Racial/ethnic disparities in the association between fine particles and respiratory hospital admissions in San Diego county, CA.

Ambient air pollution exposure is associated with exacerbating respiratory illnesses. Race/ethnicity (R/E) have been shown to influence an individual's vulnerability to environmental health risks such as fine particles (PM 2.5). This study aims to assess the R/E disparities in vulnerability to air pollution with regards to respiratory hospital admissions in San Diego County, California where most days fall below National Ambient Air Quality Standards (NAAQS) for daily PM 2.5 concentrations. Daily PM 2.5 levels were estimated at the zip code level using a spatial interpolation using inverse-distance weighting from monitor networks. The association between daily PM 2.5 levels and respiratory hospital admissions in San Diego County over a 15-year period from 1999 to 2013 was assessed with a time-series analysis using a multi-level Poisson regression model. Cochran Q tests were used to assess the effect modification of race/ethnicity on this association. Daily fine particle levels varied greatly from 1 µg/m3 to 75.86 µg/m3 (SD = 6.08 µg/m3) with the majority of days falling below 24-hour NAAQS for PM 2.5 of 35 µg/m3. For every 10 µg/m3 increase in PM 2.5 levels, Black and White individuals had higher rates (8.6% and 6.2%, respectively) of hospitalization for respiratory admissions than observed in the county as a whole (4.1%). Increases in PM 2.5 levels drive an overall increase in respiratory hospital admissions with a disparate burden of health effects by R/E group. These findings suggest an opportunity to design interventions that address the unequal burden of air pollution among vulnerable communities in San Diego County that exist even below NAAQS for daily PM 2.5 concentrations.

[Pathologies of the immigrant child in the Intensive Care Unit. Update]. / Patologías del niño inmigrante en la Unidad de Cuidados Intensivos. Actualización.

It is increasingly common to provide medical care in the Intensive Care Unit (ICU) for immigrant children and adolescents as well as those born in Chile with parents in such condition. Currently, this has caused that the health team has to face diverse infrequent pathologies in our country and/ or diagnostic problems derive from the poor knowledge of genetic conditions of this population, some resulting from their health conditions. This review addresses several aspects of hematological, infectious, parasitic, respiratory, and cardiovascular pathologies, all relevant topics to know during their stay in the ICU. It is a duty of the health team to be updated on pathologies of low prevalence in our country, some of them very little known until a decade ago, but which are currently increasingly present in the ICUs of the Chilean public health system.

Structural Characteristics of Tree Cover and the Association with Cardiovascular and Respiratory Health in Tampa, FL.

Urban tree cover can provide several ecological and public health benefits. Secondary datasets for Tampa, FL, including sociodemographic variables (e.g., race/ethnicity), health data, and interpolated values for features of tree cover (e.g., percent canopy and leaf area index) were analyzed using correlation and regression. Percent canopy cover and leaf area index were inversely correlated to respiratory and cardiovascular outcomes, yet only leaf area index displayed a significant association with respiratory conditions in the logistic regression model. Percent racial/ethnic minority residents at the block group level was significantly negatively correlated with median income and tree density. Leaf area index was also significantly lower in block groups with more African-American residents. The percentage of African Americans (p = 0.101) and Hispanics (p < 0.001) were positively associated with respiratory outcomes while population density (p < 0.001), percent canopy (p < 0.01), and leaf area index (p < 0.01) were negatively associated. In multivariate models, higher tree density, leaf area index, and median income were significantly negatively associated with respiratory cases. Block groups with a higher proportion of African Americans had a higher odds of displaying respiratory admissions above the median rate. Tree density and median income were also negatively associated with cardiovascular cases. Home ownership and tree condition were significantly positively associated with cardiovascular cases.

Diet-Quality Indexes Are Associated with a Lower Risk of Cardiovascular, Respiratory, and All-Cause Mortality among Chinese Adults.

