Elizabeth L McQuaid

Virginia Commonwealth University, Richmond, Virginia, United States

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Publications (96)260.55 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: In this study, we examine the association of asthma (asthma symptoms, asthma control, lung function) and sleep problems in a group of urban children. The role of allergic rhinitis (AR), a comorbid condition of asthma, on children's sleep problems is also examined. Finally, we investigate whether sleep hygiene moderates the association between asthma and sleep problems, and whether there are differences in these associations based on ethnic background. Non-Latino White, Latino, and African American urban children with asthma (n = 195) ages 7-9 (47% female) and their primary caregivers participated in a baseline visit involving interview-based questionnaires on demographics, asthma and rhinitis control, and caregiver report of children's sleep problems and sleep hygiene. Children and their caregivers participated in a clinical evaluation of asthma and AR, followed by a month monitoring period of children's asthma using objective and subjective methods. Total sleep problem scores were higher in children of the sample who were from African American and Latino backgrounds, compared to non-Latino white children. Poor asthma control was predictive of higher levels of sleep problems in the entire sample. Poorer AR control also was related to more sleep problems, over and above children's asthma in the sample. This association was more robust in non-Latino white children. Poor sleep hygiene heightened the association between poor asthma control and sleep problems in the entire sample and in African American children. Multidisciplinary interventions integrating the co-management of asthma, AR, and the effects of both illnesses on children's sleep, need to be developed and tailored to children and their families' ethnic background. © 2014 American Academy of Sleep Medicine.
    Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine 10/2014; · 2.83 Impact Factor
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    ABSTRACT: Abstract Caregivers of children with asthma smoke at a rate similar to the general population. Research on the relative importance of structural or functional social support in smoking cessation has been mixed. Participants were smokers (N = 154) who were caregivers of children with asthma. Both functional (perception of social support measured by the Interpersonal Support Evaluation List) and structural social support (living with another smoker, partner status, and the proportion of smoking friends) were measured at baseline. Participants received an asthma-education and smoking cessation intervention based on Motivational Interviewing. Biochemically-verified abstinence was assessed at 6-months post treatment. Hierarchical logistic regression analyses indicated that functional support predicted smoking abstinence even when controlling for relevant covariates and structural support (OR = .896, p = .025). Exploratory analyses revealed that this effect was driven primarily by the self-esteem ISEL subscale. Structural support (lower proportion of smoking friends), but not functional support, predicted making a 24-hour quit attempt (OR = 1.476, p = .031) but this effect became non-significant when the effect of functional support was accounted for. Smoking cessation that focuses on building general functional support, particularly self-esteem support, may be beneficial for smoking cessation in caregivers of children with asthma.
    Behavioral Medicine 06/2014; · 1.14 Impact Factor
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    ABSTRACT: Allergic rhinitis (AR) is a risk factor for the development of asthma, and if poorly controlled, it may exacerbate asthma. We sought to describe AR symptoms and treatment in a larger study about asthma, sleep, and school performance. We examined the proportion (1) who met criteria for AR in an urban sample of school children with persistent asthma symptoms, (2) whose caregivers stated that they were not told of their child's allergies, (3) who had AR but were not treated or were undertreated for the disease, as well as (4) caregivers and healthcare providers' perceptions of the child's allergy status compared with study assessment, and (5) associations between self-report of asthma and AR control over a 4-week monitoring period. One hundred sixty-six children with persistent asthma participated in a clinical evaluation of asthma and rhinitis, including allergy testing. Self-report of asthma control and rhinitis control using the Childhood Asthma Control Test (C-ACT) and Rhinitis Control Assessment Test (RCAT) were measured 1 month after the study clinic session. Persistent rhinitis symptoms were reported by 72% of participants; 54% of rhinitis symptoms were moderate in severity, though only 33% of the sample received adequate treatment. AR was newly diagnosed for 53% during the clinic evaluation. Only 15% reported using intranasal steroids. Participants with poorly controlled AR had poorer asthma control compared with those with well-controlled AR. This sample of urban school-aged children with persistent asthma had underdiagnosed and undertreated AR. Healthcare providers and caregivers in urban settings need additional education about the role of allergies in asthma, recognition of AR symptoms, and AR's essential function in the comanagement of asthma. Barriers to linkages with allergy specialists need to be identified.
