Asthma and allergy as risk factors for suicidal behavior among young adults.

An association between allergic disease, depression and suicidality has been reported. OBJECTIVE: To explore the relationships between suicidality and asthma, allergy, internet addiction, stress, sleep quality, pain/discomfort, and depression, among emerging adults. PARTICIPANTS: 929 college students completed an online survey between October 2015 and April 2017. METHODS: A cross-sectional study using multivariate analysis techniques was implemented. RESULTS: Using structural equation modeling, we found that allergies and stress were directly related to pain/discomfort; pain/discomfort was associated to poor sleep, depression, and suicidality. Sleep quality was also affected by stress; while sleep, stress, pain/discomfort, and internet addiction were directly related to depression (all p < .05). Ultimately, four factors impacted suicidality: stress, pain/discomfort, depression, and, indirectly, sleep quality (all p < .05). Although allergy had some effects, these did not reach statistical significance (p < .09). CONCLUSION: Findings suggest that allergy might impact suicidality indirectly through increased pain/discomfort, poor sleep, and depression.

The Link Between Inadequate Sleep and Obesity in Young Adults.

The prevalence of obesity has increased dramatically over the past decade. Although an imbalance between caloric intake and physical activity is considered a key factor responsible for the increase, there is emerging evidence suggesting that other factors may be important contributors to weight gain, including inadequate sleep. Overall research evidence suggests that inadequate sleep is associated with obesity. Importantly, the strength and trajectory of the association seem to be influenced by multiple factors including age. Although limited, the emerging evidence suggests young adults might be at the center of a "perfect health storm," exposing them to the highest risk for obesity and inadequate sleep. Unfortunately, the methods necessary for elucidating the complex relationship between sleep and obesity are lacking. Uncovering the underlying factors and trajectories between inadequate sleep and weight gain in different populations may help to identify the windows of susceptibility and to design targeted interventions to prevent the negative impact of obesity and related diseases.

Patterns of responding on a balloon analogue task reveal individual differences in overall risk-taking: choice between guaranteed and uncertain cash.

We explored the utility of analyzing within- and between-balloon response patterns on a balloon analogue task (BAT) in relation to overall risk scores, and to a choice between a small guaranteed cash reward and an uncertain reward of the same expected value. Young adults (n = 61) played a BAT, and then were offered a choice between $5 in cash and betting to win $0 to $15. Between groups, pumping was differentially influenced by explosions and by the number of successive unexploded balloons, with risk takers responding increasingly on successive balloons after an explosion. Within-balloons, risk takers showed a characteristic pattern of constant high rate, while non-risk takers showed a characteristic variable lower rate. Overall, results show that the higher number of pumps and explosions that characterize risk takers at a molar level, result from particular forms of adaptation to the positive and negative outcomes of choices seen at a molecular level.

Sleep quality and body mass index in college students: the role of sleep disturbances.

OBJECTIVE: Obesity and its comorbidities have emerged as a leading public health concern. The aim of this study was to explore the relationship between body mass index (BMI) and sleep patterns, including duration and disturbances. METHODS: A convenience sample of 515 college students completed an online survey consisting of the Pittsburgh Sleep Quality Index (PSQI), and self-reported height and weight to calculate BMI. Univariate and multivariate logistic regression analyses were performed using components of the PSQI as predictors of overweight (BMI ≥ 25). RESULTS: One-third of the participants had BMI ≥ 25, and 51% were poor-quality sleepers (PSQI > 5). Controlling for age and sex, only sleep disturbances were associated with overweight (odds ratio = 1.66, 95% confidence interval [1.08, 2.57]). CONCLUSIONS: Sleep disturbances, rather than sleep duration, predicted overweight among young adults; this is consistent with the most recent evidence in the literature. These findings support expanding the scope of wellness programs to promote healthy sleep among students.

Development and validation of educational materials for food allergy.