Background: Diet-quality indexes have been associated with a lower risk of chronic disease mortality in Western populations, but it is unclear whether these indexes reflect protective dietary patterns in Asian populations. Objective: We examined the association between Alternative Healthy Eating Index-2010 (AHEI-2010), alternate Mediterranean diet (aMED), Dietary Approaches to Stop Hypertension (DASH), and Healthy Diet Indicator (HDI) scores and the risk of all-cause cardiovascular disease (CVD), cancer, and respiratory disease mortality. Methods: We used data from a prospective cohort of 57,078 Singapore Chinese men and women (aged 45-74 y) who were free of cancer and CVD at baseline (1993-1998) and who were followed up through 2014. The diet-quality index scores were calculated on the basis of data from a validated 165-item food-frequency questionnaire. Cox regression models with adjustment for potential confounders including sociodemographic and lifestyle variables, body mass index, and medical history were used to estimate HRs and 95% CIs. Results: During a total of 981,980 person-years of follow-up, 15,262 deaths (CVD: 4871; respiratory: 2690; and cancer: 5306) occurred. Comparing the highest with the lowest quintiles, the multivariable adjusted HRs (95% CIs) for all-cause mortality were 0.82 (0.78, 0.86) for AHEI-2010, 0.80 (0.76, 0.85) for aMED, 0.80 (0.75, 0.84) for DASH, and 0.88 (0.83, 0.92) for HDI scores (all P-trend < 0.001). Higher diet index scores were associated with a 14-28% lower risk of CVD and respiratory mortality, but only a 5-12% lower risk of cancer mortality. Higher consumption of vegetables, fruit, nuts, and long-chain n-3 (ω-3) fatty acids, lower consumption of red meat, and avoidance of high alcohol consumption were the diet index components associated with a lower risk of mortality. Conclusion: Adherence to several recommended dietary patterns that emphasize healthy plant-based foods was associated with a substantially lower risk of chronic disease mortality in an Asian population. The Singapore Chinese Health Study was registered at www.clinicaltrials.gov as NCT03356340.

Asthma-related mortality in the United States, 1999 to 2015: A multiple causes of death analysis.

BACKGROUND: Asthma mortality based on the underlying cause of death (UCOD) underestimates disease burden. OBJECTIVE: To analyze asthma mortality in the United States from 1999 to 2015 and the pattern of reporting of asthma and its comorbidities in death certificates, using multiple cause of death (MCOD) records. METHODS: All 156,517 death certificates with any mention of asthma were analyzed for 1999 to 2015. Asthma was defined by International Classification of Diseases, 10th Revision code J45 based on the UCOD or MCOD. Annual age-adjusted asthma death rates were computed according to age, sex, and race/ethnicity. The 6,304 MCOD coded status asthmaticus cases (J46) were also examined. RESULTS: From 1999 to 2015 a total of 59,067 deaths with a UCOD of asthma occurred; 37,832 deaths occurred in females and 21,235 in males (female-male ratio = 1.78). A total of 156,517 deaths with MCOD of asthma occurred; 101,371 deaths occurred in females and 55,146 in males (female-male ratio = 1.83). Hence, 37.7% of deaths with any mention of asthma had asthma as the UCOD (37.3% in females and 38.45% in males). Of these deaths, 41.7% occurred in non-Hispanic blacks and 36% in non-Hispanic whites. Between 1999 and 2015, age-adjusted MCOD death rates changed as follows: 38.1% in Hispanic white females, 34.1% in non-Hispanic black females, 15.1% in non-Hispanic white females, 28.5% in Hispanic white males, 21.3% in non-Hispanic black males, and 25.0% in non-Hispanic white males. Non-Hispanic black females and males had the highest MCOD and UCOD rates throughout the period. CONCLUSION: Among deaths with any mention of asthma, asthma was chosen as the UCOD most often in non-Hispanic black males and least often in non-Hispanic white females. Age-adjusted MCOD rates decreased most in non-Hispanic white males and least in non-Hispanic white females.

Rates of Perioperative Respiratory Adverse Events Among Caucasian and African American Children Undergoing General Anesthesia.

