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Shah R, Hassan N, Harris S. Impact of a Vision Photoscreener in Very Young Children in an Inner-City Pediatric Clinic in Detroit. Clin Pediatr (Phila) 2024; 63:625-632. [PMID: 37568267 DOI: 10.1177/00099228231191950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/13/2023]
Abstract
Pediatric vision screening is important because approximately 80% of visual impairments, including amblyopia, can be prevented or cured, especially if caught early. This retrospective study aims to determine whether the implementation of a machine photoscreener improves vision outcomes in 1- to 4-year-old children in an urban clinic. Before the vision screener, 91 patients were seen (control group), while 205 were seen following its implementation (study group). The number of children screened increased by 27.4% after implementing the photoscreener (57.1% study, 29.7% control, P < .001). All patients who failed the screening, 14.6% in the study period, were referred to ophthalmology (n = 30); 40% (n = 12) were evaluated, and 9 were diagnosed with a true vision abnormality. Instrument vision screening allows children as young as 1 year to be screened and allows for early intervention for potential vision-threatening pathologies in a vulnerable urban population.
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Affiliation(s)
- Riya Shah
- School of Medicine, Wayne State University, Detroit, MI, USA
| | - Nimra Hassan
- School of Medicine, Wayne State University, Detroit, MI, USA
| | - Susan Harris
- Department of Pediatrics, School of Medicine, Wayne State University, Detroit, MI, USA
- Wayne Pediatrics, Detroit, MI, USA
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2
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Akar-Ghibril N, Greco KF, Jackson-Browne M, Phipatanakul W, Permaul P. High plasma IL-6 levels may enhance the adverse effects of mouse allergen exposure in urban schools on asthma morbidity in children. J Allergy Clin Immunol 2023; 152:1677-1682. [PMID: 37541489 PMCID: PMC10837306 DOI: 10.1016/j.jaci.2023.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/25/2023] [Accepted: 06/16/2023] [Indexed: 08/06/2023]
Abstract
BACKGROUND Few data on the relationships between environmental exposures, asthma morbidity, and systemic IL-6 inflammation exist. OBJECTIVE We sought to determine whether baseline plasma IL-6 level is associated with increased asthma morbidity in children exposed to mouse allergen in inner-city classrooms. METHODS Data from the longitudinal School Inner-City Asthma Studies of 215 children with asthma, aged 4 to 14 years and recruited from urban elementary schools, were analyzed. Given the unknown threshold of IL-6 risk levels and skewness of the distribution, the children were stratified into tertiles as follows: low baseline IL-6 level (<0.013 pg/mL), moderate baseline IL-6 level (0.013-0.302 pg/mL), and high baseline IL-6 level (>0.302 pg/mL). Relationships between plasma IL-6 level and body mass index (BMI) percentile, inflammatory markers, lung function, mouse allergen exposure, and asthma outcomes were assessed. RESULTS Cross-sectional analysis demonstrated that increasing IL-6 level was associated with higher BMI percentile (P < .0001), C-reactive protein level (P = .0006), and blood neutrophil count (P = .0024). IL-6 was not associated with type 2 inflammatory markers, including blood eosinophil count, allergic sensitization, or fractional exhaled nitric oxide level. Longitudinal analysis showed that children with high IL-6 levels had a higher number of days with asthma symptoms than did those children with moderate (incidence rate ratio = 1.74 [95% CI = 1.10-2.77]; P = .0187) or low (incidence rate ratio =1.83 [95% CI = 1.21-2.77]; P = .0043) IL-6 levels. Children with high IL-6 levels who were exposed to increasing levels of mouse allergen exhibited lower ratios of FEV1 value to forced vital capacity than did children with moderate IL-6 levels (β = -0.0044 [95% CI = -0.0073 to -0.0015]; pairwise interaction P = .0028) or low IL-6 levels (β = -0.0042 [95% CI = - 0.0070 to -0.0013]; pairwise interaction P = .0039). CONCLUSIONS Inner-city children with asthma and high plasma IL-6 levels are more likely to have an increased BMI, elevated C-reactive protein level, elevated blood neutrophil count, and greater asthma symptoms. High IL-6 level appears to increase susceptibility to the effects of classroom exposure to mouse allergen on lung function in urban children.
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Affiliation(s)
- Nicole Akar-Ghibril
- Division of Immunology, Allergy, and Rheumatology, Joe DiMaggio Children's Hospital, Hollywood, Fla
| | - Kimberly F Greco
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | | | - Wanda Phipatanakul
- Division of Immunology, Boston Children's Hospital, Harvard Medical School, Boston, Mass.
| | - Perdita Permaul
- Division of Pulmonology, Allergy and Immunology, Weill Cornell Medicine/New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY
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3
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Ruchkin V, Isaksson J, Stickley A, Schwab-Stone M. Longitudinal Associations Between Community Violence Exposure and Mental Health Problems in Inner-City Youth: Ethnicity and Gender Perspectives. J Interpers Violence 2023; 38:8619-8644. [PMID: 36915222 DOI: 10.1177/08862605231158754] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
There is a lack of agreement on whether children and adolescents with different cultural/ethnic backgrounds react to trauma in a similar fashion. This study adds to the existing literature by providing ethnicity and gender perspectives on the longitudinal associations between the degree of community violence exposure (CVE) and mental health problems in U.S. inner-city youth. The study was conducted on a representative sample of predominantly ethnic minority youth (N = 2,794; 54.1% female; age 11-16 years old (M [SD] = 12.77 [1.29]); 60.0% African-American, 26.1% Hispanic American, 13.9% White). Self-reported information was obtained on CVE in year 1 and on mental health problems (depressive symptoms, posttraumatic stress, alcohol use, and conduct problems) in year 1 and year 2. Multivariate analyses of covariance (MANCOVA) were used to compare mental health problems in youth from the three ethnic groups in relation to the different degrees of CVE experienced one year prior, while controlling for their baseline mental health problem levels, age, and socio-economic status. Mental health problems in year 2 increased in a similar fashion in relation to the degree of severity of CVE in year 1 in all three ethnic groups. The interaction effects suggested a gender-specific response to CVE, where girls in the three ethnic groups reported higher levels of depression and posttraumatic stress in relation to the same degree of CVE, as compared to boys. Adolescents from different ethnic backgrounds respond similarly to differing degrees of CVE with an increase in mental health problems over time. In response to a similar degree of exposure, girls tend to experience greater levels of internalizing problems than boys. Timely recognition of traumatic exposure and associated mental health problems is important for early prevention and intervention strategies.
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Affiliation(s)
- Vladislav Ruchkin
- Uppsala University, Sweden
- Yale University School of Medicine, New Haven, CT, USA
- Sala Forensic Psychiatric Clinic, Sweden
| | | | - Andrew Stickley
- National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
- Södertörn University, Huddinge, Sweden
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4
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Dunning HT, Boy C, Davis NL, Griffing E, Lasso-Pirot A. A hospital-based multidimensional intervention for high risk pediatric patients with asthma. J Asthma 2021; 59:1732-1741. [PMID: 34374617 DOI: 10.1080/02770903.2021.1963764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objective: To determine the effects of a multi-dimensional intervention (consisting of education, recommendations for medical management, and short-term case management) provided by pulmonology nurse practitioners(NP) on inpatient and post-discharge outcomes for patients admitted with asthma exacerbations to a Pediatric Intensive Care Unit(PICU).Methods: A retrospective cohort study was completed on subjects with an asthma exacerbation admitted to the PICU from 01-01-2015 to 31-12-2018. Records were reviewed for 12-months post-discharge. We compared inpatient and post-discharge outcomes for those who did vs. did not receive NP consultation. The primary outcome evaluated was optimization of discharge medications. Rates of follow up, repeat ED visits and hospitalizations were also reviewed.Results: 222 subjects met inclusion and exclusion criteria; of those, 101(45.5%) patients received NP consultation and 121(54.5%) had PICU management only. Patients with NP consultation were more likely to have controllers initiated (34.6% vs. 15%) or adjusted (55.5% vs. 33.3%) per asthma guidelines (p < 0.001). The consult group were more likely to have an asthma follow-up appointment made prior to discharge (99% vs. 45%, p < 0.001), and were more likely to attend the appointment (51% vs. 21%, p < 0.001). There were no significant differences between groups for ED visits or readmission for asthma 12-months post-discharge.Conclusions: Patients with NP consultation were more likely to have controllers started or adjusted per guidelines and were more likely to attend specialty follow-up appointments post-discharge. No impact was seen on ED visits or readmissions. Implementation of such a program may aid in optimizing asthma management and continuity of care post hospitalization.
