Marcella R. Price

Unraveling the ecology of risks for early childhood asthma among ethnically diverse families in the southwest

OBJECTIVES We describe the prevalence of asthma risk factors within racial/ethnic and language groups of infants participating in an intervention study for reducing chronic asthma. METHODS Low-income children aged 9 to 24 months with 3 or more episodes of wheezing illness were enrolled. Baseline information included family and medical histories, allergic status, environmental exposures, emotional environment, and caregiver psychosocial resources. RESULTS Racial/ethnic and language groups-European Americans, African Americans, high-acculturated Hispanics, and low-acculturated Hispanics-showed different patterns of risk factors for childhood asthma, with low-acculturated Hispanics showing the most distinctive pattern. CONCLUSIONS Patterns of covariation of biological and psychosocial risk factors for childhood asthma were associated with racial/ethnic and language status among urban, low-income children.

Caregiver negative affect is a primary determinant of caregiver report of pediatric asthma quality of life

BACKGROUND Quality of life has increased in popularity as an outcome measure in health research. However, the measurement of quality of life has been questioned on methodologic grounds, as it often shows little association with objective measures of disease status. OBJECTIVE For this report we studied the determinants of pediatric asthma caregiver report of quality of life and its relationship to disease burden. METHOD Ninety-eight children who were admitted to a Pediatric Day Program for an asthma evaluation were enrolled in an outcome study. A complete set of medical records for the 2-year period before and after the admission was collected and systematically coded for health care utilization. Using the Pediatric Asthma Caregivers Quality of Life Questionnaire, data were collected at baseline, discharge, and year after the admission. Caregiver negative affect (anxiety and depression), measured with the Brief Symptom Inventory, was also collected at baseline and discharge. RESULTS Caregiver report of quality of life was unrelated to health care utilization at baseline but instead was significantly related to baseline caregiver negative affect. A significant relationship between health care utilization and quality of life was present at followup. The Emotional Function scale from the quality of life measure can account for most of the relationship between quality of life and negative affect. CONCLUSIONS Caregiver affect may have a considerable influence on report of quality of life. Understanding the individual characteristics of the respondent is important when using a quality of life instrument as an outcome measure.

Reliability and Validity of a System for Coding Asthma Outcomes from Medical Records

To evaluate the reliability and validity of a standardized asthma outcome coding system, we obtained medical records for 182 asthmatic children. Records were coded by trained staff using explicit and detailed criteria. Outcome variables coded included number of corticosteroid bursts, asthma-related physician contacts, emergency room visits, hospitalizations, and number of asthma episodes. Interrater reliability was excellent. Patterns of associations between the coded variables and other independently obtained outcome measures supported concurrent and construct validity. Given the intense scrutiny of health outcomes in the current managed-care marketplace, use of this system may foster further clinical research examining asthma outcomes.

An investigation of the medical care utilization of children with severe asthma according to their type of insurance.

A comparison of the medical care utilization of children with severe asthma according to insurance type was performed. Subjects were grouped by which type of insurance they had: capitated, fee for service, or Medicaid insurance. Medical records were coded into utilization categories, by presenting complaint, sick- or well-child visit, and if a generalist or specialist provided care during the visit. The Medicaid group had less specialist, sick-child care than the groups with capitated or fee for service insurance. The Medicaid group also had more emergency room visits than the other two groups. The three groups had a similar amount of total physician/clinic visits. Even though similar care was shown to be available for those with Medicaid insurance, this low resource group often uses expensive emergency room care.

Asthma phenotypes at age 4: Follow-up of disadvantaged wheezing infants

5 5 Asthma Phenotypes at Age 4: Follow-up of Disadvantaged Wheezing Infants M. D. Klinnert l, M. R. Price 2, A. H. Liu I, C. A. Dennisl; ]Pediatrics, National Jewish Medical and Research Center, Denver, CO, 2pediatrics, National Jewish Medical and Research Center, Denver, CO. RATIONALE: Despite epidemiological evidence indicating an increase in asthma morbidity among low income minority children less than age 5 years, little is known regarding the natural history and phenotypic distribution of asthma in this group. METHODS: The Childhood Asthma Prevention Study recruited lowincome families of children age 9-24 months with >3 wheezing episodes. Home and laboratory assessments were conducted, and half of the families were randomized to environmental support lasting one year. At age 4 years the children were evaluated using prick skin testing, pulmonary functions, and medical record review, and caregiver symptom reports (modified ATS-B questionnaire assessing 5 symptoms) for the previous 12 months. We report here illness patterns for children (n=124) with complete 4-year evaluations, regardless of intervention assignment. RESULTS: Caregivers reported wheezing between 3 and 4 years for 85% of children. 58% were positive for 3/5 ATS-B questions, and 38% for 4/5 questions. 34% of the children had >1 positive skin test (atopic). Children meeting ATS-B criteria for asthma were no more likely to be atopic than those not (3/5 p=0.32; 4/5 p=0.60). Among the children meeting either criteria level, atopic children were significantly more likely to have had a corticosteroid burst (p<0.04) or hospitalization (p<0.005). However, atopic and nonatopic children were equally likely to utilize the ED for wheezing illness. CONCLUSIONS: Most disadvantaged children with frequent wheezing as infants showed significant morbidity at age 4 years, with continued wheezing and frequent ED visits. Those with both wheezing and atopy showed a pattern of more severe illness. Funding: N1H/NIAID