greenville SC
| | - Kharah M. Ross
- Department of Psychology and Institute for Policy Research, Northwestern University, Evanston IL
| | - Sameen Qadir
- Department of Obstetrics & Gynecology, NorthShore University Health System, University of Chicago Pritzker School of Medicine, Evanston IL
| | - Lauren Keenan-Devlin
- Department of Obstetrics & Gynecology, NorthShore University Health System, University of Chicago Pritzker School of Medicine, Evanston IL
| | - Adam K. Leigh
- Department of Psychology and Institute for Policy Research, Northwestern University, Evanston IL
| | - Paula Ham
- Department of Psychology and Institute for Policy Research, Northwestern University, Evanston IL
| | - Jeffrey Ma
- Division of Hematology-Oncology, UCLA AIDS Institute, Molecular Biology Institute, Jonsson Comprehensive Cancer Center, Norman Cousins Center, UCLA School of Medicine, Los Angeles CA
| | - Jesusa M.G. Arevalo
- Division of Hematology-Oncology, UCLA AIDS Institute, Molecular Biology Institute, Jonsson Comprehensive Cancer Center, Norman Cousins Center, UCLA School of Medicine, Los Angeles CA
| | - Linda M. Ernst
- Department of Pathology, NorthShore University Health System, University of Chicago Pritzker School of Medicine, Evanston IL
| | - Steve W. Cole
- Division of Hematology-Oncology, UCLA AIDS Institute, Molecular Biology Institute, Jonsson Comprehensive Cancer Center, Norman Cousins Center, UCLA School of Medicine, Los Angeles CA
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Cardet JC, Louisias M, King TS, Castro M, Codispoti CD, Dunn R, Engle L, Giles BL, Holguin F, Lima JJ, Long D, Lugogo N, Nyenhuis S, Ortega VE, Ramratnam S, Wechsler ME, Israel E, Phipatanakul W. Income is an independent risk factor for worse asthma outcomes. J Allergy Clin Immunol 2017; 141:754-760.e3. [PMID: 28535964 DOI: 10.1016/j.jaci.2017.04.036] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 02/17/2017] [Accepted: 04/04/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Socioeconomic status (SES) is associated with asthma morbidity in observational studies, but the factors underlying this association are uncertain. OBJECTIVE We investigated whether 3 SES correlates-low income, low education, and high perceived stress-were independent risk factors for treatment failure and asthma exacerbations in the context of a randomized controlled trial. METHODS The effect of low SES (household income of <$50,000/y and household educational level of less than a Bachelor's degree) and high perceived stress (defined as a score of >20 on a perceived stress scale) on asthma morbidity was analyzed in 381 participants by using Poisson regression models. The primary outcome was treatment failure (defined in the trial protocol as a significant clinical or airflow deterioration), and the secondary outcome was asthma exacerbations requiring systemic corticosteroids. RESULTS Fifty-four percent of participants had a low income, 40% had a low educational level, and 17% had high perceived stress levels. Even after adjusting for race and other important confounders, participants with lower income had higher rates of both treatment failures (rate ratio, 1.6; 95% CI, 1.1-2.3; P = .03) and exacerbations (rate ratio, 1.9; 95% CI, 1.1-3.3; P = .02). Adherence with inhaled corticosteroids was similarly high for both income categories. Education and perceived stress were not significantly associated with either outcome. CONCLUSIONS In the context of a randomized controlled trial, participants with lower income were more likely to experience adverse asthma outcomes independent of education, perceived stress, race, and medication adherence.
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Affiliation(s)
| | - Margee Louisias
- Department of Medicine, Brigham and Women's Hospital, Boston, Mass; the Division of Allergy and Immunology, Boston Children's Hospital, Boston, Mass
| | - Tonya S King
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pa
| | - Mario Castro
- Washington University School of Medicine, St Louis, Mo
| | | | - Ryan Dunn
- National Jewish Health, Denver, Colo
| | - Linda Engle
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pa
| | | | | | - John J Lima
- Nemours Children's Health System, Jacksonville, Fla
| | - Dayna Long
- Department of Pediatrics, University of California at San Francisco's Benioff Children's Hospital at Oakland, Oakland, Calif
| | | | - Sharmilee Nyenhuis
- University of Illinois at Chicago, Chicago, Ill; University of Illinois Hospital & Health Sciences System, Chicago, Ill
| | - Victor E Ortega
- Center for Genomics and Personalized Medicine Research, Wake Forest School of Medicine, Winston-Salem, NC
| | - Sima Ramratnam
- University of Wisconsin Hospital and Clinics, Madison, Wis
| | - Michael E Wechsler
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pa
| | - Elliot Israel
- Department of Medicine, Brigham and Women's Hospital, Boston, Mass
| | - Wanda Phipatanakul
- Department of Medicine, Brigham and Women's Hospital, Boston, Mass; the Division of Allergy and Immunology, Boston Children's Hospital, Boston, Mass.
