Scoping review: multiple stakeholders and child asthma management interventions.

OBJECTIVE: This study reviewed research to identify interventions aimed at improving asthma management among children by educating parents and other professionals. DATA SOURCES: PubMed, Medline, and Embase databases were utilized. STUDY SELECTIONS: Three databases were searched for child asthma management interventions published between 2012-2022 in English. Search terms included children, asthma, intervention(s), community pediatrics, coaches, schools, and stakeholders. Inclusion criteria were being an experimental study focused on children with asthma (birth-18 years), including stakeholder involvement, education, and a community focus. The search yielded 153 articles; nine were reviewed. RESULTS: In general, stakeholders developed programs that resulted in improvements in asthma symptoms, knowledge of asthma management, perceptions of health care, and decreased emergency health care visits. Successful interventions involved education about asthma management, providing medications, and partnerships with school staff, healthcare teams, and community members. Effective coordination and communication contributed to successful program implementation. Using technology for asthma management education was effective in tracking access to care and facilitated the delivery of medications. CONCLUSION: The findings indicate that interventions were effective in improving child asthma management. Stakeholder partnerships were critical to the effectiveness of interventions. Marketing the intervention and encouraging communication with parents also fostered success. Being able to assess the home environment and staying in contact with parents were barriers to these interventions. Conducting randomized controlled trials using the interventions found effective in these studies to assess change in symptoms and emergency care visits over time would yield important information about their long-term success and cost for implementation.

Association among friendship skills, involvement in after-school activities, and flourishing for adolescents with asthma and comorbid emotional and behavioral problems.

OBJECTIVES: Primary objectives were to examine the relations among abilities for making and keeping friends, involvement in after-school activities, and flourishing for adolescents with current asthma, as well as comorbid behavior problems, anxiety, or depression. METHODS: Data from the 2021 National Survey of Child Health was analyzed. Parents provided data on one child. Multinomial logistic regression analyses, both unadjusted and adjusted for the sampling weight, were conducted for adolescents with current asthma and comorbid behavior problems, anxiety, or depression. Predictors of flourishing included difficulty in making and keeping friends and involvement in after-school activities. Sex, age, race/ethnic group, and having been bullied were covariates. To examine differences for children with varied comorbid emotional and behavioral problems, relations were tested separately for children with asthma and behavior problems, children with asthma and anxiety, and children with asthma and depression. RESULTS: Skills for making and keeping friends were positively related to flourishing of adolescents with current asthma for all three types of mental health concerns. The relationship between involvements in after-school activities was less clear-cut, as this predictor was not always positively related to flourishing. CONCLUSIONS: Abilities to make and keep friends were related to flourishing, indicating that peer support is a resilience factor. Conversely, it was not clear that involvement in after-school activities was a resilience factor and more research about factors constituting successful after-school involvement for adolescents with asthma is needed. Future research, illuminating how social support from peers and involvement in activities promote flourishing will extend knowledge.

Needs assessment: knowledge of self-management of asthma for children with co-morbid physical and intellectual disabilities: brief report.

OBJECTIVES: The main goal of this study was to conduct a needs assessment to ascertain professionals' and parents' knowledge of and perceptions about education for self-management of asthma for children with physical and intellectual disabilities (IDs). Another goal was to understand needs for education of children with IDs about severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; coronavirus) and other infectious diseases. METHODS: Surveys, presented in the RedCap system, were administered online. Respondents (n = 498) were recruited through sites and listservs for children with disabilities and individuals with asthma. Respondents answered eight questions about knowledge and education for self-management of asthma for children with physical disabilities and IDs. Respondents answered four questions pertaining to management of coronavirus for children with IDs. RESULTS: Respondents' indicated that it would be easier to educate youth with mild or moderate versus severe levels of disabilities. Children with IDs may not receive the education they need to manage their asthma. When comparing those in different occupations, teachers reported lower knowledge for educating children with IDs about asthma management and coronavirus. CONCLUSIONS: Doctors and nurses can develop programs for children with physical disabilities and IDs. Programming for youth with severe impairments is needed and perhaps developmentally appropriate programming for youth with IDs will improve education of youth and, concomitantly improve their self-management of asthma and potentially quality of life. Educating teachers is critical specifically about asthma triggers, how to involve youth in self-care, and how to educate children with IDs about coronavirus.Abbreviations:U.S.: United States;IDs: intellectual disabilities.

