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Tyris J, Putnick DL, Bell EM, McAdam J, Lin TC, Parikh K, Yeung E. Child Opportunity Index Mobility, Recurrent Wheezing, and Asthma in Early Childhood: A Population-Based Prospective Cohort Study. J Pediatr 2024; 272:114121. [PMID: 38815746 PMCID: PMC11375966 DOI: 10.1016/j.jpeds.2024.114121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 05/02/2024] [Accepted: 05/22/2024] [Indexed: 06/01/2024]
Abstract
We prospectively examined associations between mobility in neighborhood opportunity and early childhood recurrent wheezing/asthma. Downward mobility was associated with developing asthma, but not recurrent wheezing, though associations were attenuated after adjusting for family-level socioeconomic status. Elucidating how neighborhoods impact asthma may inform asthma equity initiatives in early childhood.
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Affiliation(s)
- Jordan Tyris
- Division of Hospital Medicine, Children's National Hospital, Washington, DC; Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC; Epidemiology Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD.
| | - Diane L Putnick
- Epidemiology Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Erin M Bell
- Department of Environmental Health Sciences, University at Albany School of Public Health, Albany, NY
| | - Jordan McAdam
- Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD
| | | | - Kavita Parikh
- Division of Hospital Medicine, Children's National Hospital, Washington, DC; Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Edwina Yeung
- Epidemiology Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
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Candelaria MA, Tellerman K, Hutchison H, Silver D, Feigelman S, Endy K, Afkinich J, Wilms Floet AM. The TREE Program: Promoting Positive Early Childhood Experiences During Well-Child Visits. Clin Pediatr (Phila) 2024:99228241258526. [PMID: 38853704 DOI: 10.1177/00099228241258526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
This feasibility study evaluated the developmental coaching TREE (Talk Read Engage Encourage) program for historically marginalized children ages 0 to 2 years, embedded within pediatric visits, examining if TREE could enhance caregiver-child interactions and increase pediatric resident report of competency and self-efficacy in coaching caregivers. Using a quasi-experimental design, a convenience sample (n = 167 families) was recruited (79 intervention; 88 control). Follow-up data were obtained from 45% of families (38 intervention; 38 control), impacted by COVID-19 attendance. Analyses demonstrated significant increases in self-reported Parent Verbal Responsivity (d = 0.68; 95% confidence interval [CI] = 0.17 to 1.18; P = .009) by intervention group caregivers. Intervention pediatric residents reported significant increases in promoting positive caregiver-child interactions and confidence in conveying child development (d = -.73; 95% CI = -1.21 to -0.22; P = .003). The TREE program is a promising practice that operationalizes promotion of relational health and positive early childhood experiences within pediatric primary care.
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Affiliation(s)
- Margo A Candelaria
- Innovations Institute, University of Connecticut School of Social Work, Hartford, CT, USA
| | - Ken Tellerman
- Committee on Emotional Health, Maryland Chapter, American Academy of Pediatrics, Baltimore, MD, USA
| | - Heather Hutchison
- Innovations Institute, University of Connecticut School of Social Work, Hartford, CT, USA
| | | | - Susan Feigelman
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Katherine Endy
- Women's Institute of Torah Seminary & College, Baltimore, MD, USA
| | - Jenny Afkinich
- Collaborative for Implementation Practice, School of Social Work, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Anna Maria Wilms Floet
- Department of Pediatrics, Kennedy Krieger Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Chou YC, Cheng FS, Weng SH, Yen YF, Hu HY. Impact of household income on the risk of overweight and obesity over time among preschool-aged children: a population-based cohort study. BMC Public Health 2024; 24:549. [PMID: 38383321 PMCID: PMC10882872 DOI: 10.1186/s12889-024-18010-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 02/06/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND The temporality of household income level with overweight/obesity in children has not been extensively studied. Little research has been conducted to determine the impact of household income on the risk of childhood overweight/obesity over time. This population-based cohort study aimed to investigate the impact of household income on the risk of overweight/obesity over time among preschool-aged children in Taiwan. METHODS From 2009 to 2018, we recruited 1,482 preschool-aged children ( ≦ 7 y of age) from low-income households and selected age- and sex-matched controls from non-low-income households for comparison; All participants were selected from those who consistently participated in the Taipei Child Development Screening Program and were monitored for overweight/obesity using body mass