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Chen E, Miller GE, Shalowitz MU, Story RE, Levine CS, Hayen R, Sbihi H, Brauer M. Difficult Family Relationships, Residential Greenspace, and Childhood Asthma. Pediatrics 2017; 139:peds.2016-3056. [PMID: 28280210 PMCID: PMC5369675 DOI: 10.1542/peds.2016-3056] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/26/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Both the social environment and the physical environment are increasingly recognized as important to childhood diseases such as asthma. This study tested a novel hypothesis: that living in areas high in greenspace may help buffer the effects of difficult family relationships for children with asthma. METHODS A total of 150 children (ages 9-17), physician-diagnosed with asthma, participated in this study. To assess difficulties in parent-child relationships, parents and children completed measures of harsh/inconsistent parenting and parental hostility. Residential greenspace was calculated by using satellite-derived Normalized Difference Vegetation Index with a buffer of 250 m around the residential address. Outcomes included both clinical and biological measures: asthma control and functional limitations, as well as airway inflammation (fractional concentration of exhaled nitric oxide) and glucocorticoid receptor expression in T-helper cells. RESULTS After controlling for potential confounding variables, including family income, child demographics, and child medical variables, few main effects were found. However, interactions between residential greenspace and difficult family relationships were found for asthma control (P = .02), asthma functional limitations (P = .04), airway inflammation (P = .007), and the abundance of glucocorticoid receptor in T-helper cells (P = .05). These interactions were all in a direction such that as the quality of parent-child relationships improved, greenspace became more strongly associated with better asthma outcomes. CONCLUSIONS These findings suggest synergistic effects of positive environments across the physical and social domains. Children with asthma appear to benefit the most when they both live in high greenspace areas and have positive family relationships.
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Affiliation(s)
- Edith Chen
- Institute for Policy Research and Department of Psychology, Northwestern University, Evanston, Illinois;
| | - Gregory E. Miller
- Institute for Policy Research and Department of Psychology, Northwestern University, Evanston, Illinois
| | | | - Rachel E. Story
- Department of Medicine, NorthShore University HealthSystem, Evanston, Illinois; and
| | - Cynthia S. Levine
- Institute for Policy Research and Department of Psychology, Northwestern University, Evanston, Illinois
| | - Robin Hayen
- Institute for Policy Research and Department of Psychology, Northwestern University, Evanston, Illinois
| | - Hind Sbihi
- University of British Columbia, School of Population and Public Health, Vancouver, British Columbia, Canada
| | - Michael Brauer
- University of British Columbia, School of Population and Public Health, Vancouver, British Columbia, Canada
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Meuret AE, Kroll J, Ritz T. Panic Disorder Comorbidity with Medical Conditions and Treatment Implications. Annu Rev Clin Psychol 2017; 13:209-240. [PMID: 28375724 DOI: 10.1146/annurev-clinpsy-021815-093044] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Panic disorder (PD) is unique among the anxiety disorders in that panic symptoms are primarily of a physical nature. Consequently, comorbidity with medical illness is significant. This review examines the association between PD and medical illness. We identify shared pathophysiological and psychological correlates and illustrate how physiological activation in panic sufferers underlies their symptom experience in the context of the fight-or-flight response and beyond a situation-specific response pattern. We then review evidence for bodily symptom perception accuracy in PD. Prevalence of comorbidity for PD and medical illness is presented, with a focus on respiratory and cardiovascular illness, irritable bowel syndrome, and diabetes, followed by an outline for potential pathways of a bidirectional association. We conclude by illustrating commonalities in mediating mechanistic pathways and moderating risk factors across medical illnesses, and we discuss implications for diagnosis and treatment of both types of conditions.
