1
|
Oparanma CO, Ogbu CE, Ezeh E, Ogbu SC, Ujah OI, Kirby RS. Caregivers' Self-Rated General Health, Physical and Mental Health Status, Disease Morbidity and Association with Uncontrolled Asthma in Children. Pediatr Rep 2023; 15:272-281. [PMID: 37092475 PMCID: PMC10123736 DOI: 10.3390/pediatric15020023] [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] [Received: 02/16/2023] [Revised: 03/26/2023] [Accepted: 03/28/2023] [Indexed: 04/25/2023] Open
Abstract
This study examined the association between caregivers' self-rated general health, poor physical/mental health days, disease morbidity and asthma control in children from the United States with current asthma. The data analyzed for this study were obtained from 7522 children aged 0-17 years who participated in the 2012-2014, 2015-2017, 2018, and 2019 cycles of the Behavioral Risk Factor Surveillance System Asthma Call-back Survey (ACBS). We employed univariate analysis to describe the study population and weighted binary logistic regression to examine the association of predictors with asthma control. Approximately 50% of the children had uncontrolled asthma. The results show that caregivers who reported fair general health had a 61% higher likelihood of reporting uncontrolled asthma in their children compared to those who reported good/very good/excellent health (adjusted odds ratio [aOR] = 1.61; 95% confidence interval [CI], 1.14-2.26). Poor caregiver general health did not reach statistical significance in predicting uncontrolled asthma (aOR = 1.05, 95% CI, 0.62-1.75). Furthermore, having 1 to 14 poor physical/mental health days ([aOR] = 1.70; 95% CI, 1.28-2.227) and ≥15 poor physical/mental health days (aOR = 1.82, 95% CI, 1.31-2.53) was predictive of uncontrolled asthma in children. Additionally, endorsing one reported disease (aOR = 1.49, 95% CI, 1.15-1.93) and ≥2 diseases (aOR = 1.38, 95% CI, 1.08-1.78) was associated with uncontrolled child asthma. These findings underscore the association between caregivers' self-reported general health, poor mental/physical health days, disease morbidity and uncontrolled asthma among children from the U.S. with asthma. Pediatricians and child health practitioners should recall the importance of this relationship. To facilitate the identification of caregivers at risk and provide more comprehensive and effective care for children with asthma, healthcare practitioners should utilize every child asthma care encounter to inquire about the overall health of caregivers.
Collapse
Affiliation(s)
- Chisa O Oparanma
- Department of Medicine, Kharkiv National Medical University, 61022 Kharkiv, Ukraine
| | - Chukwuemeka E Ogbu
- Chiles Center, College of Public Health, University of South Florida, Tampa, FL 33612, USA
| | - Ebubechukwu Ezeh
- Department of Internal Medicine, Marshall University, Huntington, WV 25701, USA
| | - Stella C Ogbu
- Department of Biomedical Science, School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Otobo I Ujah
- Chiles Center, College of Public Health, University of South Florida, Tampa, FL 33612, USA
| | - Russell S Kirby
- Chiles Center, College of Public Health, University of South Florida, Tampa, FL 33612, USA
| |
Collapse
|
2
|
Rangachari P, Parvez I, LaFontaine AA, Mejias C, Thawer F, Chen J, Pathak N, Mehta R. Effect of Disease Severity, Age of Child, and Clinic No-Shows on Unscheduled Healthcare Use for Childhood Asthma at an Academic Medical Center. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1508. [PMID: 36674266 PMCID: PMC9864702 DOI: 10.3390/ijerph20021508] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/09/2023] [Accepted: 01/11/2023] [Indexed: 06/10/2023]
Abstract
This study examines the influence of various individual demographic and risk factors on the use of unscheduled healthcare (emergency and inpatient visits) among pediatric outpatients with asthma over three retrospective timeframes (12, 18, and 24 months) at an academic health center. Out of a total of 410 children who visited an academic medical center for asthma outpatient care between 2019 and 2020, 105 (26%) were users of unscheduled healthcare for childhood asthma over the prior 12 months, 131 (32%) over the prior 18 months, and 147 (36%) over the prior 24 months. multiple logistic regression (MLR) analysis of the effect of individual risk factors revealed that asthma severity, age of child, and clinic no-shows were statistically significant predictors of unscheduled healthcare use for childhood asthma. Children with higher levels of asthma severity were significantly more likely to use unscheduled healthcare (compared to children with lower levels of asthma severity) across all three timeframes. Likewise, children with three to four clinic no-shows were significantly more likely to use unscheduled healthcare compared to children with zero clinic no-shows in the short term (12 and 18 months). In contrast, older children were significantly less likely to use unscheduled healthcare use compared to younger children in the longer term (24 months). By virtue of its scope and design, this study provides a foundation for addressing a need identified in the literature for short- and long-term strategies for improving supported self-management and reducing unscheduled healthcare use for childhood asthma at the patient, provider, and organizational levels, e.g., (1) implementing telehealth services for asthma outpatient care to reduce clinic no-shows across all levels of asthma severity in the short term; (2) developing a provider-patient partnership to enable patient-centered asthma control among younger children with higher asthma severity in the long term; and (3) identifying hospital-community linkages to address social risk factors influencing clinic no-shows and unscheduled healthcare use among younger children with higher asthma severity in the long term.
