Deborah Klein Walker

Parental smoking and the risk of childhood asthma.

Data from two random population surveys are used to assess the relationship between parental smoking and the prevalence of asthma in children aged 0-17. Data from a 1977 Midwestern urbanized county indicate that, if mothers smoked, the prevalence of parent reported asthma increased from 5.0 per cent to 7.7 per cent (estimated relative risk of 1.5), and the prevalence of functionally impairing asthma increased from 1.1 per cent to 2.2 per cent (relative risk of 2.0). In a more rural Eastern county in 1980, a lower overall prevalence of asthma was noted. However, similar estimated relative risks of asthma (1.8) and functionally impairing asthma (2.4) were found to be associated with maternal smoking. Inconsistent relationships were found between the estimated prevalence of asthma and paternal smoking. When multivariate controls were introduced, the relationships between maternal smoking and asthma persisted. Estimated attributable risks indicate that between 18 per cent and 34 per cent of the asthma reported in these samples can be attributed to maternal smoking. Implications of these findings for primary care physicians are discussed.

Disability as a Public Health Issue: Findings and Reflections from the Massachusetts Survey of Secondary Conditions

Public health researchers and practitioners have begun to recognize the dynamic nature of disability, promote the health of people with disabilities, and develop strategies to prevent secondary conditions among them. To understand the epidemiology of secondary conditions, the authors developed the Massachusetts Survey of Secondary Conditions, a longitudinal study of adults with major disabilities (n = 656) based on a conceptual framework linking disability, mediating factors, and health outcomes. This paper reports baseline data on the number of secondary conditions experienced by survey respondents. Respondents experienced a mean of 5.3 of 17 secondary conditions. More numerous secondary conditions were associated with fair or poor general health and number of days unable to do routine activities. Factors amenable to public health interventions included difficulty with weight and exercise maintenance, tobacco and marijuana use, and experiencing assault. Disability should be a focus in all public health research, policy, and programs.

The emergence of attention deficits in early childhood: A prospective study.

To study the emergence of attention deficits in early childhood, the diagnostic team of an early education program documented the occurrence of poor concentration, distractibility, behavioral disorganization, poor self-monitoring, and overactivity in a group of 174 children followed prospectively from birth to school entry. Persistent attentional problems were identified in 5% of the children; 8% had problems which abated before kindergarten. Over the period from birth to kindergarten, 40% of the preschool youngsters were found to have some attentional indicator, but many of the findings were minor or transient. This study points to (1) the clustering of persistent attentional concerns with other developmental and environmental concerns, (2) the substantial long-term consequences of early attentional problems and (3) the feasibility of early detection of some children with attentional disorders.

The survival of very low-birth weight infants by level of hospital of birth: A population study of perinatal systems in four states

This study estimates differentials in survival among very low-birth weight infants according to hospital of birth, and seeks to determine importance of birth at high-technology centers versus birth at other urban or rural hospitals. Data from four states for 1978 and 1979 were used to estimate survival curves for the first 24 hours of life by type of hospital at birth, birth weight, and race. Significant (p less than 0.0001) differences in survival by type of hospital for both races at birth weights of 1000 to 1500 gm were observed. Smaller disparities were seen at birth weights of 750 to 1000 gm. Differentials in survival by hospital setting emerged in the first few hours after birth, underscoring the effectiveness of neonatal intensive care units in reducing infant mortality and the importance of maternal transport. Differentials persisted throughout the neonatal and postneonatal periods, although differences were attenuated. Prenatal assessment and provider and institutional cooperation can contribute to lowered mortality for high-risk infants and mothers.

Language Proficiency and the Enrollment of Medicaid-Eligible Children in Publicly Funded Health Insurance Programs

Objectives: The purpose of the study was to examine the effect of language proficiency on enrollment in a state-sponsored child health insurance program. Methods: 1055 parents of Medicaid-eligible children, who were enrolled in a state-sponsored child health insurance program, were surveyed about how they learned about the state program, how they enrolled their children in the program, and perceived barriers to Medicaid enrollment. We performed weighted χ2 tests to identify statistically significant differences in outcomes based on language. We conducted multivariate analyses to evaluate the independent effect of language controlling for demographic characteristics. Results: Almost a third of families did not speak English in the home. These families, referred to as limited English proficiency families, were significantly more likely than English-proficient families to learn of the program from medical providers, to receive assistance with enrollment, and to receive this assistance from staff at medical sites as compared to the toll-free telephone information line. They were also more likely to identify barriers to Medicaid enrollment related to “know-how”—that is, knowing about the Medicaid program, if their child was eligible, and how to enroll. Differences based on language proficiency persisted after controlling for marital status, family composition, place of residence, length of enrollment, and employment status for almost all study outcomes. Conclusions: This study demonstrates the significant impact of English language proficiency on enrollment of Medicaid-eligible children in publicly funded health insurance programs. Strong state-level leadership is needed to develop an approach to outreach and enrollment that specifically addresses the needs of those with less English proficiency.