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Affiliation(s)
- Alicia E Meuret
- Department of Psychology, Southern Methodist University, Dallas, Texas 75275;
| | - Juliet Kroll
- Department of Psychology, Southern Methodist University, Dallas, Texas 75275;
| | - Thomas Ritz
- Department of Psychology, Southern Methodist University, Dallas, Texas 75275;
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Lin SX, Younge RG, Kleinman LC. Does receiving care in a medical home reduce racial/ethnic disparities in ED visits among children with asthma in the United States? J Child Health Care 2017; 21:25-35. [PMID: 27422845 DOI: 10.1177/1367493516656825] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Evidence has shown the implementation of medical home model improves care quality and outcomes. However, it is not clear whether receiving care from a medical home has any impact on racial/ethnic disparities in emergency department (ED) use by children with asthma. This study using the US National Survey of Children with Special Health Care Needs, 2009-2010, estimated racial/ethnic disparities in ED use. Generalized liner models were used to examine factors associated with ED use. Racial/ethnic differences in ED use were attenuated after adjusting for socio-economic variables. Ratios of prevalence ratios were calculated to examine the effect modification of medical home on ED use associated with race/ethnicity. The adjusted prevalence ratio of ED use of the Black to non-Hispanic White was 1.51 (95% confidence interval (CI): 1.36-1.67) with medical home and 1.35 (95% CI: 1.24-1.47) without medical home. Among those with care from a medical home Latino children had higher ED use compared with White children. There is no evidence that the self-reported care from a medical home narrows the gaps in ED use between non-Hispanic White and Black or Latino children with asthma.
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Affiliation(s)
- Susan X Lin
- 1 Center for Family and Community Medicine, Columbia University Medical Center, New York, NY, USA
| | - Richard G Younge
- 1 Center for Family and Community Medicine, Columbia University Medical Center, New York, NY, USA
| | - Lawrence C Kleinman
- 2 Departments of Pediatrics and Population Health Sciences and Policy , Icahn School of Medicine at Mount Sinai, New York, NY, USA.,3 Center for Child Health and Policy and Department of Pediatrics UH Rainbow Babies & Children's Hospital and Case Western Reserve University, Cleveland, OH, USA
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Hughes HK, Matsui EC, Tschudy MM, Pollack CE, Keet CA. Pediatric Asthma Health Disparities: Race, Hardship, Housing, and Asthma in a National Survey. Acad Pediatr 2017; 17:127-134. [PMID: 27876585 PMCID: PMC5337434 DOI: 10.1016/j.acap.2016.11.011] [Citation(s) in RCA: 119] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 11/04/2016] [Accepted: 11/12/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE We sought to determine if racial disparities in pediatric asthma are explained by material hardship and home ownership. METHODS We performed a secondary analysis of the 2011 American Housing Survey. A total of 33,201 households with children age 6 to 17 years were surveyed regarding childhood asthma diagnosis and emergency department (ED) visits for asthma (for the youngest child with asthma in the household). Material hardship included poor housing quality, housing crowding, lack of amenities, and no vehicle access. We used logistic regression to determine the association between race, material hardship, and asthma diagnosis or ED visits, adjusting for potential confounders. RESULTS Non-Hispanic black heads of household had a higher odds of having a child diagnosed with asthma in the home compared with non-Hispanic white heads of household (odds ratio, 1.72; 95% confidence interval [CI], 1.50-1.96), and a higher odds of ED visits for asthma (odds ratio, 3.02; 95% CI, 2.29-3.99). The race-asthma association was decreased but not eliminated after adjusting for material hardship and home ownership (ED visit adjusted odds ratio [AOR], 2.07; 95% CI, 1.50-2.86). Poor housing quality was independently associated with asthma diagnosis (AOR, 1.45; 95% CI, 1.28-1.66) and ED visits (AOR, 1.59; 95% CI, 1.21-2.10). Home ownership was associated with a lower odds of asthma-related ED visits (AOR, 0.62; 95% CI, 0.46-0.84). CONCLUSIONS Observed racial disparities in pediatric asthma are lessened after controlling for material hardship. Poor housing quality in particular is strongly associated with asthma morbidity. Policy makers could target improving housing quality as a means of potentially reducing asthma disparities.
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Affiliation(s)
- Helen K Hughes
- Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Md.