BACKGROUND: Perioperative respiratory adverse events (PRAEs) account for the major cause of morbidity and mortality in children undergoing general anesthesia. In our institutional clinical practice, we suspected that African American children experienced untoward respiratory events more frequently than other racial groups. Identification of high-risk groups can guide decision making in the perioperative period, and aggressive optimization of specific care can enhance safety and improve outcomes. METHODS: Data came from a retrospective chart review for records from August 2013 to December 2013. The primary aim was to compare the incidence of PRAEs among racial groups of young children at a single institution. We also analyzed factors that are potentially associated with a higher risk of PRAEs. There were 1148 records that met the inclusion criteria. Racial identities, PRAEs, and risk factors were identified. Logistic regression analysis was performed to evaluate differences in PRAEs among racial groups controlling for confounding variables. RESULTS: Of all 1148 patients, 62 (5.4%) had a PRAE. African American children had significantly higher incidences of PRAE (26/231, 11.4%) compared to Caucasian (27/777, 3.5%; P < .001). Although the most common PRAE was laryngospasm, bronchospasm was the most common PRAE for African American children. Otolaryngology procedures were most commonly associated with PRAEs, followed by orthodontic procedures. CONCLUSIONS: In a multivariable logistic analysis, African American pediatric patients were shown to have significantly higher odds of PRAEs when compared with the Caucasian group.

Contributions of individual acculturation and neighborhood ethnic density to variations in Hispanic children's respiratory health in a US-Mexican border metropolis.

BACKGROUND: We used an expanded conceptualization of ethnic density at the neighborhood level, tailored to Hispanic majority communities in the USA, and a robust measure of children's acculturation at the individual level, to predict Hispanic children's respiratory health. METHODS: We conducted a cross-sectional survey of 1904 children in 2012 in El Paso, TX, USA. One thousand one hundred and seven Hispanic children nested within 72 census tracts were analyzed. Multilevel logistic regression models with cross-level interactions were used to predict bronchitis, asthma and wheezing during sleep. RESULTS: A neighborhood-level ethnic density factor was a non-significant risk factor while individual-level acculturation was a significant risk factor for the three outcomes. Pest troubles and not having been breastfed as an infant intensified the positive association between ethnic density and bronchitis. Increases in ethnic density intensified the odds of wheezing in sleep if the child was not low birth weight or was not economically deprived. CONCLUSIONS: Results suggest that increasing individual-level acculturation is detrimental for US Hispanic children's respiratory health in this Hispanic majority setting, while high ethnic density neighborhoods are mildly risky and pose more significant threats when other individual-level factors are present.

The respiratory health of urban indigenous children aged less than 5 years: study protocol for a prospective cohort study.

BACKGROUND: Despite the burden of acute respiratory illnesses (ARI) among Aboriginal and Torres Strait Islander children being a substantial cause of childhood morbidity and associated costs to families, communities and the health system, data on disease burden in urban children are lacking. Consequently evidence-based decision-making, data management guidelines, health resourcing for primary health care services and prevention strategies are lacking. This study aims to comprehensively describe the epidemiology, impact and outcomes of ARI in urban Aboriginal and Torres Strait Islander children (hereafter referred to as Indigenous) in the greater Brisbane area. METHODS/DESIGN: An ongoing prospective cohort study of Indigenous children aged less than five years registered with a primary health care service in Northern Brisbane, Queensland, Australia. Children are recruited at time of presentation to the service for any reason. Demographic, epidemiological, risk factor, microbiological, economic and clinical data are collected at enrolment. Enrolled children are followed for 12 months during which time ARI events, changes in child characteristics over time and monthly nasal swabs are collected. Children who develop an ARI with cough as a symptom during the study period are more intensely followed-up for 28 (±3) days including weekly nasal swabs and parent completed cough diary cards. Children with persistent cough at day 28 post-ARI are reviewed by a paediatrician. DISCUSSION: Our study will be one of the first to comprehensively evaluate the natural history, epidemiology, aetiology, economic impact and outcomes of ARIs in this population. The results will inform studies for the development of evidence-based guidelines to improve the early detection, prevention and management of chronic cough and setting of priorities in children during and after ARI. TRIAL REGISTRATION: Australia New Zealand Clinical Trial Registry Registration Number: 12614001214628 . Registered 18 November 2014.