Collapse
Affiliation(s)
- Pavani Rangachari
- Department of Population Health & Leadership, School of Health Sciences, University of New Haven, West Haven, CT 06516, USA
| | - Imran Parvez
- Division of Biostatistics and Data Science, Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
| | | | | | - Fahim Thawer
- Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
| | - Jie Chen
- Division of Biostatistics and Data Science, Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
| | - Niharika Pathak
- Department of Population Health & Leadership, School of Health Sciences, University of New Haven, West Haven, CT 06516, USA
| | - Renuka Mehta
- Division of Critical Care Medicine, Department of Pediatrics, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
| |
Collapse
|
3
|
Kaur K, Arcoleo KJ, Serebrisky D, Rastogi D, Marsiglia FF, Feldman JM. Impact of caregiver depression on child asthma outcomes in Mexicans and Puerto Ricans. J Asthma 2022; 59:2246-2257. [PMID: 34793283 PMCID: PMC9534376 DOI: 10.1080/02770903.2021.2008427] [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: 04/29/2021] [Revised: 10/06/2021] [Accepted: 11/16/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Examine whether caregiver depressive symptoms at baseline predict longitudinal child asthma outcomes in the two populations with the largest asthma disparities: Mexicans and Puerto Ricans. METHODS Two hundred and sixty-seven Hispanic caregiver-child dyads (Mexican = 188, Puerto Rican = 79; children 5-12 years) were recruited from clinics and hospitals in Phoenix, AZ and the Bronx, NY. The Center for Epidemiological Studies Depression Scale assessed caregiver depressive symptoms; higher scores indicate greater depressive symptomology. Medical records verified child asthma diagnosis. Assessments for outcome variables occurred at baseline, 3, 6, 9, and 12-month follow-ups. Pulmonary function was measured by spirometry, asthma control was measured by the Asthma Control Test, steroid bursts and acute healthcare utilization were assessed by caregiver report and medical records, and adherence was measured by doser devices on controller medications. Structural equation modeling analyzed baseline caregiver depressive symptoms as a predictor of longitudinal child asthma outcomes, and differences between subgroups. RESULTS Higher caregiver depressive symptoms predicted better pulmonary function (β = .02, p = .001) in Mexican children, and fewer steroid bursts (β = -.41, p = .01) and better medication adherence (β = .02, p = .07) in Puerto Rican children. Caregiver depressive symptoms did not predict pediatric asthma control or acute healthcare utilization in either subgroup. CONCLUSIONS Caregiver depressive symptomology had unexpected effects on child asthma outcomes. Results may be explained by the Hispanic paradox, caregiver resilience, acculturation, and the study's longitudinal nature. Further research is needed on social determinants of health that may influence differences in child asthma outcomes in heterogeneous Hispanic communities.
