Maternal Mental Health and Childhood Asthma among Puerto Rican Youth: The Role of Prenatal Smoking

Rationale. Childhood asthma is a major public health problem, with mainland and island Puerto Rican children having the highest asthma rates of any ethnic group in the United States. Objectives. To examine the relationship between maternal mental health problems, prenatal smoking, and risk of asthma among children in Puerto Rico and the Bronx, New York. Methods. A cross-sectional community-based study was conducted in the South Bronx in New York City and the San Juan Standard Metropolitan Area in Puerto Rico. Participants were Puerto Rican children 5 to 13 years of age and their adult caretakers with probability samples of children 5 to 13 years of age and their caregivers drawn at two sites: the South Bronx in New York City (n = 1,135) and San Juan and Caguas, Puerto Rico (n = 1,351). Measurements. Self-reported maternal mental health, prenatal smoking, and rates of childhood asthma. Results. Maternal mental health problems were associated with significantly higher levels of prenatal smoking, compared with that among women without mental health problems (p < 0.0001). Both maternal mental health problems and prenatal smoking appear to make a contribution to increased odds of asthma among youth. After adjusting for prenatal smoking, the relationship between maternal mental health problems and childhood asthma was no longer statistically significant. Conclusions. Previous research suggests children of Puerto Rican descent are especially vulnerable to asthma. Our results suggest that maternal mental health problems and prenatal smoking are both associated with increased odds of asthma among Puerto Rican youth and that prenatal smoking may partly explain the observed relationship between maternal psychopathology and childhood asthma. Future longitudinal and geographically diverse epidemiological studies may help to identify the role of both maternal mental health problems and prenatal smoking in the health disparities in childhood asthma.     

Racial and Ethnic Differences in the Management of Childhood Asthma in the United States

Objectives. We examined racial and ethnic differences in the management of childhood asthma in the United States and the extent that care conformed to clinical best practices. Methods. Two years of pooled data from the National Health Interview Survey were analyzed using logistic regression. The sample included all children between ages 2 and 17 years who had asthma currently and had been diagnosed with asthma by a doctor or health professional (n = 1757; 465 African-American, 212 Mexican-American, 190 Puerto Rican and other Hispanic, 806 white, non-Hispanic, and 84 children of other and multiple races and ethnicities). Results. African-American children with asthma were significantly less likely than white, non-Hispanic children to have taken preventive asthma medication, but more likely to have had an asthma management plan. Mexican-American and Puerto Rican and other Hispanic children did not differ significantly from white, non-Hispanic children in either receiving preventive asthma medication or having an asthma management plan. Caregivers of African-American and Puerto Rican and other Hispanic children were more likely to report that they or their child had taken a course or class on how to manage their child’s asthma. We did not find racial or ethnic differences in the extent children used quick-relief asthma medication or received advice about reducing asthma triggers in their home, school, or work environments. Conclusions. This work highlights a need for more research on racial and ethnic differences in asthma management. Implications for public health responses and racial and ethnic disparities in asthma morbidity are discussed.     

Abstracts

Objective. To examine the prevalence and natural course of asthma from childhood to adolescence in a population-based, Greek birth cohort and to identify associated factors. Methods. Longitudinal information on asthma symptoms, physician diagnosed and treated, was available for 2133 children at 7 and 18 years of age. Results. The prevalence of current asthma was 9.0% and 5.0% at 7 and 18 years, respectively. The prevalence of lifetime asthma was 26.3% at 18 years. More than half of the children (58.2%) with early onset asthma were asymptomatic at 7 years and only 7.6% continued to have symptoms during adolescence. However, in 48.2% of those with late onset asthma, symptoms persisted up to 18 years. Logistic regression analyses showed that male gender, family history of atopy, active adolescent smoking and maternal smoking were significantly positively associated with lifetime asthma at 18 years. In addition, smoking during pregnancy was associated with an increased risk for persistence of asthma symptoms at 18 years. Asthma during childhood and active adolescent smoking were positively associated, and daily consumption of fruit and vegetables was negatively associated with current asthma at 18 years of age. Finally, children who were breastfed had a lower risk for lifetime asthma at 7 years. Conclusion. The prevalence of asthma symptoms at 7 and 18 years of age was low throughout Greece. Our results suggest that, among others, nutrition is an important correlate of asthma in Greek children.     