| | - Elizabeth C Matsui
- Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Md
| | - Megan M Tschudy
- Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Md
| | - Craig E Pollack
- Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, Md
| | - Corinne A Keet
- Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Md
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Evans-Agnew RA. Asthma Disparity Photovoice: The Discourses of Black Adolescent and Public Health Policymakers. Health Promot Pract 2017; 19:213-221. [PMID: 29161900 DOI: 10.1177/1524839917691039] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Policies in U.S. public schools that address asthma management for Black adolescents may not sufficiently transform sociocultural determinants of disparities. A critical analysis of public health policy maker and adolescent discourses on asthma management using an ecological framework could inform policy development. This study describes the discourses of asthma management disparities of school and other public health policymakers and Black adolescents with asthma during a statewide asthma planning activity. METHOD I conducted a qualitative critical discourse analysis on transcripts and phototexts from a photovoice project with Black adolescents with asthma (n = 19), an asthma-planning meeting with school and public health policymakers (n = 12), and an observation of a photovoice dissemination event that included the same adolescents and policymakers. RESULTS Policymakers did not discuss sociocultural discourses concerning asthma management disparities such as racism and discrimination, but the adolescents did. The only shared discourses between adolescents and policymakers were on the management of indoor environments, health care quality, inadequate housing, and outdoor air pollution. CONCLUSIONS Including Black adolescents in policymaking activities concerning asthma management disparities furthers the identification of differing and shared discourses. School policies should include multilevel strategies that address structural inequities. Photovoice presents an opportunity for including the voice of marginalized youth in policy-planning processes.
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Abstract
Asthma disproportionately affects children who are non-White and of low socioeconomic status. One innovative approach to address these health disparities is to investigate the child's neighborhood environment and factors influencing asthma symptoms. The purpose of this integrative review is to critique research investigating the relationships between neighborhood-level factors and asthma morbidity in urban children. Three literature databases were searched using the terms "asthma," "child," "neighborhood," and "urban." The articles included were organized into six themes within the larger domains of prevalence, physical, and social factors. Literature tables provide in-depth analysis of each article and demonstrate a need for strengthening analysis methods. The current research points to the necessity for a multilevel study to analyze neighborhood-level factors that are associated with increased asthma morbidity in urban children. School nurse clinicians, working within children's neighborhoods, are uniquely positioned to assess modifiable neighborhood-level determinants of health in caring for children with asthma.
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Affiliation(s)
| | - Arlene Butz
- Johns Hopkins School of Medicine, General Pediatric and Adolescent Medicine, Baltimore, MD, USA
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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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Camacho-Rivera M, Kawachi I, Bennett GG, Subramanian SV. Revisiting the Hispanic health paradox: the relative contributions of nativity, country of origin, and race/ethnicity to childhood asthma. J Immigr Minor Health 2016; 17:826-33. [PMID: 24380929 DOI: 10.1007/s10903-013-9974-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
This study examined the relationship between race and Hispanic ethnicity, maternal and child nativity, country of origin and asthma among 2,558 non-Hispanic white and Hispanic children across 65 Los Angeles neighborhoods. A series of two-level multilevel models were estimated to examine the independent effects of race, ethnicity, and country of origin on childhood asthma. Lifetime asthma prevalence was reported among 9% of children, with no significant differences between Hispanics and non-Hispanic whites overall. However, in fully adjusted models, Hispanic children of non-Mexican origin reported higher odds of asthma compared to non-Hispanic white children. A protective nativity effect was also observed among children of foreign born mothers compared to US born mothers. Our study provides evidence in support of the heterogeneity of childhood asthma by Hispanic ethnicity and maternal nativity. These findings suggest moving beyond solely considering racial/ethnic classifications which could mask subgroups at increased risk of childhood asthma.
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Affiliation(s)
- Marlene Camacho-Rivera
- Department of Population Health, North Shore-Long Island Jewish Health System, 175 Community Drive, Room 233, Great Neck, NY, 11021, USA,
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Abstract
For the past quarter century, scientists at the Center for Family Research at the University of Georgia have conducted research designed to promote understanding of normative developmental trajectories among low socioeconomic status African American children, youths, and young adults. In this paper, we describe a recent expansion of this research program using longitudinal, epidemiological studies and randomized prevention trials to test hypotheses about the origins of disease among rural African American youths. The contributions of economic hardship, downward mobility, neighborhood poverty, and racial discrimination to allostatic load and epigenetic aging are illustrated. The health benefits of supportive family relationships in protecting youths from these challenges are also illustrated. A cautionary set of studies is presented showing that some psychosocially resilient youths demonstrate high allostatic loads and accelerated epigenetic aging, suggesting that, for some, "resilience is just skin deep." Finally, we end on an optimistic note by demonstrating that family-centered prevention programs can have health benefits by reducing inflammation, helping to preserve telomere length, and inhibiting epigenetic aging.