The Hispanic health paradox across generations: the relationship of child generational status and citizenship with health outcomes.

OBJECTIVES: In examining the Hispanic health paradox, researchers rarely determine if the paradox persists across immigrant generations. This study examines immigrant respiratory health disparities among Hispanic children in terms of current asthma, bronchitis, and allergies using an expanded six-group immigrant cohort framework that includes citizenship and the fourth-plus generation. STUDY DESIGN: Cross-sectional primary survey data from 1568 caretakers of Hispanic schoolchildren in El Paso, Texas (USA), were utilized. METHODS: Data were analyzed using generalized linear models. RESULTS: Results indicate that a healthy immigrant advantage lasts until the 2.5 generation for bronchitis and allergies (P < 0.05), and until the third generation for asthma (P < 0.10). Citizenship was not an influence on the likelihood of a child having a respiratory health condition. CONCLUSIONS: Findings demonstrate the utility of the expanded six-group cohort framework for examining intergenerational patterns in health conditions among immigrant groups.

Culturally appropriate flipcharts improve the knowledge of common respiratory conditions among Northern Territory Indigenous families.

ISSUE ADDRESSED: Flipcharts are widely used as education tools in Indigenous health but there is no published quantitative data on their use. As respiratory illness is the most frequent reason for hospitalisation of young children, we developed culturally sensitive flipcharts to educate carers of children on the 3 most common serious respiratory illness (bronchiolitis, pneumonia and bronchiectasis) affecting Indigenous children in the Northern Territory. In this study, we aimed to determine if use of these flipcharts improved the knowledge of these respiratory conditions among carers of Indigenous children admitted to the Royal Darwin Hospital. METHODS: We assessed the knowledge of 60 carers pre- and post-flipchart education using a questionnaire. Pre- and post-flipchart education scores for the three illnesses were combined and were compared using non-parametric analyses. RESULTS: Most carers were mothers (n = 43, 72%) aged between 20-40 years (n = 54, 90%) and lived in a remote community (n = 53, 88%). Knowledge of all respiratory conditions improved post education: median scores pre = 8 (Interquartile range 6, 10); post = 12 (10, 14), P = < 0.0001. CONCLUSIONS: The use of culturally appropriate educational flipcharts improves the knowledge of respiratory conditions among carers of Indigenous children hospitalised with common serious respiratory illness. SO WHAT? In the first paediatric quantitative study on the use of flipcharts as a means of providing health education to Indigenous Australians, we have shown that the use of culturally-appropriate flipcharts is an effective method of providing health education.

Indigenous Respiratory Outreach Care: the first 18 months of a specialist respiratory outreach service to rural and remote Indigenous communities in Queensland, Australia.

OBJECTIVE: Respiratory diseases are a leading cause of morbidity and mortality in Indigenous Australians. However, there are limited approaches to specialist respiratory care in rural and remote communities that are culturally appropriate. A specialist Indigenous Respiratory Outreach Care (IROC) program, developed to address this gap, is described. METHODS: The aim of the present study was to implement, pilot and evaluate multidisciplinary specialist respiratory outreach medical teams in rural and remote Indigenous communities in Queensland, Australia. Sites were identified based on a perception of unmet need, burden of respiratory disease and/or capacity to use the clinical service and capacity building for support offered. RESULTS: IROC commenced in March 2011 and, to date, has been implemented in 13 communities servicing a population of approximately 43000 Indigenous people. Clinical service delivery has been possible through community engagement and capacity building initiatives directed by community protocols. CONCLUSION: IROC is a culturally sensitive and sustainable model for adult and paediatric specialist outreach respiratory services that may be transferrable to Indigenous communities across Queensland and Australia.

Chronic respiratory disease in Indigenous peoples: a framework to address inequity and strengthen respiratory health and health care globally.

