Behavior problems among inner-city children with asthma: findings from a community-based sample

Biofeedback Training to Increase P co2 in Asthma With Elevated Anxiety: A One-Stop Treatment of Both Conditions?

OBJECTIVE

Anxiety is highly prevalent in individuals with asthma. Asthma symptoms and medication can exacerbate anxiety, and vice versa. Unfortunately, treatments of comorbid anxiety and asthma are largely lacking. A problematic feature common to both conditions is hyperventilation. It adversely affects lung function and symptoms in asthma and anxiety. We examined whether a treatment to reduce hyperventilation, shown to improve asthma symptoms, also improves anxiety in asthma patients with high anxiety.

METHOD

One hundred twenty English- or Spanish-speaking adult patients with asthma were randomly assigned to either Capnometry-Assisted Respiratory Training (CART) to raise P co2 or feedback to slow respiratory rate (SLOW). Although anxiety was not an inclusion criterion, 21.7% met clinically relevant anxiety levels on the Hospital Anxiety and Depression Scale (HADS). Anxiety (HADS-A) and depression (HADS-D) scales, anxiety sensitivity (Anxiety Sensitivity Index [ASI]), and negative affect (Negative Affect Scale of the Positive Affect Negative Affect Schedule) were assessed at baseline, posttreatment, 1-month follow-up, and 6-month follow-up.

RESULTS

In this secondary analysis, asthma patients with high baseline anxiety showed greater reductions in ASI and PANAS-N in CART than in SLOW ( p values ≤ .005, Cohen d values ≥ 0.58). Furthermore, at 6-month follow-up, these patients also had lower ASI, PANAS-N, and HADS-D in CART than in SLOW ( p values ≤ .012, Cohen d values ≥ 0.54). Patients with low baseline anxiety did not have differential outcomes in CART than in SLOW.

CONCLUSIONS

For asthma patients with high anxiety, our brief training designed to raise P co2 resulted in significant and sustained reductions in anxiety sensitivity and negative affect compared with slow-breathing training. The findings lend support for P co2 as a potential physiological target for anxiety reduction in asthma.

TRIAL REGISTRATION

Clinicaltrials.gov Identifier: NCT00975273 .

The relationship between asthma diagnosis and E-Cigarette use among youth and young adults: the mediation effects of anxiety, depression, and impulsivity and the moderation effects of substance use

INTRODUCTION

Youth and young adults with asthma use electronic cigarettes (e-cigarettes) at a higher rate than those without asthma. However, the factors that influence e-cigarette use in this vulnerable population are scarce. Therefore, the study aim was to assess the effects of anxiety, depression, impulsivity, and substance use in the relationship between e-cigarette use and youth and young adults with asthma status.

METHOD

We enrolled youth and young adults (15-25 years old) in Alabama with a clinical diagnosis of asthma (n = 151) or without a diagnosis of any chronic pulmonary disease (n = 132; reference group). Validated questionnaires were administered to collect demographic data and assess susceptibility to e-cigarette use, current use of e-cigarettes, anxiety, depression, impulsivity, and substance use (alcohol and cannabis). We then conducted parallel mediation analyses to test the mediational effects of anxiety, depression, and impulsivity, and moderation analyses to assess the moderation effects of substance use in the relationship between asthma and e-cigarette use.

RESULTS

Susceptibility to e-cigarette use and current use of e-cigarettes were both lower among youth and young adults with asthma. After controlling for covariates, anxiety, depression, and impulsivity were not significant mediators of the relationships between asthma and susceptibility to e-cigarette use and current use of e-cigarettes. However, the frequency of cannabis use in the past 30 days moderated the relationship between asthma and susceptibility to e-cigarette use (Unstandardized beta = - 2.03, p = 0.046), such that more frequent cannabis use was associated with less susceptibility.

CONCLUSION

Among youth and young adults with asthma, cannabis use was associated with reduced susceptibility to e-cigarette use. Longitudinal assessments of this population are needed to better assess the temporal relationship between asthma, comorbid substance use, and e-cigarette use among young people with asthma to avoid pulmonary complications.

Anxiety Disorders and Medical Comorbidity: Treatment Implications

Anxiety disorders are debilitating psychological disorders characterized by a wide range of cognitive and somatic symptoms. Anxiety sufferers have a higher lifetime prevalence of various medical problems. Chronic medical conditions furthermore increase the likelihood of psychiatric disorders and overall dysfunction. Lifetime rates of cardiovascular, respiratory, gastrointestinal, and other medical problems are disproportionately high in anxiety and panic/fear sufferers. The heightened comorbidity is not surprising as many symptoms of anxiety and panic/fear mimic symptoms of medical conditions. Panic disorder specifically is strongly linked to medical conditions due to its salient somatic symptoms, such as dyspnea, dizziness, numbness, chest pain, and heart palpitations, all of which can signal danger and deterioration for chronic disease sufferers. This chapter identifies shared correlates of medical illness and anxiety disorders and evidence for misinterpretation of symptoms as medically relevant and offers an analysis of implications for treatment of both types of conditions. We will concentrate on medical conditions with high associations for anxiety and panic by aspects of symptomatology, specifically neurological disorders (fibromyalgia, epilepsy, cerebral palsy), diabetes, gastrointestinal illness (irritable bowel syndrome, gastroesophageal reflux disease), and cardiovascular and respiratory illnesses (asthma).