Collapse
Affiliation(s)
- Karenjot Kaur
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York
| | | | | | - Deepa Rastogi
- Children’s National Medical Center, GW University School of Medicine and Health Science, Washington, DC
| | | | - Jonathan M. Feldman
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York
- Albert Einstein College of Medicine, Children’s Hospital at Montefiore, Bronx, NY
| |
Collapse
|
4
|
Tiwari T, Poravanthattil A, Rai N, Wilson A. Association of Acculturation and Latino Parents' Oral Health Beliefs and Knowledge. CHILDREN-BASEL 2021; 8:children8030243. [PMID: 33810091 PMCID: PMC8004731 DOI: 10.3390/children8030243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/09/2021] [Accepted: 03/18/2021] [Indexed: 12/04/2022]
Abstract
The purpose of our study was to explore the association of acculturation and Latino parent behavioral and psychosocial characteristics. A cross-sectional survey was conducted with 197 parent-children triads. Participating parents completed survey questions encompassing oral health knowledge, behaviors and beliefs from a validated oral health instrument. The mean score for acculturation in this sample was 3.8, where acculturation was dichotomized to a categorical variable. The bivariate associations between the independent variables (caregiver psychosocial factors and socio-economic factors (SES) factors) and acculturation (more/less acculturated) were conducted using logistic regression analysis, and for the final model a multivariate logistic regression model was used. In the bivariate analyses, less acculturated parents reported lower oral health knowledge (p = 0.02), higher social support (p = 0.028) and chronic stress (p = 0.015) and lower perceived susceptibility to dental caries in their children (p = 0.039). The bivariate analysis demonstrated that less acculturated parents had less education and employment (p < 0.0001) than more acculturated parents. The multivariate logistic model demonstrated that social support (p = 0.028), chronic stress (p = 0.015) and health beliefs as barriers to access dental care (p = 0.039) were higher in less acculturated parents compared to more acculturated parents. Less acculturated parents demonstrated lower oral health knowledge, higher stress and more barriers to accessing oral health care for their children. Oral health interventions for Latino families should incorporate strategies that include consideration of parental oral health beliefs.
Collapse
Affiliation(s)
- Tamanna Tiwari
- School of Dental Medicine, University of Colorado, Aurora, CO 80045, USA; (N.R.); (A.W.)
- Correspondence: ; Tel.: +1-303-724-9539
| | | | - Nayanjot Rai
- School of Dental Medicine, University of Colorado, Aurora, CO 80045, USA; (N.R.); (A.W.)
| | - Anne Wilson
- School of Dental Medicine, University of Colorado, Aurora, CO 80045, USA; (N.R.); (A.W.)
- Children’s Hospital, University of Colorado, Aurora, CO 80045, USA;
| |
Collapse
|
5
|
Sloand E, Butz A, Rhee H, Walters L, Breuninger K, Pozzo RA, Barnes CM, Wicks MN, Tumiel-Berhalter L. Influence of social support on asthma self-management in adolescents. J Asthma 2021; 58:386-394. [PMID: 31771375 PMCID: PMC7269846 DOI: 10.1080/02770903.2019.1698601] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 11/20/2019] [Accepted: 11/25/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Adolescents with asthma are influenced by peers and family. The objective was to better understand family social support and test its association with medication adherence, asthma control, and Emergency Department (ED) use. METHODS This study is a cross-sectional secondary data analysis from a randomized controlled trial with urban adolescents from three U.S. cities. Participants (12-20 years old) with asthma completed the Perceived Family Support Scale (PFS) and Horne's Medication Adherence Report Scale (MARS). Data from both tools were classified into 2 categories- high and low (< 25th percentile) perceived family support and high (total score >10) and low medication adherence, respectively. Chi-square statistic and logistic regression were used for analysis. RESULTS Of the 371 participants, the majority were young (96% ≤ 17 years), African American or Bi-racial (85%), and Medicaid-insured (72%); over one-third had maternal family history of asthma. Among those on a controller medication (n = 270), only 37% reported its use ≥8 days over 2 weeks. Asthma control was poor with 50% categorized "not well controlled," 34% "very poorly controlled." Participants responded positively to most social support items. One item, providing and receiving social support to and from family members, was less often positively reported. Low medication adherence was significantly associated with lower perceived social support (p = 0.018). CONCLUSION This study underscores the importance of family social support in understanding the extent of adolescents' self-management, particularly medication adherence.
