Molly Gong

A Model of Self-Regulation for Control of Chronic Disease*

Chronic disease poses increasing threat to individual and community health. The day-to-day manager of disease is the patient who undertakes actions with the guidance of a clinician. The ability of the patient to control the illness through an effective therapeutic plan is significantly influenced by social and behavioral factors. This article presents a model of patient management of chronic disease that accounts for intrapersonal and external influences on management and emphasizes the central role of self-regulatory processes in disease control. Asthma serves as a case for exploration of the model. Findings from a 5-year study of 637 children with asthma and their care-taking parents supported that the self-regulation elements of the model were reasonably stable over time and baseline values were predictive of important disease management outcomes.

Issues in identifying asthma and estimating prevalence in an urban school population

UNLABELLED This article first presents salient issues related to identifying children in urban schools who might benefit from asthma services. It discusses a brief questionnaire for identifying cases and problems in estimating asthma prevalence. Subsequently, results of case detection in 14 urban schools are presented and discussed in light of these issues. The questionnaire was employed with parents of 4,653 African-American children in Detroit. Results suggest that determining number, type, and frequency of symptoms may be necessary to ascertain prevalence of asthma. Using only number and type produced a rate of asthma of 25%. Adding frequency provided a more conservative estimate of 19%. About 9% of children exhibiting symptoms of asthma had no physician diagnosis. Only 25% with symptoms reflecting mild persistent, 35% with moderate persistent, and 26% with severe persistent disease had prescriptions for anti-inflammatory medicine. Further, 23% of children with asthma-like symptoms had no prescription for asthma medicine of any type. CONCLUSIONS (1) low-cost procedures can be used in schools to identify children with suspected undiagnosed and undertreated asthma; (2) prevalence estimates for asthma in the group of urban school children studied are among the highest in the United States; and (3) asthma is undertreated in this sample.

Physician-patient partnership in managing chronic illness.

No abstract available.

Associations of BMI, TV-Watching Time, and Physical Activity on Respiratory Symptoms and Asthma in 5th Grade Schoolchildren in Taipei, Taiwan

The study evaluated the associations of body fatness, TV-watching time, and physical activity with the occurrences of asthma and respiratory symptoms in schoolchildren in Taipei, Taiwan. A questionnaire survey was conducted to elicit episodes of respiratory symptoms and data on lifestyle and anthropometric factors in 2290 5th-grade schoolchildren. Results show that overweight was positively associated with 5 of the 7 respiratory symptoms. The risk of having respiratory symptoms increased 47%–94% in overweight schoolchildren. Watching TV ≥ 3 hrs/day was associated with more occurrences of respiratory symptoms (aOR = 1.42–1.90). Physical activity ≥3 times/week was associated with fewer occurrences of respiratory symptoms (aOR = 0.66–0.73). Overweight was positively associated with an increased risk of suspected asthma in boys (aOR = 1.56, 95% CI = 1.07–2.29), but not in girls. In summary, overweight and greater TV-watching time increase the risk of respiratory symptoms, while habitual physical activity decreases the risk of respiratory symptoms. Weight status, sedentary life, and frequency of physical exercise are the factors that can impact on the respiratory health of schoolchildren.

A Bayesian Approach for Clustered Longitudinal Ordinal Outcome With Nonignorable Missing Data: Evaluation of an Asthma Education Program

Asthma, a chronic inflammatory disease of the airways, affects an estimated 6.3 million children under age 18 in the United States. A key to successful asthma management, and hence improved quality of life (QOL), calls for an active partnership between asthma patients and their health care providers. To foster this partnership, an intervention program was designed and evaluated using a randomized longitudinal study. The study focused on several outcomes where typically missing data remained a pervasive problem. We suspected that the underlying missing-data mechanism may not be ignorable. Thus here we present a method for analyzing clustered longitudinal data with missing values resulting from a nonignorable missing-data mechanism. The transition Markov model with random effects was used to investigate changes in ordinal outcomes over time. A Bayesian pattern-mixture model with the flexibility to incorporate models for missing data in both outcome and time-varying covariates was used to model the nonignorable missing-data mechanism. The pattern-mixture model uses easy-to-understand parameters—namely, ratios of the cumulative odds across patterns with the complete-data pattern—as the reference pattern. Sensitivity analysis was performed using different prior distributions for the parameters. A fully Bayesian approach was derived by integrating over a class of prior distributions. The data from the Asthma Intervention Study were analyzed to explore the effect of the intervention program on improving QOL.

Risk Factors for Respiratory Symptoms and Asthma in the Residential Environment of 5th Grade Schoolchildren in Taipei, Taiwan

This study examined the association of residential environmental factors with respiratory symptoms and asthma in 2,290 fifth graders in Taipei, Taiwan. A self-report survey questionnaire elicited experiences of respiratory symptoms, disease history, and characteristics of residential environmental factors from schoolchildren. The proportion of schoolchildren having physician-diagnosed asthma was 9.8% and suspected asthma was 16.1%. The proportions of having respiratory symptoms in the past 12 months ranged from 9.8% for wheezing without a cold to 40.5% for exercise-induced cough. Higher proportions of boys had non-exercise-induced respiratory symptoms, physician-diagnosed asthma, and suspected asthma than girls (p < 0.05). Exposure to odoriferous chemical vapor was significantly associated with all seven respiratory symptoms considered in the study (p < 0.05). After adjusting for confounding factors including residential districts, gender, diagnosed allergy, and parental history of respiratory symptoms, odoriferous chemical vapors, gas leaks, dehumidifier use, presence of cockroaches at home, and leaky water/water puddle at home were significantly associated with the proportions of physician-diagnosed asthma or suspected asthma of the schoolchildren. The adjusted odds ratio (aOR) of physician-diagnosed asthma was 2.35 (95% confidential interval = 1.45–3.82) for odoriferous chemical vapor. The aOR of suspected asthma measure was 2.14 (95% CI = 1.40–3.26) for odoriferous chemical vapor. Odoriferous chemical vapor was the major risk factor of respiratory illness in the residential environment of schoolchildren in Taipei. Other household risk factors included gas leaks, dampness, and cockroaches at home.

Influences on Childhood Asthma in Low-Income Communities in China and the United States

For comparison of childhood asthma, the same case-finding survey and parent interview questionnaires were used to collect data from 639 children with asthma in 21 elementary schools in Beijing and 835 children with asthma in 14 elementary schools in Detroit, Michigan. Asthma prevalence in Beijing (7.3%) was more than three times lower than in Detroit (24%) despite a high level of smoking among Chinese parents. Body mass index (BMI; weight in kilograms divided by height in meters squared) levels were higher in Detroit but were not associated with persistent asthma in either country. Higher levels of past infection in Beijing and household allergens in Detroit were noted and may be associated with differences in prevalence. Despite less severe disease observed in Beijing, hospitalizations and office visits did not differ from Detroit. This may be partially associated with less use of anti-inflammatory medicine and lower levels of parental asthma management in China.