Asthma symptoms, interactive physical play and behavioral and academic outcomes in urban children with persistent asthma

OBJECTIVES

Asthma may lead to reduced participation in interactive physical play (IPP). Urban youth with asthma are also at risk for behavioral and academic difficulties. Exploring associations between asthma, IPP and socio-emotional and academic outcomes in children with asthma is important. Study objectives are to: (1) describe IPP participation among school children with persistent asthma; (2) determine if IPP varies with asthma severity (3) determine independent associations of both asthma severity and IPP with socio-emotional and academic outcomes.

METHODS

We analyzed data from children with persistent asthma enrolled in the SB-TEAM trial (Rochester, NY). Caregiver surveys assessed asthma severity, IPP participation (gym ≥3 days/week, running at recess, sports team participation), socio-emotional and academic outcomes. Bivariate and regression analyses assessed relationships between variables.

RESULTS

Of 324 children in the study (59% Black, 31% Hispanic, mean age 7.9), 53% participated in any IPP at school. Compared to those with mild persistent asthma, fewer children with moderate-severe asthma had no limitation in gym (44% vs. 58%, p < .01), and fewer ran at recess (29% vs. 42%, p < .01) or engaged in any IPP (48% vs. 58%, p = .046). Asthma severity was not associated with socio-emotional or academic outcomes. However, children participating in IPP had better positive peer social and task orientation skills, were less shy/anxious, and more likely to meet academic standards (all p < .05). Results were consistent in multivariable analyses.

CONCLUSIONS

Urban children with moderate-severe asthma partake in less IPP, which is associated with socio-emotional and academic outcomes. Further efforts are needed to optimize asthmatic children's participation in IPP.

Physician perceptions of children's coping with asthma are associated with children's psychosocial and disease functioning

INTRODUCTION

Low-income, ethnic minority children disproportionately face poor asthma control, and poorly controlled asthma is related to psychosocial difficulties. This study assessed physician reports of coping in child patients and examined associations between physician reports of child coping and parent and child reports of children's coping, psychosocial, and asthma outcomes (asthma-related stress, emotional and behavioral problems, asthma control, and school missed due to asthma).

METHOD

Physicians reported on coping in their patients (N = 67) ages 5-17 with asthma. Parents reported on child coping, asthma-related stress, emotional and behavioral problems, asthma control, and school missed due to asthma. Children ages 9-17 provided self-reports.

RESULTS

Physicians' reports of primary control coping (e.g., problem solving) and secondary control coping (e.g., cognitive restructuring) were not associated with parent ratings of corresponding coping strategies, but physician reports of disengagement coping (e.g., avoidance) were correlated with parent reports of disengagement and secondary control coping. Physician perceptions of higher child primary control, and lower disengagement, were correlated with less parent-reported stress, better asthma control, and for primary control, fewer partial days of school missed. Physician reports were not correlated with child reports of coping, but physician reports of disengagement were correlated with child-reported conduct problems.

DISCUSSION

Findings suggest that physician reports of child coping provide independent information from parent and child reports of coping, and could be leveraged to identify and intervene with patients who are at elevated risk for poor outcomes. (PsycINFO Database Record

The relationship between helplessness and the child's asthma symptoms: the role of social support

OBJECTIVE

Objectives of this study were to survey parents and children independently regarding feelings of helplessness specific to asthma and to examine the relationship between helplessness and the child's symptom-free days.

METHODS

Parent-child dyads (children 7-12 years) from Rochester, NY were enrolled (November 2011-August 2012) from general pediatric clinics, pulmonary clinics, an Emergency Department, and area youth and asthma programs. Assessments included demographics, symptoms, ratings of helplessness related to asthma and parent social support. A multivariate linear regression was conducted to examine the relationship between feelings of helplessness and symptoms-free days: post hoc analysis assessed the moderating role of social support.

RESULTS

Overall, 107 parent-child dyads enrolled (participation rate: 72%); 104 were included in analysis. Most children were male (58%), 7-9 years (58%) and White (46%). The child's feelings of helplessness scores were positively correlated with symptom-free days indicating less feelings of helplessness as symptom-free days increased (rs = 0.273, p = 0.01). In a stratified analysis, among parents who reported minimal social support (<1 sources of support), child's helplessness scores were positively correlated with symptom-free days (rs = 0.335, p = 0.02). Conversely, among parents reporting >2 supports, no relationship was found (rs = 0.195, p = 0.15).

