The relationship of health insurance to the diagnosis and management of asthma and respiratory problems in children in a predominantly Hispanic urban community

Biomarkers of organophosphate insecticides exposure and asthma in general US adults: findings from NHANES 1999-2018 data

The limited evidence linking exposure to organophosphate insecticides (OPIs) and asthma in the general population prompted us to investigate this association. Our study focused on US adults and utilized representative samples from the National Health and Nutrition Examination Survey (NHANES). From the 7 NHANES waves (1999-2018), we detected OPIs exposure using the urinary concentrations of six metabolites of dialkyl phosphates (DAPs). To evaluate the relationship between these OPIs and asthma, we employed three statistical methods: survey-multivariable logistic regression (SMLR), generalized weighted quantile sum (WQS) regression, and Bayesian kernel machine regression (BKMR). Stratified analyses were done based on the relevant variable subgroups, and sensitivity analyses were carried out to evaluate the robustness of findings. A total of 6009 adults aged from 20 to 85 years old, representing the 313.5 million adults in the non-institutionalized US population, were included in our analyses. Among them, 842 participants were determined as asthma patients with an age-adjusted prevalence of 14.2%. Our results showed that dimethyl phosphate (DMP) (adjusted odd ratio (AOR) = 1.471, 95% CI: 1.086, 1.993), diethyl phosphate (DEP) (AOR = 1.453, 95% CI: 1.118, 1.888), dimethyl thiophosphate (DMTP) (AOR = 1.454, 95% CI: 1.071, 1.973), and dimethyl dithiophosphate (DMDTP) (AOR = 1.478, 95% CI: 1.119, 1.953) had a positive correlation with asthma in adults. This association was stronger in females, non-Hispanic White populations and those with a small amount of physical activity. Our study findings indicated that exposure to OPIs may elevate the risk of asthma in US general adults. Specifically, females, individuals from non-Hispanic White backgrounds, and those with lower levels of physical activity are more susceptible to developing asthma when exposed to OPIs.

Short or Long End of the Lever? Associations between Provider Communication of the "Asthma-Action Plan" and Outpatient Revisits for Pediatric Asthma

BACKGROUND

At the Children's Hospital of Georgia (CHOG), we found that outpatient revisits for pediatric asthma were significantly above national norms. According to the NIH, costly hospital revisits for asthma can be prevented through guidelines-based self-management of asthma, central to which, is the use of a written Asthma-Action Plan (AAP).

PURPOSE

The asthma services literature has emphasized the role of the healthcare provider in promoting asthma self-management using the AAP, to prevent hospital revisits. On the other hand, the asthma policy literature has emphasized the need for community-based interventions to promote asthma self-management. A gap remains in understanding the extent of leverage that healthcare providers may have in preventing hospital revisits for asthma, through effective communication of AAP in the outpatient setting. Our study sought to address this gap.

METHODS

We conducted a 6-month intervention to implement "patient-and-family-centered communication of the AAP" in CHOG outpatient clinics, based on the "change-management" theoretical framework. Provider communication of AAP was assessed through a survey of "Parent Understanding of the Child's AAP." A quasi-experimental approach was used to measure outpatient revisits for pediatric asthma, pre- and post-intervention.

RESULTS

Survey results showed that provider communication of the AAP was unanimously perceived highly positively by parents of pediatric asthma patients, across various metrics of patient-centered care. However, there were no statistically significant differences in outpatient "revisit behavior" for pediatric asthma between pre- and post-intervention periods after controlling for several demographic variables. Additionally, revisits remained significantly above national norms.

CONCLUSIONS

Results suggest limited potential of "effective provider communication of AAP," in reducing outpatient revisits for pediatric asthma; and indicate need for broader community-based interventions to address patient life variables impacting self-management and hospital revisits for pediatric asthma. Findings suggest need for a revised "socio-ecological" theoretical framework, and also provide insight into various policy, research, and practice implications for asthma management and control.