Collapse
Affiliation(s)
| | - Arlene Butz
- Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Hyekyun Rhee
- School of Nursing, University of Rochester, Rochester, NY, USA
| | - Leanne Walters
- School of Nursing, University of Rochester, Rochester, NY, USA
| | - Kathleen Breuninger
- Primary Care Pediatric Nurse Practitioner, Park Pediatrics, Takoma Park, MD, USA
| | | | - Christina Marie Barnes
- Pediatric Nurse Practitioner, Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH, USA
| | - Mona Newsome Wicks
- Health Promotion and Disease Prevention Department, University of Tennessee Health Science Center, College of Nursing, Memphis, TN, USA
| | - Laurene Tumiel-Berhalter
- Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, University of Buffalo, Buffalo, NY, USA
| |
Collapse
|
6
|
da Costa ADPV, Dos Santos LM, Feitosa CA, de Miranda CT. Maternal common mental disorder over time and asthma control: The role of social support. Pediatr Allergy Immunol 2020; 31:628-635. [PMID: 32202344 DOI: 10.1111/pai.13249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 03/10/2020] [Accepted: 03/11/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Despite therapeutic advances, asthma prevalence remains high. Psychosocial factors, including maternal mental disorders, may be involved. This study aims to evaluate the association of maternal common mental disorders (CMDs) and their change over time with asthma morbidity in the child and to observe the effect of social support on this association. METHODS This prospective study involved 189 dyads of mothers and their asthmatic children aged between 2 and 14 years, assisted in specialized outpatient clinics. We measured the association of maternal CMD evolution (absent, maintained, or improved over time) with asthma control and visits to the emergency department (ED) due to asthma attacks through Poisson regression analysis. We further stratified the sample according to social support levels to identify a possible effect of this variable on the association of maternal psychological symptoms with asthma morbidity. RESULTS Compared with mothers who maintained CMD over time, maternal CMD absence had a protective effect on the occurrence of visits to the ED (RR: 0.45; 95% CI: 0.26-0.79) and maternal CMD improvement was associated with lower risk of uncontrolled asthma in the child (RR: 0.60; 95% CI: 0.37-0.97). There was a stronger association of maternal CMD improvement with asthma control in the child only for the stratum of mothers with high social support in its three dimensions (affective-social interaction, emotional-informational, and material dimensions). CONCLUSIONS Maternal CMD absence and improvement over the study period were protective factors for uncontrolled asthma in the child, mainly in the presence of high social support.
Collapse
Affiliation(s)
| | - Leticia Marques Dos Santos
- Institute of Humanities Arts and Sciences Professor Milton Santos, Federal University of Bahia, Salvador, Brazil
| | - Caroline Alves Feitosa
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil.,UNIFESP, Federal University of São Paulo, São Paulo, Brazil
| | | |
Collapse
|
7
|
Foronda CL, Kelley CN, Nadeau C, Prather SL, Lewis-Pierre L, Sarik DA, Muheriwa SR. Psychological and Socioeconomic Burdens Faced by Family Caregivers of Children With Asthma: An Integrative Review. J Pediatr Health Care 2020; 34:366-376. [PMID: 32299726 DOI: 10.1016/j.pedhc.2020.02.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 02/11/2020] [Accepted: 02/18/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Asthma affects nearly 1 in every 12 children in the United States. Caring for a child with asthma poses significant challenges for the parent or caregiver. The purpose of this integrative review was to identify the psychological and socioeconomic burdens faced by family caregivers of children with asthma. METHOD An integrative review was conducted to review and appraise 80 studies. RESULTS Psychosocial burdens included decreased mental health, quality of life, sleep, family stress, educational deficits, cultural and health disparities, and health care communication challenges. Socioeconomic burdens included poor access to care, as well as work and financial challenges. Studies demonstrated a link between family caregiver health and child health outcomes. Facilitators included education and empowerment, social support, and use of technology. DISCUSSION As the family caregiver's health directly affects the asthmatic child's health, addressing the burdens of family caregivers should be a key consideration in pediatric asthma care.
Collapse
|
8
|
Foronda CL, Jawid MY, Alhusen J, Muheriwa SR, Ramunas MM, Hooshmand M. Healthcare Providers' Experiences with Gaps, Barriers, and Facilitators Faced by Family Caregivers of Children with Respiratory Diseases. J Pediatr Nurs 2020; 52:49-53. [PMID: 32179377 DOI: 10.1016/j.pedn.2020.03.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 03/04/2020] [Accepted: 03/04/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE The purpose of this study was to identify healthcare providers' experiences of the gaps in the healthcare system, barriers to obtaining care, and facilitators that promoted safe, quality care for family caregivers of children with respiratory diseases. DESIGN AND METHODS A qualitative, descriptive design was used with 13 pediatric healthcare providers. FINDINGS Gaps included themes of 1) fragmented healthcare system and 2) lack of asthma management knowledge. Barriers included themes of 1) poor access to healthcare and medications, 2) non-adherence, and 3) linguistic diversity and poor health literacy. Facilitators of optimal respiratory management included themes of 1) education, 2) improved communication, and 3) peer support. CONCLUSIONS Through better understanding the gaps, barriers, and facilitators, pediatric nurses will be able to more effectively anticipate and address the needs of the caregivers. PRACTICE IMPLICATIONS The nurse is in a pivotal role to empower caregivers with the skills and resources to address challenges and connect them with providers for optimal respiratory management.
