Yvonne D. Senturia

Design and Methods of the National Cooperative Inner-City Asthma Study

The National Cooperative Inner‐City Asthma Study (NCICAS) was established to identify and then intervene on those factors which are related to asthma morbidity among children in the inner‐city. This paper describes the design and methods of the broad‐based initial Phase I epidemiologic investigation. Eight research centers enrolled 1,528 children, 4 to 9 years of age, from English‐ or Spanish‐speaking families, all of whom resided in major metropolitan inner‐city areas. The protocol included an eligibility assessment and an extensive baseline visit, during which symptom data, such as wheezing, lost sleep, changes in activities of daily living, inpatient admissions, and emergency department and clinic visits were collected. A comprehensive medical history for each child was taken and adherence to the medical regimen was assessed. Access, as well as barriers, to the medical system were addressed by a series of questions including the location, availability, and consistency of treatment for asthma attacks, follow‐up care, and primary care. The psychological health of the caretaker and of the child was also measured. Asthma knowledge of the child and caretaker was determined. Sensitization to allergens was assessed by skin‐prick allergen testing and exposure to cigarette smoke and the home environment were assessed by questionnaire. For more than a third of the families, in‐home visits were conducted with dust sample allergen collection and documentation of the home environment, such as the presence of pets and evidence of smoking, mildew, and roaches. Urine specimens were collected to measure passive smoke exposure by cotinine assays, blood samples were drawn for banking, and children age 6 to 9 years were given spirometric lung function assessment. At 3, 6 and 9 months following the baseline assessment, telephone interviews were conducted to ask about the childs symptoms, unscheduled emergency department or clinic visits, and hospitalizations. At this time, peak flow measurements with 2‐week diary symptom records were collected. Pediatr. Pulmonol. 1997;24:237–252.

Infant and toddler feeding patterns and problems : Normative data and a new direction

To fill information gaps, predominantly non-Hispanic white parents in five Chicago-area pediatric offices were surveyed concerning infant (n = 130) and toddler (n = 151) feeding times and behaviors. Feeding time distributions did not differ by age. Percentiles (in minutes) were: 10th, 9.4; 50th, 17.7; and 90th, 29.3. The most common infant problematic feeding behavior (PFB) was “not always hungry at mealtime” (33%). Toddler PFB included “not always hungry at mealtime” (52%), “trying to end meals after a few bites” (42%), “picky eating” (35%), and strong food preferences (33%). Toddler picky eaters ate more slowly (means 23.3 vs 19.7 minutes, p<.04). Toddlers with recalled PFB at 6 and 12 months ate most slowly (mean 37.5 minutes). We conclude that: (1) infants and toddlers who take <30 minutes to feed are slow feeders; (2) reports of behavioral feeding problems are common in toddlers and are related to slow feeding; (3) and these data can guide clinical care and future studies. J Dev Behav Pediatr 17:149–153, 1996. Index terms: behavior, feeding, nutrition.

Successful Techniques for Retention of Study Participants in an Inner-City Population

The purpose of this work was to describe methods of retaining participants in studies of inner-city populations, including the timing and intensity of contacts; and to describe the characteristics of participants who did not complete all follow-up interviews and/or return all peak flow diaries in the National Cooperative Inner-City Asthma Study. A cohort study design was used involving hospital emergency rooms and community clinics in seven major urban areas. Participants included 1337 4- to 9-year-old asthmatic children and their caretakers. Nearly 89% of participants completed 3-, 6-, and 9-month follow-up interviews. The 15% of participants who completed a baseline interview on the weekends were significantly more likely to complete follow-up interviews on a weekend. The percent of follow-up interviews conducted in person increased over time from 5% to 8%. The percent of participants with complete follow-up increased as the number of contact names increased (86% with zero contacts, 91% with two contracts; p = 0.03, test for trend). Participants who required at least four phone calls to complete the 3- and 6-month assessment were significantly more likely to be black, have higher participant stress, and have a smoker in the household (p < 0.05). Multiple logistic regression suggests that higher social support and lower parental stress were both predictors of completed interviews. Within our study sample of inner-city minority participants with asthmatic children, only a small proportion of participants missed any follow-up interviews. Increased caretaker stress, decreased social support, and inability to provide several alternate contacts were all predictive of retention problems. Having a flexible staff, computer tracking, and face-to-face recruitment appear essential to achieving nearly complete follow-up within a population historically difficult to follow.

Children fathered by men treated with chemotherapy for testicular cancer

In a study designed to assess the potential teratogenic effect of paternal chemotherapy, information was obtained on 131 children fathered by 107 men treated for metastatic testicular cancer. Of this group, first born children fathered by 96 chemotherapy patients were compared with 96 children fathered by matched controls. There was no excess of malformations (relative risk 1.0, 95% confidence intervals 0.41 and 2.40). In addition, the rates for specific malformations in the total cohort of 131 children were compared with the general population. There were no significant differences from national rates although the rate for congenital heart disease was higher than expected.

Exposure corrected risk estimates for childhood product related injuries

This study assesses the effect of exposure correction on injury risk estimates for children, using Chicago-area survey data on age-specific exposure of children to seven products: amusement park rides, sleds, bunkbeds, skateboards, fireworks, toboggans, and air guns and rifles. National Electronic Injury Surveillance System estimates for 1987 were used as numerators with two denominators: (i) uncorrected age-specific U.S. Census estimates for 1987 and (ii) these estimates corrected for exposure. Except for bunkbeds, skateboards and sleds, corrected injury risk decreased as age increased. Uncorrected population injury rates underestimated the risk posed to product-using children, especially those who are youngest and those who use skateboards.

In-office survey of children's hazard exposure in the chicago area: age-specific exposure information and methodological lessons

ABSTRACT. Anticipatory guidance on injury prevention should reflect the risks children face, yet hazard exposure information is generally unavailable. The objectives of this study were (1) to obtain information on age-specific exposure of Chicago-area children to amusement park rides, sleds, snow discs, bunkbeds, skateboards, fireworks, toboggans, and air guns and (2) to assess methodological issues in gathering exposure information by parental survey in pediatric practices. Questionnaires were received from 679 families, including 1469 children. The proportion of families with at least one exposed child varied: amusement park rides (94%), sleds (67%), snow discs (25%), bunkbeds (24%), skateboards (22%), fireworks (17%), toboggans (15%), and air guns and rifles (6%). Use of skateboards, air guns and rifles, and bunkbeds was highest in males. Use of skateboards, air guns and rifles, and snow discs peaked among young adolescents (ages 10 to 14), whereas use of sleds, toboggans and amusement park rides peaked among young children (ages 5 to 9) and young adolescents. Use of bunkbeds peaked among young children. Log linear analyses found: the likelihood of exposure to sleds and snow discs was highest in rural communities and for families owning their own home; toboggan exposure was highest among home owners; air gun and rifle exposure was highest in rural areas; fireworks exposure decreased with increased paternal education; exposure to skateboards was highest in single family dwellings and suburban home owners. This study generates the only available current estimates for use of these products, and demonstrates that in-office parental surveys concerning exposure are feasible. The findings can help guide future hazard exposure research and may affect anticipatory guidance in some settings. Future studies should concentrate on larger populations to allow calculation of exposure-corrected injury risk and to assess regional differences. J Dev Behav Pediatr 14:169–175, 1993. Index terms: injuries, prevention, epidemiology, firearms, sleds, skateboards, fireworks, development.