Biomarkers of Insecticide Exposure and Asthma in Children: A National Health and Nutrition Examination Survey (NHANES) 1999-2008 Analysis

Pesticide exposure is a potential risk factor for increased asthma prevalence among children. The authors used National Health and Nutrition Examination Survey (1999-2008) biomarker data to evaluate dialkylphosphate (DAP) urinary concentrations, serum dichlorodiphenyldichloroethylene (DDE), and asthma among school-aged children (Mexican American, Non-Hispanic Black, Non-Hispanic White). Poisson logistic regression included age, sex, nativity, poverty index ratio, tobacco smoke exposure, and body mass index covariates. No association was found between DAP (N=2,777) and asthma outcomes; adverse effect of DDE (N=940) was suggested for Current Wheeze. Subgroup analyses identified positive associations with some asthma outcomes among Non-Hispanic Blacks, whereas inverse associations were identified among Mexican Americans. Results support previous associations observed among children's DDE exposure and wheeze. Characterization of risk factors for pesticide exposure and disease recognition among Mexican Americans is needed.

Racial and ethnic differences in the management of childhood asthma in the United States

OBJECTIVES

We examined racial and ethnic differences in the management of childhood asthma in the United States and the extent that care conformed to clinical best practices.

METHODS

Two years of pooled data from the National Health Interview Survey were analyzed using logistic regression. The sample included all children between ages 2 and 17 years who had asthma currently and had been diagnosed with asthma by a doctor or health professional (n = 1757; 465 African-American, 212 Mexican-American, 190 Puerto Rican and other Hispanic, 806 white, non-Hispanic, and 84 children of other and multiple races and ethnicities).

RESULTS

African-American children with asthma were significantly less likely than white, non-Hispanic children to have taken preventive asthma medication, but more likely to have had an asthma management plan. Mexican-American and Puerto Rican and other Hispanic children did not differ significantly from white, non-Hispanic children in either receiving preventive asthma medication or having an asthma management plan. Caregivers of African-American and Puerto Rican and other Hispanic children were more likely to report that they or their child had taken a course or class on how to manage their child's asthma. We did not find racial or ethnic differences in the extent children used quick-relief asthma medication or received advice about reducing asthma triggers in their home, school, or work environments.

CONCLUSIONS

This work highlights a need for more research on racial and ethnic differences in asthma management. Implications for public health responses and racial and ethnic disparities in asthma morbidity are discussed.

Understanding sibilancias (wheezing) among Mexican American parents

BACKGROUND

Asthma is one of the most common pediatric chronic diseases in the United States; however, prevalence varies across Latino ethnicities, such as Mexican Americans (MAs). Linguistic and cultural issues may contribute to difficulties in diagnosis.

METHODS

We conducted a qualitative study to assess the comprehension of common words used in a validated asthma questionnaire. The study sample consisted of 40 MA Spanish-speaking parents of 2- to 18-year-old children, with and without asthma, at a community health clinic.

RESULTS

Regardless of their child's asthma status, the majority of parents (12 [80%] with non-asthmatic children; 16 [64%] with asthmatic children) did not understand common Spanish words used in clinical settings to identify asthma (e.g., wheezing and whistling). Instead, parents used physical symptoms and sounds to describe asthma.

CONCLUSION

This exploratory study demonstrates MA parents' limited comprehension of common words used in clinical settings to identify asthma. Future research should examine tools that incorporate visual and auditory descriptions of asthma.

A comparison of medical and dental outcomes for Medicaid-insured and uninsured Medicaid-eligible children: a U.S. population-based study

BACKGROUND

In a population-based study of Medicaid-eligible children, the authors described and compared sociodemographic attributes, medical and dental health care utilization, and health status between Medicaid-insured and uninsured Medicaid-eligible children.

METHODS

The authors analyzed data from 2,491 poor Medicaid-eligible children 2 to 16 years of age who participated in the 1999-2004 National Health and Nutrition Examination Survey. They quantified the association of medical and dental health care utilization, health status and treatment needs with Medicaid insurance status by using multivariable logistic regression modeling, taking into account the complex survey design and sample weights.

RESULTS

Approximately 40 percent of Medicaid-eligible children were uninsured. Medicaid-insured children were more likely to have an annual physician visit but no more or less likely to have good general or oral health, asthma or dental caries, or treatment needs than were uninsured Medicaid-eligible children. Medicaid-insured older children (9-16 years old) were more likely to have an annual dentist visit than were uninsured Medicaid-eligible older children.

CONCLUSIONS

Children with Medicaid coverage were more likely to use health care services but no more or less likely to have good general health, good oral health, asthma treatment needs or dental treatment needs.

PRACTICE IMPLICATIONS

To improve health care use, more poor children need to be enrolled in Medicaid.