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Affiliation(s)
- Heather T Dunning
- University of Maryland Children's Hospital, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Christine Boy
- University of Maryland Children's Hospital, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Natalie L Davis
- University of Maryland Children's Hospital, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Emily Griffing
- University of Maryland Children's Hospital, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Anayansi Lasso-Pirot
- University of Maryland Children's Hospital, University of Maryland School of Medicine, Baltimore, MD, USA
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Fani N, Currier JM, Turner MD, Guelfo A, Kloess M, Jain J, Mekawi Y, Kuzyk E, Hinrichs R, Bradley B, Powers A, Stevens JS, Michopoulos V, Turner JA. Moral injury in civilians: associations with trauma exposure, PTSD, and suicide behavior. Eur J Psychotraumatol 2021; 12:1965464. [PMID: 34603635 PMCID: PMC8480773 DOI: 10.1080/20008198.2021.1965464] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Moral injury (MI) describes emotional, spiritual, and social suffering that can arise following psychological trauma. Prior research in military pop ulations indicates the relevance of MI to adverse psychological outcomes, such as post-traumatic stress disorder (PTSD) and suicidal behaviours, and shows evidence for MI as a unique construct. Minimal studies of MI have been implemented in civilians, usually restricted to small samples with a specific set of traumatic experiences, despite the conceptual relevance of MI to non-military trauma reactions more broadly (e.g. feelings of betrayal towards a perpetrator of sexual abuse). OBJECTIVE To address this problem, we assessed MI in trauma-exposed civilians to examine ways in which this construct was related to and distinct from trauma and traumatic stress-related problems, including PTSD and depression. METHOD We adapted an existing MI scale, Moral Injury Events Scale (MIES) and administered this measure to 81 men and women along with measures of trauma exposure, PTSD and depression, and also asked participants about past suicide attempts. RESULTS We observed that both greater exposure and distress related to potentially morally injurious events were associated with higher trauma exposure, particularly childhood maltreatment, as well as post-traumatic and depressive psychopathology. However, even after accounting for current PTSD and depression symptoms, MI exposure (F = 6.05, p = .017) was significantly higher among participants who had previously attempted suicide. CONCLUSIONS These pilot data reveal the ways in which MI is associated with trauma exposure, PTSD and depression and highlight the salience of MI in civilians. Similarly, these data demonstrate the unique relevance of MI to suicide behaviours, independent of post-traumatic psychopathology, indicating that this construct may be an understudied contributor to suicide risk in civilians.
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Affiliation(s)
- Negar Fani
- Department of Psychiatry, Emory University, Atlanta, GA, USA
| | - Joseph M Currier
- Department of Psychology, University of South Alabama, Mobile, AL, USA
| | - Matthew D Turner
- Department of Psychology, Georgia State University, Atlanta, USA
| | | | | | - Jahnvi Jain
- Department of Psychiatry, Emory University, Atlanta, GA, USA
| | - Yara Mekawi
- Department of Psychiatry, Emory University, Atlanta, GA, USA
| | - Eva Kuzyk
- Department of Psychiatry, Emory University, Atlanta, GA, USA
| | | | - Bekh Bradley
- Department of Psychiatry, Emory University, Atlanta, GA, USA
| | - Abigail Powers
- Department of Psychiatry, Emory University, Atlanta, GA, USA
| | | | | | - Jessica A Turner
- Department of Psychology, Georgia State University, Atlanta, USA
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6
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Lin NY, Ramsey RR, Miller JL, McDowell KM, Zhang N, Hommel K, Guilbert TW. Telehealth delivery of adherence and medication management system improves outcomes in inner-city children with asthma. Pediatr Pulmonol 2020; 55:858-865. [PMID: 31905264 PMCID: PMC9125769 DOI: 10.1002/ppul.24623] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 12/16/2019] [Indexed: 12/19/2022]
Abstract
Healthcare disparities exist in pediatric asthma in the United States. Children from minority, low-income families in inner-city areas encounter barriers to healthcare, leading to greater rates of poorly controlled asthma and healthcare utilization. Finding an effective way to deliver high-quality healthcare to this underserved population to improve outcomes, reduce morbidity and mortality, and reduce healthcare utilization is of the utmost importance. The purpose of this study was to assess the feasibility and efficacy of a novel school-based care delivery model that incorporates video-based telehealth (VBT) medical and self-management visits with electronic inhaler monitoring to improve asthma outcomes. Over a 6-month period, children from inner-city, low-income schools with uncontrolled asthma completed seven scheduled medical visits with an asthma specialist and five self-management visits with an adherence psychologist at school using VBT. Composite Asthma Severity Index (CASI) scores and electronic inhaler monitor data were recorded and analyzed. A total of 21 patients were enrolled in the study. Study subjects with higher baseline severity (CASI ≥ 4 at visit 1) demonstrated a greater reduction in their score than those with lower baseline severity (CASI < 4 at visit 1). The CASI domains showed improvement in daytime symptoms, nighttime symptoms, and exacerbations. Adherence results demonstrated a significant improvement in adherence from baseline to postintervention. Study retention was 100%. This study demonstrates that a multicomponent medical and behavioral interventional program delivered by VBT to a school-based setting is feasible and can significantly improve asthma outcomes and care in a challenging population.
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Affiliation(s)
- Nancy Y Lin
- Division of Pulmonary Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Rachelle R Ramsey
- Division of Behavioral Medicine and Clinical Psychology, Center for Health Technology Research, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - James L Miller
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Karen M McDowell
- Division of Pulmonary Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Nanhua Zhang
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.,Division of Biostatistics and Epidemiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Kevin Hommel
- Division of Behavioral Medicine and Clinical Psychology, Center for Health Technology Research, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Theresa W Guilbert
- Division of Pulmonary Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
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7
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Permaul P, Gaffin JM, Petty CR, Baxi SN, Lai PS, Sheehan WJ, Camargo CA, Gold DR, Phipatanakul W. Obesity may enhance the adverse effects of NO 2 exposure in urban schools on asthma symptoms in children. J Allergy Clin Immunol 2020; 146:813-820.e2. [PMID: 32197971 DOI: 10.1016/j.jaci.2020.03.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 02/26/2020] [Accepted: 03/09/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Sparse data address the effects of nitrogen dioxide (NO2) exposure in inner-city schools on obese students with asthma. OBJECTIVE We sought to evaluate relationships between classroom NO2 exposure and asthma symptoms and morbidity by body mass index (BMI) category. METHODS The School Inner-City Asthma Study enrolled students aged 4 to 13 years with asthma from 37 inner-city schools. Students had baseline determination of BMI percentile. Asthma symptoms, morbidity, pulmonary inflammation, and lung function were monitored throughout the subsequent academic year. Classroom NO2 data, linked to enrolled students, were collected twice per year. We determined the relationship between classroom NO2 levels and asthma outcomes by BMI stratification. RESULTS A total of 271 predominantly black (35%) or Hispanic students (35%) were included in analyses. Fifty percent were normal weight (5-84th BMI percentile), 15% overweight (≥85-94th BMI percentile), and 35% obese (≥95th BMI percentile). For each 10-parts per billion increase in NO2, obese students had a significant increase in the odds of having an asthma symptom day (odds ratio [OR], 1.86; 95% CI, 1.15-3.02) and in days caregiver changed plans (OR, 4.24; 95% CI, 2.33-7.70), which was significantly different than normal weight students who exhibited no relationship between NO2 exposure and symptom days (OR, 0.90; 95% CI, 0.57-1.42; pairwise interaction P = .03) and change in caregiver plans (OR, 1.37; 95% CI, 0.67-2.82; pairwise interaction P = .02). Relationships between NO2 levels and lung function and fractional exhaled nitric oxide did not differ by BMI category. If we applied a conservative Holm-Bonferroni correction for 16 comparisons (obese vs normal weight and overweight vs normal weight for 8 outcomes), these findings would not meet statistical significance (all P > .003). CONCLUSIONS Obese BMI status appears to increase susceptibility to classroom NO2 exposure effects on asthma symptoms in inner-city children. Environmental interventions targeting indoor school NO2 levels may improve asthma health for obese children. Although our findings would not remain statistically significant after adjustment for multiple comparisons, the large effect sizes warrant future study of the interaction of obesity and pollution in pediatric asthma.