    Pediatric Allergy, Immunology, and Pulmonology 06/2014; 27(2):75-81. · 0.56 Impact Factor
  • Journal of Pediatric Psychology 05/2014; · 2.91 Impact Factor
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    ABSTRACT: This study examines factors associated with recruitment and retention of Latino, Dominican (DR) and mainland Puerto Rican (PR), and non-Latino white (NLW) families into a pediatric asthma study. Over eleven hundred (n=1185) families were screened, and 489 (n= 174 NLW, n= 160 DR, n= 155 PR) were enrolled. Rates of recruitment by source of recruitment and rates of retention differed by ethnic group. Families whose caregiver had never married had lower odds of completing the study. The findings highlight the need for further study to examine the effectiveness of specific recruitment and retention strategies with Latino and non-Latino white families.
    Journal of the Association for the Care of Children's Health 04/2014; 43(2):132-150.
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    ABSTRACT: Pediatric asthma disparities exist with Latino children, especially from Island Puerto Rico (PR), experiencing greater asthma prevalence and morbidity than non-Latino White (NLW) children. Families must balance attention to child asthma with other child and family needs, defined as the "balanced integration of asthma." This study examined the impact of culturally related factors on the balanced integration of asthma in NLW and Latino families in Rhode Island (RI) and PR, as well as associations between balanced integration and asthma morbidity. Participants included 601 caregivers and their children with asthma (7-16 years) from NLW and Latino backgrounds in RI and PR. Caregivers and children completed interview-administered assessments and a semistructured interview related to family asthma management. Balanced integration of asthma differed significantly by ethnic group/site (p < .001), with Island PR families having the lowest levels of balanced integration. Higher balanced integration was associated with fewer concerns about asthma medications, higher levels of Spanish proficiency in RI Latino families, lower levels of functional limitation, and no emergency department visits in the last year (all ps < .05). Findings suggest that Latino families may experience more difficulty adjusting to child asthma in the context of other child and family demands. Medication beliefs and language proficiency may begin to explain these differences. Our study suggests the importance of continuing to understand how families balance asthma with other aspects of daily life, as culturally appropriate interventions to improve family adjustment to asthma may serve to reduce child asthma morbidity. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
    Families Systems & Health 03/2014; · 1.74 Impact Factor
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    ABSTRACT: Objective The current study sought to evaluate patterns of complementary and alternative medicine (CAM) use in a sample of Latino and non-Latino white (NLW) children with asthma to determine whether parental beliefs about conventional medications and barriers to obtaining these medications were related to CAM use and to assess whether CAM use was associated with decreased adherence to controller medications. Methods Participants included 574 families of children with asthma from NLW, Puerto Rican (PR), and Dominican backgrounds from Rhode Island (RI) and from Island PR. All parents completed a brief checklist of barriers to medication use and an assessment of CAM approaches. A subsample of 259 families had controller medication use monitored objectively for approximately 1 month by MDILog (fluticasone propionate), TrackCap (montelukast), or dosage counter (fluticasone/salmeterol combination). Results Prevalence of CAM use was high among Latino families. Perceived barriers to obtaining medication were related to increased CAM use in PR families from RI. Elevated medication concerns were positively associated with CAM use among NLW and Island PR families. CAM use was positively related to objective adherence within NLW families, and unrelated in other groups. Conclusions CAM use is common among Latino families with asthma. Among some families, CAM use may be initiated as a way to cope with barriers to obtaining medication or when parents have concerns about conventional medications. Families who report CAM use do not appear to be substituting CAM for conventional asthma medication.
    Academic pediatrics 03/2014; 14(2):192–199.