State of childhood asthma and future directions conference: overview and commentary

The Merck Childhood Asthma Network, Inc conference titled "State of Childhood Asthma and Future Directions: Strategies for Implementing Best Practices" was held December 13 to 14, 2006. Here we summarize the presentations and recommendations for systems approaches from that conference and discuss current asthma care.

Parental language and asthma among urban Hispanic children

BACKGROUND

Many Hispanics in the United States have limited English proficiency and prefer communicating in Spanish. Language barriers are known to adversely affect health care quality and outcomes.

OBJECTIVE

We explored the relationship between parent language preference in a Hispanic population and the likelihood that a child with symptoms receives a diagnosis of asthma.

METHODS

We conducted a school-based survey in 105 Chicago public and Catholic schools. Our sample included 14,177 Hispanic children 6 to 12 years of age with a parent who completed an asthma survey. Outcomes of diagnosed asthma and possible asthma (asthma symptoms without diagnosis) were assessed by using the Brief Pediatric Asthma Screen Plus instrument.

RESULTS

Overall, 12.0% of children had diagnosed asthma, and 12.7% had possible asthma. Parents of children at risk who completed the survey in English reported higher rates of asthma diagnosis compared with parents who completed it in Spanish (55.2% vs 36.3%, P < .001). Predictors of asthma diagnosis were child sex, parental language preference, parental asthma status, and other household members with asthma.

CONCLUSIONS

Parental language preference might be an important characteristic associated with childhood asthma diagnosis. Whether language itself is the key factor or the fact that language is a surrogate for other attributes of acculturation needs to be explored.

CLINICAL IMPLICATIONS

Our findings suggest that estimates of asthma among Hispanic schoolchildren might be low because of underdiagnosis among children whose parents prefer communicating in Spanish.

Asthma, body mass, gender, and Hispanic national origin among 517 preschool children in New York City

BACKGROUND

Striking differences in asthma prevalence have been reported among Hispanic adults and children living in different cities of the USA. Prevalence is highest among those of Puerto Rican and lowest among those of Mexican origin. We hypothesized that body size would mediate this association.

METHODS

Parents of children in New York City Head Start programs completed a questionnaire including demographic factors, health history, a detailed history of respiratory conditions, lifestyle, and home environment. Children's height and weight were measured in home visits. Logistic regression was used to model the association of asthma with body mass index percentile (<85th percentile, gender/age specific vs>or=85th percentile, gender/age specific), national origin, and other factors.

RESULTS

Of 517 children at mean age of 4.0 +/- 0.6 years, 34% met the study criteria for asthma, and 43% were above the 85th percentile. Asthma was strongly associated with non-Mexican national origin, male gender, allergy symptoms, and maternal asthma, and marginally with body size. The odds of asthma among boys of non-Mexican origin was 5.9 times that among boys of Mexican origin [95% confidence interval (CI): 2.9-12.2]; the comparable odds ratio (OR) among girls was 1.8 (95% CI: 0.9-3.6). Body mass was associated with asthma among girls [OR = 2.0 (95% CI: 1.1-3.7)], but not boys [OR = 1.4 (95% CI: 0.8-2.6)].

CONCLUSIONS

The association of asthma with both body mass and national origin was gender-specific among the children in our study. Ours is one of the first studies to report on pediatric asthma in different Hispanic populations in the same city, by gender.

Does Medicaid improve utilization of medical and dental services and health outcomes for Medicaid-eligible children in the United States?

BACKGROUND

Data are lacking to support the contention that Medicaid services improve utilization of healthcare services and result in better health.

OBJECTIVE

To compare sociodemographic, utilization of healthcare services and health status characteristics among Medicaid-eligible children.

METHODS

The third National Health and Nutrition Examination Survey included 2821 children 2-16 years of age eligible for Medicaid. The main outcome measures are annual physician visit, annual dentist visit, general health status, oral health status, asthma (second most common childhood disease), dental caries (most common childhood disease), asthma treatment needs, and dental treatment needs. We quantified the association of these outcome measures with Medicaid insurance status and sociodemographic status using multiple logistic regression modeling, taking into account the complex survey design and sample weights.

RESULTS

Among Medicaid-eligible children, 27% were uninsured. Among uninsured Medicaid-eligible children, 62% had an annual physician visit, 32% had an annual dentist visit, 10% needed asthma treatment, and 57% needed dental treatment. Among insured Medicaid-eligible children, 81% had an annual physician visit, 39% had an annual dentist visit, 13% needed asthma treatment, and 42% needed dental treatment. After simultaneously taking into account other characteristics, uninsured Medicaid-eligible children were more likely to not have an annual physician visit (OR(NoMDvisit) = 2.21; 1.26-3.90), and to need dental treatment (OR(DentalNeed) = 1.57; 1.13-2.18).