Physical Activity and Asthma Symptoms among New York City Head Start Children

The coincidence of both an obesity epidemic and an asthma epidemic among children in the United States has suggested that childhood overweight and sedentary lifestyles may be risk factors for asthma development. We therefore conducted a study of those factors among children enrolled in Head Start Centers located in areas of New York City with high asthma hospitalization rates.

Data were gathered from 547 children through an intensive home visit, and physical activity was measured on 463 children using the Actiwatch accelerometer. Data on allergy and asthma symptoms and demographic variables were obtained from parents' responses to a questionnaire and complete data were available from 433 children.

Overall physical activity was highest in warmer months, among boys, among children whose mothers did not work or attend school, and among children of mothers born in the United States. Activity was also positively associated with the number of rooms in the home. The season in which the activity data were collected modified many of the associations between demographic predictor variables and activity levels. Nearly half the children were above the range considered healthy weight. In cross-sectional analyses, before and after control for demographic correlates of physical activity, asthma symptoms were not associated with physical activity in this age group. Comparing the highest quartile of activity to the lowest, the odds ratio for asthma was 0.91 (95% CI = 0.46, 1.80).

However, the novel associations with physical activity that we have observed may be relevant to the obesity epidemic and useful for planning interventions to increase physical activity among preschool children living in cities in the northern United States.     

Smoking and Asthma in Men and Women with Normal Weight,Overweight, and Obesity

Background. There is a complex interrelationship among smoking, body weight, and asthma. It needs to be clarified whether smoking is related to an increased risk of asthma after taking into account for relative body weight. Objective. To examine the association between cigarette smoking and the prevalence of asthma in Canadian men and women with normal weight, overweight, and obesity. Methods. The analysis was based on data from 112,830 Canadians aged 18 years or more who participated in a national survey in 2007–2008. A questionnaire covered the information on prevalent asthma, smoking status, height, weight, and other factors. Logistic regression analysis was used to determine the association between smoking and the prevalence of asthma stratified by sex and body mass index (BMI). Results. The crude prevalence of asthma was 6.6% for men and 9.3% for women. After adjustment for covariates, the odds ratios (ORs) for current smoking associated with asthma was 1.20 [95% confidence interval (CI): 1.01–1.43] for men with normal weight, 0.98 (95% CI: 0.81, 1.18) for overweight men, and 1.02 (95% CI: 0.80–1.30) for obese men. For women, the corresponding adjusted ORs were 1.41 (95% CI: 1.23–1.62), 1.27 (95% CI: 1.05–1.54), and 1.28 (95% CI: 1.03–1.59), respectively. Conclusion. Current smoking was significantly associated with prevalent asthma in all women regardless of their relative body weight. In men, however, the association was only observed in those with under- or normal weight.     

Community-Level Data Suggest That Asthma Prevalence Varies Between U.S. and Foreign-Born Black Subpopulations

For Mexican and Chinese immigrants it has been reported that foreign born children have a lower prevalence of asthma than U.S.-born children. Inner-city black populations have a high prevalence of asthma. However, despite growing populations of black immigrants, we are aware of no previous studies that have looked at the effect of nativity on their asthma prevalence. We report data collected from a convenience sample in the Dorchester neighborhood of Boston for black respondents. The survey was conducted by medical students and community residents using a community-based participatory research approach. For adult respondents (n = 290) there was a strong negative association between being born outside the United States and reporting asthma (OR = 0.39; p = 0.033) that was retained in our multivariate model. For children (n = 157, reported by their parents) there was also a strong association with being born outside the United States (p < 0.05 using χ² tabular analysis); however, there were no foreign-born children with asthma so an OR could not be calculated and this association could not be carried forward into multivariate analyses. For children, but not adults, there were also strong associations between asthma and environmental factors. These findings point to the need for further research into nativity and asthma in black U.S. populations. Future studies should seek to obtain a representative sample, gather more demographic data than we did and seek a larger sample of children. It makes sense to ask about nativity in asthma prevalence studies in order to distinguish these two apparently very different subpopulations.     