OBJECTIVE: To develop and validate a food allergy educational program. STUDY DESIGN: Materials developed through focus groups and parental and expert review were submitted to 60 parents of newly referred children with a prior food allergy diagnosis and an epinephrine autoinjector. The main outcome was correct demonstration of an autoinjector. RESULTS: The correct number of autoinjector activation steps increased from 3.4 to 5.95 (of 6) after training (P < .001) and was 5.47 at 1 year (P < .05). The mean score for comfort with using the autoinjector (7-point Likert scale) before the curriculum was 4.63 (somewhat comfortable) and increased to 6.23 after the intervention (P < .05) and remained elevated at 1 year (6.03). Knowledge tests (maximum 15) increased from a mean score of 9.2 to 12.4 (P < .001) at the initial visit and remained at 12.7 at 1 year. The annualized rate of allergic reactions fell from 1.77 (historical) the year prior, to 0.42 (P < .001) after the program. On a 7-point Likert scale, all satisfaction categories remained above a favorable mean score of 6: straight-forward, organized, interesting, relevant, and recommend to others. CONCLUSIONS: This food allergy educational curriculum for parents, now available online at no cost, showed high levels of satisfaction and efficacy.

Developing a food allergy curriculum for parents.

BACKGROUND: Food allergy (FA) is potentially severe and requires intensive education to master allergen avoidance and emergency care. There is evidence suggesting the need for a comprehensive curriculum for food allergic families. METHODS: This paper describes the results of focus groups conducted to guide the development of a curriculum for parents of food allergic children. The focus groups were conducted using standard methodology with experienced parents of food allergic children. RESULTS: Participants were parents (n = 36) with experience managing FA recruited from allergy clinics at two academic centers. Topics identified by parents as key for successful management included as expected: (i) early signs/symptoms, (ii) 'cross-contamination', (iii) label-reading, (iv) self-injectable epinephrine; and (v) becoming a teacher and advocate. Participants also recommended developing a 'one page-road map' to the information, and to provide the information early and be timed according to developmental stages/needs. Suggested first points for curriculum dissemination were emergency rooms, obstetrician and pediatrician offices. Participants also recommended targeting pediatricians, emergency physicians, school personnel, and the community-at-large in educational efforts. Parents often sought FA information from non-medical sources such as the Internet and support groups. These resources were also accessed to find ways to cope with stress. Paradoxically, difficulties gaining access to resources and uncertainty regarding reliability of the information added to the stress experience. DISCUSSION: Based on reports from experienced parents of food allergic children, newly diagnosed parents could benefit from a comprehensive FA management curriculum. Improving access to clear and concise educational materials would likely reduce stress/anxiety and improve quality of life.

Using information technology to reduce asthma disparities in underserved populations: a pilot study.

BACKGROUND: Low health literacy has been identified as an independent predictor of poor asthma control. The Institute of Medicine considers the role of information technology (IT) as critical in providing "safe, effective, patient centered, timely, efficient, and equitable" care with the potential to reduce health disparities in underserved populations. The aim of this study was to design and evaluate an interactive computer-based questionnaire to assess asthma symptoms in children of parents with limited health literacy and/or limited English proficiency. METHODS: Volunteer caregivers attending a mobile asthma clinic were randomly assigned to complete the electronic or the paper-and-pencil version of an asthma screening questionnaire (ASQ) in their language of choice (English or Spanish). In the electronic version, a tablet computer was used to present the ASQ questions as video clips and to collect information through the touchscreen. Participants also completed a demographic questionnaire, a brief health literacy questionnaire, and a system usability and satisfaction questionnaire. Reliability of the paper and electronic self-assessments was evaluated by comparing each participant's answers to information they provided during a nurse-guided structured interview (gold standard). RESULTS: A total of 48 parents participated in the study, 26 completed the electronic ASQ and 21 the paper-and-pencil form. Thirty-five percent of the children had well-controlled asthma (n = 17). Most participants were Spanish speaking (67%) Hispanic (n = 44) mothers (n = 43) with a median age of 32 years. More than half had ≤8 years of education (n = 25) and earned <$20,000 per year (n = 27). The median health literacy score was 32 (range 0-36). The correlation between health literacy scores and years of education was significant (ρ = .47, p < .01). Concordance between the electronic ASQ and the nurse interview was significantly higher than concordance between the paper ASQ and the nurse interview (68% versus 54%; p < .01). All parents who completed the electronic questionnaire reported being satisfied; 96% felt comfortable using it, and found it simple to use. CONCLUSIONS: By facilitating the assessment of asthma symptoms at manageable cost, interactive information technology tools may help reduce barriers to access due to inadequate levels of English proficiency and health literacy.