CONCLUSIONS

This USA population-based study found disparities exist within Medicaid's services between utilization of dental and medical services. Medicaid insurance improved utilization of medical services, but did not improve the utilization of dental services. This suggests that Medicaid insurance does not improve access to dental services for poor children.

Area of residence, birthplace, and asthma in Puerto Rican children

RATIONALE

Puerto Ricans have the highest prevalence of asthma among all ethnic groups in the United States. There have been no studies that directly compare the burden of asthma between Puerto Ricans living in Puerto Rico and those living in the mainland United States.

OBJECTIVE

To examine the relation between birthplace, area of residence, and asthma in Puerto Rican children.

METHODS

Multistage population-based probability sample of children in the San Juan and Caguas metropolitan areas in Puerto Rico and in the Bronx, NY. Information was collected in a household survey of 2,491 children and their primary caretakers.

RESULTS

The overall prevalence of asthma among Puerto Rican children in this study was very high (38.6%). Although children from Puerto Rico had higher socioeconomic status and lower rates of premature birth and prenatal smoke exposure, the prevalence of lifetime asthma was higher in Puerto Rican children living in Puerto Rico than in Puerto Rican children living in the South Bronx (41.3% vs 35.3%, p = 0.01). In multivariable analysis, residence in Puerto Rico was associated with increased odds of lifetime asthma (odds ratio [OR], 1.27; 95% confidence interval [CI], 1.03 to 1.57) and lifetime hospitalization for asthma (OR, 1.47; 95% CI, 1.04-2.07).

CONCLUSIONS

Puerto Rican children in Puerto Rico had a higher risk of asthma than Puerto Rican children in the South Bronx, highlighting the need for further examination of the roles of migration, acculturation, and environmental and psychosocial factors on the development of asthma in this high-risk population.

The effects of acculturation on asthma burden in a community sample of Mexican American schoolchildren

OBJECTIVES

We sought to determine whether low acculturation among Mexican American caregivers protects their children against asthma.

METHODS

Data were obtained from an observational study of urban pediatric asthma. Dependent variables were children's diagnosed asthma and total (diagnosed plus possible) asthma. Regression models were controlled for caregivers' level of acculturation, education, marital status, depression, life stress, and social support and children's insurance.

RESULTS

Caregivers' level of acculturation was associated with children's diagnosed asthma (P = .025) and total asthma (P = .078) in bivariate analyses. In multivariate models, protective effects of caregivers' level of acculturation were mediated by the other covariates. Independent predictors of increased diagnosed asthma included caregivers' life stress (odds ratio [OR] = 1.12, P= .005) and children's insurance, both public (OR = 4.71, P= .009) and private (OR = 2.87, P= .071). Only caregiver's life stress predicted increased total asthma (OR = 1.21, P= .001).

CONCLUSIONS

The protective effect of caregivers' level of acculturation on diagnosed and total asthma for Mexican American children was mediated by social factors, especially caregivers' life stress. Among acculturation measures, foreign birth was more predictive of disease status than was language use or years in country. Increased acculturation among immigrant groups does not appear to lead to greater asthma risk.

Asthma disparities in the prevalence, morbidity, and treatment of Latino children

The paper reviews the existing research related to asthma disparities and frames the results of this research within a conceptual model modified from the Institute of Medicine model in order to explain asthma health disparities in Latino children in the USA. The model of pediatric asthma disparity presented is based on the conceptualization of health disparities as the result of a complex interaction of factors related to four main domains: the individual and family, the environment or context in which the child lives, the health-care system, and provider characteristics. Asthma disparities are discussed as they are reflected in the process of care (access and quality of treatment) and outcome (prevalence, morbidity, severity) experienced by Latino children. The potential mechanisms that may account for the asthma disparities documented as reflected by the conceptual model proposed are discussed. Finally, several suggestions for future research examining determinants that account for asthma disparities are examined.

Differences in disease outcomes between medicaid and privately insured children: possible health disparities in juvenile rheumatoid arthritis

OBJECTIVE

To determine the relationship between health insurance status and disease outcome in children with juvenile rheumatoid arthritis (JRA).