CONCLUSIONS

This study found less feelings of helplessness among children with asthma as symptom-free days increased. Social support appears to moderate this relationship; however further studies to confirm these findings are needed.

Asthma and adaptive functioning among homeless kindergarten-aged children in emergency housing

BACKGROUND

Children who experience homelessness have elevated rates of asthma, a risk factor for other problems. Purpose. Examine rates of asthma and its relation to health care use and adaptive functioning among young children staying in family emergency shelters.

METHODS

Children and caregivers (N = 138) completed assessments in shelters, including measurement of child cognitive functioning, parent report of child health care service utilization and asthma diagnosis, and teacher report of child school functioning.

RESULTS

Asthma diagnosis was reported for 21% of 4-to-6-year-old children, about twice the national and state prevalences. Children with asthma used more health care services and had worse peer relationships. Asthma did not relate to cognitive test performance or subsequent academic performance, or to other behavior problems in school.

CONCLUSIONS

High rates of asthma remain an important issue for children in emergency family housing, a context with high levels of child risk for toxic stress exposure and developmental problems.

Psychosocial factors and behavioral medicine interventions in asthma

OBJECTIVE

This review examines the evidence for psychosocial influences in asthma and behavioral medicine approaches to its treatment.

METHOD

We conducted a systematic review of the literature on psychosocial influences and the evidence for behavioral interventions in asthma with a focus on research in the past 10 years and clinical trials. Additional attention was directed at promising new developments in the field.

RESULTS

Psychosocial factors can influence the pathogenesis and pathophysiology of asthma, either directly through autonomic, endocrine, immunological, and central nervous system mechanisms or indirectly through lifestyle factors, health behaviors, illness cognitions, and disease management, including medication adherence and trigger avoidance. The recent decade has witnessed surging interest in behavioral interventions that target the various pathways of influence. Among these, self-management training, breathing training, and exercise or physical activation programs have proved particularly useful, whereas other essential or promising interventions, such as smoking cessation, dietary programs, perception and biofeedback training, and suggestive or expressive psychotherapy, require further, more rigorous evaluation. Given the high comorbidity with anxiety and mood disorders, further evaluation of illness-specific cognitive behavior therapy is of particular importance. Progress has also been made in devising community-based and culturally tailored intervention programs.

CONCLUSION

In concert with an essential medication treatment, behavioral medicine treatment of asthma is moving closer toward an integrated biopsychosocial approach to disease management.

The longitudinal relationship between parental reports of asthma and anxiety and depression symptoms among two groups of Puerto Rican youth

OBJECTIVES

This study aims to examine the relationship between parental reports of child asthma and levels and slopes of anxiety and depression symptoms among two contrasting groups of Puerto Rican youth, and to determine whether asthma is a special risk above and beyond parents' reports of other youths' medical conditions.

METHODS

Two probability samples of youth in San Juan and Caguas, Puerto Rico (n=673) and in the south Bronx, New York (n=598), and their caretakers were interviewed in three yearly assessments. Parental reports of their children's asthma during each assessment were used to indicate whether youth had intermittent (PR=34%, NY=23%) or persistent (PR=7%, NY=16%) asthma. Youths' depression and anxiety symptoms were assessed using self reports to the DISC-IV. Information on youths' medical comorbidity was gathered through parental reports.

RESULTS

Multilevel analyses adjusting for comorbid medical conditions indicated that parental reports of youths' intermittent and persistent asthma were related to higher levels, but similar slopes, of anxiety and depression among youth in New York. In Puerto Rico, youth with persistent asthma experienced less improvement in anxiety over time than youth without asthma, but no other associations were found.

CONCLUSION

Having asthma, based on parental reports, represents a risk factor for Puerto Rican youths' internalizing symptoms, even after adjusting for comorbid medical conditions. This risk is more pronounced among youth living in New York, which highlights the importance of considering the social context in which youth develop and minority status when examining associations between physical health risk factors and mental health.

Sleep and allergic disease: a summary of the literature and future directions for research

Atopic diseases, such as asthma and allergic rhinitis, are common conditions that can influence sleep and subsequent daytime functioning. Children and patients with allergic conditions from ethnic minority groups might be particularly vulnerable to poor sleep and compromised daytime functioning because of the prevalence of these illnesses in these groups and the high level of morbidity. Research over the past 10 years has shed light on the pathophysiologic mechanisms (eg, inflammatory mediators) involved in many atopic diseases that can underlie sleep disruptions as a consequence of the presence of nocturnal symptoms. Associations between nocturnal symptoms and sleep and poorer quality of life as a result of missed sleep have been demonstrated across studies. Patients with severe illness and poor control appear to bear the most burden in terms of sleep impairment. Sleep-disordered breathing is also more common in patients with allergic diseases. Upper and lower airway resistance can increase the risk for sleep-disordered breathing events. In patients with allergic rhinitis, nasal congestion is a risk factor for apnea and snoring. Finally, consistent and appropriate use of medications can minimize nocturnal asthma or allergic symptoms that might disrupt sleep. Despite these advances, there is much room for improvement in this area. A summary of the sleep and allergic disease literature is reviewed, with methodological, conceptual, and clinical suggestions presented for future research.