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Affiliation(s)
- Gene H. Brody
- Center for Family Research, University of Georgia, Athens, GA 30602-4527 USA
| | - Tianyi Yu
- Center for Family Research, University of Georgia, Athens, GA 30602-4527 USA
| | - Steven R. H. Beach
- Center for Family Research, University of Georgia, Athens, GA 30602-4527 USA
- Department of Psychology, University of Georgia, Athens, GA 30602 USA
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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: 81] [Impact Index Per Article: 10.1] [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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Vo P, Bair-Merritt M, Camargo CA, Eisenberg S, Long W. Individual factors, neighborhood social context and asthma at age 5 years. J Asthma 2016; 54:265-272. [PMID: 27485524 DOI: 10.1080/02770903.2016.1216563] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Childhood asthma is a major public health problem and its development is multifactorial. We examined whether neighborhood cohesion and disorder were associated with caregiver-report of asthma at age 5 years. METHODS This study is a secondary data analysis of the 2011-2012 United States National Survey of Children's Health. Data were available for 4680 children, age 5 years old born at term or preterm with birthweight >2500 g. Neighborhood disorder and cohesion were assessed based on caregivers' responses to validated questionnaires. Child asthma diagnosis was reported by the caregiver. Multivariable logistic regression was used to examine the relationship between these neighborhood factors and caregiver-report of child asthma, while accounting for individual level covariates. RESULTS Approximately two-thirds of the 4680 children were White and lived in households with income >400% of federal poverty line. Asthma was present in 399 (9%) children. Child female sex was associated with reduced risk of caregiver-reported asthma while non-Hispanic Black race and having smokers in the household were independently associated with increased risk in multivariable models. In these models, neighborhood disorder was significantly associated with asthma (adjusted Odds Ratio [aOR] 1.70, 95% Confidence Interval [CI] 1.04-2.78), while neighborhood cohesion was not (aOR 0.93, 95% CI 0.51-1.68). CONCLUSION Even after adjustment for several individual level factors, neighborhood disorder was associated with caregiver-report of asthma in this nationally representative sample of 5-year-old children. Further research is needed to better understand how risk factors at different levels of the socio-ecological framework may interact to affect childhood asthma development.
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Affiliation(s)
- Phuong Vo
- a Department of Pediatrics , Boston Medical Center , Boston , MA , USA
| | | | - Carlos A Camargo
- b Department of Emergency Medicine , Massachusetts General Hospital , Boston , MA , USA
| | - Staci Eisenberg
- c Departments of Pediatrics and Medicine , Brown University/Hasboro , Providence , RI , USA
| | - Webb Long
- d Child Health Associates , Auburn , MA , USA
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O'Lenick CR, Winquist A, Mulholland JA, Friberg MD, Chang HH, Kramer MR, Darrow LA, Sarnat SE. Assessment of neighbourhood-level socioeconomic status as a modifier of air pollution-asthma associations among children in Atlanta. J Epidemiol Community Health 2016; 71:129-136. [PMID: 27422981 DOI: 10.1136/jech-2015-206530] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 02/15/2016] [Accepted: 06/29/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND A broad literature base provides evidence of association between air pollution and paediatric asthma. Socioeconomic status (SES) may modify these associations; however, previous studies have found inconsistent evidence regarding the role of SES. METHODS Effect modification of air pollution-paediatric asthma morbidity by multiple indicators of neighbourhood SES was examined in Atlanta, Georgia. Emergency department (ED) visit data were obtained for 5-18 years old with a diagnosis of asthma in 20-county Atlanta during 2002-2008. Daily ZIP Code Tabulation Area (ZCTA)-level concentrations of ozone, nitrogen dioxide, fine particulate matter and elemental carbon were estimated using ambient monitoring data and emissions-based chemical transport model simulations. Pollutant-asthma associations were estimated using a case-crossover approach, controlling for temporal trends and meteorology. Effect modification by ZCTA-level (neighbourhood) SES was examined via stratification. RESULTS We observed stronger air pollution-paediatric asthma associations in 'deprivation areas' (eg, ≥20% of the ZCTA population living in poverty) compared with 'non-deprivation areas'. When stratifying analyses by quartiles of neighbourhood SES, ORs indicated stronger associations in the highest and lowest SES quartiles and weaker associations among the middle quartiles. CONCLUSIONS Our results suggest that neighbourhood-level SES is a factor contributing vulnerability to air pollution-related paediatric asthma morbidity in Atlanta. Children living in low SES environments appear to be especially vulnerable given positive ORs and high underlying asthma ED rates. Inconsistent findings of effect modification among previous studies may be partially explained by choice of SES stratification criteria, and the use of multiplicative models combined with differing baseline risk across SES populations.
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Affiliation(s)
- Cassandra R O'Lenick
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Andrea Winquist
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - James A Mulholland
- School of Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Mariel D Friberg
- School of Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Howard H Chang
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Michael R Kramer
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Lyndsey A Darrow
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Stefanie Ebelt Sarnat
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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