METHODS

JRA patients followed at a tertiary pediatric rheumatology center were assessed for the number of active joints and number of joints with limited range of motion. Disease activity, patient well-being, and pain were measured. Disability was assessed by the Childhood Health Assessment Questionnaire, health-related quality of life by the Pediatric Quality of Life Inventory (PedsQL) Generic Core Scale, and the PedsQL Rheumatology Module. Health care resource utilization was estimated based on the number of billing events for health services coded in administrative databases; these databases also provided information on patient health insurance status. Children insured by Medicaid or similar state programs for low-income families were considered to have Medicaid status. Disease outcomes of children with Medicaid status was compared with that of children with private health insurance.

RESULTS

Forty (14%) of the 295 children with JRA had Medicaid status. Patients with Medicaid status were more often of nonwhite race (P < or = 0.04) and more frequently had a polyarticular or systemic disease course (P = 0.04) compared with other patients (n = 255). After correction for differences in disease duration, race, JRA onset, and JRA course between groups, children with Medicaid status continued to have significantly higher disability (P < 0.0003), and lower mean PedsQL Generic Core Scale scores (P < 0.05), while health resource utilization appeared similar between groups.

CONCLUSION

Despite apparently similar health resource utilization and joint involvement, Medicaid status is associated with significantly lower health-related quality of life and higher disability in JRA.

Progress in pediatric asthma surveillance II: geospatial patterns of asthma in Alameda County, California

INTRODUCTION

As with many diseases, the epidemic of asthma among children over the past few decades has been shaped by a social and environmental context that is becoming progressively more evident. Commonly used methods for asthma surveillance, however, are based on national rather than local data. The purpose of this study was to develop high-resolution asthma surveillance techniques responsive to the needs of health care professionals and local child health and social justice advocates.

METHODS

We assembled a working data set of health care use records from 2001 from public and private sources covering 1.7 million person-months among children younger than 18 years in Alameda County, California. Health care use was categorized by type and analyzed by census tract demographic information. Images of the geographic distribution of health service events were created using density estimation mapping with overlapping 0.5-mile (805-m) radius spatial buffers, and statistical significance (two-tailed P & .05) was estimated using a Monte Carlo simulation algorithm.

RESULTS

High-poverty communities had higher rates of emergency department visits due to asthma than low-poverty communities but had lower rates for indicators of quality primary asthma care. Geospatial analysis enabled visualization of this phenomenon; it further detected areas with elevated emergency department visit rates and potentially related environmental hazards in and around communities of concern. Areas of the county not previously considered to be deeply burdened by asthma were identified as having high emergency department visit rates.

CONCLUSION

The assembly and high-resolution geospatial analysis of health care use data contributed to a more detailed depiction of pediatric asthma disparities than was previously available to community members, public health professionals, and clinicians. Information generated using these techniques facilitated discussion among stakeholders of the environmental and social contexts of asthma and health disparities in general. Proceedings of group evaluations suggested that the material aided in the translation of data describing spatial variations in health event risk to address specific community experiences and concerns.

Racial disparities in childhood asthma in the United States: evidence from the National Health Interview Survey, 1997 to 2003

OBJECTIVE

To examine differences in asthma prevalence and emergency department (ED) visits for asthma between non-Hispanic black and white children, and factors that might explain those differences, in a large, nationally representative sample covering the period 1997 to 2003.

METHODS

Bivariate and multivariate regression analyses (with logit and multinomial logit methods) were conducted with a sample consisting of all non-Hispanic black and white children (<18 years of age) from the 1997 to 2003 rounds of the National Health Interview Survey. Models included a progressively larger set of controls for factors that might explain racial differences in asthma prevalence and ED visits for asthma.

RESULTS

Being black was associated with a greater likelihood of currently having asthma and with a greater likelihood of having gone to the ED for asthma treatment in the past 1 year. Elevated asthma risks for black children were robust after controlling for a host of child and family characteristics that might explain them.

CONCLUSIONS

Black children are more likely to have asthma and to experience ED visits for asthma, compared with otherwise comparable white children, and these racial disparities cannot be explained by differences in measurable child or family characteristics. These results suggest that racial disparities in asthma continue to pose risks for black children, and they point to the need for additional research into potential explanations and remedies.