Collapse
Affiliation(s)
- Cynthia L Foronda
- University of Miami, School of Nursing and Health Studies, Coral Gables, FL, United States of America.
| | - Maryam Yasmeen Jawid
- University of Miami, School of Nursing and Health Studies, Coral Gables, FL, United States of America.
| | - Jeanne Alhusen
- University of Virginia, School of Nursing, Charlottesville, VA, United States of America.
| | - Sadandaula Rose Muheriwa
- University of Miami, School of Nursing and Health Studies, Coral Gables, FL, United States of America.
| | - Marisa M Ramunas
- University of Miami, School of Nursing and Health Studies, Coral Gables, FL, United States of America.
| | - Mary Hooshmand
- University of Miami, School of Nursing and Health Studies, Coral Gables, FL, United States of America.
| |
Collapse
|
9
|
Weinstein SM, Orozco K, Pugach O, Rosales G, Songthangtham N, Martin MA. Parent Nativity and Child Asthma Control in Families of Mexican Heritage: The Effects of Parent Depression and Social Support. Acad Pediatr 2020; 20:967-974. [PMID: 32407888 PMCID: PMC7483789 DOI: 10.1016/j.acap.2020.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/06/2020] [Accepted: 05/07/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Research has repeatedly demonstrated that parent foreign nativity has a protective effect on child asthma outcomes among Mexican Americans, but the mechanisms underlying this relationship are not well understood. The current study explored parent depression as a mediator and social support as a moderator of the parent nativity-child asthma control pathway. METHODS Data come from the baseline sample of a trial (NCT02481986) testing community interventions for 223 children aged 5 to 16 with uncontrolled asthma. We focused on parent/child dyads of Mexican heritage (N = 165; mean age = 9.08, standard deviation = 2.94; 57.3% with Mexico-born parent). Asthma control was defined using the child and adult versions of the Asthma Control Test (ACT). Psychosocial factors included parent depression symptoms and social (instrumental, informational, and emotional) support. RESULTS Mexican-born parents had fewer depressive symptoms (β^ = -2.03, SE^ = 0.24) and children with better asthma control (β^ = 1.78, SE^ = 0.24) than US-born parents, P < .0001. Analyses suggested partial mediation of the nativity-ACT path via parent depression (P < .001). An interaction between Instrumental Support and Nativity was marginally significant (β^ = -0.10, SE^ = 0.05, P = .07), with protective effects only observed at higher support levels. Last, among Mexico-born parents, the protective nativity effects on ACT declined with increasing residential years in the United States through 12 years. CONCLUSIONS This study is novel in identifying parent depression as one mechanism underlying the effects of parent nativity on child asthma control, but results suggest that the health advantages may depend on availability of support. Providing resources for parent depression and instrumental support (transportation, childcare) can optimize asthma interventions in this population.