THE IMPACT OF TELEVISION VIEWING ON MENTAL APTITUDE AND ACHIEVEMENT: A LONGITUDINAL STUDY

Previous studies of the effects of television viewing on mental abilities have shown mixed results, but most suffered from one or more of the following shortcomings: a small or other- wise unrepresentative sample, a cross-sectional rather than longi- tudinal approach, and a failure to consider intervening variables between television viewing and cognitive skills. This study was designed to overcome these deficiencies by using nationally rep- resentative data from the National Health Examination Cycle 2 and Cycle 3 Surveys. These surveys included 1,745 children who

Assessing psychosocial adjustment of children with chronic illnesses: A review of the technical properties of PARS III

Four groups of investigators in the Research Consortium on Chronic Illness in Childhood have used the Personal Adjustment and Role Skills Scale (PARS) III to assess the psychosocial adjustment of children with chronic physical illnesses and no mental impairment. The PARS III consists of 28 items that measure psychosocial functioning in six areas: peer relations, dependency, hostility, productivity, anxiety-depression, and withdrawal. Analyses of the measures reliability and validity, using a total combined sample of 450 school-age children (ages 5–18 years) with a variety of chronic illnesses and three comparison samples of healthy children, provide evidence that the PARS III can be used successfully to assess psychosocial adjustment of children with chronic illnesses and no cognitive impairments. J Dev Behav Pediatr 11:116–121, 1990. Index terms: chronic illness, psychological development, social skills, behavior, measurement.

Variation in Special Education Classification Across School Districts: How Does Where You Live Affect What You Are Labeled?

Using independent information collected from the parents and teachers of a stratified random sample of 829 special education students, we compared the classification practices of five major metropolitan school districts. We examined the functional levels of students with the same labels living in different districts and tested whether differences in functional status were associated with the prevalence of the classification. To determine whether special education designations might change if the students lived elsewhere, we reclassified the students in each district’s sample using discriminant functions estimated within each of the other districts (which empirically replicated that district’s classification scheme). We found that (a) functional levels of students classified as mentally retarded, physically/multiply handicapped and hearing impaired differed across districts; (b) districts that classified more students as mentally retarded were serving less severely impaired students under this label; and (c) districts were least consistent in their use of the mentally retarded and emotionally disturbed designations and most consistent in their use of the hearing impaired and, to a lesser extent, physically/multiply handicapped designations; districts’ use of the speech impaired and learning disabled designations fell between these two extremes.

Chronic Illness, Psychosocial Problems, and School Absences: Results of a Survey of One County

The number of days absent from school during the 1979-80 school year for 573 children aged 6-17 years in Berkshire County, Massachusetts was ascertained by parent reporting in a random household survey. Children with a wide range of chronic health impairments were reported as missing more school than their healthy peers (8.7 days vs. 5.8, p < .001). Although there was a trend for children reported as having functional impairments to miss more school than those with chronic conditions without functional impairments (11.0 vs. 8.1), the difference was not statistically significant. Children with a variety of reported psychosocial difficulties missed more school than those without psychosocial difficulties for the sample as a whole and for those with reported chronic conditions. These findings document support for the assumption that children with a wide range of physical and psychological problems miss more school than their healthy peers and illustrate that the etiology of school absences is multifactoral and reflects behavioral as well as purely physical phenomena.

Monitoring health care for children with chronic conditions in a managed care environment.

Objective: Children with chronic health conditions face special issues in their interactions with managed care. These children often require additional and more varied services than do other children. Managed care plans increasingly include these children, especially with the growth of Medicaid managed care. This article examines the special issues facing children with chronic conditions and develops strategies for monitoring their care in managed care settings. Methods: The project staff conducted an extensive review of the research and policy literature related to managed care and the special needs of families with children with chronic conditions. The project also reviewed current and proposed plans of federal, state, and private groups for monitoring and, working with parents and other outside groups, identified key issues to consider in developing monitoring plans. Results: The relative rarity of many childhood conditions and the complex interactions among child, family, and community over time make assessment of their care difficult. We describe these child and family characteristics, outline essential features and domains for monitoring systems, and describe population-based and plan-based monitoring systems to assess managed care for these children and their families. Conclusions: Monitoring for children with chronic conditions in managed care arrangements will require public health agencies and health providers to define populations systematically, assess across a variety of conditions, and monitor several domains central to the health of these families.