index (BMI) until December 31, 2018. Low-income households were defined as those with an average monthly disposable income < 60% of the minimum standard of living expense in Taiwan. The primary outcome was childhood overweight or obesity in study participants, defined as BMI (kg/m2) ≥ 85th percentile or ≥ 95th percentile, respectively. The generalized estimating equations (GEE) model was used to determine the impact of low-income households on the risk of overweight/obesity in study participants. RESULTS Over 21,450 person-years of follow-up, 1,782 participants developed overweight /obesity, including 452 (30.5%) and 1,330 (22.4%) children from low- and non-low-income households, respectively. The GEE model showed that the first group had a significantly higher risk of becoming overweight/obese than the other during the follow-up period (adjusted odds ratio [aOR] = 1.44, 95% CI: 1.29-1.60). Moreover, children of foreign mothers had a higher risk of becoming overweight/obese than those of Taiwanese mothers during the follow-up period (aOR = 1.51, 95% CI: 1.24-1.8). The subgroup analysis revealed a significant association between low-income households and an increased risk of overweight/obesity in children aged 2-7 years (P =.01). However, this association was not observed in children aged 0-1 years (P >.999). CONCLUSIONS During the follow-up period, there was a notable correlation between low-income households and an increased risk of preschool-aged children developing overweight or obesity. Implementing health promotion initiatives aimed at reducing overweight and obesity in this demographic is crucial.
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Affiliation(s)
- Yi-Chang Chou
- Department of Education and Research, Taipei City Hospital, No.145, Zhengzhou Rd., Datong Dist., 103212, Taipei, Taiwan
- University of Taipei, Taipei, Taiwan
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Feng-Shiang Cheng
- Department of Education and Research, Taipei City Hospital, No.145, Zhengzhou Rd., Datong Dist., 103212, Taipei, Taiwan
- University of Taipei, Taipei, Taiwan
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shih-Han Weng
- Department of Education and Research, Taipei City Hospital, No.145, Zhengzhou Rd., Datong Dist., 103212, Taipei, Taiwan
- University of Taipei, Taipei, Taiwan
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yung-Feng Yen
- Department of Education and Research, Taipei City Hospital, No.145, Zhengzhou Rd., Datong Dist., 103212, Taipei, Taiwan
- University of Taipei, Taipei, Taiwan
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Section of Infectious Diseases, Taipei City Hospital, Yangming Branch, Taipei, Taiwan
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Hsiao-Yun Hu
- Department of Education and Research, Taipei City Hospital, No.145, Zhengzhou Rd., Datong Dist., 103212, Taipei, Taiwan.
- University of Taipei, Taipei, Taiwan.
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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Renneberg CK, Brund RBK, Heuckendorff S, Gunaseelan A, Kruse LV, Fonager K. Preschool children from lower household incomes experience inequality in asthma treatment: findings from a Danish nationwide cohort study. Eur J Public Health 2024; 34:85-90. [PMID: 37862429 PMCID: PMC10843934 DOI: 10.1093/eurpub/ckad187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND The obligation to pay for asthma medication in a country with universal healthcare might lead to increased asthma exacerbations and inequitable healthcare access for children from low-income households. Thus, the aim of this study was to examine the association between household income and childhood/preschool asthma regarding hospitalization and medication receipt. METHODS In this nationwide register-based cohort study, we encompassed all 3-year-old children residing in Denmark, born between 2000 and 2014, along with their linked parents and followed them until their sixth birthday. Household income was divided into quartiles. Asthma was categorized in two mutually exclusive groups as either the redemption of two prescriptions for asthma medication or receiving a hospital diagnosis. We utilized Poisson regression to estimate the risk ratio (RR). RESULTS The analysis included 834 422 preschool children. The prevalence of asthma dependent on medication alone was 7.3%, while 1.8% of children necessitated asthma-related hospitalization. Income inequality was evident across all income quartiles. Notably, children from the lowest income quartile had a RR of 0.95 (95% CI: 0.92-0.98) of redeeming asthma medication and conversely a RR of 1.18 (95% CI: 1.14-1.23) of asthma-related hospitalization. CONCLUSIONS Despite universal healthcare, income inequality has a dual impact on children from low-income households. They face a diminished risk of redeeming asthma medication and a higher susceptibility to asthma-related hospitalizations indicating an unequal access to healthcare. Prioritizing efforts to reduce childhood health inequalities is crucial. However, further research, particularly qualitative studies, is needed to better comprehend the underlying mechanisms to address the complexities of income inequality.
