Associations of unsafe, unsupportive, and underdeveloped neighborhoods with atopic dermatitis in US children.

BACKGROUND: Atopic dermatitis (AD) is influenced by multiple emotional and environmental factors. Yet, little is known about the impact of neighborhood environment characteristics on AD. OBJECTIVE: To determine the association of neighborhood characteristics with AD prevalence and severity in US children. METHODS: We analyzed data from the 2007-2008 National Survey of Children's Health, including a representative sample of 79,667 children and adolescents (age 0-17 years) in the United States. Multivariable weighted logistic regression models that adjusted for sociodemographics were constructed to determine the associations of neighborhood characteristics with AD prevalence and severity. RESULTS: Atopic dermatitis prevalence or severity were significantly increased in children residing in neighborhoods where people reportedly definitely do not help each other out (adjusted odds ratio [95% confidence interval]: 1.32 [1.15-1.52]), watch out for each other's children (1.26 [1.10-1.45] and 1.66 [1.14-2.41], respectively), have people to count on (1.28 [1.13-1.45]), and trusted adults to help the child (1.16 [1.01-1.32] and 1.54 [1.05-2.27], respectively). Children also had increased odds of AD if their caregiver felt that the child was never (1.52 [1.27-1.82]) or sometimes (1.23 [1.12-1.36]) safe in his/her neighborhood. Severe AD was less common in children residing in a neighborhood with a bookmobile or library (0.68 [0.52-0.90]). CONCLUSION: US children residing in unsafe, unsupportive, or underdeveloped neighborhoods have higher prevalence and severity of AD.

The prevalence and persistence of atopic dermatitis in urban United States children.

BACKGROUND: Previous studies found that childhood atopic dermatitis (AD) and asthma are associated with residence in urban areas. However, little is known about the prevalence and determinants of AD in US urban populations and its impact on quality-of-life (QOL) and asthma. OBJECTIVE: To determine AD prevalence and persistence, sociodemographic predictors thereof, and association with QOL and atopic comorbidities in US urban children. METHODS: We analyzed data from The Fragile Families and Child Wellbeing Study, a prospective cohort study of 4898 women and their children born in 20 large US cities between 1998 and 2000. AD prevalence was determined at ages 5, 9, and 15 years, and stratified by sex, race/ethnicity, and household poverty income level. RESULTS: The prevalences (95% confidence interval [CI]) of childhood AD were 15.0% (11.0%-18.9%), 15.1% (11.5%-18.7%), and 14.5% (10.4%%-18.5%) at ages 5, 9, and 15 years, respectively. Female sex (multivariable repeated measures logistic regression; adjusted odds-ratio [95% CI]: 1.56 [1.02-2.37]) and black race (1.80 [1.07-3.01]) were associated with persistent AD across all 3 ages. Children with AD at ages 5 and 15 (2.63 [1.42-4.86]), 5, 8 and 15 (1.47 [1.02-2.12]) and 9 and 15 years (1.61 [1.00-2.60]) had higher odds of poor/fair/good overall health. Children with AD at ages 5 and 9 years had the highest odds of ever having asthma (adjusted odds ratio [95% confidence interval]: 6.05 [5.88-6.22]), followed by children with AD at ages 5, 9, and 15 years (3.17 [3.07%-3.27]). CONCLUSION: Atopic dermatitis prevalence and persistence were highest in US urban children who were female or black. Urban children with persistent AD were more likely to have poor QOL and asthma.

Association of family structure with atopic dermatitis in US children.

BACKGROUND: Children from families without 2 married biologic parents have an increased risk of poverty and poor health. The relationship between family structure and atopic dermatitis (AD) has not been elucidated. OBJECTIVES: To determine the prevalence of AD and related outcomes in children from different family structures. METHODS: Data on 13,275 children (age ≤17 years) and their parents from the 2012 National Health Interview Survey were analyzed. RESULTS: In multivariable logistic regression models adjusting for sociodemographic groups, children from single-adult households (adjusted odds ratio [aOR], 1.272; 95% confidence interval [CI], 1.050-1.542), families with 2 or fewer members (aOR, 1.413; 95% CI, 1.079-1.852), families with a mother but no father present (aOR, 1.402; 95% CI, 1.179-1.667), nonbiologic fathers (aOR, 1.464; 95% CI, 1.089-1.969), or unmarried mothers (aOR, 1.508; 95% CI, 1.017-2.237) had increased odds of AD. Among children with AD, there were significantly increased odds of having only good, fair, or poor versus very good or excellent overall health (aOR, 1.545; 95% CI, 1.262-1.893) and greater odds of depression (aOR, 2.287; 95% CI, 1.523-3.434), anxiety (aOR, 2.001; 95% CI, 1.543-2.595), and stress (aOR, 2.013; 95% CI, 1.499-2.704). LIMITATIONS: Cross-sectional study. CONCLUSIONS: Children in the United States who are from families with single adults, single mothers, nonbiologic fathers, or unmarried mothers may have increased odds of AD. Family structures were associated with poorer overall health, depression, anxiety, and stress in children with AD.