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Affiliation(s)
- Perdita Permaul
- Division of Pediatric Pulmonology, Allergy and Immunology, New York-Presbyterian/Weill Cornell Medicine, New York, NY; Weill Cornell Medical College, New York, NY
| | - Jonathan M Gaffin
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
| | - Carter R Petty
- Clinical Research Center, Boston Children's Hospital, Boston, Mass
| | - Sachin N Baxi
- Division of Allergy and Immunology, Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
| | - Peggy S Lai
- Harvard Medical School, Boston, Mass; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Mass; Division of Pulmonary and Critical Care, Massachusetts General Hospital, Boston, Mass
| | - William J Sheehan
- Division of Allergy and Immunology, Children's National Health System, Washington, DC; George Washington University School of Medicine, Washington, DC
| | - Carlos A Camargo
- Harvard Medical School, Boston, Mass; Department of Emergency Medicine, Massachusetts General Hospital, Boston, Mass
| | - Diane R Gold
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Mass; Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Mass
| | - Wanda Phipatanakul
- Division of Allergy and Immunology, Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass.
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8
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McClelland QYL, Avalos MI, Reznik M. Asthma management in New York City schools: A physical education teacher perspective. J Asthma 2019; 56:422-430. [PMID: 29667459 PMCID: PMC6295268 DOI: 10.1080/02770903.2018.1463380] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 03/22/2018] [Accepted: 04/05/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Physical education (PE) teachers may be the first to assist students with asthma attacks during PE class. This study explores the PE teachers' perspectives on in-school asthma management and barriers to physical activity (PA) in children with asthma attending urban elementary schools. METHODS We conducted qualitative semi-structured interviews with 16 PE teachers from 10 Bronx, NY elementary schools. Interviews were recorded, transcribed, and independently coded. Content analysis was used to identify 10 major themes common across interviews which were then categorized into 3 domains. RESULTS Three domains were identified: 1) school procedures and policies for asthma management; 2) role of PE teachers in asthma management; and 3) barriers to PA for students. Most PE teachers were unaware of written procedures for acute asthma management and did not receive asthma-specific training. Many PE teachers expressed confidence regarding asthma management. PE teachers identified students with asthma most commonly through communication with students. The PE teachers utilized various methods to manage asthma but all relied on the nurse to handle acute asthma symptoms. Several barriers to PA were determined, including PE teachers' unawareness of NYS PE requirements, lack of gym facilities, inclement weather, inconsistent PE class time, asthma diagnosis, and having no asthma inhalers at the nurse's office. CONCLUSIONS PE teachers' perspectives on asthma management may influence the way asthma is handled at school. The results from this study highlight several barriers that can be targeted in future interventions to improve asthma management.
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Affiliation(s)
- Qi Ying Li McClelland
- Pediatrics, Children’s Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Maria Ivanna Avalos
- Pediatrics, Children’s Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Marina Reznik
- Pediatrics, Children’s Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
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Abstract
We aim to explore the experiences of fathers from inner-city families caring for children affected by chronic health conditions or disabilities. A systematic scoping review was conducted using the Arskey and O'Malley framework. Fourteen of the 5114 articles were included in the full review and were qualitatively evaluated in terms of stressors, resources, perception, coping, and adaptation according to the Double ABCX model. Stressors included financial strain and health care access barriers. Resources ranging from immediate to extended family members depended on ethnicity. Fathers' perceptions of their primary caregiver roles depended on ethnicity in the context of cultural gender norms. While inner-city fathers desired information about their children's health, some were uncomfortable asking physicians. They had a higher risk for coping difficulties and maladaptation, including depression. We highlight a need for pediatricians to advocate for additional resources to provide comprehensive care for inner-city fathers caring for their children with chronic health conditions or disabilities.
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Affiliation(s)
- Anna Kobylianskii
- 1 University of Toronto, Toronto, Ontario, Canada.,2 St Michael's Hospital, Toronto, Ontario, Canada
| | - Thivia Jegathesan
- 1 University of Toronto, Toronto, Ontario, Canada.,2 St Michael's Hospital, Toronto, Ontario, Canada
| | - Elizabeth Young
- 1 University of Toronto, Toronto, Ontario, Canada.,2 St Michael's Hospital, Toronto, Ontario, Canada
| | - Kimmy Fung
- 2 St Michael's Hospital, Toronto, Ontario, Canada
| | - Joelene Huber
- 1 University of Toronto, Toronto, Ontario, Canada.,2 St Michael's Hospital, Toronto, Ontario, Canada.,3 The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ripudaman S Minhas
- 1 University of Toronto, Toronto, Ontario, Canada.,2 St Michael's Hospital, Toronto, Ontario, Canada
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10
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Abstract
PURPOSE We sought to examine whether low-income inner-city expectant women who intend to breastfeed make different contraceptive choices than those who intend to formula feed. MATERIALS AND METHODS This cross-sectional pilot study surveyed expectant women age 14 years and older receiving prenatal care at MacDonald Women's Hospital, Cleveland Ohio (01 November 2016-15 January 2017). Questions assessed knowledge and attitudes regarding infant feeding and contraception options, and postpartum feeding and contraceptive intentions. RESULTS We enrolled 223 expectant women, mean age 25.6 years at a median of 30 weeks gestation; 192 (86.5%) were African-American and 171 (75%) were multiparous. Women intending to breastfeed had 0.44 times the odds of intending to use birth control after delivery (95% CI [0.19-1.05], p = .06), while women intending to feed formula had 2.26 times the odds of intending to use birth control after delivery (95% CI [0.95-5.40]). Contraceptive attitudes significantly impacted intent to use contraception (p = .007), with every point higher on the contraception attitudes scale equating to a 7% increase in odds of postpartum contraception use. CONCLUSIONS Postpartum contraceptive intentions do not differ significantly between women intending to breastfeed and those intending formula feeding. Contraception attitudes do not significantly change this association, but were significantly related to contraceptive intent. Findings highlight the importance of providing comprehensive birth control education to all expectant mothers, regardless of feeding intention. Our study is unique in addressing interactions between maternal contraceptive and feeding intentions among expectant women at high risk for both not breastfeeding and unintended short interval pregnancy.
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Affiliation(s)
- Elena Fuell Wysong
- a Case Western Reserve University School of Medicine , Cleveland , OH , USA
| | - Krystel Tossone
- b Case Western Reserve University Jack Joseph and Morton Mandel School of Applied Social Sciences , Cleveland , OH , USA
| | - Lydia Furman
- c University Hospitals Rainbow Babies and Children's Hospital , Cleveland , OH , USA
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11
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Dilley MA, Petty CR, Sheehan WJ, Gaffin JM, Hauptman M, Phipatanakul W. Adherence and stress in a population of inner-city children with asthma. Pediatr Allergy Immunol 2017; 28:610-612. [PMID: 28686791 PMCID: PMC5585050 DOI: 10.1111/pai.12756] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Meredith A Dilley
- Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | | | - William J Sheehan
- Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Jonathan M Gaffin
- Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Marissa Hauptman
- Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Wanda Phipatanakul
- Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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12
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Abstract
OBJECTIVE To examine whether children with asthma in an urban health care network are receiving asthma specialty care, and which factors, if any, are associated with the receipt of this care, including child's racial/ethnic group, age, socio-economic status (SES), insurance, and/or acute care utilization. METHODS This study is a retrospective cohort study of children aged 7-17 years who received primary care at an urban medical center in 2012 and had a primary or secondary ICD9 code for asthma. Data on asthma-related health care utilization from 1997 to 2012 were accessed using a software application linked to the electronic medical record. Analyses included descriptive statistics (means and percentages) as well as bivariate and multivariable logistic regressions. RESULTS The participants were 4959 children (59% Hispanic and 37% Black, Non-Hispanic) with a mean age = 11.1 years ± 3.05, with 56.8% males. Only 19% of the children had outpatient asthma specialist care: pulmonary (16%) and/or allergy (7%). Only 42% with an asthma-related hospitalization had an outpatient asthma specialist visit. The receipt of specialty care did not vary by race/ethnicity, SES or private vs. public insurance, but was more likely with hospitalization for asthma (OR 3.4) or ≥2 lifetime ED visits (OR 2.6) and less likely for those who were uninsured (OR 0.7). CONCLUSIONS In contrast to guideline recommendations, few inner-city children with high asthma morbidity in this sample had seen asthma specialists. Efforts are needed to ensure that inner-city children with asthma are receiving guideline-recommended asthma specialty care.