Family resilience and health among adolescents with asthma only, anxiety only, and comorbid asthma and anxiety.

OBJECTIVES: The objectives were to examine the relationships between current asthma and anxiety and family resilience and overall health status in US adolescents. METHODS: Data were from parents of adolescents (12-17 years) who completed the 2017-2018 National Survey of Children's Health (NSCH). Examined variables included: current asthma and anxiety diagnoses, family resilience, child health status, number of adverse childhood experiences (ACEs), family poverty, parent education, and child demographic factors. Multinomial logistic regression models were performed. RESULTS: Findings indicated that compared to adolescents with high resilience scores, adolescents with anxiety only and comorbid asthma and anxiety were more likely to have moderate or low family resilience scores than adolescents with no asthma or anxiety. Compared with adolescents with an excellent/very good health status, youth with asthma only, anxiety only, and asthma and anxiety had higher odds of having good or fair/poor health status than adolescents with no asthma or anxiety. Among those with current diagnoses, adolescents with asthma only were less likely to have moderate and low resilience scores than adolescents with asthma and anxiety. Adolescents with asthma only and anxiety only were also at reduced odds to have good or fair/poor health status than those with comorbid diagnoses. CONCLUSIONS: Results indicated that anxiety is linked to family resilience of adolescents with and without comorbid asthma. Experiencing a higher number of ACEs was a risk factor for lower family resilience scores and health status. Future research should consider the impact of other mental health problems and family resilience and health status.

Exposure to Tobacco Smoke and Temperament among U.S. Children 0-5 Years Old.

OBJECTIVES: This study examined the association between tobacco smoke exposure (TSE) and temperament among children 0-5 years old overall and within age groups: 0-2 and 3-5 years. METHODS: Data were obtained from the 2017-2018 NSCH (N = 14,345). TSE status was defined as whether children lived with a smoker who: does not smoke inside the home (no home TSE) or smokes inside the home (home TSE). We conducted logistic regression analyses while controlling for covariates. RESULTS: Overall, 12.5% of children lived with a smoker with no home TSE and 1.1% had home TSE. Children with home TSE were at increased odds to not always: be affectionate and tender (aOR = 1.74, 95% CI = 1.18-2.58), show interest and curiosity (aOR = 1.81, 95% CI = 1.23-2.68), and smile and laugh (aOR = 1.77, 95% CI = 1.13-2.77) than those with no TSE. Among 0- to 2-year-olds, those with home TSE were more likely to not always be affectionate and tender (aOR = 1.97, 95% CI = 1.04-3.74). Among 3- to 5-year-olds, those who lived with a smoker with no home TSE were more likely to not always: bounce back quickly (aOR = 1.21, 95% CI = 1.05-1.40) and smile and laugh (aOR = 1.26, 95% CI = 1.03-1.54), and those with home TSE were more likely to not always: show interest and curiosity (aOR = 2.24, 95% CI = 1.40-3.59) and smile and laugh (aOR = 2.43, 95% CI = 1.43-4.11). CONCLUSIONS: Tobacco smoke-exposed children were at increased odds of not always demonstrating positive early childhood temperament behaviors, with 3- to 5-year-olds having more pronounced odds.

A family affair: Supporting children with chronic illnesses.

BACKGROUND: Children living with chronic illnesses may rely on family for social support during hospitalization. Understanding child and parent perspectives about the nature of the sibling and family relationships during hospitalization will provide information about these relationships during a stressful period. METHODS: English-speaking children diagnosed with chronic illnesses, siblings, and parents participated. They were residing at a Ronald McDonald House. A qualitative study using interviews with children and parents was completed. RESULTS: Seventeen mothers, eight children with illnesses, and twelve siblings completed interviews. Children with illnesses benefitted from connections with parents. Mothers believed that siblings and the ill child benefitted from being in close contact. Siblings were worried about their brother or sister with an illness, and despite this, the family was coping well. Siblings helped with the medical regimen for a brother or sister with a chronic illness. Trying to help the family function in a routine or "normal" fashion was important to children with illnesses and siblings. CONCLUSIONS: Family connection was critical for children with chronic illnesses during hospitalization. Findings highlighted the importance of sibling support as a factor promoting child and family resilience when a child is facing medical procedures.