Sun-protective behaviors and sunburn among US adults.

Individuals can reduce the risk of developing skin cancer by minimizing ultraviolet sunlight exposure, though recent trends in sun-protective behaviors remain to be investigated. To evaluate sun-protective behaviors and sunburn among US adults. We analyzed data from the 2010, 2015, and 2020 National Health Interview Survey (NHIS), an annual, cross-sectional survey conducted by the US Census Bureau. Multivariable regression models were stratified by demographic variables and constructed to evaluate sun-protective behaviors and sunburn avoidance across time. From 2010 through 2020, US adults had significantly increased prevalence of seeking shade (p value, 0.003), wearing wide-brimmed hats (< 0.001), wearing long-sleeved shirts (< 0.001), using sunscreen (< 0.001), and avoiding sunburns (< 0.001) and significantly decreased prevalence of sun avoidance (< 0.001). Disparities in sun-protective behaviors also exist among different sexes, ages, education levels, and those reporting higher sun sensitivity. This cross-sectional study found that by 2020, US adults had an increased prevalence of wearing sun-protective clothing and sunscreen use, though decreased prevalence of sun avoidance. Although certain sun-protective behaviors have become more prevalent, the incidence of skin cancer continues to rise. Efforts to understand drivers of sun-protective behaviors and targeted intervention efforts are needed.

Maternal Depression and Atopic Dermatitis in American Children and Adolescents.

Atopic dermatitis (AD) is a chronic, inflammatory skin disease associated with considerable burden and mental health symptoms. We sought to determine the association of maternal depression in the postpartum period and maternal and paternal depression in later childhood with AD prevalence and persistence in US children. Data were analyzed from the Fragile Families and Child Wellbeing Study, a prospective cohort study of 4898 children born in 20 metropolitan US cities. History of postpartum depression was associated with childhood AD overall (multivariable logistic regression; adjusted odds ratio [aOR], 1.32; 95% confidence interval [CI], 1.06-1.64), and particularly at ages 5 years (aOR, 1.34; 95% CI, 1.04-1.73) and 9 years (aOR, 1.37; 95% CI, 1.10-1.70). Postpartum depression was associated with more persistent AD (present at 2 years: aOR, 1.58; 95% CI, 1.12-2.22; 3 years: aOR, 1.73; 95% CI, 1.15-2.60). Maternal depression in the past year was associated with significantly higher odds of AD at age 5 years (aOR, 1.54; 95% CI, 1.20-1.99), 9 years (aOR, 1.36; 95% CI, 1.10-1.71), and 15 years (aOR, 1.43; 95% CI, 1.13-1.80). Maternal depression was associated with higher odds of AD during 1 year (aOR, 1.50; 95% CI, 1.16-1.94), 2 years (aOR, 1.60; 95% CI, 1.16-2.19), or all 3 years of interviews (aOR, 1.61; 95% CI, 1.06-2.45). In conclusion, maternal depression in the postpartum period and beyond is associated with AD throughout childhood and adolescence.

Association of Adverse Childhood Experiences With Childhood Atopic Dermatitis in the United States.

Traumatic and stressful events of childhood, known as adverse childhood experiences (ACEs), have been associated with numerous health outcomes. However, little is known about ACEs in atopic dermatitis (AD) patients. We sought to determine the relationship between ACEs and childhood AD. Data were analyzed from the Fragile Families and Child Wellbeing Study, a longitudinal birth cohort study that followed 4898 women and their children born in large US cities. Multivariable weighted logistic regression models adjusting for sociodemographics were constructed to determine the associations of ACEs with AD prevalence at ages 5, 9, and 15 years. Children who experienced 1 ACE (multivariable logistic regression; adjusted odds ratio [aOR], 1.42; 95% confidence interval [CI], 1.08-1.86), 2 ACEs (1.49; 95% CI, 1.10-2.02), or 3 or more ACEs (2.10; 95% CI, 1.52-2.89) had significantly increased odds of AD history compared with children without ACEs at age 5 years. Children who experienced 3 or more ACEs (1.48; 95% CI, 1.09-2.01) had significantly increased odds of AD history compared with children without ACEs at age 9 years. There were no significant associations between ACEs and history of AD at age 15 years. In conclusion, ACE exposures are related to childhood AD across time. Children who experience a greater number of ACEs have higher prevalence of AD.