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Affiliation(s)
- Karen L Warman
- a The Children's Hospital at Montefiore , Albert Einstein College of Medicine , Bronx , NY , USA
| | - Ellen J Silver
- a The Children's Hospital at Montefiore , Albert Einstein College of Medicine , Bronx , NY , USA
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Liu AH, Babineau DC, Krouse RZ, Zoratti EM, Pongracic JA, O'Connor GT, Wood RA, Khurana Hershey GK, Kercsmar CM, Gruchalla RS, Kattan M, Teach SJ, Makhija M, Pillai D, Lamm CI, Gern JE, Sigelman SM, Gergen PJ, Togias A, Visness CM, Busse WW. Pathways through which asthma risk factors contribute to asthma severity in inner-city children. J Allergy Clin Immunol 2017; 138:1042-1050. [PMID: 27720018 DOI: 10.1016/j.jaci.2016.06.060] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 05/24/2016] [Accepted: 06/03/2016] [Indexed: 01/18/2023]
Abstract
BACKGROUND Pathway analyses can be used to determine how host and environmental factors contribute to asthma severity. OBJECTIVE To investigate pathways explaining asthma severity in inner-city children. METHODS On the basis of medical evidence in the published literature, we developed a conceptual model to describe how 8 risk-factor domains (allergen sensitization, allergic inflammation, pulmonary physiology, stress, obesity, vitamin D, environmental tobacco smoke [ETS] exposure, and rhinitis severity) are linked to asthma severity. To estimate the relative magnitude and significance of hypothesized relationships among these domains and asthma severity, we applied a causal network analysis to test our model in an Inner-City Asthma Consortium study. Participants comprised 6- to 17-year-old children (n = 561) with asthma and rhinitis from 9 US inner cities who were evaluated every 2 months for 1 year. Asthma severity was measured by a longitudinal composite assessment of day and night symptoms, exacerbations, and controller usage. RESULTS Our conceptual model explained 53.4% of the variance in asthma severity. An allergy pathway (linking allergen sensitization, allergic inflammation, pulmonary physiology, and rhinitis severity domains to asthma severity) and the ETS exposure pathway (linking ETS exposure and pulmonary physiology domains to asthma severity) exerted significant effects on asthma severity. Among the domains, pulmonary physiology and rhinitis severity had the largest significant standardized total effects on asthma severity (-0.51 and 0.48, respectively), followed by ETS exposure (0.30) and allergic inflammation (0.22). Although vitamin D had modest but significant indirect effects on asthma severity, its total effect was insignificant (0.01). CONCLUSIONS The standardized effect sizes generated by a causal network analysis quantify the relative contributions of different domains and can be used to prioritize interventions to address asthma severity.
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Affiliation(s)
- Andrew H Liu
- National Jewish Health, Denver, Colo; Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colo.
| | | | | | | | | | | | - Robert A Wood
- Johns Hopkins University School of Medicine, Baltimore, Md
| | | | | | | | - Meyer Kattan
- College of Physicians and Surgeons, Columbia University, New York, NY
| | - Stephen J Teach
- Children's National Health System and the George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Melanie Makhija
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill
| | - Dinesh Pillai
- Children's National Health System and the George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Carin I Lamm
- College of Physicians and Surgeons, Columbia University, New York, NY
| | - James E Gern
- University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | | | - Peter J Gergen
- National Institute of Allergy and Infectious Diseases, Bethesda, Md
| | - Alkis Togias
- National Institute of Allergy and Infectious Diseases, Bethesda, Md
| | | | - William W Busse
- University of Wisconsin School of Medicine and Public Health, Madison, Wis
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14
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Abstract
OBJECTIVE Classroom teachers play an important role in facilitating asthma management in school but little is known about their perspectives around asthma management. We examined the perspectives of classroom teachers around barriers to school asthma management. METHODS We conducted key informant interviews with 21 inner-city classroom teachers from 3rd to 5th grades in 10 Bronx, New York elementary schools. Sampling continued until thematic saturation was reached. Interviews were recorded, transcribed, and independently coded for common themes. We used thematic and content review to analyze interview data. RESULTS Seven themes representing teachers' perspectives on in-school asthma management emerged: (1) the problematic process of identifying students with asthma; (2) poor familiarity with the city health department's asthma initiative and poor general knowledge of school policies on asthma management; (3) lack of competency in managing an acute asthma attack in the classroom and poor recognition of symptoms of an asthma attack; (4) lack of confidence in dealing with a hypothetical asthma attack in the classroom; (5) lack of quick access to asthma medication in school; (6) limited communication between school staff; and (7) enthusiasm about learning more about asthma management. CONCLUSIONS Our results revealed several barriers contributing to suboptimal in-school asthma management: ineffective ways of identifying students with asthma, lack of teacher knowledge of guidelines on asthma management, lack of comfort in managing students' asthma, inadequate access to asthma medication in school, and limited communication between school staff. These issues should be considered in the design of interventions to improve in-school asthma management.
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Affiliation(s)
- Agnieszka Cain
- a Medical School, Albert Einstein College of Medicine , Bronx , NY , USA
| | - Marina Reznik
- b Department of Pediatrics , Children's Hospital at Montefiore, Albert Einstein College of Medicine , Bronx , NY , USA
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15
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Heaman MI, Sword W, Elliott L, Moffatt M, Helewa ME, Morris H, Tjaden L, Gregory P, Cook C. Perceptions of barriers, facilitators and motivators related to use of prenatal care: A qualitative descriptive study of inner-city women in Winnipeg, Canada. SAGE Open Med 2015; 3:2050312115621314. [PMID: 27092262 PMCID: PMC4822530 DOI: 10.1177/2050312115621314] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 11/11/2015] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The objective of this qualitative descriptive study was to explore the perceptions of women living in inner-city Winnipeg, Canada, about barriers, facilitators, and motivators related to their use of prenatal care. METHODS Individual, semi-structured interviews were conducted in person with 26 pregnant or postpartum women living in inner-city neighborhoods with high rates of inadequate prenatal care. Interviews averaged 67 min in length. Recruitment of participants continued until data saturation was achieved. Inductive content analysis was used to identify themes and subthemes under four broad topics of interest (barriers, facilitators, motivators, and suggestions). Sword's socio-ecological model of health services use provided the theoretical framework for the research. This model conceptualizes service use as a product of two interacting systems: the personal and situational attributes of potential users and the characteristics of health services. RESULTS Half of the women in our sample were single and half self-identified as Aboriginal. Participants discussed several personal and system-related barriers affecting use of prenatal care, such as problems with transportation and child care, lack of prenatal care providers, and inaccessible services. Facilitating factors included transportation assistance, convenient location of services, positive care provider qualities, and tangible rewards. Women were motivated to attend prenatal care to gain knowledge and skills and to have a healthy baby. CONCLUSION Consistent with the theoretical framework, women's utilization of prenatal care was a product of two interacting systems, with several barriers related to personal and situational factors affecting women's lives, while other barriers were related to problems with service delivery and the broader healthcare system. Overcoming barriers to prenatal care and capitalizing on factors that motivate women to seek prenatal care despite difficult living circumstances may help improve use of prenatal care by inner-city women.