Educational and home-environment asthma interventions for children in urban, low-income, minority families.

OBJECTIVE: This review examined the impact of environmental change and educational interventions targeting young children from minority groups living in urban environments and who were from low-income families. DATA SOURCES: A scoping methodology was used to find research across six databases, including CINAHL, ERIC, PsycINFO, PubMed, MEDLINE, and EMBASE. STUDY SELECTION: 299 studies were identified. Duplicates were removed leaving 159 studies. After reviewing for inclusion and exclusion criteria, 23 manuscripts were identified for this study: 11 featured home-environment change interventions and 12 emphasized education of children. RESULTS: Studies were reviewed to determine key interventions and outcomes for children. Both environmental interventions and educational programs had positive outcomes. Interventions did not always impact health outcomes, such as emergency department visits. CONCLUSIONS: Results indicated many of the environmental change and education interventions improved asthma management and some symptoms. A multipronged approach may be a good method for targeting both education and change in the home and school environment to promote the well-being of young children in urban areas. New research with careful documentation of information about study participants, dose of intervention (i.e., number and duration of sessions, booster sessions) and specific intervention components also will provide guidance for future research.

Adolescent flourishing in relation to having asthma: Results from a population-based cross-sectional study.

OBJECTIVE: This study investigated parent report of adolescent behaviors and flourishing of adolescents with asthma from a nationwide sample. METHODS: A secondary analysis of the 2011-2012 National Survey of Children's Health was conducted. There were 2,880 youth with asthma in our sample and 25,841 without asthma between 13 and 17 years of age. Analyses examined flourishing among adolescents with and without asthma and the impact of adolescent arguing, bullying, and mood difficulties on adolescent flourishing for adolescents with asthma, while controlling for sex, age, and race. RESULTS: Findings indicated lower flourishing for youth with asthma compared to youth without asthma. Moreover, adolescents with asthma who experienced negative behaviors, such as arguing and bullying, and adolescents who were experiencing sad feelings had lower flourishing. CONCLUSIONS: The results were consistent with literature, indicating that relatively poorer behavioral and emotional functioning is related to lower flourishing in adolescents with asthma. The results highlight the importance of screening for emotional functioning in adolescents and the need for further research to understand characteristics of adolescents related to their positive functioning.

Hookah Use Among College Students: Recent Use, Knowledge of Health Risks, Attitude and Reasons for Use.

Notwithstanding the efforts of health educators and other health professionals regarding tobacco and smoking cessation, research indicates that hookah smoking among college students remains a health concern. Research shows an upward trend in college students' hookah use. The purpose of this study was to identify and describe potential patterns/differences in college students' hookah use, and the relations among attitudes toward and knowledge about hookah use and use of this drug. A four-page, 20-item survey was used to collect data from participants (N = 403) and to measure participants 'recent use, knowledge of health risks, attitudes and reasons for hookah use among college students. Results indicated increased prevalence rates (53.8%) among participants of this study. Participants' recent hookah use was consistent with that of current research. Study findings supports current research, which found that college students have low negative perceptions of the health risks (addictive and detrimental properties) of hookah use. Analyses also determined that college students' attitudes toward hookah was associated with use of this drug. Regarding reasons why students may use hookah, data analysis indicated statistical significance in lifetime hookah use based on reasons for use. Study provide information for health educators creating hookah risk awareness educational programs aimed at reducing rates of hookah smoking among college students.

Motivational Interviewing in an Obesity Prevention Program for Children.

After-school programs are an ideal setting for childhood obesity prevention interventions. This qualitative study examined the implementation of a training technique in the Children's Healthy Eating and Exercise Program: motivational interviewing. Participants included 19 children in Grades 3 through 5, nine coaches enrolled in university health education classes, and four parents. Nine lessons were presented during the fall session (N = 5) and eight during the spring (N = 14), with five individual coaching sessions per child. From September, 2014 through April 2015, child and coach perceptions were assessed using goal sheets, surveys, a focus group, and the analysis of the video recording of a health habit commercial created by teams of children grouped by gender. Children developed weekly eating and exercise goals with coaches and reported on their progress the following week. Following the intervention, children reported improved eating and exercise habits and coaches reported they learned more about healthy food options for themselves. Overall, children responded positively to the motivational interviewing. Involving teachers may allow for dissemination of lessons and reinforcement for healthy choices during the school day. Involving parents in training may remove roadblocks to healthy lifestyle changes for children for nonschool hours and when packing lunches.