Indigenous peoples around the world bear a disproportionate burden of chronic respiratory diseases, which are associated with increased risks of morbidity and mortality. Despite the imperative to address global inequity, research focused on strengthening respiratory health in Indigenous peoples is lacking, particularly in low-income and middle-income countries. Drivers of the increased rates and severity of chronic respiratory diseases in Indigenous peoples include a high prevalence of risk factors (eg, prematurity, low birthweight, poor nutrition, air pollution, high burden of infections, and poverty) and poor access to appropriate diagnosis and care, which might be linked to colonisation and historical and current systemic racism. Efforts to tackle this disproportionate burden of chronic respiratory diseases must include both global approaches to address contributing factors, including decolonisation of health care and research, and local approaches, co-designed with Indigenous people, to ensure the provision of culturally strengthened care with more equitable prioritisation of resources. Here, we review evidence on the burden of chronic respiratory diseases in Indigenous peoples globally, summarise factors that underlie health disparities between Indigenous and non-Indigenous people, propose a framework of approaches to improve the respiratory health of Indigenous peoples, and outline future directions for clinical care and research.

Intra-ethnic disparities in respiratory health problems among Hispanic residents impacted by a flood.

OBJECTIVES: The primary objective of this article is to assess the respiratory health impacts of a flood disaster on Hispanic people residing in the United States, with a focus on intra-ethnic disparities related to age, sex, socioeconomic status, mold exposure, family conflict, English-language proficiency, and a lack of US citizenship. METHODS: Data were collected in 2010 after a flood disaster (2006) in El Paso County (Texas), which has a Hispanic majority population. A mail-out population-based survey was used retrospectively to assess respiratory health impacts for 363 people residing in 176 self-identified Hispanic households impacted by the flood; logistic regression was utilized to assess intra-ethnic health disparities in flood impacts. RESULTS: About 41% of individuals experienced one or more post-flood respiratory health problem. Lower income (OR = 0.532,p = .002), mold exposure (OR = 2.267, p < .001), increased family conflict (OR = 1.452, p = .025), English-language proficiency (OR = 4.023, p < .001) and a lack of US citizenship (OR = 13.111, p = .013) were significantly associated with higher odds of respiratory health problems in the regression model. CONCLUSION: Statistical findings provide evidence of intra-ethnic disparities in post-flood respiratory health status. Specifically within this Hispanic sample, individuals with lower household incomes, whose homes were covered by larger surface areas of mold, and whose families were characterized by increased tension experienced higher odds of post-flood respiratory health problems. Interestingly, greater English-language proficiency and lacking US citizenship were also risk factors. Given that this is one of the first studies of intra-Hispanic disparities in health following a US-based disaster, the findings underscore the importance of considering diversity within the US Hispanic population when studying environmental and post-disaster respiratory health.

Wahine hauora: linking local hospital and national health information datasets to explore maternal risk factors and obstetric outcomes of New Zealand Maori and non-Maori women in relation to infant respiratory admissions and timely immunisations.

BACKGROUND: Significant health inequities exist around maternal and infant health for Maori, the indigenous people of New Zealand. The infants of Maori are more likely to die in their first year of life and also have higher rates of hospital admission for respiratory illnesses, with the greatest burden of morbidity being due to bronchiolitis in those under one year of age. Timely immunisations can prevent some respiratory related hospitalisations, although for Maori, the proportion of infants with age appropriate immunisations are lower than for non-Maori. This paper describes the protocol for a retrospective cohort study that linked local hospital and national health information datasets to explore maternal risk factors and obstetric outcomes in relation to respiratory admissions and timely immunisations for infants of Maori and non-Maori women. METHODS/DESIGN: The study population included pregnant women who gave birth in hospital in one region of New Zealand between 1995 and 2009. Routinely collected local hospital data were linked via a unique identifier (National Health Index number) to national health information databases to assess rates of post-natal admissions and access to health services for Maori and non-Maori mothers and infants. The two primary outcomes for the study are: 1. The rates of respiratory hospitalisations of infants (≤ 1 yr of age) calculated for infants of both Maori and non-Maori women (for mothers under 20 years of age, and overall) accounting for relationship to parity, maternal age, socioeconomic deprivation index, maternal smoking status. 2. The proportion of infants with age appropriate immunisations at six and 12 months, calculated for both infants born to Maori women and infants born to non-Maori women, accounting for relationship to parity, maternal age, socioeconomic deprivation index, smoking status, and other risk factors. DISCUSSION: Analysis of a wide range of routinely collected health information in which maternal and infant data are linked will allow us to directly explore the relationship between key maternal factors and infant health, and provide a greater understanding of the causes of health inequalities that exist between the infants of Maori and non-Maori mothers.