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Affiliation(s)
- Maureen I Heaman
- College of Nursing, University of Manitoba, Winnipeg, MB, Canada
| | - Wendy Sword
- School of Nursing, University of Ottawa, Ottawa, ON, Canada
| | - Lawrence Elliott
- Departments of Community Health Sciences and Medical Microbiology, University of Manitoba, Winnipeg, MB, Canada
| | - Michael Moffatt
- Departments of Community Health Sciences and Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - Michael E Helewa
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Heather Morris
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Lynda Tjaden
- Public Health, Winnipeg Regional Health Authority, Winnipeg, MB, Canada
| | | | - Catherine Cook
- Population and Aboriginal Health, Winnipeg Regional Health Authority, Winnipeg, MB, Canada
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16
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Butz AM, Ogborn J, Mudd S, Ballreich J, Tsoukleris M, Kub J, Bellin M, Bollinger ME. Factors associated with high short-acting β2-agonist use in urban children with asthma. Ann Allergy Asthma Immunol 2015; 114:385-92. [PMID: 25840499 PMCID: PMC4426068 DOI: 10.1016/j.anai.2015.03.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 02/10/2015] [Accepted: 03/03/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND One goal of guideline-based asthma therapy is minimal use of short-acting β₂ agonist (SABA) medications. Inner-city children with asthma are known to have high SABA use. OBJECTIVE To examine factors associated with high SABA use in inner-city children with asthma. METHODS One hundred inner-city children with persistent asthma were enrolled into a randomized controlled trial of an emergency department (ED) and home intervention. All children underwent serologic allergen specific IgE and salivary cotinine testing at the ED enrollment visit. Pharmacy records for the past 12 months were obtained. Number of SABA fills during the past 12 months was categorized into low- to moderate- vs high-use groups. SABA groups were compared by the number of symptom days and nights, allergen sensitization, and exposures. Regression models were used to predict high SABA use. RESULTS Mean number of SABA fills over 12 months was 3.12. Unadjusted bivariate analysis showed that high SABA users were more than 5 times more likely to have an asthma hospitalization, almost 3 times more likely to have an asthma intensive care unit admission, and more than 3 times more likely to have prior specialty asthma care or positive cockroach sensitization than low to moderate SABA users. In the final regression model, for every additional inhaled corticosteroid fill, a child was 1.4 times more likely and a child with positive cockroach sensitization was almost 7 times more likely to have high SABA use when controlling for prior intensive care unit admission, receipt of specialty care, child age, and income. CONCLUSION Providers should closely monitor SABA and controller medication use, allergen sensitization, and exposures in children with persistent asthma. TRIAL REGISTRATION ClinicalTrials.gov, identifier NCT01981564.
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Affiliation(s)
- Arlene M Butz
- Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Jean Ogborn
- Department of Pediatric Emergency Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Shawna Mudd
- The Johns Hopkins University School of Nursing, Baltimore, Maryland
| | - Jeromie Ballreich
- The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Mona Tsoukleris
- The University of Maryland School of Pharmacy, Baltimore, Maryland
| | - Joan Kub
- The Johns Hopkins University School of Nursing, Baltimore, Maryland
| | - Melissa Bellin
- The University of Maryland School of Social Work, Baltimore, Maryland
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Ownby DR, Tingen MS, Havstad S, Waller JL, Johnson CC, Joseph CLM. Comparison of asthma prevalence among African American teenage youth attending public high schools in rural Georgia and urban Detroit. J Allergy Clin Immunol 2015; 136:595-600.e3. [PMID: 25825215 DOI: 10.1016/j.jaci.2015.02.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 01/30/2015] [Accepted: 02/04/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The high prevalence of asthma among urban African American (AA) populations has attracted research attention, whereas the prevalence among rural AA populations is poorly documented. OBJECTIVE We sought to compare the prevalence of asthma among AA youth in rural Georgia and urban Detroit, Michigan. METHODS The prevalence of asthma was compared in population-based samples of 7297 youth attending Detroit public high schools and in 2523 youth attending public high schools in rural Georgia. Current asthma was defined as a physician diagnosis and symptoms in the previous 12 months. Undiagnosed asthma was defined as multiple respiratory symptoms in the previous 12 months without a physician diagnosis. RESULTS In Detroit, 6994 (95.8%) youth were AA compared with 1514 (60.0%) in Georgia. Average population density in high school postal codes was 5628 people/mile(2) in Detroit and 45.1 people/mile(2) in Georgia. The percentages of poverty and of students qualifying for free or reduced lunches were similar in both areas. The prevalence of current diagnosed asthma among AA youth in Detroit and Georgia was similar: 15.0% (95% CI, 14.1-15.8) and 13.7% (95% CI, 12.0-17.1) (P = .22), respectively. The prevalence of undiagnosed asthma in AA youth was 8.0% in Detroit and 7.5% in Georgia (P = .56). Asthma symptoms were reported more frequently among those with diagnosed asthma in Detroit, whereas those with undiagnosed asthma in Georgia reported more symptoms. CONCLUSIONS Among AA youth living in similar socioeconomic circumstances, asthma prevalence is as high in rural Georgia as it is in urban Detroit, suggesting that urban residence is not an asthma risk factor.
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Affiliation(s)
- Dennis R Ownby
- Department of Pediatrics, Medical College of Georgia, Georgia Regents University, Augusta, Ga.
| | - Martha S Tingen
- Department of Pediatrics, Medical College of Georgia, Georgia Regents University, Augusta, Ga
| | - Suzanne Havstad
- Department of Public Health Sciences, Henry Ford Hospital, Detroit, Mich
| | - Jennifer L Waller
- Department of Biostatistics and Epidemiology, Medical College of Georgia, Georgia Regents University, Augusta, Ga
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18
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Abstract
Functional gastrointestinal disorders (FGIDs) are a common problem in pediatric patients and can affect quality of life. However, the extent of these disorders may vary in different subpopulations of children. This study investigated the prevalence of FGIDs in an inner-city primary care practice. Healthy patients between the ages of 9 and 17 were administered a validated questionnaire that assessed for FGIDs and other somatic complaints. Eleven of 145 patients (7.5%) met criteria for FGIDs based on Rome III Diagnostic Criteria. Raynaud-like symptoms tended to occur more often in patients meeting criteria for FGIDs, although this association was not statistically significant (P = .07). The lower prevalence of FGIDs in this population compared with earlier studies may suggest a link between socioeconomic status and the prevalence of FGIDs. Larger population-based studies consisting of a heterogeneous cohort from a variety of socioeconomic backgrounds are necessary to further elucidate the true connection between FGIDs and socioeconomic status.
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Affiliation(s)
- Ronen Stein
- University Hospitals Case Medical Center, Cleveland, OH, USA; The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Hong Li
- Case Western University School of Medicine, Cleveland, OH, USA
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19
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Kopel LS, Gaffin JM, Ozonoff A, Rao DR, Sheehan WJ, Friedlander JL, Permaul P, Baxi SN, Fu C, Subramanian SV, Gold DR, Phipatanakul W. Perceived neighborhood safety and asthma morbidity in the school inner-city asthma study. Pediatr Pulmonol 2015; 50:17-24. [PMID: 24421055 PMCID: PMC4096619 DOI: 10.1002/ppul.22986] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Accepted: 12/11/2013] [Indexed: 11/09/2022]
Abstract
AIM The aim of this study was to investigate whether neighborhood safety as perceived by primary caregivers is associated with asthma morbidity outcomes among inner-city school children with asthma. METHODS School children with asthma were recruited from 25 inner-city schools between 2009 and 2012 for the School Inner-City Asthma Study (N = 219). Primary caregivers completed a baseline questionnaire detailing their perception of neighborhood safety and their children's asthma symptoms, and the children performed baseline pulmonary function tests. In this cross-sectional analysis, asthma control was compared between children whose caregivers perceived their neighborhood to be unsafe versus safe. RESULTS After adjusting for potential confounders, those children whose primary caregivers perceived the neighborhood to be unsafe had twice the odds of having poorly controlled asthma (odds ratio [OR] adjusted = 2.2, 95% confidence interval [CI] = 1.2-3.9, P = 0.009), four times the odds of dyspnea and rescue medication use (OR adjusted = 4.7; 95% CI = 1.7-13.0, P = 0.003, OR adjusted = 4.0; 95% CI = 1.8-8.8, P < 0.001, respectively), three times as much limitation in activity (OR adjusted = 3.2; 95% CI = 1.4-7.7, P = 0.008), and more than twice the odds of night-time symptoms (OR adjusted = 2.2; 95% CI = 1.3-4.0, P = 0.007) compared to participants living in safe neighborhoods. There was no difference in pulmonary function test results between the two groups. CONCLUSIONS Primary caregivers' perception of neighborhood safety is associated with childhood asthma morbidity among inner-city school children with asthma. Further study is needed to elucidate mechanisms behind this association, and future intervention studies to address social disadvantage may be important.