Collapse
|
10
|
Fallon M, Haynes L, Cadet T, Petrosino S, Cazeau E, Solis J, Cox J, Wu AC, Holder-Niles FF. A Group Visit for High-Risk Pediatric Asthma Patients: A Quality Improvement Initiative to Improve Asthma Care. Clin Pediatr (Phila) 2019; 58:746-751. [PMID: 30938184 DOI: 10.1177/0009922819839238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Asthma disproportionately affects poor and minority children. Limited parental knowledge and confidence in asthma management, as well as stress from chronic illness, may contribute to poor outcomes. Novel approaches for providing care are essential for this vulnerable population. Our objective was to evaluate the feasibility and impact of an asthma group visit for high-risk children. METHODS Our primary care practice cares for more than 2600 children with asthma. The majority have public insurance. Children classified as high risk (≥1 asthma-related emergency department visit/hospitalization in the preceding 2 years) were eligible. Children received brief physical examinations, medication review, and updated Asthma Action Plans. Educational sessions were held for children and parents. Pre and post surveys were used to assess parents' experience and changes in confidence in asthma management. RESULTS Twenty children and their parents participated. Mean parent confidence scores (5-point Likert-type scale, 5 indicating greatest confidence) improved in managing their child's asthma symptoms (3.60, 4.40, P ≤ .005), managing their child's asthma medications (3.85, 4.30, P ≤ .005), using their child's Asthma Action Plan (3.79, 4.45, P ≤ .02), communicating with the school about their child's food allergies (4.32, 4.72, P ≤ .03), and helping their child relax to reduce emotional triggers of asthma (3.25, 4.47, P ≤ .01). All families reported that they would return to a group visit. CONCLUSION Group visits are feasible for providing care, education, and peer support to a vulnerable population. Parents expressed satisfaction and improved confidence in aspects of asthma management. Group visits have the potential to improve asthma outcomes for high-risk families.
Collapse
Affiliation(s)
- Margaret Fallon
- 1 Boston Children's Hospital, Boston, MA, USA.,2 Harvard Medical School, Boston, MA, USA
| | | | | | | | | | | | - Joanne Cox
- 1 Boston Children's Hospital, Boston, MA, USA.,2 Harvard Medical School, Boston, MA, USA
| | - Ann Chen Wu
- 1 Boston Children's Hospital, Boston, MA, USA.,2 Harvard Medical School, Boston, MA, USA.,3 Center for Healthcare Research in Pediatrics (CHeRP), Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Faye F Holder-Niles
- 1 Boston Children's Hospital, Boston, MA, USA.,2 Harvard Medical School, Boston, MA, USA
| |
Collapse
|
11
|
Margolis R, Bellin MH, Sacco P, Harrington D, Butz A. Evaluation of MOS social support in low-income caregivers of African American children with poorly controlled asthma. J Asthma 2018; 56:951-958. [PMID: 30273501 DOI: 10.1080/02770903.2018.1510504] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Objective: The purpose of this study was to examine the factor structure of the Medical Outcomes Study Social Support Survey (MOS-SSS) in a sample of low-income, urban caregivers of African American children with poorly controlled asthma. Although the MOS-SSS is a commonly used measure of social support, its psychometric properties have not been studied in this population. Methods: Confirmatory factor analysis was conducted to determine the most appropriate factor structure for the MOS-SSS in caregivers of African American children with frequent Emergency Department visits for uncontrolled asthma. The following models were tested and compared using established fit statistics: an 18-item second-order four factor model, an 18-item four factor model, a bifactor model and an 18-item one factor model with nested models. Results: Participating caregivers were single (75.6%) and female (97%). An 18-item one factor version of the scale had the best fit statistics compared to the other models tested: χ2 (142) = 308.319, p > 0.001; Root mean square error of approximation (RMSEA) = 0.077; CFI (Comparative Fit Index) = 0.990; and Tucker-Lewis Index (TLI) = 0.988. Construct validity was supported by a statistically significant negative relationship between our final MOS-SSS model and caregiver depressive symptoms ( β = -0.374, p < 0.001). Conclusions: The 18-item one factor MOS-SSS may be appropriate for use in research and clinical practice with caregivers of African American children with poorly controlled asthma. It appears promising as a mechanism to advance understanding of relationships between social support and asthma outcomes in this vulnerable population.