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    ABSTRACT: Urban children with asthma and allergic rhinitis (AR) are at risk for experiencing worse AR-related quality of life (QOL). Although AR may be underdiagnosed and undertreated in urban minority children, research has not considered which illness-related indicators (eg, AR control) may contribute to AR QOL in this population. To examine associations among AR control, asthma control, allergy symptoms, asthma symptoms, and AR QOL in a sample of 195 urban caregivers and their children with asthma (7-9 years of age) from African American, Latino, and non-Latino white backgrounds. Racial and ethnic differences in AR QOL were also examined. Families resided in 1 of 4 cities selected as recruitment sources because of their high concentrations of ethnic minority and non-Latino white, urban families. Caregivers and children completed a series of interview-based and clinician-based assessments across one academic year and 4-week periods to track daily asthma and nasal symptoms. Better AR control was associated with higher AR QOL (β = -.32, P < .01) and all QOL subscales. AR control predicted AR QOL over and above asthma control (β = -.28, P < .01). Controlling for AR control, non-Latino white children reported better QOL related to practical problems than both Latino and African American children (P < .05). Findings suggest that strategies to enhance AR control in urban children with asthma may assist in improving AR QOL. Non-Latino white children may experience less impairment of their AR QOL because of practical problems (eg, blow nose) than African American or Latino children with asthma.
    Annals of allergy, asthma & immunology: official publication of the American College of Allergy, Asthma, & Immunology 02/2014; · 2.75 Impact Factor
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    ABSTRACT: Previous investigations have produced mixed findings on whether youth with inflammatory bowel disease (IBD) experience elevated rates of depressive symptoms. Our first aim was to compare self-report of depressive symptoms by youth with IBD with a community sample. The second aim was to examine the relationship between symptoms of depression and measures of disease activity. Item-level responses on the Children's Depression Inventory among a sample of 78 youth diagnosed with IBD were compared with responses from a community sample using 1-sample t-tests. Particular attention was given to items assessing somatic symptoms of depression given the potential overlap with IBD disease symptoms. The relationship between depressive symptoms and IBD disease activity was evaluated using Spearman's rank correlation coefficients and linear regression. Youth with IBD reported lower levels of depressive symptoms compared with the community sample on the Children's Depression Inventory Total Score, and similar or lower levels of difficulty on items assessing somatic symptoms. Most of the sample had inactive or mild disease activity at the time of participation, with 14% experiencing moderate/severe disease activity. Higher ratings of disease activity were related to greater depressive symptoms. Responses on somatic items from the Children's Depression Inventory were not differentially related to disease activity. As a group, pediatric patients with IBD did not experience the clinical levels of depressive symptoms or elevations in depressive symptoms when compared with a community sample. Somatic symptoms of depression do not differentiate youth with IBD experiencing elevations in disease activity from youth experiencing nonsomatic symptoms of depression.
    Inflammatory Bowel Diseases 02/2014; · 5.12 Impact Factor
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    ABSTRACT: To examine differences in asthma outcomes by levels of child-reported neighborhood and family stress related to urban living in a sample of children and their caregivers. A total of 208 urban children with asthma, ages 6-12 and their primary caregivers from African-American, Latino, and non-Latino white backgrounds were included in this study. Children's report of higher levels of stress was related to poorer asthma control. Children's report of stressors of urban living was associated with asthma functional limitation in families living below the poverty threshold. The results from this study may inform future avenues for intervention to decrease the effects of specific stressors associated with urban poverty that may serve as barriers to optimal asthma control in this high-risk group.
    American journal of health behavior 01/2014; 38(1):22-30. · 1.31 Impact Factor
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    ABSTRACT: Secondhand smoke (SHS) exposure remains a public health problem. Few, if any, studies include both children with and without asthma to assess differences in caregiver smoking behavior, risk perception, and SHS. Participants were 738 daily U.S. smokers [443 caregivers of children with asthma (CG-AC) and 295 caregivers of healthy children (CG-HC); 50.9% White, 25% Black, 15% Latino). Data are cross-sectional. SHS was measured through self-report and passive dosimetry. Compared with CG-HC, CG-AC had fewer risk factors for exposing children to SHS (lower nicotine dependence, higher motivation to quit, greater perceived benefits of cessation on child's health, and lower optimistic bias, all p values < .05). Specifically, 60.6% of CG-AC reported a household smoking ban versus 40.1% of CG-HC (p < .05), though >95% of both groups had detectable levels of SHS in their home. CG-AC self-reported lower SHS than CG-HC, but both groups had nearly equivalent SHS when measured objectively. CG-AC were almost twice as likely as CG-HC to report a home smoking ban when they had detectable levels of household SHS as measured by passive dosimetry (OR = 1.71; 95% CI = 1.2, 2.4; p = .003). Caregivers of children with chronic health conditions, such as asthma, may be motivated to self-report lower levels of SHS. Child health status (e.g., asthma) may cue practitioners to inquire about SHS, but given the low proportion of household bans and high levels of actual exposure among both groups, SHS exposure assessment and reduction/elimination counseling should be prompted to occur for all children.