High Prevalence of Depression amongst Mothers of Children with Asthma

Objective. To compare the prevalence of depression among mothers of children with asthma and mothers of children without asthma and to investigate the influence of severity and duration of childhood asthma on maternal depression. Method. A cross-sectional study including 80 mothers of children with asthma and 160 mothers of children without asthma who attended the pediatric outpatient clinics of a teaching hospital in Southern Brazil. The main outcome measure was the presence of depression in these mothers, measured by the Beck Depression Inventory. Results. The prevalence of depression was higher among mothers of asthmatic children compared with mothers of non-asthmatic children (43.8% vs. 17.5%, p < 0.001), with an adjusted prevalence ratio of 2.74 (95% confidence interval [CI] 1.76–4.25). Mothers of children with persistent asthma had a higher prevalence of depression than mothers of children with intermittent asthma (62.8% vs. 21.6%, p < 0.001), with an adjusted prevalence ratio of 2.77 (95% CI: 1.46–5.27). No significant association was observed between duration of childhood asthma and maternal depression. Conclusion. Mothers of children with asthma have a higher prevalence of depression than mothers of children without asthma. The severity but not duration of childhood asthma is associated with maternal depression.     

Association between Prenatal and Postnatal Tobacco Smoke Exposure and Allergies in Young Children

Background. Many studies have shown a positive association between environmental tobacco smoke (ETS) exposure and allergic disorders, whereas epidemiological evidence of the effect of maternal smoking during pregnancy on allergic diseases is inconsistent. We investigated the independent and joint effects of in utero exposure to maternal smoking and postnatal ETS exposure at home on allergic disorders among Japanese children. Methods. Study subjects were 1951 children aged 3 years. Data on maternal smoking during pregnancy and postnatal exposure to ETS at home, allergic symptoms, and potential confounders were collected through the use of a questionnaire. Outcomes were defined according to the criteria of the International Study of Asthma and Allergies in Childhood (ISAAC). Results. The prevalence values of symptoms of wheeze, asthma, and eczema in the previous 12 months were 22.0%, 8.8%, and 17.2%, respectively. We found that postnatal ETS exposure at home in the absence of in utero exposure to maternal smoking was associated with a higher prevalence of wheeze (adjusted odds ratio (OR) = 1.30, 95% confidence interval (CI): 1.01–1.67). In contrast, in utero exposure without subsequent postnatal ETS exposure at home or exposure to postnatal ETS at home in addition to in utero exposure to maternal smoking was not associated with the prevalence of wheeze. No measurable associations were observed between fetal, postnatal, or joint exposure and the prevalence of asthma or eczema. Conclusions. Data from this study indicate that ETS at home may be associated with a higher prevalence of wheeze among young Japanese children.     

Association between Obesity and Asthma in US Children and Adolescents

Background. To explore the association between obesity and asthma in US children and adolescents with adjustment of other structural and behavioral factors. Method. Prevalence and associated risk factors of asthma were explored in 102,273 children and adolescents in the National Survey of Children's Health (2003–2004). Subgroup analysis was performed for subjects of 0-6 year-old, 7–12 year-old, and 13–17 year-old. Crude and adjusted odds ratios for the potential risk factors were examined in univariate and multivariate logistic regressions. Results. The overall prevalence of obesity was 24.5% and that of asthma was 12.5%. The adjusted odds ratio of asthma with obesity remains significantly bigger than 1 for children in the 7–12 and the 13–17 year-old age-groups. Gender and race were significantly associated with asthma in all age groups. The two parent family structure showed significant protectiveness against asthma with children in the 0–6 year-old age group. Poverty was positively associated with asthma in the 7–12 years old age group. Having a smoker in the household increased the odds of asthma by 29% and 23.5% in the 0–6 and 13–17 year-old age-groups, respectively. Higher education level of the parents and access to healthcare showed positive association with asthma in the 13–17 year-old age group. Conclusion. Gender and race were significantly associated with asthma. In the 13–17 year-old age-groups, obesity, household education level, healthcare coverage, and household smoking were positively associated with asthma. Further studies should characterize how the family structure and household education level influence childhood asthma in 0–6 and 13–17 year-old age-groups respectively.     

Survey of primary care physicians and home care clinicians

CONTEXT: Providing home care in the United States is expensive, and significant geographic variation exists in the utilization of these services. However, few data exist on how well physicians and home care providers communicate and coordinate care for patients. OBJECTIVE: To assess communication and collaboration between primary care physicians (PCPs) and home care clinicians (HCCs) within 1 primary care network.     