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Affiliation(s)
| | | | - Signe Heuckendorff
- Department of Social Medicine, Aalborg University Hospital, Aalborg, Denmark
- Psychiatry Region North Jutland, Aalborg, Denmark
| | - Artika Gunaseelan
- Department of Social Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Lisbeth Venø Kruse
- Department of Paediatrics, Aalborg University Hospital, Aalborg, Denmark
| | - Kirsten Fonager
- Department of Social Medicine, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Haraldstad K, Abildsnes E, Bøe T, Vigsnes KL, Wilson P, Mølland E. Health-related quality of life of children from low-income families: the new patterns study. BMC Public Health 2023; 23:2439. [PMID: 38057731 PMCID: PMC10702070 DOI: 10.1186/s12889-023-17335-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 11/25/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Child poverty has been gradually rising, and about 12% of all Norwegian children are living in a state of relative poverty. This study was part of the New Patterns project, which recruits low-income families requiring long-term welfare services. Included families receive integrated welfare services, with the help of a family coordinator. The current study objectives were to explore the associations between HRQoL, demographic variables (age, gender, immigration status) and leisure activities in children and adolescents in low-income families. METHODS A cross-sectional survey was conducted among low-income families. Participating families had children (N = 214) aged 8-18 years.The family had a household income below 60% of the equivalized median population income for three consecutive years and needed long-term welfare services. HRQoL was measured using the KIDSCREEN-27 self-report instrument. Descriptive statistics, including means, standard deviations, and proportions, were calculated, and ordinary least squares regressions were performed, clustering standard errors at the family level. RESULTS Compared with boys, girls reported lower HRQoL on only one out of five dimensions, physical wellbeing. In the regression analysis we found statistically significant positive associations between migrant status and HRQoL on all five dimensions: physical wellbeing, psychological wellbeing, parents and autonomy, peers and social support, and school environment. In addition, age was associated with school environment, and age, gender and participation in leisure activities was associated with better physical wellbeing. CONCLUSIONS Baseline results regarding HRQoL among children and adolescents in low-income families indicate that they have overall good HRQoL, though some participants had low HRQoL scores, especially on the physical and social support dimensions. Children with an immigrant background report higher HRQoL than do children without an immigrant background.
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Affiliation(s)
- Kristin Haraldstad
- Department of Health and Nursing science, Faculty of Health and Sport Science, University of Agder, Agder, Norway.