Collapse
Affiliation(s)
- Rachel Margolis
- a School of Social Work, University of Maryland , Baltimore , MD , USA
| | - Melissa H Bellin
- a School of Social Work, University of Maryland , Baltimore , MD , USA
| | - Paul Sacco
- a School of Social Work, University of Maryland , Baltimore , MD , USA
| | - Donna Harrington
- a School of Social Work, University of Maryland , Baltimore , MD , USA
| | - Arlene Butz
- b Department of Pediatrics, The Johns Hopkins University School of Medicine , Freeland , MD , USA
| |
Collapse
|
12
|
Bellin MH, Collins KS, Osteen P, Kub J, Bollinger ME, Newsome A, Lewis-Land C, Butz AM. Characterization of Stress in Low-Income, Inner-City Mothers of Children with Poorly Controlled Asthma. J Urban Health 2017; 94:814-823. [PMID: 28560612 PMCID: PMC5722723 DOI: 10.1007/s11524-017-0162-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The goal of this longitudinal analysis was to characterize factors associated with the experience of life stress in low-income, inner-city mothers of minority children with high-risk asthma.Participants (n = 276) reported on family demographics, child asthma control and healthcare utilization, social support, contemporary life difficulties (housing, finances, violence exposure) measured by the validated Crisis in Family Systems scale, and daily stress. Latent growth curve modeling examined predictors of life stress across 12 months as a function of home and community difficulties, asthma-specific factors, and social support. Mothers were primarily single (73%), unemployed (55%), and living in extreme poverty with most (73%) reporting an annual family income <$20,000 (73%). The children were young (mean age = 5.59, SD = 2.17), African-American (96%), and had poorly controlled asthma (94%) at study enrollment. Higher daily stress was associated with financial difficulties, safety concerns in the home and community, and housing problems. Access to social support was consistently related to reduced stress. The only asthma-specific factor associated with life stress was healthcare utilization, with more emergency services for asthma related to higher daily stress. Findings underscore the clinical significance of assessing diverse home and community stressors and social support in low-income, inner-city caregivers of children with poorly controlled asthma.
Collapse
Affiliation(s)
- Melissa H Bellin
- University of Maryland School of Social Work, 525 West Redwood Street, Baltimore, MD, 21201, USA.
| | - Kathryn S Collins
- University of Maryland School of Social Work, 525 West Redwood Street, Baltimore, MD, 21201, USA
| | - Philip Osteen
- Florida State University College of Social Work, Tallahassee, USA
| | - Joan Kub
- Department of Nursing, University of Southern California, Los Angeles, USA
| | - Mary Elizabeth Bollinger
- Division of Pediatric Pulmonary and Allergy, University of Maryland School of Medicine, Baltimore, USA
| | - Angelica Newsome
- University of Maryland School of Social Work, 525 West Redwood Street, Baltimore, MD, 21201, USA
| | - Cassie Lewis-Land
- Division of General Pediatrics and Adolescent Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Arlene M Butz
- Division of General Pediatrics and Adolescent Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| |
Collapse
|
13
|
Abstract
This article reviews the literature on the effects of living in a disenfranchised community for low-income African American children who have asthma. The review focuses on social integration, social network, interactions with parents, and limited cultural resources, which lead to negative health outcomes among these children.
Collapse
Affiliation(s)
- Jo A Dowell
- 1 College of Nursing, Kent State University, Kent, OH, USA
| |
Collapse
|
14
|
Clawson AH, Borrelli B, McQuaid EL, Dunsiger S. The role of caregiver social support, depressed mood, and perceived stress in changes in pediatric secondhand smoke exposure and asthma functional morbidity following an asthma exacerbation. Health Psychol 2016; 35:541-51. [PMID: 26867039 PMCID: PMC4868653 DOI: 10.1037/hea0000318] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Caregiver depressed mood and stress are associated with increased child asthma functional morbidity (AFM) and secondhand smoke exposure (SHSe), whereas social support (SS) reduces risk. This study extends previous literature by examining (1) longitudinal patterns of pediatric AFM and SHSe and (2) how caregiver stress, depressed mood, and SS are related to child SHSe and AFM changes. METHOD Participants were 334 caregivers who smoked, had a child with asthma, and were enrolled in a smoking cessation induction/asthma intervention. SHSe and AFM were measured at baseline and 4, 6, and 12 months. All measures were caregiver self-report. We used an autoregressive latent trajectory model to examine the intercept, linear, and quadratic growth factors and autoregressive and cross-lagged effects of SHSe and AFM. RESULTS After an asthma exacerbation, decreases in child AFM and SHSe were followed by respective increases over time. Child SHSe at 4 months and 6 months predicted subsequent child AFM. Autoregressive paths were significant for only AFM. Higher baseline caregiver depressed mood and stress predicted higher baseline child AFM but not other growth factors. Higher baseline caregiver self-esteem SS was associated with only lower baseline child AFM and fewer increases in AFM across time. Exploratory analyses indicated higher baseline caregiver depressed mood and stress were associated with less-favorable changes in child SHSe and AFM. CONCLUSIONS Caregiver depressed mood, stress, and SS should be considered when addressing pediatric SHSe and AFM. Caregiver support may be needed to maintain intervention gains. (PsycINFO Database Record