Food allergy educational needs of pediatric dietitians: a survey by the Consortium of Food Allergy Research.

OBJECTIVE: To determine pediatric dietitians' self-reported proficiency, educational needs, and preferences regarding food allergy (FA) management. DESIGN AND SETTING: An Internet-based, anonymous survey was distributed to the Pediatric Nutrition Practice Group (PNPG) of the American Dietetic Association. PARTICIPANTS: Respondents (n = 311) were registered dietitians and members of the PNPG. ANALYSIS: Results are presented using descriptive statistics. Chi-square tests were applied for subgroup analyses. Percentage responses were calculated per question based on the number of respondents answering the question. RESULTS: On a 4-point scale of proficiency ("high," "moderate," "low," and "none"), respondents primarily rated themselves "moderate" for educating families, creating diets, and evaluating safe food items, and "low" for creating diagnostic food challenges. Education was primarily self-taught (75%). Preferences for future resources included handbooks (77%) and Web-based instructional programs (53%). On a 4-point scale ("very" to "not at all" needed) among practices that included >10% patients with FA, ratings of "very" were defined as need resources to update FA knowledge (87%) and need for a FA "tool kit" (84%). CONCLUSIONS AND IMPLICATIONS: Pediatric dietitians manage FA for a substantial patient base although their self-reported proficiency is overall only moderate. Dietitians would prefer and likely benefit from Internet-accessible management handbooks and patient handouts.

Food allergy education for school nurses: a needs assessment survey by the consortium of food allergy research.

Food allergy is increasing in school-age children. School nurses are a primary health care resource for children with food allergy and must be prepared to manage allergen avoidance and respond in the event of an allergic reaction. An anonymous survey was administered to school nurses attending their association meetings to determine their educational needs regarding children with food allergy. With 199 school nurses responding, their self-reported proficiency for critical areas of food allergy knowledge and management varied, with weaknesses identified particularly for emergency plan development, staff education, delegation, developing guidelines for banning foods and planning school trips. Nurses reported a high interest in obtaining educational materials in these areas and prefer video and Internet resources that could be promoted through professional organizations.

A comparison of asthma prevalence and morbidity between rural and urban schoolchildren in Arkansas.

BACKGROUND: Asthma disproportionately affects minority and low-income children. Investigations that focus on high-risk pediatric populations outside the inner city are limited. OBJECTIVE: To compare asthma prevalence and morbidity in urban and rural children in Arkansas. METHODS: We administered a validated survey to parents of children enrolled in urban and rural school districts in Arkansas. Rates of asthma diagnosis, asthma symptoms, medication use, and health care utilization were compared between urban and rural groups. RESULTS: Age and sex distributions were similar; however, 85% of rural and 67% of urban children were black and 78% of rural and 37% of urban children had state-issued medical insurance (P < .001 for both). Provider-diagnosed asthma was similar in the rural vs urban groups (19% vs 20%); however, rural children were more commonly diagnosed as having chronic bronchitis (7% vs. 2%, P < .001). Rural children had more asthma morbidity compared with urban children, including recurrent trouble breathing (odds ratio [OR], 1.9; 95% confidence interval [CI], 1.5-2.2), recurrent cough (OR, 2.2; 95% CI, 1.9-2.6), recurrent chest tightness (OR, 1.8; 95% CI, 1.5-2.2), and repeated episodes of bronchitis (OR, 2.2; 95% CI, 1.7-2.8) during the preceding 2 years. Rural children were more likely to report symptoms consistent with moderate to severe asthma compared with urban children (46% vs. 35%, P < .001). There were no differences in health care utilization between groups. CONCLUSION: Asthma prevalence was similar between representative rural and urban groups in Arkansas, but asthma morbidity was significantly higher in the rural group.