| | - Eirik Abildsnes
- Department of Psychosocial Health, Faculty of Health and Sport Science, University of Agder, Agder, Norway
- Kristiansand Municipality, Agder, Norway
| | - Tormod Bøe
- Department of psychosocial science, Faculty of Psychology, University of Bergen, Bergen, Norway
- RKBU Vest, NORCE Norwegian Research Center, Bergen, Norway
| | - Kristine L Vigsnes
- Kristiansand Municipality, Agder, Norway
- Department of Nutrition and Public Health, Faculty of Health and Sport Science, University of Agder, Agder, Norway
| | - Philip Wilson
- Institute of Applied Health Science, University of Aberdeen, Aberdeen, Scotland
- Centre for Research and Education in General Practice, University of Copenhagen, Copenhagen, Denmark
| | - Eirin Mølland
- Department of Economics and Finance, School of Business and Law, University of Agder, Agder, Norway
- NORCE, Norwegian Research Centre As, Bergen, Norway
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Zhao Y, Zhao J, Xie R, Zhang Y, Xu Y, Mao J, Yan C, Sun Y. Association between family income to poverty ratio and HPV infection status among U.S. women aged 20 years and older: a study from NHANES 2003-2016. Front Oncol 2023; 13:1265356. [PMID: 37860196 PMCID: PMC10582625 DOI: 10.3389/fonc.2023.1265356] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/20/2023] [Indexed: 10/21/2023] Open
Abstract
Background HPV infection is closely related to the occurrence of cervical cancer and has an important adverse effect on human life and health. This study used data from the NHANES 2003-2016 to investigate the relationship between PIR and HPV infection status among Americans aged 20 and older. Methods The data for this cross-sectional investigation came from the 2003-2016 National Health and Nutrition Examination Survey (NHANES), which included 9580 women who were 20 years of age or older. The linear and nonlinear correlations between PIR and the presence of HPV infection were investigated using multiple linear regression and smooth curve fitting. The stability of the relationship across groups was examined using subgroup analysis and interaction tests. Results There were 2232 impoverished homes and 2543 rich households among the 9580 adult participants aged 20 and above. PIR (ratio of income to poverty) was found to be significantly inversely related to the presence of HPV infection [0.91 (0.89, 0.94)] after adjusting for all other covariates, and the trend persisted even after categorizing PIR into high- and low-income groups (PIR>4 and PIR<1). In addition, significant negative relationships were discovered in subgroup analyses for women aged 25 to 59 [0.90 (0.88, 0.93)], non-Hispanic whites [0.80 (0.70, 0.92)], non-diabetics [0.91 (0.88, 0.94)], and those who had ever engaged in sex [0.91 (0.89, 0.94)]. Conclusions PIR was highly and negatively correlated with the presence of HPV infection in American women aged 20 and older. The results of this study are of great significance for preventing HPV infection and improving the accuracy of HPV screening.
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Affiliation(s)
- Yuan Zhao
- Department of Clinical Laboratory, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Jing Zhao
- Department of Gynecology, Hebei General Hospital, Shijiazhuang, China
| | - Ruijie Xie
- The Affiliated Nanhua Hospital, Hengyang Medical School, University of South China, Hengyang, China
| | - Yu Zhang
- Department of Clinical Laboratory, The First People’s Hospital of Yunnan Province, Kunming, China
| | - Ya Xu
- Department of Clinical Laboratory, The First People’s Hospital of Yunnan Province, Kunming, China
| | - Jing Mao
- Department of Clinical Laboratory, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Cheng Yan
- Department of Clinical Laboratory, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Yi Sun
- Department of Clinical Laboratory, The First People’s Hospital of Yunnan Province, Kunming, China
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Tanaka K, Tsuno K, Tomata Y. Impact of Household Economic and Mothers' Time Affluence on Obesity in Japanese Preschool Children: A Cross-sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6337. [PMID: 37510570 PMCID: PMC10379818 DOI: 10.3390/ijerph20146337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/29/2023] [Accepted: 07/06/2023] [Indexed: 07/30/2023]
Abstract
Although the association between household economic affluence and children's obesity has been reported, the association between mothers' time affluence and obesity remains unclear. We conducted a cross-sectional study using Japanese national survey data (2015). The target population was 2-6-year-old preschool children and their mothers. Subjective household economic affluence and mothers' time affluence were divided into "affluent," "neither," "less affluent," and "non-affluent" groups. Obesity was defined based on the International Obesity Task Force. A logistic regression model was conducted to examine the association between household economic affluence, mothers' time affluence, and children's obesity. A total of 2254 respondents were included in the present analysis. The lower household economic affluence was not significantly associated with higher rates of children's obesity (odds ratio (OR) for the "non-affluent" compared with the "affluent" group was 1.68 (95% CI, 0.93-3.03)). A lower mothers' time affluence was not significantly associated with higher rates of children's obesity (OR for the "non-affluent" compared with the "affluent" group was 1.67 (95% CI, 0.92-3.03)). The prevalence of obesity was not synergistically higher when lower household economic affluence and lower mothers' time affluence were combined.