Effect of financial incentives on ethnic disparities in smoking cessation interventions in primary care: cross-sectional study.

BACKGROUND: Smoking cessation interventions are underprovided in primary care. Financial incentives may help address this. However, few studies in the UK have examined their impact on disparities in the delivery of smoking cessation interventions. METHODS: Cross-sectional study using 2007 data from 29 general practices in Wandsworth, London, UK. We used logistic regression to examine associations between disease group [cardiovascular disease (CVD), respiratory disease, depression or none of these diseases], ethnicity and smoking outcomes following the introduction of the Quality and Outcomes Framework in 2004. RESULTS: Significantly, more CVD patients had smoking status ascertained compared with those with respiratory disease (89 versus 72%), but both groups received similar levels of cessation advice (93 and 89%). Patients with depression or none of the diseases were less likely to have smoking status ascertained (60% for both groups) or to receive advice (80 and 75%). Smoking prevalence was high, especially for patients with depression (44%). White British patients had higher rates of smoking than most ethnic groups, but black Caribbean men with depression had the highest smoking prevalence (62%). CONCLUSIONS: Smoking rates remain high, particularly for white British and black Caribbean patients. Extending financial incentives to include recording of ethnicity and rewarding quit rates may further improve smoking cessation outcomes in primary care.

Ethnic differences in respiratory disease for Native Hawaiians and Pacific Islanders: Analysis of mediation processes in two community samples.

OBJECTIVE: The prevalence of asthma and chronic obstructive pulmonary disorder (COPD) is elevated for Native Hawaiians but the basis for this differential is not well understood. We analyze data on asthma and COPD in two samples including Native Hawaiians Pacific Islanders, and Filipinos to determine how ethnicity is related to respiratory disease outcomes. METHODS: We analyzed the 2016 and 2018 Behavioral Risk Factor Surveillance Survey (BRFSS), a telephone survey of participants ages 18 and over in the State of Hawaii. Criterion variables were a diagnosis of asthma or COPD by a health professional. Structural equation modeling tested how five hypothesized risk factors (cigarette smoking, e-cigarette use, second-hand smoke exposure, obesity, and financial stress) mediated the ethnic differential in the likelihood of disease. Age, sex, and education were included as covariates. RESULTS: Structural modeling with 2016 data showed that Native Hawaiian ethnicity was related to higher levels of the five risk factors and each risk factor was related to a higher likelihood of respiratory disease. Indirect effects were statistically significant in almost all cases, with direct effects to asthma and COPD also observed. Mediation effects through comparable pathways were also noted for Pacific Islanders and Filipinos. These findings were replicated with data from the 2018 survey. CONCLUSIONS: Native Hawaiian and Pacific Islander ethnicity is associated with greater exposure to five risk factors and this accounts in part for the ethnic differential in respiratory disease outcomes. The results support a social-ecological model of health disparities in this population. Implications of the findings for preventive interventions are discussed.

Is there progress toward eliminating racial/ethnic disparities in the leading causes of death?