Underdiagnosed and uncontrolled asthma: findings in rural schoolchildren from the Delta region of Arkansas.

BACKGROUND: Studies of asthma in school-aged rural children in the United States are limited, and there are no studies of high-risk pediatric populations in rural environments. OBJECTIVES: To examine the prevalence of asthma and to evaluate markers of morbidity in 2 rural school districts in the Arkansas Delta region. METHODS: Children at risk for asthma were identified by using a cross-sectional asthma case-finding survey. Surveys were distributed to students enrolled in the Marvell and Eudora school districts during the 2005-2006 school year. RESULTS: The response rate was 81% (964 of 1,190). The mean age of the 964 children who completed the survey was 10.3 years (age range, 4-17 years); 85% were African American, and 78% had state-issued insurance. Twenty-eight percent (268 of 964) of the children were categorized as being at risk for asthma by previous physician diagnosis (33%), algorithm diagnosis (16%), or both (51%). Of the 268 at-risk children, 79% reported persistent symptoms and 21% reported intermittent or no current symptoms. In the previous 4 weeks, 59% of the children experienced daytime and nocturnal symptoms and 62% used rescue medications. Activity limitation and treatment in the emergency department or hospitalization for asthma in the previous 2 years were reported by 82% and 49% of the children, respectively. CONCLUSIONS: Active asthma symptoms are prevalent in this predominantly minority, low-income, rural population. High rates of undiagnosed and uncontrolled asthma are suggested by frequent asthma symptoms, activity limitation, rescue medication use, and emergency health care utilization. Future studies of pediatric asthma should focus on high-risk populations in rural locales.

Classroom aeroallergen exposure in Arkansas head start centers.

BACKGROUND: The impact of preschool environmental conditions on classroom aeroallergen concentrations is not fully understood. OBJECTIVE: To examine the relationship between school environmental conditions and classroom aeroallergen concentrations in the Pulaski County Head Start (HS) Program. METHODS: Thirty-three HS centers in Pulaski County, Arkansas, underwent a detailed environmental evaluation. Classroom settled dust samples were analyzed for the presence of common indoor allergens. RESULTS: Classroom eating (70%), wall-to-wall carpeting (58%), and water damage (33%) were common. Median classroom allergen levels were as follows: dust mite (Der p 1 and Der f 1), 0.6 microg/g; Fel d 1, 0.4 microg/g; Can f 1, 1.7 microg/g; cockroach, below detection; Mus m 1, 0.18 microg/g; and mold spores, 17,800 CFU/g. Can f 1 and Mus m 1 allergens were detected in 100% of HS centers. Facilities with carpeting, increased humidity, and single-use facilities showed trends toward increased dust mite concentrations. Detectable cockroach allergen was more common in classrooms cleaned by teachers than by professional housekeepers. CONCLUSIONS: Aeroallergens were commonly detected in Pulaski County HS center classrooms, with dog and mouse allergens detected in 100% of centers. Median classroom allergen concentrations were low, and classroom characteristics were not strongly predictive of increased allergen exposure.

Parameters of delay discounting assessment: number of trials, effort, and sequential effects.

Procedural variants in estimating delay discounting (DD) have been shown to yield significant within-subject differences in estimated degree of delay discounting as well as variations in the patterns of choice. The purpose of this study was to evaluate the effect of subject control over the number of trials in a delay discounting task, on degree of delay discounting. Participants were assessed with two computerized DD assessments: the full-length method presented participants with a fixed set of 240 trials, and the abbreviated task, where once participants had shown indifference between the immediate and delayed rewards, the remaining trials for that delay value were omitted. While the full-length and abbreviated methods did not differentially affect patterns of choice or estimated delay discounting, the order of presentation (ascending or descending) of immediate rewards produced differences in each measure: rate of delay discounting was significantly lower when estimated with the descending sequence; a larger proportion of area under the discounting curve was concentrated around the indifference point trial with the descending sequence; and a lower correlation was observed between estimates obtained across methods with the descending sequence.