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Affiliation(s)
- Kotone Tanaka
- Faculty of Health and Social Services, School of Nutrition and Dietetics, Kanagawa University of Human Services, 1-10-1 Heiseicho, Yokosuka 238-8522, Kanagawa, Japan
| | - Kanami Tsuno
- School of Health Innovation, Kanagawa University of Human Services, Research Gate Building TONOMACHI2, 3-25-10 Tonomachi, Kawasaki 210-0821, Kanagawa, Japan
| | - Yasutake Tomata
- Faculty of Health and Social Services, School of Nutrition and Dietetics, Kanagawa University of Human Services, 1-10-1 Heiseicho, Yokosuka 238-8522, Kanagawa, Japan
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Tyris J, Rodean J, Kulesa J, Dixon G, Bhansali P, Gayle T, Akani D, Magyar M, Tamaskar N, Parikh K. Social Risks and Health Care Utilization Among a National Sample of Children With Asthma. Acad Pediatr 2023; 23:130-139. [PMID: 35940571 DOI: 10.1016/j.acap.2022.07.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 07/26/2022] [Accepted: 07/28/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Prior studies using single-center populations have established associations between social risks and health care utilization among children with asthma. We aimed to evaluate associations between social risks and health care utilization among a nationally representative sample of children with asthma. STUDY DESIGN In this cross-sectional study, we utilized the 2018-2019 National Survey of Children's Health to identify children 2 to 17 years old with asthma. Using the Healthy People (HP) 2030 social determinants of health (SDOH) framework, we identified 31 survey items assessing 18 caregiver-identified social risks as exposure variables and classified them into the 5 HP SDOH domains (Economy, Education, Health care, Community, and Environment). Primary outcome was caregiver-reported health care utilization. Associations between individual social risks and total number of SDOH domains experienced with health care utilization were assessed. RESULTS The weighted study population included 8.05 million children, 96% of whom reported ≥1 social risk. Fourteen social risks, spanning all 5 SDOH domains, were significantly associated with increased health care utilization. The 3 risks with the highest adjusted odds ratios (aOR) of health care utilization included: experiencing discrimination (aOR 3.26 [95% confidence interval (CI): 1.75, 6.08]); receiving free/reduced lunch (aOR 2.16, [95% CI 1.57, 2.98]); and being a victim of violence (aOR 2.11, [95% CI 1.11, 4]). Children with risks across more SDOH domains reported significantly higher health care utilization. CONCLUSIONS Among our national population of children with asthma, social risks are prevalent and associated with increased health care utilization, highlighting their potential contribution to pediatric asthma morbidity.
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Affiliation(s)
- Jordan Tyris
- Division of Hospital Medicine (J Tyris, J Kulesa, G Dixon, P Bhansali, T Gayle, D Akani, M Magyar, N Tamaskar, and K Parikh), Children's National Hospital, Washington, DC; Department of Pediatrics (J Tyris, J Kulesa, G Dixon, P Bhansali, T Gayle, D Akani, M Magyar, N Tamaskar, and K Parikh), George Washington University School of Medicine and Health Sciences, Washington, DC.
