Brief report: social risk factors predict cigarette smoking progression among adolescents with asthma

OBJECTIVE: To compare smoking progression in adolescents with and without asthma and to compare their psychosocial risk factors. METHODS: Participants were 1,507 adolescents with asthma and 1,507 healthy matched controls from Waves I and II of the Add Health Project assessed at baseline and again 1 to 2 years later at follow-up. Three levels of smoking progression (defined as smoking more frequently and/or intensely over time) were identified: (a) Late Experimenters (never smokers at baseline, ever smokers at follow-up), (b) Early Experimenters (ever smokers at baseline, current/current frequent smokers at follow-up), and (c) Early Smokers (current smokers at baseline, current frequent smokers at follow-up). RESULTS: Twenty percent of adolescents experienced progression in their smoking behavior; those with and without asthma were equally likely to progress. Among adolescents who progressed, 37% were Late Experimenters, 42% were Early Experimenters, and 21% were Early Smokers. Exposure to friends who smoked was a consistent and powerful social risk factor for smoking progression among adolescents with asthma-more so than among adolescents without asthma. This effect was intensified among Late Experimenters by the presence of a positive history of parent smoking. CONCLUSIONS: Findings underscore the importance of addressing cigarette smoking behavior and its social risk factors among adolescents with asthma in both clinical and public health contexts, during early adolescence, and through research on this topic.     

Tobacco-refusal skills and tobacco use among high-risk adolescents

Psychosocial tobacco use prevention programs are based on the assumption that refusal skills training will have a suppressive effect on the onset of use by enabling non-using adolescents to refuse offers of cigarettes and smokeless tobacco. The present study investigated this assumption with 389 high-risk junior high-school students involved in a prevention program during their seventh, eighth, and ninth-grade years. Direct behavioral measures of refusal skills were taken by having subjects respond to audiotaped offers of tobacco and then rating the quality of their responses. These ratings were then linked to tobacco use measures obtained at the end of each of the 3 study years. Results showed that the comprehensive prevention program produced a favorable trend in delaying or preventing the onset of tobacco use. However, the refusal skills training, which was carried out throughout the 3-year intervention period, produced significant differences in overall refusal skill quality only at the seventh grade. Moreover, refusal skill quality was not related to overall tobacco use or cigarette use at any grade.This work was supported by Grant R01-CA44921 from the National Cancer Institute.     

Asthma-specific predictors of smoking onset in adolescents with asthma: a longitudinal study

Objective Despite even occasional smoking being more riskyfor adolescents with asthma, the smoking rate in this vulnerablepopulation remains high. This is the first longitudinal studyinvestigating asthma-specific predictors of smoking initiation. Methods Athree-wave longitudinal survey study (22 months) among 257 adolescentswith asthma was conducted. The effects of asthma-specific factors[symptom severity, medication adherence, coping, attitude towardsasthma, and quality of life (QOL)] on smoking onset were testedwith logistic regression models. Results Poorer self-reportedadherence and the maladaptive coping strategy of hiding asthmapredicted smoking onset. Poorer QOL predicted smoking in boysonly. Conclusions Our findings underscore the importanceof recognizing and addressing adherence problems during adolescenceas low adherence is a risk factor for smoking initiation. Moreover,psychosocial factors, such as coping and QOL for boys, wereassociated with smoking initiation. This highlights the importanceof attending to the psychosocial needs of youth with asthma.     

Psychosocial Predictors of Health Risk Factors in Adolescents

Previous research has confirmed the role of problem-behaviortheory constructs as predictors of nonconventional behaviorssuch as adolescent drug abuse. No prospective study, however,has examined this theory's relevance to less extreme nonconventionaladolescent behaviors, such as poor health practices. In thepresent study, an attempt was made to predict an index composedof seven health risk factor items measured in 8th grade fromnumerous variables measured in 7th grade selected to reflectpersonality, perceived environment, and behavior systems ofproblem-behavior theory. In addition, problem-behavior theorywas compared in predictive efficacy to a wellness notion. Factoranalysis did not support the construct validity of the threesystems as measured herein. Instead, resulting empirically derivedfactors reflected domains labeled "wellness," "subjective distress,"and "problem behavior." In addition, linear regression resultsindicated that constituents of wellness, subjective distress,and problem-behavior domains, as well as the demographic variableof lower socioeconomic status, and taking less care of one'sown physical health in 7th grade, were predictors of takingless care of one's physical health the next year. One interpretationof these results is that lack of a sense of wellness may leadone to yield to problem behavior-related social environmentinfluences including participation in poor health practices.     