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Affiliation(s)
- Lianne S Kopel
- Division of Respiratory Diseases, Boston Children's Hospital, Boston, Massachusetts
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20
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Jennings L. Do men need empowering too? A systematic review of entrepreneurial education and microenterprise development on health disparities among inner-city black male youth. J Urban Health 2014; 91:836-50. [PMID: 25135594 PMCID: PMC4199443 DOI: 10.1007/s11524-014-9898-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Economic strengthening through entrepreneurial and microenterprise development has been shown to mitigate poverty-based health disparities in developing countries. Yet, little is known regarding the impact of similar approaches on disadvantaged U.S. populations, particularly inner-city African-American male youth disproportionately affected by poverty, unemployment, and adverse health outcomes. A systematic literature review was conducted to guide programming and research in this area. Eligible studies were those published in English from 2003 to 2014 which evaluated an entrepreneurial and microenterprise initiative targeting inner-city youth, aged 15 to 24, and which did not exclude male participants. Peer-reviewed publications were identified from two electronic bibliographic databases. A manual search was conducted among web-based gray literature and registered trials not yet published. Among the 26 papers retrieved for review, six met the inclusion criteria and were retained for analysis. None of the 16 registered microenterprise trials were being conducted among disadvantaged populations in the U.S. The available literature suggests that entrepreneurial and microenterprise programs can positively impact youth's economic and psychosocial functioning and result in healthier decision-making. Young black men specifically benefited from increased autonomy, engagement, and risk avoidance. However, such programs are vastly underutilized among U.S. minority youth, and the current evidence is insufficiently descriptive or rigorous to draw definitive conclusions. Many programs described challenges in securing adequate resources, recruiting minority male youth, and sustaining community buy-in. There is an urgent need to increase implementation and evaluation efforts, using innovative and rigorous designs, to improve the low status of greater numbers of African-American male youth.
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Affiliation(s)
- Larissa Jennings
- Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room E5038, Baltimore, MD, 21205, USA,
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21
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Kanchongkittiphon W, Gaffin JM, Phipatanakul W. The indoor environment and inner-city childhood asthma. Asian Pac J Allergy Immunol 2014; 32:103-10. [PMID: 25003723 PMCID: PMC4110514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 03/21/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE Exposure to indoor pollutants and allergens has been speculated to cause asthma symptoms and exacerbations and influence the risk of developing asthma. The aim of this article is to review the medical literature regarding the role of the indoor environment on inner-city childhood asthma. DATA SOURCES A literature search was performed in PubMed. Studies focusing on inner-city indoor allergen, childhood asthma, and environmental controls were included. RESULTS The prevalence of asthma in children is increasing especially in inner-city area. Exposure to high levels of indoor allergens and pollutants has been related to asthma development. Studies have shown that mouse, cockroach, pets, dust mite, mold, tobacco smoke, endotoxin and nitrogen dioxide are the important exposures. Recent studies have shown that indoor environmental control is beneficial in reducing asthma morbidity and development. CONCLUSIONS Inner-city children are exposed to various indoor allergens and pollutants that may lead to asthma development and exacerbation of existing asthma. Multifaceted environmental controls are beneficial in improving asthma symptom and maybe a viable prevention strategy. Further prospective studies of environmental intervention are needed to further identify effective strategies to improve and prevent asthma symptoms in inner-city children.
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Affiliation(s)
- Watcharoot Kanchongkittiphon
- Division of Allergy and Immunology, Boston Children’s Hospital, Boston, MA, U.S
- Harvard Medical School, Boston, MA, U.S
- Department of Pediatrics, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Jonathan M. Gaffin
- Harvard Medical School, Boston, MA, U.S
- Division of Respiratory Diseases, Boston Children’s Hospital, Boston, MA, U.S
| | - Wanda Phipatanakul
- Division of Allergy and Immunology, Boston Children’s Hospital, Boston, MA, U.S
- Harvard Medical School, Boston, MA, U.S
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22
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Abstract
OBJECTIVE Regular physical activity (PA) is an important component of pediatric asthma management. No studies have examined how in-school asthma management influences PA from children's perspectives. The aim of this study was to explore children's perceptions of the impact of in-school asthma management on PA. METHODS Qualitative interviews with 23 inner-city minority children with asthma (aged 8-10 yrs; 12 girls, 11 boys) were conducted in 10 Bronx, New York elementary schools. Sampling continued until saturation was reached. Interviews were recorded, transcribed and independently coded for common themes. RESULTS Interviews produced five themes representing students' perceptions about (1) asthma symptoms during in-school PA; (2) methods to control asthma episodes during school PA; (3) methods to prevent asthma episodes during school; (4) limited accessibility of asthma medications; and (5) negative feelings about asthma and medication use. The majority of students experienced asthma symptoms while performing PA during school. Primary methods of managing asthma symptoms were sitting out during activity, drinking water, and visiting the nurse. Students lacked awareness or adherence to action plans to prevent or control asthma. Students reported limited access to medication during school and feelings of embarrassment and/or concerns of teasing when medicating in front of others. CONCLUSIONS Our results indicate inappropriate in-school management of asthma symptoms, poor asthma control, lack of accessible medication, and stigma around publicly using asthma medication. Thus, students often missed or were withheld from PA. Interventions to improve in-school asthma care must consider ways to address these issues.
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Affiliation(s)
- Timothy J Walker
- Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine , Bronx, New York , USA
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23
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Baxi SN, Muilenberg ML, Rogers CA, Sheehan WJ, Gaffin J, Permaul P, Kopel LS, Lai PS, Lane JP, Bailey A, Petty CR, Fu C, Gold DR, Phipatanakul W. Exposures to molds in school classrooms of children with asthma. Pediatr Allergy Immunol 2013; 24:697-703. [PMID: 24112429 PMCID: PMC3782748 DOI: 10.1111/pai.12127] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/05/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Students spend a large portion of their day in classrooms which may be a source of mold exposure. We examined the diversity and concentrations of molds in inner-city schools and described differences between classrooms within the same school. METHODS Classroom airborne mold spores, collected over a 2 day period, were measured twice during the school year by direct microscopy. RESULTS There were 180 classroom air samples collected from 12 schools. Mold was present in 100% of classrooms. Classrooms within the same school had differing mold levels and mold diversity scores. The total mold per classroom was 176.6 ± 4.2 spores/m3 (geometric mean ± standard deviation) and ranged from 11.2 to 16,288.5 spores/m3. Mold diversity scores for classroom samples ranged from 1 to 19 (7.7 ± 3.5). The classroom accounted for the majority of variance (62%) in the total mold count, and for the majority of variance (56%) in the mold diversity score versus the school. The species with the highest concentrations and found most commonly included Cladosporium (29.3 ± 4.2 spores/m3), Penicillium/Aspergillus (15.0 ± 5.4 spores/m3), smut spores (12.6 ± 4.0 spores/m3), and basidiospores (6.6 ± 7.1 spores/m3). CONCLUSIONS Our study found that the school is a source of mold exposure, but particularly the classroom microenvironment varies in quantity of spores and species among classrooms within the same school. We also verified that visible mold may be a predictor for higher mold spore counts. Further studies are needed to determine the clinical significance of mold exposure relative to asthma morbidity in sensitized and non-sensitized asthmatic children.
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Affiliation(s)
- Sachin N Baxi
- Division of Allergy and Immunology, Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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24
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Jay M, Stepney C, Wijetunga NA, Akinrinade G, Dorsey K, Bruzzese JM. Accuracy of weight perception among urban early adolescents with uncontrolled asthma and their caregivers. Ann Behav Med 2013; 45:239-48. [PMID: 23355113 PMCID: PMC3602231 DOI: 10.1007/s12160-012-9452-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Obesity is associated with poor asthma outcomes; weight loss improves such outcomes. Inaccurate recognition of obesity may impede weight control. PURPOSE We examined perception of weight by early adolescents with uncontrolled asthma and their caregivers, and tested the relationship between medical visit frequency and accuracy of perceived weight status. METHODS A total of 373 adolescents and their caregivers reported the adolescent's height/weight and weight perception; caregivers reported healthcare utilization. We measured height/weight. Logistic regression modeled accuracy of weight perception. RESULTS A total of 43.7 % of the overweight/obese adolescents and caregivers accurately perceived weight status. BMI percentile [odds ratio (OR) = 1.19, confidence interval (CI) = 1.10-1.28] and total medical visits (OR = 1.18, CI = 1.05-1.33) were associated with higher accuracy in caregivers. Total medical visits (OR = 0.84, CI = 0.74-0.96) was associated with lower accuracy in adolescents. CONCLUSIONS Accurate perception of weight status was poor for overweight adolescents with uncontrolled asthma and their caregivers. Frequent medical visits were associated with improved caregivers' but not adolescents' perceptions.