| | | | - John Kulesa
- Division of Hospital Medicine (J Tyris, J Kulesa, G Dixon, P Bhansali, T Gayle, D Akani, M Magyar, N Tamaskar, and K Parikh), Children's National Hospital, Washington, DC; Department of Pediatrics (J Tyris, J Kulesa, G Dixon, P Bhansali, T Gayle, D Akani, M Magyar, N Tamaskar, and K Parikh), George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Gabrina Dixon
- Division of Hospital Medicine (J Tyris, J Kulesa, G Dixon, P Bhansali, T Gayle, D Akani, M Magyar, N Tamaskar, and K Parikh), Children's National Hospital, Washington, DC; Department of Pediatrics (J Tyris, J Kulesa, G Dixon, P Bhansali, T Gayle, D Akani, M Magyar, N Tamaskar, and K Parikh), George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Priti Bhansali
- Division of Hospital Medicine (J Tyris, J Kulesa, G Dixon, P Bhansali, T Gayle, D Akani, M Magyar, N Tamaskar, and K Parikh), Children's National Hospital, Washington, DC; Department of Pediatrics (J Tyris, J Kulesa, G Dixon, P Bhansali, T Gayle, D Akani, M Magyar, N Tamaskar, and K Parikh), George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Tamara Gayle
- Division of Hospital Medicine (J Tyris, J Kulesa, G Dixon, P Bhansali, T Gayle, D Akani, M Magyar, N Tamaskar, and K Parikh), Children's National Hospital, Washington, DC; Department of Pediatrics (J Tyris, J Kulesa, G Dixon, P Bhansali, T Gayle, D Akani, M Magyar, N Tamaskar, and K Parikh), George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Damilola Akani
- Division of Hospital Medicine (J Tyris, J Kulesa, G Dixon, P Bhansali, T Gayle, D Akani, M Magyar, N Tamaskar, and K Parikh), Children's National Hospital, Washington, DC; Department of Pediatrics (J Tyris, J Kulesa, G Dixon, P Bhansali, T Gayle, D Akani, M Magyar, N Tamaskar, and K Parikh), George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Matthew Magyar
- Division of Hospital Medicine (J Tyris, J Kulesa, G Dixon, P Bhansali, T Gayle, D Akani, M Magyar, N Tamaskar, and K Parikh), Children's National Hospital, Washington, DC; Department of Pediatrics (J Tyris, J Kulesa, G Dixon, P Bhansali, T Gayle, D Akani, M Magyar, N Tamaskar, and K Parikh), George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Nisha Tamaskar
- Division of Hospital Medicine (J Tyris, J Kulesa, G Dixon, P Bhansali, T Gayle, D Akani, M Magyar, N Tamaskar, and K Parikh), Children's National Hospital, Washington, DC; Department of Pediatrics (J Tyris, J Kulesa, G Dixon, P Bhansali, T Gayle, D Akani, M Magyar, N Tamaskar, and K Parikh), George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Kavita Parikh
- Division of Hospital Medicine (J Tyris, J Kulesa, G Dixon, P Bhansali, T Gayle, D Akani, M Magyar, N Tamaskar, and K Parikh), Children's National Hospital, Washington, DC; Department of Pediatrics (J Tyris, J Kulesa, G Dixon, P Bhansali, T Gayle, D Akani, M Magyar, N Tamaskar, and K Parikh), George Washington University School of Medicine and Health Sciences, Washington, DC
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Nanishi M, Chandran A, Li X, Stanford JB, Alshawabkeh AN, Aschner JL, Dabelea D, Dunlop AL, Elliott AJ, Gern JE, Hartert T, Herbstman J, Hershey GKK, Hipwell AE, Karagas MR, Karr CJ, Leve LD, Litonjua AA, McEvoy CT, Miller RL, Oken E, O’Shea TM, Paneth N, Weiss ST, Wright RO, Wright RJ, Carroll KN, Zhang X, Zhao Q, Zoratti E, Camargo CA, Hasegawa K. Association of Severe Bronchiolitis during Infancy with Childhood Asthma Development: An Analysis of the ECHO Consortium. Biomedicines 2022; 11:23. [PMID: 36672531 PMCID: PMC9855570 DOI: 10.3390/biomedicines11010023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 12/13/2022] [Indexed: 12/25/2022] Open
Abstract
Objective: Many studies have shown that severe (hospitalized) bronchiolitis during infancy is a risk factor for developing childhood asthma. However, the population subgroups at the highest risk remain unclear. Using large nationwide pediatric cohort data, namely the NIH Environmental influences on Child Health Outcomes (ECHO) Program, we aimed to quantify the longitudinal relationship of bronchiolitis hospitalization during infancy with asthma in a generalizable dataset and to examine potential heterogeneity in terms of major demographics and clinical factors. Methods: We analyzed data from infants (age <12 months) enrolled in one of the 53 prospective cohort studies in the ECHO Program during 2001−2021. The exposure was bronchiolitis hospitalization during infancy. The outcome was a diagnosis of asthma by a physician by age 12 years. We examined their longitudinal association and determined the potential effect modifications of major demographic factors. Results: The analytic cohort consisted of 11,762 infants, 10% of whom had bronchiolitis hospitalization. Overall, 15% subsequently developed asthma. In the Cox proportional hazards model adjusting for 10 patient-level factors, compared with the no-bronchiolitis hospitalization group, the bronchiolitis hospitalization group had a significantly higher rate of asthma (14% vs. 24%, HR = 2.77, 95%CI = 2.24−3.43, p < 0.001). There was significant heterogeneity by race and ethnicity (Pinteraction = 0.02). The magnitude of the association was greater in non-Hispanic White (HR = 3.77, 95%CI = 2.74−5.18, p < 0.001) and non-Hispanic Black (HR = 2.39, 95%CI = 1.60−3.56; p < 0.001) infants, compared with Hispanic infants (HR = 1.51, 95%CI = 0.77−2.95, p = 0.23). Conclusions: According to the nationwide cohort data, infants hospitalized with bronchiolitis are at a higher risk for asthma, with quantitative heterogeneity in different racial and ethnic groups.