A prospective comparison of moderating relationships among stressors, hopelessness, and internalizing symptoms in low-income urban youth with asthma

There are many risk factors associated with the development of internalizing symptoms in low-income urban youth, and youth with asthma appear to be at greater risk for experiencing stressors in multiple domains. The purpose of the current study was to examine stressors, hopelessness, and the interaction between them, as predictors of trajectories of anxious/depressed and withdrawn symptoms over a 4-year period of adolescence. Participating in the study were 53 youth from Chicago public schools, the majority of whom identified themselves as African American or Latino. Multi-level modeling was used to examine major life events, daily hassles, exposure to violence, poverty, and hopelessness as predictors of both types of symptoms. Major life events and exposure to violence predicted anxious/depressed symptoms but not withdrawn symptoms. Hopelessness predicted both types of symptoms and further interacted with major life events to predict both anxious/depressed and withdrawn symptoms. Hopelessness also moderated the effects of daily hassles on anxious/depressed symptoms and poverty on withdrawn symptoms. Results of this study provide insight into the psychosocial risk factors associated with the experience of asthma in urban adolescents.

A comparison of friendship quality and social functioning among children with perinatally acquired HIV, children with persistent asthma, and healthy children of HIV-positive mothers

OBJECTIVE

To examine the friendships and social expectations of children with perinatally acquired HIV and compare them to children with moderate to severe persistent asthma and healthy children of HIV-positive mothers.

METHODS

70 children (ages 8-14 years) were recruited from pediatric allergy and immunology multidisciplinary clinics and hospital-based HIV-support programming. Children completed measures of friendship quality and interpersonal functioning. Caregivers completed a measure of child psychosocial functioning.

RESULTS

Children with asthma, not HIV, demonstrated poorer indicators of friendship and the most negative social expectations of the three groups. Children with HIV maintained best friendships and rated themselves as socially well-adjusted.

CONCLUSIONS

Comprehensive multidisciplinary services and ancillary supports may have buffered against stressors and facilitated positive psychosocial outcomes in children with HIV. Children with asthma displayed higher disease activity, possibly contributing to poorer outcomes. Results suggest a need to better understand the protective factors that enhance social functioning in children with HIV.

Relationship among asthma knowledge, behavior management and social adaptation in school-age children with asthma in Taiwan

This study examined the relationships between asthma knowledge, behavior management, and social adaptation among school-age children with asthma. A total of 210 school-age asthmatic children and their parents were recruited from a medical hospital in Taiwan. The children completed asthma knowledge and behavior management questionnaires, and their parents completed the Child and Adolescent Adjustment Profile. There was a statistically significant positive correlation between behavior management and social adaptation among asthmatic children. Asthma knowledge and behavior management were positively associated but did not correlate with children's social adaptation. The behavior management of the children acted as a predictor of their social adaptation. These findings suggest that efforts to raise children's asthma knowledge will benefit these individuals in terms of behavior management. The introduction of asthma behavior management plans could facilitate the social adaptation of asthmatic children and, in particular, increase their independence and reduce their withdrawal as well as enhance their self-confidence and self-esteem.

Health-related quality of life (HRQOL) in Latino families experiencing pediatric asthma

The purpose of the present study was to examine health-related quality of life (HRQOL) in Latino children with asthma and their parents. Twenty-six parents completed the Pediatric Asthma Caregivers Quality of Life Questionnaire (PACQLQ), the Health Status and Activities Questionnaire for Children with Asthma (HSAQ) and four subscales from the Family Environment Scale. The results indicated that, overall, neither children with asthma nor their parents showed significant impairments in their HRQOL, though higher illness severity was associated with lower child quality of life and lower parent quality of life related to activity limitations. Other child and family variables, including dimensions of family functioning, did not correlate significantly with HRQOL. However, child and parent HRQOL were significantly associated with each other. This study provides additional context for understanding the experiences of Latino families dealing with pediatric asthma.

Asthma and the achievement gap among urban minority youth

OBJECTIVES

To outline the prevalence and disparities of asthma among school-aged urban minority youth, causal pathways through which poorly controlled asthma adversely affects academic achievement, and proven or promising approaches for schools to address these problems.

METHODS

Literature review.