Predictors of intentions to use tobacco among adolescent survivors of cancer

OBJECTIVE: To examine the relationship between knowledge of tobacco-related health risks, perceptions of vulnerability to these health risks, and future intentions to use tobacco in a sample of adolescent survivors of cancer. METHODS: Written self-report questionnaires were administered to 46 survivors, 10-18 years of age (61% males, 93.5% Caucasian). RESULTS: Overall, survivors were generally knowledgeable about tobacco-related health risks, perceived themselves to be vulnerable to these health risks, and reported low future intentions to use tobacco. Regression analyses indicated that demographic factors, treatment-related variables, knowledge, and perceived vulnerability explained 28% of the variance in intentions scores, F:(6, 39) = 2.52, p <.05. Age and knowledge were significant predictors, indicating that older adolescent survivors and those with lower knowledge scores reported greater intentions to use tobacco. CONCLUSIONS: Young survivors will benefit from risk counseling interventions that educate them about their susceptibility to specific tobacco-related health risks secondary to their cancer treatment. Intensive tobacco prevention programs that target older adolescents should be developed.     

Pulmonary function in adolescents with childhood asthma

The aim of this study was to determine the pulmonary function in former and present asthmatics. We examined 77 persons aged 12–24 years, classified into four groups: 1) healthy subjects (controls) ( n = 19), 2) former asthmatics ( n = 19), 3) present mild asthmatics ( n = 20), and 4) present severe asthmatics ( n = 19). Although exhibiting no respiratory symptoms, former asthmatics had reduced airflow values measured by FEV, (median (range) 89.7 (83–99) vs 101.4 (91–110)) and MEF₂₅ (76.5 (68–94) vs 103.0 (97–124)), as compared with controls. Furthermore, former asthmatics had significantly increased PEF variability, as compared with controls, whereas no significant differences were found in static lung parameters, i.e. total lung capacity and residual volume, as compared with controls. In conclusion, former asthmatics, although now exhibiting no respiratory symptoms, were found to have obstructive airflow limitation, increased bronchial responsiveness, and normal lung volumes.     

Smokeless tobacco use in adolescent females: Prevalence and psychosocial factors among racial/ethnic groups

From a stratified, random sampling of Southeastern, nonurban high schools, survey data on smokeless tobacco use and potential psychosocial risk factors were obtained from 5683 adolescent females. Of the 15.3% who reported trying smokeless tobacco, most (75%) reported only experimental use. Factor analysis of the psychosocial items resulted in four factors: perceived negative consequences, substance use, modeling, and active lifestyle. Discriminant analysis on use indicated that modeling influences and use of other substances were the strongest predictors of initial smokeless tobacco use. Level of use, however, was most strongly associated with lower perceived negative consequences for use and the use of other substances. Separate analyses on American Indian, Black, and White subgroups suggested that factors associated with initial use were similar but that substantial differences exist between subgroups on risk factors for level of smokeless tobacco use.The research was funded by a grant from the American Society of Dentistry for Children.     

Development,initial content validation and reliability of Nigerian Composite Lifestyle CVD risk factors questionnaire for adolescents

Background

Cardiovascular disease risk (CVD) factors affect every age category including adolescents in developing nations. Prevention strategies are effective only when there are epidemiological data for the targeted populations. The collection of such data is only made easy with composite lifestyle CVD risk factors measures that are culturally sensitive and acceptable among the target populations.

Objective

The objective of the study was to develop a culturally sensitive and friendly composite lifestyle CVD risk factors questionnaire for adolescents in Nigeria

Methods

A systematic review was conducted to identify existing, published questionnaires from which items could be selected. Content and face validation were conducted using an expert panel and a sub-sample of the target population. Data was analyzed qualitatively and reliability was assessed using intra-class correlation and Kappa statistic.