OBJECTIVES: We examined changes in relative disparities between racial/ethnic populations for the five leading causes of death in the United States from 1990 to 2006. METHODS: The study was based on age-adjusted death rates for four racial/ethnic populations from 1990-1998 and 1999-2006. We compared the percent change in death rates over time between racial/ethnic populations to assess changes in relative differences. We also computed an index of disparity to assess changes in disparities relative to the most favorable group rate. RESULTS: Except for stroke deaths from 1990 to 1998, relative disparities among racial/ethnic populations did not decline between 1990 and 2006. Disparities among racial/ethnic populations increased for heart disease deaths from 1999 to 2006, for chronic obstructive pulmonary disease deaths from 1990 to 1998, and for chronic lower respiratory disease deaths from 1999 to 2006. CONCLUSIONS: Deaths rates for the leading causes of death are generally declining; however, relative differences between racial/ethnic groups are not declining. The lack of reduction in relative differences indicates that little progress is being made toward the elimination of racial/ethnic disparities.

Respiratory infections in Tamariki (children) and Taitamariki (young people) Maori, New Zealand.

The Maori population is young, with 53% aged less than 25 years and with a higher prevalence of both acute (bronchiolitis, pneumonia, pertussis, tuberculosis) and chronic (bronchiectasis) respiratory tract infections than non-Maori. Environmental, economic and poorer access to health promotion programmes and health care rather than specific or genetic underlying disorders appear to contribute to this burden. While new initiatives are needed, we can do better with current public health programmes and building on regional initiatives that have already proven successful.

Differences in Febrile and Respiratory Illnesses in Minority Children: The Sociodemographic Context of Restrictive Parenting.

OBJECTIVE: To examine the moderating role of restrictive parenting on the relation of socioeconomic status (SES) to febrile illnesses (FIs) and upper respiratory illnesses (URIs) among ethnic minority and non-minority children. METHODS: Children from diverse ethnic backgrounds (Caucasian, African American, Asian, Latino, other, or multiethnic) were followed across the course of the kindergarten year. Parents reported on SES and parenting. A nurse completed 13 physical exams per child over the year to assess FIs and URIs. RESULTS: During the school year, 28% of children (n = 199, 56% ethnic minority) exhibited one or more FIs (range, 0-6) and 90% exhibited one or more URIs (range, 0-10). No main or moderating effects of SES or restrictive parenting on FIs or URIs were found among Caucasian children; however, among ethnic minority children, the relation of SES to FIs was conditional upon restrictive parenting (ß = .66; P = .02), as the fewest FIs were found for lower SES minority children whose parents reported more restrictive practices. Additionally, among minority children, more restrictive parenting was marginally associated with fewer URIs (ß = -.21; P = .05). CONCLUSIONS: Unexpectedly, among minority children the fewest illnesses occurred among lower SES children whose parents endorsed more restrictive parenting. This may be due to unique appraisals of this rearing style among minority children in lower SES environments and its potential to influence immune functioning. Results suggest variability in the effects of parenting on offspring health and support context-specific evaluations of parenting in efforts to ameliorate early health disparities.

Prevalence and Risk Factors Associated with Self-Rated Morbidities Among South Asian Migrant Gas Station Workers in Kuwait.

Gas station workers (GSWs) are at elevated risk of morbidities associated with exposure to petrochemical substances. This cross-sectional study assessed the prevalence and examined demographics and occupation-related risk factors associated with self-rated ill-health among GSWs in Kuwait. Structured questionnaire was used to record self-rated ill-health from 460 selected GSWs of South-Asian origin. Prevalence of self-rated ill-health conditions was computed. Random-intercept multivariable logistic regression model was used to identify the demographics and/or work-place related potential risk factors associated with one or more morbidities. Prevalent morbidities were eye(s) complaint (45.2%), asthma/shortness of breath (7.6%), frequent sneezing and allergic rhinitis (44.3%), recurrent headache (48.3%), dizziness (9.8%), tremors (42%), and eczema/skin complaint (44.1%). Furthermore, GSWs were significantly more likely to report one or more ill-health conditions (vs. none), if they were overweight/obese (aOR 1.8; 95% CI 1.1-2.9), married (aOR 2.6; 95% CI 1.5-4.5) or on current job for more than one year (aOR 6.4; 95% CI 2.9-15.4). In conclusion, GSWs suffer from ailments of multiple organ systems and need education and facilitation for self-protection.