RESULTS

Asthma is the most common chronic disease affecting youth in the United States; almost 10 million youth under 18 (14%) have received a diagnosis and 6.8 million (9%) have active asthma. Average annual prevalence estimates were approximately 45% higher for Black versus White children (12.8% vs. 8.8%), as were average annual estimates of asthma attacks (8.4% vs. 5.8%). Urban minority youth have highly elevated prevalence of poorly controlled asthma as evidenced by overuse of emergency departments and under-use of efficacious medications. Poorly controlled asthma has functional consequences on cognition, connectedness with school, and absenteeism. Exemplary asthma programs include management and support systems, school health and mental health services, asthma education, healthy school environments, physical education and activity, and coordination of school, family, and community efforts.

CONCLUSIONS

Asthma and, more importantly, poorly controlled asthma are highly and disproportionately prevalent among school-aged urban minority youth, has a negative impact on academic achievement through its effects on cognition, school connectedness, and absenteeism, and effective practices are available for schools to address this problem. To reduce the adverse effects of poorly controlled asthma on learning, a multifaceted approach to asthma control and prevention in which schools can and must play a central role is essential.

Predictors of substance use among black urban adolescents with asthma: a longitudinal assessment

The physical and psychological consequences of asthma, a chronic respiratory disease disproportionately affecting black urban adolescents, may be amplified by substance use, yet studies have not assessed rates or predictors of substance use in this at-risk population. Therefore, this study examined rates of substance use and mental health/ asthma-related predictors of use among 110 black urban adolescents with asthma. Participants completed study questionnaires at baseline and 11 to 14 months post baseline. The mean age of the sample was 15.8 (SD +/- 1.85), 66 (60%) were female, and 82 (74%) of the participants had intermittent/mild persistent asthma. At follow-up, 37 (34%) participants endorsed using at least 1 substance in the past 30 days, including cannabis (n = 18 [16%]), cigarettes (n = 13 [12%]), and/or alcohol (n = 23 [21%]). The substance use variables were dichotomized for analyses (1 = use, 0 = nonuse). Logistic regression results indicated that older age (odds ratio [OR], 1.83; p < .05) was significantly associated with cigarette use and had a marginally significant (p = .06) association with cannabis use at follow-up. Increased anxiety symptoms were significantly associated with alcohol use (OR, 1.12; p < .05) and cannabis use (OR, 0.90; p < .05) at follow-up. Targeting adolescents earlier, those with anxiety difficulties, and those who report early substance initiation may improve prevention/intervention efforts for substance use reduction in this population. Asthma-related factors were not significantly associated with substance use. Future studies should assess the relationship between other asthma-related variables, as well as social and community factors, and substance use among black adolescents with asthma.

Association between childhood asthma and ADHD symptoms in adolescence--a prospective population-based twin study

BACKGROUND

Cross-sectional studies report a relationship between childhood asthma and attention-deficit hyperactivity disorder (ADHD) symptoms, but the mechanisms are yet unclear. Our objective was to investigate the longitudinal link between childhood asthma and the two dimensions of ADHD (hyperactivity-impulsivity, HI, and inattention, IN) in adolescence. We also aimed to explore the genetic and environmental contributions and the impact of asthma medication.

METHODS

Data on asthma, HI and IN, birth weight, socioeconomic status, zygosity, and medication were collected from the Swedish Medical Birth Register and through parental questionnaires at ages 8-9 and 13-14 years on 1480 Swedish twin pairs born 1985-1986. The association between asthma at age 8-9 and ADHD symptoms at age 13-14 was assessed with generalized estimating equations, and twin analyses to assess the genetic or environmental determinants were performed.

RESULTS

Children with asthma at age 8-9 had an almost twofold increased risk of having one or more symptom of HI (OR 1.88, 95% CI 1.18-3.00) and a more than twofold increased risk to have three symptoms or more of HI (OR 2.73, 95% CI 1.49-5.00) at age 13-14, independent of asthma medication. For IN, no significant relationship was seen. Results from twin modeling indicate that 68% of the phenotypic correlation between asthma and HI (r=0.23, 0.04-0.37) was because of genetic influences.

CONCLUSIONS

Our findings suggest that childhood asthma is associated with subsequent development of HI in early adolescence, which could be partly explained by genetic influences. Early strategies to identify children at risk may reduce burden of the disease in adolescence.

Psychosocial Factors in Pediatric Asthma

This review discusses evidence-based perspectives on psychosocial factors in pediatric asthma. Future directions for inquiry and clinical management also are addressed.