Results

Based on the comments received from experts, the questions were restructured, simplified, clarified, formatted, some questions were added and expert reached a consensus. Kappa showed fair to moderate agreement in 65% of the questions and perfect agreement in one question.

Conclusion

The CVD risk factors questionnaire has acceptable content validity and reliability and should be used to assess CVD risk factors among adolescents in Nigeria     

Omalizumab therapy for children and adolescents with severe allergic asthma

Omalizumab, a therapeutic humanized monoclonal antibody specific for human IgE, was introduced in clinical practice more than a decade ago as an add-on therapy for moderate-to-severe allergic asthma in patients aged ≥12 years. Omalizumab has been demonstrated to be effective in adults with uncontrolled persistent asthma, with an excellent safety profile. In simple terms, omalizumab works by inhibiting the allergic cascade, that is, by neutralization of the circulating free IgE. This leads to reduction in the quantity of cell-bound IgE, downregulation of high-affinity IgE receptors, and, eventually, prevention of mediator release from effector cells. Evidence is far less abundant on the role of omalizumab in pediatric asthma. Although efficacy and safety of omalizumab in children and adolescents with uncontrolled, persistent allergic asthma has been recognized as well, further studies are needed to clarify a number of open questions in this specific patient population.     

Self-reported prevalence and risk factors of asthma among Korean adolescents: 5-year follow-up study, 1995–2000

OBJECTIVES: The International Study of Asthma and Allergies in Childhood (ISAAC) questionnaires have shown that the prevalence of childhood asthma is increasing worldwide. Although Asian countries used to have lower prevalence rates of allergic disease than Western countries, this prevalence is increasing in several Asian countries. To determine whether the prevalence of childhood asthma is changing in Korean adolescents, we compared findings from nationwide cross-sectional surveys in 1995 and 2000 on populations of middle-school children using the Korean version of the ISAAC questionnaire. METHODS: We developed Korean versions of the ISAAC written (WQ) and video (AVQ) questionnaires for allergic diseases. In 1995, the enrolled population consisted of 15,481 children, ages 12-15, and encompassing all three grades in middle school, selected from 34 schools across the nation; the response rate was 97.3%. In 2000, 15,894 children were selected from 31 of the same schools, and the response rate was 96.4%. The SAS system version 8.0 was utilized for all statistical analyses. RESULTS: The WQ showed that the lifetime and 12-month prevalence of wheeze did not change from 1995 to 2000. While the 12-month prevalence rates of sleep disturbed by wheezing and night cough increased, the rates of severe attack of wheezing and exercise-induced wheeze did not change, over this period of time. The lifetime prevalence of asthma diagnosis, however, increased significantly, from 2.7% in 1995 to 5.3% in 2000, as did the 12-month prevalence of asthma treatment, from 1.0% in 1995 to 1.9% in 2000. The AVQ also showed increases in the lifetime and 12-month prevalence rates of wheeze at rest, exercise-induced wheeze, nocturnal wheeze, nocturnal cough, and severe wheeze over this period of time. These were especially because of significant increases in the Provincial cities of Korea. Interestingly, the 12-month prevalence of wheeze was consistently high in Cheju with low air pollution indices, whereas this rate was low in Ulsan and Ansan with very high air pollution indices. Risk factor analysis showed that body mass index (BMI), passive smoking, and living with a dog or cat, but not air pollution, were associated with higher risk of wheeze. CONCLUSIONS: In the 5-year period from 1995 to 2000, the prevalence of asthma symptoms has increased in Korean adolescents, much of it because of increases in Provincial Centers. BMI, passive smoking, and living with a dog or cat are important risk factors. Environmental factors other than air pollution may be associated with increases in asthma, especially in Provincial Centers.     