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Affiliation(s)
- Makiko Nanishi
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Aruna Chandran
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Xiuhong Li
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Joseph B. Stanford
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT 84112, USA
| | - Akram N. Alshawabkeh
- Department of Civil and Environmental Engineering, Northeastern University, Boston, MA 02115, USA
| | - Judy L. Aschner
- Departments of Pediatrics, Hackensack Meridian School of Medicine, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Dana Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Anne L. Dunlop
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA 30307, USA
| | - Amy J. Elliott
- Avera Research Institute & Department of Pediatrics, University of South Dakota School of Medicine, Sioux Falls, SD 57069, USA
| | - James E. Gern
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI 53726, USA
| | - Tina Hartert
- Departments of Medicine and Pediatrics, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Julie Herbstman
- Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY 10027, USA
| | - Gurjit K. Khurana Hershey
- Division of Asthma Research, Cincinnati Children’s Hospital, Department of Pediatrics, University of Cincinnati, Cincinnati, OH 45221, USA
| | - Alison E. Hipwell
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Margaret R. Karagas
- Department of Epidemiology, Geisel School of Medicine, Dartmouth College, Hanover, NH 03756, USA
| | - Catherine J. Karr
- Department of Epidemiology, University of Washington, Seattle, WA 98195, USA
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA 98195, USA
- Department of Pediatrics, University of Washington, Seattle, WA 98195, USA
| | - Leslie D. Leve
- Prevention Science Institute, University of Oregon, Eugene, OR 97403, USA
| | - Augusto A. Litonjua
- Division of Pediatric Pulmonary Medicine, Department of Pediatrics, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Cindy T. McEvoy
- Department of Pediatrics, Oregon Health & Science University, Portland, OR 97239, USA
| | - Rachel L. Miller
- Division of Clinical Immunology, Department of Medicine, Icahn School of Medicine, New York, NY 10029, USA
| | - Emily Oken
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, MA 02215, USA
| | - T. Michael O’Shea
- Division of Neonatal-Perinatal Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27559, USA
| | - Nigel Paneth
- Departments of Epidemiology and Biostatistics and Pediatrics and Human Development, Michigan State University, College of Human Medicine, East Lansing, MI 49503, USA
| | - Scott T. Weiss
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Robert O. Wright
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Rosalind J. Wright
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Kecia N. Carroll
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Xueying Zhang
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Qi Zhao
- Department of Preventive Medicine, The University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Edward Zoratti
- Department of Medicine, Henry Ford Health, Detroit, MI 48202, USA
| | - Carlos A. Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Kohei Hasegawa
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
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10
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Mutic AD, Mauger DT, Grunwell JR, Opolka C, Fitzpatrick AM. Social Vulnerability Is Associated with Poorer Outcomes in Preschool Children With Recurrent Wheezing Despite Standardized and Supervised Medical Care. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY: IN PRACTICE 2022; 10:994-1002. [PMID: 35123099 PMCID: PMC9007879 DOI: 10.1016/j.jaip.2021.12.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 12/13/2021] [Accepted: 12/31/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Social determinants of health are associated with disparate asthma outcomes in school-age children. Social determinants have not been studied in preschool children with recurrent wheezing. OBJECTIVE We hypothesized that preschool children with recurrent wheezing at highest risk of social vulnerability would have more frequent symptoms and exacerbations when followed over 1 year, despite receiving standardized and supervised asthma care. METHODS A multicenter population of adherent preschool children receiving standardized and supervised care for wheezing was stratified by a composite measure of social vulnerability based on individual-level variables. Primary outcomes included days with upper respiratory infections