Preschoolers with asthma: narratives of family functioning predict behavior problems

This study tested a model predicting behavior symptoms in preschoolers with asthma. Specifically, it examined the role that asthma severity and children's representations of family functioning may play in the development of child behavior problems in a sample of 53 low-income preschoolers. The study included parent report of asthma severity and a narrative story-stem method to assess children's representations of both general and disease-specific family processes. A regression model tested the inclusion of both types of family processes in predicting child internalizing and externalizing behavior. Disease severity and children's family narratives independently predicted children's behavior over and above the combined effects of demographic variables including child age, socioeconomic status, and family structure. Although children's narratives about general family functioning predicted children's behavior, narratives about family response to asthma symptoms did not. Findings support that both disease severity and family functioning are important considerations in understanding children's behavior problems in the context of asthma. Clinical applications of findings may include: (1) Informing family based-assessments to incorporate children's narratives, and (2) A focus on reducing asthma symptoms and strengthening family functioning to prevent or address child behavior problems.

Asthma and behavior in homeless 4- to 7-year-olds

OBJECTIVE

Low-income, urban, ethnic minority children have higher rates of asthma, more severe symptoms, and more management issues, as well as high risk for academic and behavior problems. This study focused on asthma reported in young children who resided in a family emergency homeless shelter. Asthma rates were considered along with their relation to hospitalization and emergency department use and behavior that is important for school success, including cognitive function, conduct, and academic functioning.

METHODS

A total of 104 children (age 4.0-7.5 years) and parents were recruited while residing in an urban emergency homeless shelter for families. Children had no previously identified developmental delays and spoke English proficiently. Parents reported whether the child experienced asthma, as well as emergency department use and hospitalization. Parents and teachers completed measures of child inattention/hyperactivity and behavior problems. Cognitive function of children was directly assessed.

RESULTS

Asthma was reported for 27.9% of children, approximately 3 times the national average. Children with asthma had been hospitalized more often, showed higher levels of inattention/hyperactivity and behavior problems, and evidenced lower academic functioning.

CONCLUSIONS

Young children in homeless family emergency shelters have high rates of asthma and related problems that could lead to higher hospitalization rates, more behavioral problems, and lower academic functioning at school. Screening and treatment of children who stay in emergency family shelters may be particularly important for reducing risks associated with asthma in highly mobile, low-income families.

Sleep-disordered breathing and behaviors of inner-city children with asthma

OBJECTIVE

To explore the relationship between sleep-disordered breathing (SDB) and behavioral problems among inner-city children with asthma.

METHODS

We examined data for 194 children (aged 4-10 years) who were enrolled in a school-based asthma intervention program (response rate: 72%). SDB was assessed by using the Sleep-Related Breathing Disorder Questionnaire that contains 3 subscales: snoring, sleepiness, and attention/hyperactivity. For the current study, we modified the Sleep-Related Breathing Disorder Questionnaire by removing the 6 attention/hyperactivity items. A sleep score of >0.33 was considered indicative of SDB. To assess behavior, caregivers completed the Behavior Problem Index (BPI), which includes 8 behavioral subdomains. We conducted bivariate analyses and multiple linear regression to determine the association of SDB with BPI scores.

RESULTS

The majority of children (mean age: 8.2 years) were male (56%), black (66%), and insured by Medicaid (73%). Overall, 33% of the children experienced SDB. In bivariate analyses, children with SDB had significantly higher (worse) behavior scores compared with children without SDB on total BPI (13.7 vs 8.8) and the subdomains externalizing (9.4 vs 6.3), internalizing (4.4 vs 2.5), anxious/depressed (2.4 vs 1.3), headstrong (3.2 vs 2.1), antisocial (2.3 vs 1.7), hyperactive (3.0 vs 1.8), peer conflict (0.74 vs 0.43), and immature (2.0 vs 1.5). In multiple regression models adjusting for several important covariates, SDB remained significantly associated with total BPI scores and externalizing, internalizing, anxious/depressed, headstrong, and hyperactive behaviors. Results were consistent across SDB subscales (snoring, sleepiness).

CONCLUSIONS

We found that poor sleep was independently associated with behavior problems in a large proportion of urban children with asthma. Systematic screening for SDB in this high-risk population might help to identify children who would benefit from additional intervention.

Screen time use among urban children with asthma

OBJECTIVE

To describe screen time use and factors related to screen time among urban children with persistent asthma.

METHODS

We analyzed data for 224 children (aged 3 to 10 years) with persistent asthma. Parents reported on children's asthma severity, screen time use, and family practices regarding screen time. We asked parents: "On weekdays [and weekends] on average, over a 24-hour period, how many hours of screen time does your child have?" Parents also reported activity limitation due to asthma, and activities their child engaged in during times of activity limitation.

RESULTS

Most children were male (58%), black (65%), and had Medicaid (74%); average screen time was 3.4 hours per day. Most parents (74%) reported that their child had >2 hours of screen time per day, and one-third were concerned that their child had too much screen time. Many children (63%) engaged in screen time activities during activity limitation due to asthma. Children who needed to slow down or stop normal activity due to asthma had more screen time compared with children who didn't need to slow down (3.51 hours vs 2.44 hours, P = .02). Additionally, children who engaged in screen time activities during times of physical limitation had more screen time compared with children who engaged in other activities (3.67 hours vs 2.99 hours, P = .01).