Relationship of body mass index with asthma indicators in head start children.

OBJECTIVE: To examine the relationship of body mass index (BMI) and asthma indicators on children with asthma in a Head Start (HS) program. METHODS: In this cross-sectional study (November 18, 2000, to December 12, 2003) of children aged 3 to 5 years with asthma, we compared the BMI data of HS asthmatic patients (n = 213) with the data of peer control subjects from a sample (n = 816) of the National Health and Nutrition Examination Survey aged 3 to 5 years and with children in prekindergarten in Arkansas public schools (n = 1,024). Parental reports of asthma symptoms, health care use, medication use, school days missed, and quality of life were used as indicators of asthma morbidity. Categorical analysis and chi2 tests were performed to examine the relationship between BMI and asthma morbidity. RESULTS: The prevalence of overweight (> or =95th percentile) was significantly higher in HS children with asthma compared with the National Health and Nutrition Examination Survey children (P < .001) and Arkansas prekindergarten children (P = .05). Compared with HS asthmatic children with a BMI less than the 85th percentile, HS asthmatic patients with a BMI of the 85th percentile or greater reported significantly more school days missed (P = .02), lifetime hospitalizations (P = .04), emergency department visits (P = .02), and activity limitations (P = .03) and fewer oral corticosteroid bursts (P = .04). There was also a trend for more daytime symptoms (P = .05) and lower quality of life (P = .06). No differences were observed in rescue (P = .28) or controller (P = .47) medications, environmental tobacco smoke exposure (P = .47), positive allergy test results (P = .85), and nighttime symptoms (P > .99). CONCLUSIONS: Having an increased BMI was associated with more asthma morbidity in this group of HS asthmatic patients. Despite the lack of a clear explanation for the link between asthma and BMI, our data suggest that an increased BMI significantly affects the well-being of young asthmatic patients and should be further addressed.

Exposure to environmental tobacco smoke among children presenting to the emergency department with acute asthma: a multicenter study.

Environmental tobacco smoke (ETS) exposure has been associated with increased use of the emergency department (ED) for acute asthma care. The purpose of this study was to determine the prevalence of ETS exposure among children presenting to the ED for acute asthma care and whether ETS exposure affects acute asthma severity or response to therapy. We conducted a multi-center study of children 2-11 years with physician-diagnosed acute asthma presenting to 44 EDs in 18 states. Chi-square test, Student's t-test, Wilcoxon rank sum test, and logistic regression were used for the analyses. The study population included 954 children. Thirty-six percent (95% CI, 33-39%) of caregivers reported that their child was exposed to ETS. Among exposed children, 35% were exposed 1-6 days/week, and 65% were exposed daily. Compared to unexposed children, ETS-exposed children were older at asthma diagnosis, older at ED presentation, and were less likely to be Hispanic. Indicators of chronic asthma severity were higher among unexposed children (i.e., total number of medications, use of controller medications, use of beta(2) agonists, number of urgent clinic visits, and lifetime hospitalizations). There was a weak association between ETS and acute asthma severity. Response to therapy (including ED disposition) did not differ between groups. On multivariate analysis, ETS-exposed children were more likely to be older, female, non-Hispanic, have lower household income, not use controller medications, and have a pet at home (all P < 0.05). Our study showed that the prevalence of ETS exposure among children presenting to the ED with acute asthma differs across demographic factors. There were no significant differences in acute asthma symptoms or response to ED therapy between ETS-exposed and unexposed children. Lower use of controller medications and less frequent urgent clinic visits among ETS-exposed children suggest inadequate asthma care or milder disease. The weak association between ETS exposure and acute asthma severity might reflect confounding by psychological factors and/or chronic asthma severity. The frequency of ETS exposure suggests that the ED may be an appropriate venue to engage caregivers of children with asthma in asthma education and smoking cessation efforts.