Risk factors for asthma among children in Maputo (Mozambique)

BACKGROUND: Few studies have looked at risk factors for asthma in African children. We aimed to identify the risk factors associated with childhood asthma in Maputo (Mozambique). METHODS: This case-control study included 199 age-matched children (100 asthmatic and 99 nonasthmatic) who attended Maputo Central Hospital between January 1999 and July 2000. We collected information concerning their familial history of atopy, birth weight, environment and breast-feeding. Detailed information about morbidity and treatment was obtained for each asthmatic child. RESULTS: The children were aged between 18 months and 8 years; 60% were male. The asthmatic children were hospitalized more frequently than the nonasthmatic children (P < 0.0001). Most of the asthmatic children lived in the urban area of Maputo [odd ratio (OR) = 6.73, CI = 3.1-14.0, P < 0.0001], had a parental history of asthma (OR = 26.8, CI = 10.8-68.2, P < 0.0001) or rhinitis (OR = 4, CI = 1.2-13.3, P = 0.005), had at least parent who smoked and were weaned earlier than the nonasthmatic children (OR = 2.4, CI = 1.3-4.4, P < 0.001). CONCLUSION: Childhood asthma was strongly associated with a family history of asthma and rhinitis, the place of residence, having smokers as parents and early weaning from maternal breast milk. These results highlight the need to reassess the management of asthmatic children in Maputo.     

A comparison of coronary risk factors in groups of trained and untrained adolescents

Summary Fifty-five experimental (29 male, 25 female) and 38 control (20 male, 18 female) adolescent subjects participated in this study to investigate the differences in coronary heart disease (CHD) risk factors in groups of trained and untrained adolescents. As expected the trained group (both sexes) had higher maximal aerobic power and lower systolic blood pressure at rest. The level of total cholesterol was the same in both groups, but the levels of high-density lipoprotein and its lipoprotein subfractions apolipoprotein (Apo-A) and Apo-A1 were higher, and low-density lipoprotein, Apo-B and triglycerides were significantly lower in the experimental group. The value of risk factors from the family history was the same in both groups, but the behavioural and physical risk factors such as smoking and percentage of body fat were lower in the trained group. It would appear that the group of adolescents, trained for several years in athletics and swimming, had a more beneficial lipoprotein profile and a lower level of behavioural and physical risk factors than the control group. For methodological reasons it remains an open question whether these profile differences are the consequences of self-selection procedures or the effects of training.     

Risk factors associated with asthma and rhinoconjunctivitis among Swedish farmers

BACKGROUND: Earlier studies have shown a high prevalence of respiratory symptoms in farming communities and that storage mites constitute important allergens. We examined risk factors associated with asthma and rhinoconjunctivitis among Swedish farmers. METHODS: A population of 1015 small-scale dairy farmers was part of an epidemiologic survey. After selection based on symptom reports in a questionnaire, 461 of the farmers attended a medical examination, which comprised SPT, RAST analyses, and lung-function measurements. Risk factors for sensitization to different allergens, and development of asthma and rhinoconjunctivitis were assessed by multiple logistic regression. RESULTS: The prevalence of atopy was 26.7% among the farmers. For both asthma and rhinoconjunctivitis, sensitization to mites (OR = 5.8 vs. OR = 3.8) and pollens (OR = 10.3 vs. OR=5.8) was a significant risk factor. There was a significant relationship between sensitization to mites and working time (OR = 5.2). Environmental tobacco smoke and exposure to different animal species at the farm did not appear to affect the risk of allergen sensitization or respiratory symptoms. Farmers smoked less than the general population, but they more frequently had reduced FEV1. CONCLUSIONS: Allergen sensitization, especially to mites and pollens, was significantly associated with asthma and rhinoconjunctivitis in a farming community. The results point to allergen avoidance as a major goal for the prevention of occupational respiratory diseases among the farming population.     