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Affiliation(s)
- Melanie Jay
- NYU School of Medicine, Division of General Internal Medicine, New York, NY
| | | | - N. Ari Wijetunga
- Albert Einstein College of Medicine, Yeshiva University, Bronx, NY
| | - Grace Akinrinade
- NYU School of Medicine, Dept. of Child and Adolescent Psychiatry, New York, NY
| | - Karen Dorsey
- Yale University, School of Medicine, Dept. of Pediatrics, New Haven, CT
| | - Jean-Marie Bruzzese
- NYU School of Medicine, Dept. of Child and Adolescent Psychiatry, New York, NY
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25
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Abstract
Little is known about the resources used by urban caregivers of children with asthma to obtain health information. The authors analyzed data for 304 families of children with persistent asthma to describe (1) sources of health information, (2) access and use of Internet resources, and (3) the association between the caregiver's health literacy (HL) and use of health information sources. Overall, 37% of caregivers had limited HL. Most families received health information from a health care professional (94%), written sources (51%), family/friends (42%), non-print media (34%), and the Internet (30%). Less than half of caregivers had access to the Internet at home, but 73% reported Internet use in the past year. Caregivers with adequate HL were more likely to obtain information from multiple sources and to use and have access to the Internet. The results suggest that HL is associated with where caregivers obtain health information from for their children and their use of the Internet.
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Affiliation(s)
- Maria Fagnano
- University of Rochester School of Medicine and Dentistry, Strong Memorial Hospital, 601 Elmwood Avenue, Rochester, NY 14642, USA.
| | - Jill S. Halterman
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Kelly M. Conn
- Department of Community and Preventive Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Laura P. Shone
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY
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Francoeur RB. Ensuring safe access to medication for palliative care while preventing prescription drug abuse: innovations for American inner cities, rural areas, and communities overwhelmed by addiction. Risk Manag Healthc Policy 2011; 4:97-105. [PMID: 22312232 PMCID: PMC3270923 DOI: 10.2147/rmhp.s24068] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
This article proposes and develops novel components of community-oriented programs for creating and affording access to safe medication dispensing centers in existing retail pharmacies and in permanent or travelling pharmacy clinics that are guarded by assigned or off-duty police officers. Pharmacists at these centers would work with police, medical providers, social workers, hospital administrators, and other professionals in: planning and overseeing the safe storage of controlled substance medications in off-site community safe-deposit boxes; strengthening communication and cooperation with the prescribing medical provider; assisting the prescribing medical provider in patient monitoring (checking the state prescription registry, providing pill counts and urine samples); expanding access to lower-cost, and in some cases, abuse-resistant formulations of controlled substance medications; improving transportation access for underserved patients and caregivers to obtain prescriptions; and integrating community agencies and social networks as resources for patient support and monitoring. Novel components of two related community-oriented programs, which may be hosted outside of safe medication dispensing centers, are also suggested and described: (1) developing medication purchasing cooperatives (ie, to help patients, families, and health institutions afford the costs of medications, including tamper-or abuse-resistant/deterrent drug formulations); and (2) expanding the role of inner-city methadone maintenance treatment programs in palliative care (ie, to provide additional patient monitoring from a second treatment team focusing on narcotics addiction, and potentially, to serve as an untapped source of opioid medication for pain that is less subject to abuse, misuse, or diversion).
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Affiliation(s)
- Richard B Francoeur
- School of Social Work, Adelphi, University, Garden City, NY, USA; Center for the Psychosocial Study, of Health and Illness, Columbia, University, New York, NY, USA
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Wood RA, Bloomberg GR, Kattan M, Conroy K, Sandel MT, Dresen A, Gergen PJ, Gold DR, Schwarz JC, Visness CM, Gern JE. Relationships among environmental exposures, cord blood cytokine responses, allergy, and wheeze at 1 year of age in an inner-city birth cohort (Urban Environment and Childhood Asthma study). J Allergy Clin Immunol 2011; 127:913-9.e1-6. [PMID: 21333343 PMCID: PMC3070829 DOI: 10.1016/j.jaci.2010.12.1122] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2010] [Revised: 12/17/2010] [Accepted: 12/22/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND The Urban Environment and Childhood Asthma study was established to investigate the immunologic and environmental causes of asthma in inner-city children. OBJECTIVE We sought to evaluate potential atopic outcomes in the first 12 months and their relationships to environmental exposures and immune development. METHODS A birth cohort of 560 children with at least 1 parent with allergy or asthma was established in Baltimore, Boston, New York, and St Louis. Wheezing is assessed every 3 months, allergen-specific IgE yearly, and mononuclear cell cytokine responses at birth and yearly; environmental assessments include dust allergen and endotoxin, maternal stress, and indoor nicotine and nitrogen dioxide levels. RESULTS Key outcomes in the first year include wheeze in 49%, 2 or more episodes of wheeze in 23%, eczema in 30%, and detectable IgE to milk, egg, and/or peanut in 32% and to cockroach in 4%. Household dust revealed levels of greater than 2 μg/g to cockroach in 40%, mite in 19%, cat in 25%, and mouse in 29%, and 66% of homes housed at least 1 smoker. Positive associations were detected between multiple wheeze and cotinine levels, maternal stress, and maternal depression, whereas cytokine responses to a variety of innate, adaptive, and mitogenic stimuli were inversely related to eczema. CONCLUSIONS This high-risk cohort of inner-city infants is exhibiting high rates of wheeze, eczema, and allergic sensitization. Low cytokine responses at birth might be a risk factor for eczema, whereas a variety of adverse environmental exposures contribute to the risk of wheezing in infancy. These findings provide evidence of specificity in the interactions between immune development, environmental exposures, and the development of early features that might predict future asthma.
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Affiliation(s)
- Robert A Wood
- Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
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Abstract
The Controlling Asthma in American Cities Project (CAACP) was designed to improve the control of asthma in inner-city populations of children with a disparate burden of symptoms and adverse outcomes. As with many chronic diseases, asthma is the manifestation of multiple biologic, environmental, and social determinants. In addition to appropriate medical management, individuals with asthma must have logistical, financial, and cultural access to environments that allow avoidance of asthma triggers and encourage good asthma management practices. In recognition of this complexity, the CAACP required the seven project sites to coordinate and synchronize multiple interventions (education, healthcare access, medical management, trigger reduction) at multiple levels (individual, home, school, community, and policy) through the collaboration of relevant groups, institutions, and individuals. This paper describes the "program theory" of the CAACP project-the assumptions about how the project worked, how the components were linked, and what outcomes were anticipated. It relates the subsequent papers in the supplement to the program theory and describes how the papers can inform and guide other community-based interventions, and advance the translation of scientific knowledge to effective interventions in communities of need.
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Affiliation(s)
- Elizabeth Jane Herman
- Air Pollution and Respiratory Health Branch, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Highway, Atlanta, GA 30341, USA.
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Furr-Holden CDM, Campbell KDM, Milam AJ, Smart MJ, Ialongo NA, Leaf PJ. Metric properties of the Neighborhood Inventory for Environmental Typology (NIfETy): an environmental assessment tool for measuring indicators of violence, alcohol, tobacco, and other drug exposures. Eval Rev 2010; 34:159-184. [PMID: 20479211 PMCID: PMC3042134 DOI: 10.1177/0193841x10368493] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVES Establish metric properties of the Neighborhood Inventory for Environmental Typology (NIfETy). METHOD A total of 919 residential block faces were assessed by paired raters using the NIfETy. Reliability was evaluated via interrater and internal consistency reliability; validity by comparing NIfETy data with youth self-reported violence, alcohol, and other drug exposure and crime statistics. RESULTS Validity and reliability metrics were moderate to exemplary for the total scale and subscales. NIfETy data correlated strongly with crime data and youth self-reported exposure. CONCLUSIONS The NIfETy is valid and reliable. Future investigations will explore its use in other urban centers and association to other health outcomes.
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Affiliation(s)
- C D M Furr-Holden
- Department of Mental Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21202, USA.