CONCLUSIONS

We found that urban children with asthma, particularly those with activity limitation, have excessive use of screen time. Strategies are needed to avoid activity limitation by improving asthma care and to empower families with alternative strategies to avoid excess screen time.

Environmental tobacco smoke exposure and child behaviors

RATIONALE

Emerging evidence suggests that exposure to environmental tobacco smoke (ETS) may be linked with behavior problems in childhood, but previous research has relied primarily on parent report of exposure, and results are inconclusive.

OBJECTIVES

To investigate the relationship between exposure to ETS and child behavior problems among children with asthma.

METHODS

The sample included 220 children who were enrolled in an asthma intervention trial and regularly exposed to ETS at home. Serum cotinine was used to measure exposure to tobacco smoke, and behavior problems were assessed by parent report on the Behavior Assessment System for Children. Covariates in adjusted analyses included: sex, age, race, asthma severity, asthma medication, maternal education, prenatal tobacco exposure, maternal depression, and Home Observation for Measurement of the Environment score.

RESULTS

Child behavior problems increased with increasing exposure to ETS. A stratified analysis of boys and girls separately indicated higher exposure among girls, but behavior problems were statistically significantly associated with exposure only in boys. Increasing behavior problems included externalizing behavior problems (beta= 2.23, p =.02) such as hyperactivity and aggression, internalizing behavior problems (beta= 2.19, p= .01) such as depression, and behavior symptoms (beta= 2.55, p= .01).

CONCLUSIONS

Among children with asthma, exposure to ETS is related to increased child behavior problems among boys.

Mental, emotional, and social problems among school children with asthma

OBJECTIVES

To use representative population chronic disease and risk factor data to investigate the relationship between asthma and social factors in school-age children.

METHODS

Representative cross-sectional data for children 5 to 15 years of age were collected from 2002 to June 2007 (n = 4,611) in the South Australian Monitoring and Surveillance System (SAMSS) using Computer-Assisted Telephone Interviews (CATI). Univariate and multivariate analyses were conducted to investigate the variables that were associated with asthma among children.

RESULTS

The overall prevalence of self-reported asthma among children 5 to 15 years of age was 18.6% (95% CI = 17.5-19.8). Children with asthma were more likely to have been treated for a mental health problem, have been unhappy at school, have been absent from school in the last month, have fair or poor overall health and well-being, have ongoing pain or chronic illness, and less likely to have a group of friends to play with. Asthma was also more prevalent among males and less likely to occur in children from households where the gross annual income was greater than $AU80,000.

CONCLUSIONS

Children with asthma were more likely to be treated for a mental health problem and demonstrate more negative social outcomes as well as poorer overall health and well-being. Asthma management plans need to be sensitive to these psychosocial factors for adequate care of these vulnerable young patients.

Asma, competência social e transtornos comportamentais em crianças e adolescentes

O objetivo deste estudo foi avaliar competência social e transtornos comportamentais em crianças com asma. Participaram 62 crianças (sete a 16 anos) com asma moderada e grave e um grupo controle, cujos pais responderam à versão brasileira do Child Behavior Checklist. Houve associação entre asma e déficit na competência social global (p=0,000), na competência social associada a atividades (p=0,001) e associada à escola (p=0,010). A gravidade da asma não se mostrou associada à competência social. Houve associação entre transtornos comportamentais e asma, principalmente transtornos internalizantes, como ansiedade e depressão, que não se mostraram associados ao gênero, idade e tipo de asma. Concluiu-se que crianças com asma apresentaram mais alterações na competência social global e competência social relacionada a atividades e escola, quando comparadas ao grupo controle. Apresentaram, ainda, mais transtornos globais e internalizantes, que podem prejudicar seu desenvolvimento, qualidade de vida e o manejo adequado da doença.

Inhaled corticosteroids do not affect behaviour

AIM

To determine whether children with asthma and on inhaled corticosteroids have more behavioural problems, such as aggressiveness and hyperactivity, as compared with healthy controls and with children under medical care because of other disorders.

METHODS

Questionnaires were given to three groups of children: a group of asthmatic children with inhaled corticosteroids (ICS), a group of children attending the ear, nose and throat (ENT) outpatient clinic and the healthy controls. Included were questions about health, medication use, demographical data and about behaviour, including the child behaviour check list (CBCL) and questions about attention deficit hyperactivity disorder (ADHD).