Geographic variation in inhaled corticosteroid use for children with persistent asthma in Medicaid

Objective: Geographic variation in the rates of inhaled corticosteroid (ICS) use for children with persistent asthma in Medicaid has been reported, but the source of this variation is unknown. The objective of this study was to quantify the geographic variation in ICS use for children with persistent asthma in Medicaid that remains after adjusting for the characteristics of children in an area. Methods: Data from the 2005–2007 Medicaid Analytic eXtract files were used. Frequent fills of short-acting beta₂-agonist (SABA) were used to identify children 5–18 years of age with persistent asthma across the United States. A child was considered to have used an ICS if the child initially filled an ICS following frequent SABA use. Areas were determined using published methods, and the unadjusted ICS rate and the area treatment ratio for ICS, which adjusted for demographic and clinical characteristics, were calculated for each area. Results: Of 15,917 children, 13% used an ICS. The median unadjusted ICS rate for all areas was 10% but ranged from 0% to 64%. ICS use was less than expected for more than half of the areas based on the characteristics of the children in the area, but use was nearly five times what was expected in some areas. Areas with higher than expected ICS use were found contiguous to areas with lower than expected use. Conclusions: Geographic variation in ICS not attributable to the demographic and clinical characteristics of the children in an area exists and could prove useful in the struggle to reduce asthma exacerbation rates.     

The Role of Maternal Illness Perceptions in Perceived Asthma Symptoms in School-Aged Children

Objective. To examine the unique contribution of perceptions held by mothers about their children’s asthma in relation to the symptoms as reported by their children. Methods. Families with a child diagnosed with asthma participating in a larger smoking prevention study were invited to participate. For all, 89 children (mean age 10.1 years) and 87 mothers questionnaire and lung function data during home visits were provided. The main outcome of this study involved asthma symptoms as measured by the Pediatric Quality of Life Inventory. Mothers’ and children’s reports of symptoms, as well as the lung function parameter of percentage of predicted Forced Expiratory Volume in one second (% of predicted FEV1), were analyzed in relation to maternal illness perceptions. Results. Mothers’ perceptions of illness were not associated with % of predicted FEV_1. However, while controlling for gender and children’s baseline asthma symptoms, four out of eight mothers’ perceptions of illness (i.e., identity, consequences, concern, and emotional influence) were associated with children’s asthma symptoms. Additional analyses controlling for % of predicted FEV₁ in the models with subjective asthma symptoms reports of mother and child did not change the study findings. Conclusions. This pilot study provides evidence that, in addition to children’s lung function and baseline symptoms, maternal perception of illness contributes to symptom-related quality of life (QoL) of children. More research on underlying mechanisms, which addresses the linking of mothers’ perceptions of concern and emotion to the QoL symptoms as reported by children is necessary.     

Elevated Asthma and Indoor Environmental Exposures Among Puerto Rican Children of East Harlem

Objective. East Harlem in New York City, a community with a large Puerto Rican population, has among the highest rates of asthma hospitalizations and mortality in the United States, but it is not known if the high rates are related to the ethnic composition, environmental or community factors, or if the higher rates reflect differentials in access to appropriate asthma care. A survey was conducted to: (a) estimate the prevalence of current asthma by ethnicity among school-age children, (b) assess indoor environmental risk factors for childhood asthma, and (c) assess health care utilization and school absences associated with childhood asthma. Design.?A cross-sectional survey of parents of elementary school children, using a self-administered questionnaire with a 12-month recall on asthma symptoms based on the International Study of Asthma and Allergies in Childhood. Setting.?Two public elementary schools in East Harlem (n = 1615 students 5–12 years of age). Results.?Among the 1319 respondents (response rate 82%), the prevalence for current asthma (doctor or nurse diagnosis at any time plus wheezing in the past 12 months) was 23%. Puerto Rican children had a prevalence of 35%. Puerto Rican children reported both higher symptomatic frequencies and higher rates of physician diagnosis. Living in a home where cockroaches, rats, or mice had been seen in the past month and with a dust-enhancing heating system also was associated with having asthma, regardless of ethnicity. Compared with other children with asthma, Puerto Rican children with asthma were more likely to live in homes where rats or mice had been seen in the past month. Regardless of ethnicity, children with more frequent, more severe asthma symptoms and incomplete asthma action plans were more likely to have visited the emergency department in the past year. Puerto Rican children were more likely to have missed school because of their asthma in the past year. Conclusion.?The prevalence of current asthma was significantly higher among Puerto Ricans, who had higher symptomatic frequency and greater diagnosis rates. Although all children with asthma in the East Harlem study appear to be sensitive to selected indoor environmental risk factors, only Puerto Rican children with asthma appear to be sensitive to the presence of rodents in their buildings. However, their higher school absence rate suggests problems with routine asthma management that could be addressed by improved medical management, programs to help parents manage their children's asthma, or school staff assistance with medications.     