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Lee HJ, Elo IT, McCollum KF, Culhane JF. Racial/Ethnic Differences in Breastfeeding Initiation and Duration Among Low-income, Inner-city Mothers. Soc Sci Q 2009; 90:1251-1271. [PMID: 20160902 PMCID: PMC2768401 DOI: 10.1111/j.1540-6237.2009.00656.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVES: Despite the promotion of breastfeeding as the "ideal" infant feeding method by health experts, breastfeeding continues to be less common among low-income and minority mothers than among other women. This paper investigates how maternal socio-demographic and infant characteristics, household environment, and health behaviors are related to breastfeeding initiation and duration among low-income, inner-city mothers, with a specific focus on differences in breastfeeding behavior by race/ethnicity and nativity status. METHODS: Using data from a community-based, longitudinal study of women in Philadelphia, PA (N=1,140), we estimate logistic regression and Cox proportional hazard models to predict breastfeeding initiation and duration. RESULTS: Both foreign-born black mothers and Hispanic mothers (most of whom were foreign-born) were significantly more likely to breastfeed their infants than non-Hispanic white women, findings that were partly explained by foreign-born and Hispanic mothers' prenatal intention to breastfeed. In contrast to previous studies, we also found that native-born black women were more likely to breastfeed than non-Hispanic white women. CONCLUSION: Our findings suggest that when poor whites and African Americans are similarly situated in an inner-city context, the disparity in their behavior with respect to infant feeding is not as distinct as documented in national surveys. Breastfeeding was also more common among low-income immigrant black women than white or native-born black mothers.
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Fagnano M, van Wijngaarden E, Connolly HV, Carno MA, Forbes-Jones E, Halterman JS. Sleep-disordered breathing and behaviors of inner-city children with asthma. Pediatrics 2009; 124:218-25. [PMID: 19564303 PMCID: PMC2704979 DOI: 10.1542/peds.2008-2525] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To explore the relationship between sleep-disordered breathing (SDB) and behavioral problems among inner-city children with asthma. METHODS We examined data for 194 children (aged 4-10 years) who were enrolled in a school-based asthma intervention program (response rate: 72%). SDB was assessed by using the Sleep-Related Breathing Disorder Questionnaire that contains 3 subscales: snoring, sleepiness, and attention/hyperactivity. For the current study, we modified the Sleep-Related Breathing Disorder Questionnaire by removing the 6 attention/hyperactivity items. A sleep score of >0.33 was considered indicative of SDB. To assess behavior, caregivers completed the Behavior Problem Index (BPI), which includes 8 behavioral subdomains. We conducted bivariate analyses and multiple linear regression to determine the association of SDB with BPI scores. RESULTS The majority of children (mean age: 8.2 years) were male (56%), black (66%), and insured by Medicaid (73%). Overall, 33% of the children experienced SDB. In bivariate analyses, children with SDB had significantly higher (worse) behavior scores compared with children without SDB on total BPI (13.7 vs 8.8) and the subdomains externalizing (9.4 vs 6.3), internalizing (4.4 vs 2.5), anxious/depressed (2.4 vs 1.3), headstrong (3.2 vs 2.1), antisocial (2.3 vs 1.7), hyperactive (3.0 vs 1.8), peer conflict (0.74 vs 0.43), and immature (2.0 vs 1.5). In multiple regression models adjusting for several important covariates, SDB remained significantly associated with total BPI scores and externalizing, internalizing, anxious/depressed, headstrong, and hyperactive behaviors. Results were consistent across SDB subscales (snoring, sleepiness). CONCLUSIONS We found that poor sleep was independently associated with behavior problems in a large proportion of urban children with asthma. Systematic screening for SDB in this high-risk population might help to identify children who would benefit from additional intervention.
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Affiliation(s)
- Maria Fagnano
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York 14642, USA.
| | - Edwin van Wijngaarden
- Department of Community and Preventive Medicine, University of Rochester School of Medicine and Dentistry
| | - Heidi V. Connolly
- Department of School of Nursing, University of Rochester School of Medicine and Dentistry
| | - Margaret A. Carno
- Department of School of Nursing, University of Rochester School of Medicine and Dentistry
| | - Emma Forbes-Jones
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry
| | - Jill S. Halterman
- Department of Pediatrics and Golisano Children’s Hospital at Strong, University of Rochester School of Medicine and Dentistry
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Abstract
Low income, urban children with asthma are experiencing community violence that may contribute to asthma morbidity. The objective of this study was to examine the relationship between caregiver report of feeling unsafe, seeing community violence or child seeing community violence and asthma morbidity and health care utilization. Two hundred thirty-one caregivers of children with asthma enrolled in an asthma,education, intervention reported perceptions of safety and violence exposure in six months and frequency of child asthma symptoms, emergency department (ED), primary care (PCP) visits and hospitalizations over 12 months. Children were primarily male (93%), black (61%), and reported income <$30,000 (56%). Violence exposure was high: feeling unsafe (25%), seeing violence themselves (22%), child saw violence (14%). If caregivers or children saw violence, there were significantly more nighttime symptoms than those who were not exposed (caregiver: yes violence = 6.72 +/- 9.19, no violence = 4.23 +/- 6.98, P = 0.03; child: yes violence = 7.09 +/- 7.15, no violence = 4.37 +/- 9.49, P = 0.05). Children who saw violence were less likely to see their PCP. Families exposed to community violence report more asthma symptoms, but are less likely to seek care for asthma. Health care providers and asthma educators should evaluate potential violence exposure with asthma patients and tailor care and education to include violence prevention and avoidance.
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Affiliation(s)
- Jennifer Walker
- Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA.
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Tonorezos ES, Breysse PN, Matsui EC, McCormack MC, Curtin-Brosnan J, Williams D, Hansel NN, Eggleston PA, Diette GB. Does neighborhood violence lead to depression among caregivers of children with asthma? Soc Sci Med 2008; 67:31-7. [PMID: 18406503 PMCID: PMC2409198 DOI: 10.1016/j.socscimed.2008.02.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2007] [Indexed: 10/22/2022]
Abstract
Prior studies have related community violence to depression among children, but few studies have examined this relationship among adults. We hypothesized that victimization, awareness, and fear of neighborhood violence would increase the odds of depression among adult caregivers of children with asthma. We surveyed caregivers in the Baltimore Indoor Environment Study of Asthma in Kids (BIESAK), USA. The primary outcome was screening positive for depression on the Center for Epidemiological Studies Depression index. We assessed victimization, awareness, and fear of neighborhood violence, and conducted spatial analysis identifying subject homes within 500 ft of a homicide to validate survey measures of neighborhood violence. A multilevel logistic model with clustering by neighborhood estimated odds ratios and 95% confidence intervals. Survey responses about fear of neighborhood violence were strongly predicted by having a home within 500 ft of a homicide. Of 150 caregivers of children with asthma, 49% were aware of a neighborhood violent event, 36% were fearful of neighborhood violence, 22% reported victimization, and 27% had a homicide within 500 ft of the home. In our multilevel model, fear of violence increased the odds of depression by 6.7. Victimization was associated with a possible trend towards depression, and awareness of neighborhood violence did not increase the odds of depression. Based on our findings, personal experience with neighborhood violence may be more important than simple awareness. Health care workers should consider screening for depression among patients exposed to community violence.
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Affiliation(s)
- Emily S Tonorezos
- Department of Medicine, New York University, 462 First Aveunue, New York, NY 10016, United States.
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Dunlap E, Golub A, Johnson BD. The Severely-Distressed African American Family in the Crack Era: Empowerment is not Enough. J Sociol Soc Welf 2006; 33:115-139. [PMID: 18852841 PMCID: PMC2565489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Numerous African American families have struggled for generations with persistent poverty, especially in the inner city. These conditions were further strained during the 1980s and 1990s by the widespread use of crack cocaine. For many, crack use became an obsession, dominated their lives, and superseded family responsibilities. This behavior placed additional pressure on already stressed kin support networks. This paper explores the processes prevailing in two households during this period. In the 2000s, children born to members of the Crack Generation are avoiding use of crack but face major deficits from their difficult childhoods. This presents both challenges and opportunities. The discussion considers initiatives from both a social problems and a strengths perspective that could help these families and help these families help themselves to advance their economic circumstances.
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