RESULTS

Forty asthmatic children on ICS, 50 children visiting the ENT outpatient clinic and 183 healthy controls were studied. The total CBCL and mean ADHD scores of the children on ICS were 28.1 and 9.1, which were both significantly higher than the scores of the healthy controls (20.4 and 7.1), but not when compared with the ENT outpatient group (26.2 and 8.6). Further analysis revealed statistically significant differences between the ICS group and healthy controls in CBCL-axes. There were, however, no differences between the ENT group and the ICS on one side and the healthy controls on the other.

CONCLUSION

There is a difference in behaviour between healthy children and asthmatic children on ICS, but not when compared with children visiting the ENT department. Although hyperactivity, aggressiveness and anxiety might occur in children on ICS, this is probably caused by individual susceptibility. Being under specialist care can possibly explain behavioural differences between children on ICS and healthy controls.

Environmental tobacco smoke and behaviors of inner-city children with asthma

OBJECTIVE

To explore the relationship between environmental tobacco smoke (ETS) exposure and behavior among inner-city children with significant asthma.

METHODS

We analyzed baseline data for 200 children 4 to 10 years old who were enrolled in an asthma program. Environmental tobacco smoke exposure was measured by the child's salivary cotinine level. Caregivers completed the 28-item Behavior Problem Index (BPI). Positive responses were summed for a total BPI score, and children with scores >14 were considered to have significant behavior problems. We conducted Student t tests and multivariate regression analyses to determine the association of children's cotinine levels with BPI scores.

RESULTS

Overall, 56% of children were male, 65% were black, and 72% had Medicaid. Mean cotinine level was 1.47 ng/mL. Overall, 30% of children had total BPI scores >14. Children with cotinine values >1.47 ng/mL had significantly higher scores compared with children with lower cotinine values on total BPI (12.5 vs 10.2), as well as externalizing (9.0 vs 7.2), antisocial (2.3 vs 1.7), and immature (2.1 vs 1.6) subscales. In a multivariate model, log cotinine remained independently associated with externalizing (P = .04), headstrong (P = .04), and antisocial behavior (P = .04).

CONCLUSIONS

Cotinine levels are independently associated with problem behaviors among this sample of urban children with asthma.

Family psychological factors in relation to children's asthma status and behavioral adjustment at age 4

The objectives of this study were to determine whether family psychosocial factors influenced asthma development by age 4, and whether family factors and early wheezing illness were associated with behavioral adjustment at age 4. Participants were 98 children enrolled in an intervention study at 9-24 months and followed to age 4. Baseline evaluations assessed infants' respiratory illness severity, family psychosocial characteristics, and parental risk factors for asthma development. Active asthma categorization at age 4 utilized both parent report and objective data. Parents completed the Child Behavior Checklist (CBCL). Caregiver single-parent status, a composite of baseline family stresses, and early wheezing illness severity were associated with active asthma at age 4. The contribution of prenatal smoke exposure and early hospitalization to active asthma varied with racial/ethnic group membership. Maternal mental health and family stresses predicted CBCL scores at age 4, whereas early illness severity and hospitalization were unrelated to CBCL scores. CBCL scores were not elevated for children with active asthma at age 4. Family factors consistent with a negative emotional environment were associated with both active asthma and adjustment problems at age 4, suggesting that both outcomes may be influenced by a common factor.

Developmental and behavioral comorbidities of asthma in children

OBJECTIVE

Asthma is the most common chronic childhood illness. Treatment is typically focused on disease management rather than developmental and behavioral comorbidities that may affect quality of life or contribute to poor disease control. The purpose of this study was to explore the prevalence of developmental and behavioral comorbidities of asthma and the role of confounding socioeconomic factors.

METHODS

The first National Survey of Children's Health was the data source for this study. Interviews with parents or guardians were conducted during 2003-2004 to ascertain the physical, emotional, and behavioral health of 102,353 randomly selected children ages 0-17 years. Associations were examined between asthma and rates of developmental and behavioral problems. Logistic regression was used to adjust for potential confounding effects of age, gender, race, income, and parent education on outcomes.

RESULTS

Children with asthma have higher rates of attention-deficit/hyperactivity disorder; diagnoses of depression, behavioral disorders, learning disabilities; and missed school days (all p < .0001). The more severe the asthma is, the higher the rates are of these problems. Children with asthma are bullied more commonly and are more likely to abuse drugs. When socioeconomic factors are controlled for, asthma significantly increases the odds of having developmental, emotional, and behavioral problems.

CONCLUSIONS

Children with asthma, especially severe asthma, are at high risk of developmental, emotional, and behavioral problems. Asthma is independently associated with these problems, although socioeconomic disadvantage adds additional risk. Asthma treatment programs must acknowledge and address these comorbidities to achieve the best overall outcomes for children with this common chronic disease.

Sex, drugs, and rock n' roll: the problems of adolescent cf and asthma

This article reviews recent literature on risky behaviors in adolescents, suggests ways to assess the extent of the problem and proposes intervention for health care providers.