Passive smoking, gas cooking, and respiratory health of children living in six cities

As part of a longitudinal study of the respiratory health effects of indoor and outdoor air pollutants, pulmonary function, respiratory illness history, and symptom history were recorded at 2 successive annual examinations of 10,106 white children living in 6 cities in the United States. Parental education, illness history, and smoking habits also were recorded, along with the fuel used for cooking in the child's home. Maternal cigarette smoking was associated with increases of 20 to 35% in the rates of 8 respiratory illnesses and symptoms investigated, and paternal smoking was associated with smaller but still substantial increases. Illness and symptom rates were linearly related to the number of cigarettes smoked by the child's mother. Illness rates were higher for children of current smokers than for children of ex-smokers. The associations between maternal smoking status and childhood respiratory illnesses and symptoms were reduced but not eliminated by adjustment for parental illness history. Levels of forced expiratory volume in one second (FEV1) were significantly lower for children of current smokers than for children of nonsmokers at both examinations and highest for children of ex-smokers. Levels of forced vital capacity (FVC) were lower for children of nonsmokers than for children of current smokers at both examinations, but the difference was statistically significant only at the first examination. Both the increase in mean FVC and the decrease in mean FEV1 among children of current smokers were linearly related to daily cigarette consumption. None of the respiratory illnesses and symptoms studied was significantly associated with exposure to gas cooking in the child's home.(ABSTRACT TRUNCATED AT 250 WORDS)     

The epidemiology of Wegener's granulomatosis. Estimates of the five-year period prevalence,annual mortality,and geographic disease distribution from population-based data sources

Objective. To estimate the prevalence, annual mortality, and geographic distribution of Wegener's granulomatosis. Methods. Analysis of national vital statistics data and hospitalization data from a national survey and from all New York State inpatient facilities. Results. Between 1979 and 1988, 1,784 death certificates in the United States listed Wegener's granulomatosis as a cause of death. Nationally, an estimated 10,771 hospitalizations included Wegener's granulomatosis among the discharge diagnoses. In New York State, there were 978 hospitalizations among 571 individuals with Wegener's granulomatosis. Conclusion. The prevalence of Wegener's granulomatosis in the United States is approximately 3.0 per 100,000 persons. Clear differences in the geographic distribution of Wegener's granulomatosis are apparent when analyses consider rates of disease in individual counties. Contrary to previous reports, associations between disease exacerbations and season were not apparent.     

Medication use,sleep, and caregiver smoking status among urban children with asthma

Objective: Children living in urban settings from low-income, minority families are at a high risk for experiencing asthma morbidity. Environmental tobacco smoke (ETS, i.e., secondhand) exposure, typically from caregiver smoking, has been associated with increased quick-relief medication use and child nocturnal awakenings due to increased asthma symptoms as well as worse sleep quality in children with asthma. This study investigated the moderating role of caregiver smoking status on the association between quick-relief medication use and child's sleep quality in urban children with persistent asthma. Methods: Fifty-four urban children with persistent asthma and their primary caregivers completed a baseline research session. Caregivers then completed ecological momentary assessment surveys via smartphones twice daily for two weeks in which smoking behaviors, child quick-relief medication use, and child's sleep quality were assessed. Results: Twenty caregivers (37%) reported smoking at least one day across the two-week period. The caregiver smoking status significantly moderated the association between quick-relief medication use and child's sleep quality after controlling for child age and monthly household income. The caregiver smoking status exacerbated the association between quick-relief medication use and child's sleep quality, such that more medication usage was associated with worse sleep quality. Conclusions: Findings suggest that in urban families with a caregiver who smokes, more daily quick-relief medication use may put children at an increased risk for worse sleep quality. The effects of ETS exposure on child's sleep quality in addition to child asthma symptoms should be an integral part of discussions between pediatric healthcare providers and families of children with asthma.     