and days with asthma symptom flares. Other outcomes included symptom scores during upper respiratory infections and respiratory symptom flare days, exacerbation occurrence, quality of life during the exacerbation, and hospitalization. RESULTS Preschool children at highest risk of social vulnerability did not have more frequent upper respiratory infections, respiratory symptoms, or exacerbations, but instead had more severe symptoms during upper respiratory infections and respiratory flare days, as well as more severe exacerbations with significantly poorer caregiver quality of life. Children at highest risk of social vulnerability also lived in poorer housing conditions with differing exposures and self-reported triggers. CONCLUSIONS Individual-level social determinants of health reflecting social vulnerability are associated with poorer outcomes in preschool children with recurrent wheezing despite access to supervised and standardized care. Comprehensive assessment of social determinants of health is warranted in even the youngest children with wheezing, because mitigation of these social inequities is an essential first step toward improving outcomes in pediatric patients.
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Affiliation(s)
- Abby D Mutic
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Ga
| | - David T Mauger
- Division of Biostatistics and Bioinformatics, Pennsylvania State University, Hershey, Pa
| | - Jocelyn R Grunwell
- Department of Pediatrics, Emory University, Atlanta, Ga; Division of Pediatric Critical Care Medicine, Children's Healthcare of Atlanta, Atlanta, Ga
| | - Cydney Opolka
- Division of Pediatric Critical Care Medicine, Children's Healthcare of Atlanta, Atlanta, Ga
| | - Anne M Fitzpatrick
- Department of Pediatrics, Emory University, Atlanta, Ga; Division of Pediatric Pulmonology, Children's Healthcare of Atlanta, Atlanta, Ga.
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11
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Cason-Wilkerson R, Scott SG, Albright K, Haemer M. Exploration of Changes in Low-Income Latino Families’ Beliefs about Obesity, Nutrition, and Physical Activity: A Qualitative Post-Intervention Study. Behav Sci (Basel) 2022; 12:bs12030073. [PMID: 35323392 PMCID: PMC8945531 DOI: 10.3390/bs12030073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/07/2022] [Accepted: 03/03/2022] [Indexed: 11/21/2022] Open
Abstract
Objective: To investigate changes in beliefs around obesity, nutrition, and physical activity among low-income majority Latino families who participated in a community-based family-inclusive obesity intervention. Methods: Six focus groups were conducted with a predominately Latino low-income population, who completed the Healthy Living Program (HeLP). Two groups were conducted in English and four groups were conducted in Spanish, and were recorded, translated, transcribed, and analyzed for thematic content. Two coders independently coded transcripts then reflexive team analysis with three members was used to reach consensus. Results: Thirty-seven caregivers representing thirty-three families participated in focus groups. A number of themes emerged around changes in beliefs about obesity, nutrition, and physical activity (PA) as a result of the HeLP curriculum. Regarding obesity, the themes that emerged focused on the acceptability of children being overweight and the importance of addressing weight at an early age. Changes in beliefs regarding nutrition emerged, noting changes in the use of food as a reward, the multiple benefits of a healthy diet, and for some participants change in their beliefs around the adaptability of traditional foods and habits. Regarding physical activity, themes emerged around the difficulty of engaging in PA due to unsafe conditions and finding creative indoor and outdoor activities with whole family participation and becoming aware of the benefits of PA. Conclusions: Parental changes in beliefs about obesity, nutrition, and physical activity as a result of a family-inclusive weight management program in a population of low-income predominately Latino families can aid and inform the development of future weight management programs for this population.
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Affiliation(s)
- Rochelle Cason-Wilkerson
- Section of Nutrition, Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA;
- Correspondence:
| | | | - Karen Albright
- Department of Internal Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA;
| | - Matthew Haemer
- Section of Nutrition, Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA;
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