Functional parameters of delay discounting assessment tasks: order of presentation.

Several variants in the methods used to estimate delay discounting (DD) have been associated with within-subject differences in degree of DD. This study compared variants in the order of presentation of reward and delay values during assessment of DD of hypothetical cash. Participants were randomly assigned to one of two groups. For one group, the immediate reward values were presented in Ascending order and for the other, they were presented in Descending order. In addition, all participants completed a DD task with the reward values presented in a Random order. Degree of DD, calculated as area under the curve (AUC), was similar between the Ascending and Descending procedures, and was significantly higher with the Random procedure. Within-subjects AUC were positively correlated. Reaction times within choice trials changed systematically as a function of order of presentation of the immediate rewards, and distance to the indifference point within each delay value. Reaction times appear to parallel the effort involved in making the individual choices. Some procedural variants in the assessment of DD yield differences in behavior during the assessment task that affect the magnitude of the estimated delay discounting. Thus, the absolute magnitude of DD may not be directly comparable between methods.

School-based asthma case finding: the Arkansas experience.

This population-based case-finding study sought to determine asthma prevalence and characterize disease severity and burden among school-aged children in the Little Rock School District. Asthma cases were identified by validated algorithm and parental report of asthma diagnosis. The overall response rate was low. Among schools with greater than 50% response rate, prevalence of physician-diagnosed asthma was comparable to other studies in public school settings. Prevalence of symptoms in cases identified as current is suggestive of poor asthma control. Improved systems for case identification of children with asthma are needed in schools. Efforts should focus on strategies to improve asthma control.

Symptom profile and asthma control in school-aged children.

BACKGROUND: Children with poorly controlled asthma are at high risk of airway remodeling, sleep disruption, school absenteeism, and limited participation in activities. OBJECTIVE: To determine asthma prevalence and characterize disease severity and burden in school-aged children. METHOD: A case-finding study was conducted via a multiple-choice questionnaire and asthma algorithm. Items used for analysis include physician diagnosis of asthma, symptom severity, and health care utilization. The chi2 test was used to determine the significance of differences among cases. Logistic regression was used to evaluate the association of patient factors and asthma indicators. RESULTS: Of the 5,417 children surveyed, 1,341 (25%) were classified as being at risk of asthma. Of these asthma cases, 55% were positive by diagnosis and algorithm (active), 10% were positive per algorithm alone (suspected), and 35% were positive per diagnosis alone (nonactive). Only 14% of all asthma cases reported experiencing no respiratory symptoms (< 1% active, 2% suspected, and 40% nonactive) compared with 75% of noncases. Also, 75% of noncases reported never missing school compared with 19%, 33%, and 54% of active, suspected, and nonactive asthma cases. African American race, Medicaid enrollment, and male sex were independent predictors of asthma risk. Similarly, African American race, Medicaid enrollment, age, and persistent asthma were independent predictors of emergency department use among asthma cases. DISCUSSION: Prevalence of active symptoms suggestive of poor asthma control was extremely high among urban, minority children enrolled in Arkansas' largest public school district. Poor asthma control greatly affects quality of life, including school attendance and performance. Interventions should raise expectations and emphasize the importance of achieving asthma control.

Multicultural medical encounters: the experience at a pediatric clinic.

Research evidence suggests that minority patients experience disparities in health care management. This study examines how cultural and language expectations affect the perceived interaction between physicians and Hispanic patients. Seventeen physicians and thirteen Hispanic parents were interviewed at Arkansas Children's Hospital's General Pediatric Clinic. It was found that parents have a positive perception of physicians and reported being satisfied with the quality of the encounter. In addition, both physicians and parents reported issues that should be addressed. Both groups felt that a physician's perceptions, along with language barriers, might affect that physician's ability to fully interact with patients, but not their decision-making regarding treatment.