The current prevalence of asthma,allergic rhinitis,and eczema related symptoms in school-aged children in Costa Rica

Objective: Asthma prevalence in Costa Rica is among the highest worldwide. We aimed to determine the prevalence of asthma among school-age children in the Central Highland Area of Costa Rica. Methods: Cross-sectional study using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire was performed. Parents or guardians of children aged 6–13 years completed written questionnaires. Results: Total of 2817 school-aged children returned these questionnaires (74.1% return rate). The prevalence of asthma, rhinitis, and eczema was 21.9%, 42.6%, and 19.2%, respectively. The co-existence of the 3 diseases was seen in 22.6% of children with asthma. Boys had a slightly higher prevalence of these conditions, and younger children had higher prevalence of asthma and eczema, but lower prevalence of rhinitis than older children. The use of acetaminophen and antibiotics in the first 12 months of life showed a significant association with the prevalence of asthma, rhinitis, and eczema. Wheezing with exercise, dry cough at night, and ever rhinitis was highly associated with asthma symptoms in the last 12 months. In contrast, no association was found between children exposed to smoking at home. Frequent traffic next to the house was reported more frequently by the parents of children with asthma, although no significant association was found. Conclusion: The prevalence of asthma showed a significant decrease compared to previous studies. However, there was an unexpected high prevalence of rhinitis. Exposure to acetaminophen and antibiotic during the first year of life was highly associated with asthma symptoms.     

Toxocariasis and childhood asthma: A case-control study

Objective: The objective of this study is to investigate the association between anti-Toxocara IgG seropositivity and asthma in children. Methods: This was a case-control study conducted in a university hospital in south Brazil between May 2012 and June 2013. Were recruited 208 children up to 12 years old of whom 156 had asthma (cases) and 52 did not have asthma (controls), with a case-control ratio of 3:1 matched by age. Children's parents or guardians were interviewed using a structured questionnaire with closed questions. Serology was performed using enzyme-linked immunosorbent assay (ELISA) with excretory-secretory antigen of Toxocara canis (TES). Results: The seroprevalence of IgG anti-T. canis antibodies was 12.8% in the cases and 7.7% in the controls. There was no significant association between seropositivity to T. canis and risk of asthma (adjusted odds ratio [OR]: 1.89, 95% CI: 0.52 to 6.89, p = 0.33). Household income < 2 minimum salaries, paternal school years < 9, allergic rhinitis in children, a positive family history of asthma and rhinitis and contact with cats were significantly associated with asthma, with adjusted ORs (95% CIs) of 3.05 (1.21 to 7.73), 2.83 (1.11 to 7.18), 10.5 (4.32 to 25.6), 2.65 (1.14 to 6.17), 2.49 (1.07 to 5.78) and 2.73 (1.03 to 7.27), respectively. Conclusions: This study did not find a statistically significant association between seropositivity to Toxocara sp. and risk of asthma in children. Low family income, low paternal education level, concomitant allergic rhinitis, family history of asthma and allergic rhinitis and contact with cats were independent factors associated with childhood asthma.     

Exposure of Children to Environmental Tobacco Smoke (ETS) and Its Association with Respiratory Ailments

Objectives. To assess the impact of domestic passive smoking (cigarettes or narghile) on the development of respiratory ailments among children ages 10–15 years. Methods.?Students were recruited from five private schools in Beirut, and information on demographic, in-home smoking, and students' respiratory tract illnesses (cough, wheezing, runny nose, or nasal congestion) were collected from each participant. Results.?Of 625 students surveyed, 438 (70.1%) had at least one individual smoking at home. Compared with the nonexposed group, the odds ratio of having respiratory illness for children exposed to narghile or cigarette smoke were 2.3 (95% Confidence Iinterval [CI] 1.1–5.1) and 3.2 (95% CI 1.9–5.4), respectively. Conclusions.?In addition to the well-established effect of smoking, domestic passive smoking of the misconceived “innocuous” habitual smoking device, narghile, is associated with significant respiratory health ailments.