Predictors of flourishing for adolescents with asthma.

OBJECTIVE: The purpose of this study was to examine well-being or flourishing of adolescents with asthma as well as factors influencing flourishing for these adolescents. METHODS: A secondary analysis of data collected for the 2011-2012 National Survey of Children's Health was conducted. Flourishing of adolescents with and without asthma was compared. Parent coping and anger, child sex and age and child flourishing were examined for adolescents with asthma. RESULTS: Youth with asthma had lower flourishing than those without this disease. Positive parent coping was related to flourishing, while parent anger negatively influenced flourishing of adolescents with asthma. Interaction terms were significant, indicating that the aforementioned variables interacted with adolescent age and sex. CONCLUSIONS: Study results point to a complex relationship between parent- and adolescent-level factors and adolescent well-being. Further research is needed to examine relations among flourishing and health outcomes in youth with asthma.

Resilience in Youth and Families Living With Pediatric Health and Developmental Conditions: Introduction to the Special Issue on Resilience.

This special issue of the Journal of Pediatric Psychology showcases a growing area of research with a collection of 16 contemporary studies of resilience in youth with chronic medical or developmental conditions and their families. The research reported in this special issue covers a broad range of pediatric populations, including cancer, type 1 diabetes, and chronic pain, among others, ranging in age from early childhood through early adulthood. This introduction to the special issue reviews the various ways the articles' authors conceptualize and define risk and resilience; most analyze protective processes in relation to resilient outcomes, including both achievement of explicitly positive experiences and avoidance of dysfunction or disruption. Challenges with measurement of resilience-related constructs is reviewed. Finally, the special issue editors offer a definition of resilience in the context of pediatric and health psychology.

Children's Learning and Goal-Setting at a Diabetes Camp.

Objective. This study provides information about children's learning and goal attainment related to change in their self-management skills during a diabetes camp. Design and methods. One hundred and thirty-one children completed an evaluation for the first year (year 1), and 68 children completed an evaluation for the second year (year 2). All of the children had type 1 diabetes. During both years, parents provided information about goals for their child before camp started. Children's learning about diabetes self-management, as well as their satisfaction with camp, was assessed at the end of the camp session. In the evaluation for year 2, a goal-setting intervention was also developed, and its effectiveness was assessed through both physicians' and children's reports. Results. Children learned new information during camp about recognizing and managing the signs of hypo- and hyperglycemia and about counting carbohydrates and rotating insulin pump sites. Children were better able to recall their self-management goals in year 2. In terms of benefiting from camp, boys reported learning more than girls about diabetes management, whereas girls were more likely than boys to report that greater opportunities to express feelings were of value. Conclusions. Goal-setting was successful in improving children's recall of their self-management goals. Children benefited from the supportive and educational camp atmosphere. Future research should assess the benefits of camp across multiple camp settings and determine whether educational benefits have long-term effects on children's goal-setting and knowledge and whether these benefits lead to psychosocial improvements.

Implementation of an Awareness Level Training to Prepare the Workforce for Future Infectious Disease Outbreaks.

OBJECTIVE: The COVID-19 pandemic underscores the need for workforce awareness-level training for infectious disease outbreaks. A training program was created and evaluated to provide strategies for emergency preparedness as well as worker health and safety during a disease outbreak. METHODS: Participants (N = 292) completed instructor-led synchronous online training modules between January 2022 and February 2023. Training covered 5 areas: vaccine awareness, infectious disease transmission and prevention, pandemic awareness, and inapparent infections, as well as workplace controls to reduce or remove hazards. Participants completed a survey before and after training to assess knowledge change in the five areas. Chi-square analyses assessed how predictors were related to knowledge change. RESULTS: Overall, an increase in knowledge was observed between pre- (80.9%) and post-training (92.7%). Participants from small businesses, with less work experience, and in non-health care roles were under-informed. Knowledge of disease transmission and prevention improved for non-health care professions and workers with less experience. All participants gained knowledge in identifying and ranking safeguards to protect workers from injuries and illness at job sites. CONCLUSIONS: Training improved employee knowledge about safe work practices and pandemic preparedness. Studies should continue to evaluate the effectiveness of preparedness training to prepare the workforce for infectious disease outbreaks and pandemics.