Collapse
Affiliation(s)
- Ashley H. Clawson
- Centers for Behavioral and Preventive Medicine, Alpert Medical School of Brown University and The Miriam Hospital
- Bradley/Hasbro Children's Research Center, Alpert Medical School of Brown University and Rhode Island Hospital
| | | | - Elizabeth L. McQuaid
- Bradley/Hasbro Children's Research Center, Alpert Medical School of Brown University and Rhode Island Hospital
| | - Shira Dunsiger
- Centers for Behavioral and Preventive Medicine, Alpert Medical School of Brown University and The Miriam Hospital
| |
Collapse
|
15
|
Everhart RS, Miadich SA, Leibach GG, Borschuk AP, Koinis-Mitchell D. Acculturation and quality of life in urban, African American caregivers of children with asthma. J Asthma 2016; 53:983-8. [PMID: 27115558 DOI: 10.3109/02770903.2016.1167904] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Racial/ethnic minority caregivers of children with asthma are at risk for low levels of quality of life (QOL). Limited research has identified factors that contribute to lower QOL among African American caregivers. This study examined associations between acculturation (e.g., engaging in values/beliefs traditional of one's culture versus adopting mainstream cultural views) and caregiver QOL in low-income, urban African American families of children (7-12 years) with persistent asthma. We also investigated the association between caregiver QOL and child emergency department (ED) use. METHODS Fifty-five caregivers and their children completed interview-based questionnaires in a single research session. Caregivers completed the Pediatric Asthma Caregiver Quality of Life Questionnaire (PACQLQ), the African American Acculturation Scale-Revised (AAAS-R), and reported on child asthma variables. Children completed items assessing asthma control. RESULTS Higher overall QOL and emotional function subscale scores were associated with more traditional African American religious beliefs/practices (r = .288, p = .033; r = .333, p = .013). Higher emotional function subscale scores were associated with more traditional values of African American families (r = .306, p = .023). Lower QOL was found among caregivers of children who had visited the ED three or more times in the last year. CONCLUSIONS Less acculturation tied to religious beliefs/practices and family values (as measured by the AAAS-R) may serve a protective role in reducing the burden low-income, urban African American caregivers experience in managing child asthma. This study is the first of its kind to study acculturation in African American caregivers of children with asthma.
Collapse
Affiliation(s)
- Robin S Everhart
- a Virginia Commonwealth University , Department of Psychology , Richmond , VA , USA
| | - Samantha A Miadich
- a Virginia Commonwealth University , Department of Psychology , Richmond , VA , USA
| | - Gillian G Leibach
- a Virginia Commonwealth University , Department of Psychology , Richmond , VA , USA
| | - Adrienne P Borschuk
- a Virginia Commonwealth University , Department of Psychology , Richmond , VA , USA
| | - Daphne Koinis-Mitchell
- b Bradley/Hasbro Children's Research Center, Alpert Medical School of Brown University , Providence , RI , USA
| |
Collapse
|
16
|
Bellin MH, Osteen P, Kub J, Bollinger ME, Tsoukleris M, Chaikind L, Butz AM. Stress and Quality of Life in Urban Caregivers of Children With Poorly Controlled Asthma: A Longitudinal Analysis. J Pediatr Health Care 2015; 29:536-46. [PMID: 26036621 PMCID: PMC4624025 DOI: 10.1016/j.pedhc.2015.04.018] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 04/28/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The intent of this analysis was to examine the longitudinal effects of risk and protective factors on quality of life (QOL) in caregivers of minority children with asthma. METHOD Caregivers (n = 300) reported on demographics, child asthma characteristics, daily asthma caregiving stress, general life stress, social support, and QOL. Latent growth curve modeling examined changes in QOL across 12 months as a function of stress, asthma control, and social support. RESULTS Caregivers were primarily the biological mother (92%), single (71%), unemployed (55%), and living in poverty. Children were African American (96%), Medicaid eligible (92%), and had poorly controlled asthma (93%). Lower QOL was associated with higher life stress, greater asthma caregiving stress, and lower asthma control over time. DISCUSSION Findings underscore the importance of assessing objective and subjective measures of asthma burden and daily life stress in clinical encounters with urban, low-income caregivers of children with poorly controlled asthma.
Collapse
|