Improving asthma research in an inner-city Latino neighborhood with community health workers

This study tests the feasibility of a partnership between an academic medical center and community health workers to perform mutually beneficial research investigating asthma in an urban Latino neighborhood. Community heath workers participated in the study design, instrument development, implementation, and analysis. The 103 participants recruited by the community health workers were primarily Mexican with very low education and acculturation levels. After the 1-year enrollment period, the community health workers described the challenges of data collection and gave explanations for the access to care outcomes. This academic-community partnership showed that community health workers can be effective research partners.

Racial and ethnic disparities in diagnosed and possible undiagnosed asthma among public-school children in Chicago

OBJECTIVES

We examined racial and ethnic disparities in the total potential burden of asthma in low-income, racially/ethnically heterogeneous Chicago schools.

METHODS

We used the Brief Pediatric Asthma Screen Plus (BPAS+) and the Spanish BPAS+, validated, caregiver-completed respiratory questionnaires, to identify asthma and possible asthma among students in 14 racially/ethnically diverse public elementary schools.

RESULTS

Among 11490 children, we demonstrated a high lifetime prevalence (12.2%) as well as racial and ethnic disparities in diagnosed asthma, but no disparities in prevalences of possible undiagnosed asthma. Possible asthma cases boost the total potential burden of asthma to more than 1 in 3 non-Hispanic Black and Puerto Rican children.

CONCLUSIONS

There are significant racial and ethnic disparities in diagnosed asthma among inner-city schoolchildren in Chicago. However, possible undiagnosed asthma appears to have similar prevalences across racial/ethnic groups and contributes to a high total potential asthma burden in each group studied. A better understanding of underdiagnosis is needed to address gaps in asthma care and intervention for low-income communities.

Applying epidemiologic concepts of primary, secondary, and tertiary prevention to the elimination of racial disparities in asthma

Despite medical and scientific advances, racial and ethnic disparities persist in US asthma morbidity and mortality rates. Progress in the elimination of these disparities will involve disentangling the contribution of social constructs, such as race, socioeconomic status, and culture, from that of the physical environment and genetic susceptibility. One approach to reducing asthma disparities is through the traditional disease prevention stages of intervention. As such, primary prevention targets reductions in asthma incidence; secondary prevention is the mitigation of established disease and involves disease detection, management, and control; and tertiary prevention is the reduction of complications caused by severe disease. Once causative factors at each level of disease prevention are understood, this knowledge can be translated into clinical practice and public health policy.

Asthma in Hispanics

Hispanic individuals trace their ancestry to countries that were previously under Spanish rule, including Mexico, large parts of Central and South America, and some Caribbean islands. Most--but not all--Hispanics have variable proportions of European, Amerindian, and African ancestry. Hispanics are diverse with regard to many factors, including racial ancestry, country of origin, area of residence, socioeconomic status, education, and access to health care. Recent findings suggest that there is marked variation in the prevalence, morbidity, and mortality of asthma in Hispanics in the United States and in Hispanic America. The reasons for differences in asthma and asthma morbidity among and within Hispanic subgroups are poorly understood but are likely due to the interaction between yet-unidentified genetic variants and other factors, including environmental tobacco smoke exposure, obesity, allergen exposure, and availability of health care. Barriers to optimal management of asthma in Hispanics in the United States and in Hispanic America include inadequate access to health care, suboptimal use of antiinflammatory medications, and lack of reference values for spirometric measures of lung function in many subgroups (e.g., Puerto Ricans). Future studies of asthma in Hispanics should include large samples of subgroups that are well characterized with regard to self-reported ethnicity, country of origin, place of birth, area of residence, and indicators of socioeconomic status. Because Hispanics are disproportionately represented among the poor in the United States, implementation of adequate access to health care and social reforms (e.g., improving housing conditions) would likely have a major impact on reducing asthma morbidity in this population.

Asthma and respiratory dysfunction among urban, primarily Hispanic school children

A screening program identified children with poorly managed asthma or respiratory dysfunction. Children in grades 2-5 in all Passaic, New Jersey, schools were eligible for screening with questionnaires and a biometric test. Those with risk factors or failed biometric screening were referred to primary care providers. Of the 6,579 eligible children, 3,657 (56%) had parental questionnaires returned and 3,834 (58%) were biometrically screened. Over the 4-yr study period, 6-22% of children were previously diagnosed with asthma. Approximately 20% of children demonstrated peak flow measures <75% of predicted values. Predictors of a prior diagnosis of asthma and a medical treatment plan for asthma management were health care coverage and ethnicity. Predictors of peak flow test failure were the presence of roaches and mold in the home, pesticide use, and a family member with asthma.