Psychological distress in high-risk youth with asthma

OBJECTIVE: To examine the relationship between asthma and psychological distress among adolescents already at-risk for adjustment problems secondary to lower economic strata and educational or vocational failure. METHOD: Twenty-five high-risk adolescents with asthma and 25 high-risk controls without asthma 16 to 21 years old completed the Brief Symptom Inventory, the Beck Depression Inventory, and the Beck Anxiety Inventory. RESULTS: Adolescents with asthma had significantly higher scores on multiple measures of psychological distress. Specifically, adolescents with asthma evidenced higher levels of anxiety, depression, and global psychological distress than those without asthma. CONCLUSIONS: High-risk adolescents with asthma may be more likely to experience psychological distress than those without asthma. Our findings suggest that asthma constitutes an additional significant independent stressor or risk factor among adolescents who already are at high risk for multiple adjustment problems.     

Symptoms of asthma and atopic disorders in preschool children: prevalence and risk factors

BACKGROUND: Published epidemiological data suggested that asthma and allergies may be increasing in preschool children. Identification of the risk factors is important for planning possible early intervention to prevent asthma. This study was designed to measure the prevalence of, and risk factors for, asthma and atopic disorders in preschool children from Hong Kong. METHODS: Children aged 2-6 years living in Hong Kong were recruited through the local nurseries and kindergartens for this study to ascertain the presence of symptoms of asthma and various possible risk factors. The parental questionnaire was developed based on the International Study of Asthma and Allergies in Childhood questionnaire. RESULTS: A total of 3089 children (1506 boys) from 14 nurseries and kindergartens participated in this study. The prevalence of wheeze ever and current wheeze were 16.7% and 9.3%. Two hundred and thirty-four subjects were born in mainland China and migrated to Hong Kong subsequently. When compared with children born and raised in Hong Kong, children born in mainland China had significantly lower prevalence of current wheeze (3.4% vs. 9.6%, P<0.01). Two environmental factors in the first year of life were associated with wheezing attacks within the last 12 months. They were the use of foam pillow (Odds ratio: 1.45; 95% Confidence interval: 1.04-2.00) and the use of gas as cooking fuel (1.68; 1.03-2.75). Frequent use of paracetamol was also associated with wheezing attack in the past 12 months. CONCLUSIONS: This study confirms the high prevalence of symptoms of atopic disorders in preschool children from Hong Kong. Early environmental exposure factors are important determinants of subsequent development of asthma symptoms in the preschool years. Further studies are needed to evaluate the possible pathogenetic role of the identified risk factors.     

Neighborhood-level risk and resilience factors: an emerging issue in childhood asthma epidemiology

Evaluation of: Gupta RS, Zhang X, Sharp LK, Shannon JJ, Weiss KB. The protective effect of community factors on childhood asthma. J. Allergy Clin. Immunol. 123(6), 1297–1304.e2 (2009).

The recent increase in the prevalence of asthma in children is now recognized as the result of a complex interplay of genetic, sociodemographic and environmental factors. Multilevel models simultaneously account for neighborhood characteristics that may be related to childhood asthma, independently of individual-level attributes. Most research that focuses on the physical and social characteristics of neighborhoods to explain disparities in childhood asthma assess such factors as persistent poverty, residential racial segregation and environmental degradation. Researchers have only begun to test models that specifically focus on risk and protective factors at the community/neighborhood level in relation to asthma. Social capital, which measures norms of reciprocity, social ties between neighborhood residents and civic engagement has the potential to buffer the effects of neighborhood risk factors on childhood asthma. Further research, specifically longitudinal studies, needs to be carried out to determine whether findings on neighborhood-level risk and protective factors can guide the development of preventive interventions for childhood asthma.     

Contributing factors to the development of childhood asthma: working toward risk minimization

Asthma is the most common chronic disease in childhood, and considerable research has been undertaken to find ways to prevent its development and reduce its prevalence. For such interventions to be successful, risk factors for asthma emergence should be identified and clearly defined. Data are robust for some of them, including atopy, viral infections and exposure to airborne irritants, whereas it is less conclusive for others, such as aeroallergen exposure and bacterial infections. Several interventions for asthma prevention, including avoidance and pharmacotherapy, have been attempted. However, most of them have furnished equivocal results. Various issues hinder the establishment of risk factors for asthma development and reduce the effectiveness of interventions, including the complexity of the disease and the fluidity of the developing systems in childhood. In this review, we revisit the evidence on pediatric asthma risk factors and prevention and discuss issues that perplex this field.