Asthma screening of inner city and urban elementary school-aged children.

OBJECTIVE: Currently, in the United States there is a lack of a standardized method to effectively screen school children with undiagnosed or poorly controlled asthma. The purpose of this proof-of-concept study was to assess the use of the American College of Allergy, Asthma, and Immunology's (ACAAI) Asthma Screening Questionnaire to identify elementary school-age children at risk for asthma (undiagnosed) or poorly controlled asthma. METHODS: Children in grades 3-5 from one urban and two suburban schools completed ACAAI's 14 question asthma screening questionnaire and had their peak expiratory flow (PEF) measured. Children were considered to have a positive asthma screen and be at risk for having undiagnosed or poorly controlled asthma if they answered 'yes' to more than three questions. Children were referred to a physician if they had a positive asthma screen, a previous history of asthma, or a low PEF. RESULTS: Of the 86 participants, 52 were identified as being at risk for asthma. The number was higher among children attending an urban versus suburban school (p = 0.04). The sensitivity and specificity of the screening questionnaire for identifying asthma risk were 90% and 66%, respectively, when the number of 'yes' responses for a positive screen was increased from three to five of 14 questions. CONCLUSIONS: The ACAAI's Asthma Screening Questionnaire identified 52 children at risk for undiagnosed or poorly controlled asthma. Our findings support the need to validate this questionnaire to be used in conjunction with PEFR for identifying elementary school children at risk for asthma.

Health and Demographic Factors for Chronic Obstructive Pulmonary Disease Among Hispanic Adults in the United States: Analysis of Behavioral Risk Factor Surveillance System Survey Data.

Introduction: Appropriate diagnosis and regular primary care appointments are markers of quality chronic obstructive pulmonary disease (COPD) care. Underdiagnosis of COPD has been associated with an absence of health insurance, lower socioeconomic status, and race and ethnicity. Methods: This study examined predictors of COPD using data from the Behavioral Risk Factor Surveillance System (BRFSS, 2021) to provide information for prevention messaging and interventions. Participants included Hispanic adults (n = 17,782) aged 45 years and older. Chi-square tests and a multinomial logistic regression analysis (adjusted with the BRFSS weighting variable) were used to understand how sex, income, health status, smoking behaviors, asthma morbidity, and health insurance coverage were related to having COPD. Results: Patients with poor health, lower income level, current smokers, former smokers, or asthma were more likely to report COPD. Females were more likely to report COPD than males. Patients with COPD were more likely to be without health insurance when compared to those who did not have COPD, indicating unmet medical needs. Conclusion: Studies such as this one, aiming to evaluate the relationship between COPD prevalence and predictors of health and outcomes among Hispanic patients in the United States will remain important for developing health messaging to attenuate disease progression.

Adverse Childhood Experiences and Electronic Cigarette Use among U.S. Young Adults.

(1) Background: Adverse childhood experiences (ACEs), which are potentially traumatic childhood events, have been associated with increased tobacco product use. Less is known about electronic cigarette (e-cigarette) use during young adulthood. This study explored the associations between ACEs and current e-cigarette use among U.S. young adults. (2) Methods: This study was a secondary analysis of 2021 Behavioral Risk Factor Surveillance System data including 2537 young adults aged 18-24 years. Unadjusted and adjusted logistic regression analyses were conducted. (3) Results: Of the participants, 19.2% currently used e-cigarettes, and 22.1% reported 1 ACE, 13.0% reported 2 ACEs, 10.7% reported 3 ACEs, and 30.6% reported ≥4 ACEs. Unadjusted results indicated that participants who experienced 1 ACE (odds ratio (OR) = 1.76, 95% confidence interval (CI) = 1.01-3.07), 2 ACEs (OR = 2.18, 95%CI = 1.24-3.83), 3 ACEs (OR = 2.63, 95%CI = 1.41-4.90), and ≥4 ACEs (OR = 3.69, 95%CI = 2.23-6.09) were at increased odds of reporting current e-cigarette use than participants who experienced 0 ACEs. Adjusted results indicated that participants who experienced 3 ACEs were at 2.20 times higher odds (95%CI = 1.15-4.23) and participants who experienced ≥4 ACEs were at 2.73 times higher odds (95%CI = 1.58-4.71) of reporting current e-cigarette use than participants who experienced 0 ACEs. (4) Conclusions: Young adults exposed to ACEs are at risk of using e-cigarettes.

Associations of household tobacco smoking status with childhood temperament among U.S. preschool-aged children.

BACKGROUND: This study investigated the association between household tobacco smoking status and temperament among U.S. 3-5-year-olds. METHODS: A secondary analysis of 2019-2020 National Survey of Children's Health data (N = 11,100) was conducted. Temperament dimensions of effortful control (characterized by attention focusing), negative affectivity (characterized by anger and soothability), and surgency (characterized by activity level and shyness) were assessed. Weighted ordinal regression models were conducted while adjusting for child and family covariates. RESULTS: Approximately 13 % of children lived with smokers. Compared to children who did not live with smokers, children living with smokers displayed behaviors of poorer effortful control and were more likely to be easily distracted (AOR = 1.59, 95%CI = 1.24-2.04) and less likely to keep working on tasks until finished (AOR = 0.56, 95%CI = 0.44-0.71). Children living with smokers displayed behaviors of greater negative affectivity and were at increased odds of being angry or anxious when transitioning between activities (AOR = 1.50, 95%CI = 1.13-1.98) and losing their temper when things did not go their way (AOR = 1.53, 95%CI = 1.20-1.96), and were at decreased odds of calming down quickly when excited (AOR = 0.54, 95%CI = 0.42-0.70). Children living with smokers displayed behaviors of poorer surgency and were less likely to play well with others (AOR = 0.58, 95%CI = 0.45-0.76) and sit still compared to same-aged children (AOR = 0.56, 95%CI = 0.44-0.71). LIMITATIONS: The NSCH uses a cross-sectional survey design; longitudinal associations and objective measures could not be assessed. However, the NSCH is nationally representative and results are generalizable to U.S. 3-5-year-olds. CONCLUSIONS: Findings suggest household tobacco smoking influences temperament in early childhood. Results signify the need to promote household tobacco cessation.

Enhancing school-based asthma education efforts using computer-based education for children.

BACKGROUND: Schools are an important site for delivery of asthma education programs. Computer-based educational programs are a critical component of asthma education programs and may be a particularly important education method in busy school environments. OBJECTIVE: The objective of this brief report is to review and critique computer-based education efforts in schools. RESULTS: The results of our literature review indicated that school-based computer education efforts are related to improved knowledge about asthma and its management. In some studies, improvements in clinical outcomes also occur. Data collection programs need to be built into games that improve knowledge. Many projects do not appear to last for periods greater than 1 year and little information is available about cultural relevance of these programs. CONCLUSIONS: Educational games and other programs are effective methods of delivering knowledge about asthma management and control. Research about the long-term effects of this increased knowledge, in regard to behavior change, is needed. Additionally, developing sustainable projects, which are culturally relevant, is a goal for future research.

Obesity screening in the pediatric emergency department.

OBJECTIVES: The purposes of this study were (1) to examine parental perception of childhood obesity and race with measured body mass index (BMI), (2) to determine if parents are receptive to obesity screening in the pediatric emergency department and if receptivity varies by race or weight status, and (3) to determine eating habits that are predictors of obesity. METHODS: This study is a cross-sectional study, with a convenience sample of 213 patients (aged 4-16 years accompanied by a parent/legal guardian to a pediatric emergency department). Weight and height were obtained, and parents were asked to complete a survey about perception of their child's weight, nutrition, and exercise habits. RESULTS: The current study found that parent perception of weight status was fairly accurate, and perception was predictive of BMI. Race, however, was not predictive of BMI. Parents were generally receptive of weight screening in the pediatric emergency department, and this did not vary as a function of weight status; however, receptivity did vary based on ethnicity, with African American parents being more receptive than white parents. Large portion sizes and the number of times a child eats fast food per week were found to be predictive of obesity. CONCLUSIONS: Greater than half of the children presenting to our pediatric emergency department were overweight or obese. Parents were generally accurate in their perception of their child's weight but were still receptive to obesity prevention and screening in the pediatric emergency department.