    Nicotine & Tobacco Research 12/2013; · 2.48 Impact Factor
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    ABSTRACT: Thiopurine immunosuppressants such as 6-mercaptopurine (6-MP) are widely used to maintain remission in children with both Crohn's disease and ulcerative colitis. Therapeutic efficacy is associated with higher red blood cell levels of the thiopurine metabolite 6-thioguanine (6-TGN). Studies in both children and adults have inexplicably failed to demonstrate a significant correlation between prescribed dose and level of 6-TGN. We aimed to quantify the relationship between 6-TGN levels and adherence. We used electronic monitoring devices to assess adherence in children and adolescents with inflammatory bowel diseases who were prescribed 6-MP. During 3230 days of monitoring in 19 subjects, adherence to 6-MP was 74.2%. Due to the generally low adherence to the prescribed dose of 6-MP, the 6-TGN level was not correlated with the prescribed dose. The 6-TGN level was significantly correlated with the adherence-adjusted dose (R = 0.395). It was also significantly correlated to adherence alone (R = 0.478). Adherence to 5-aminosalicylic acid and 6-MP were significantly positively correlated (rs (9) = 0.82, P = 0.00), and a significant relationship was found between 5-aminosalicylic acid adherence and 6-TGN levels independent of 6-MP adherence. Furthermore, low adherence to 6-MP was associated with increased likelihood of escalation of medical therapy. Red blood cell 6-TGN levels are strongly correlated with the dose, when the dose is actually taken. Lack of efficacy of thiopurines may often be the result of poor adherence. Novel ways of assessing and improving adherence are necessary. Future trials should assess adherence in study participants. Intake of 5-aminosalicylic acid positively influences 6-TGN levels.
    Inflammatory Bowel Diseases 10/2013; · 5.12 Impact Factor
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    ABSTRACT: Although the pediatric psychology literature underscores the importance of illness-related aspects of the home environment for optimal family asthma management, little is known about the contribution of more global aspects of the home environment (e.g., family routines/schedule, quality of stimulation provided to child) to asthma management in ethnic minority and urban families. The goals of this study were to (a) explore ethnic/racial group differences in global and specific dimensions of home environment quality among Latino, non-Latino White (NLW), and African American urban children with asthma; and (b) examine associations between the quality and quantity of support and stimulation within the home environment, as measured by the HOME Inventory, and family asthma management. Urban, low-income children (N = 131) between the ages of 6 and 13 with asthma and a primary caregiver participated in a multimodal assessment, including an in-home observation and semistructured interviews to assess aspects of home environment quality and family asthma management practices. While controlling for poverty, no ethnic group differences were found in the global home environment; however, there were significant differences in specific dimensions (e.g., Family Participation in Developmentally Stimulating Experiences, and Aspects of the Physical Environment) of home environment quality. Across the whole sample, home environment quality predicted family asthma management. When examining this association for specific ethnic groups, this finding did not hold for the Latino subsample. The results highlight the need to consider ethnic group differences in non-illness-specific aspects of the home environment when addressing families' asthma management strategies. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
    Families Systems & Health 06/2013; 31(2):156-170. · 1.74 Impact Factor
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    ABSTRACT: This study examines the association between caregivers' perceptions of home and neighborhood safety on family asthma management in the context of cultural risk factors (e.g., discrimination and acculturative stress) in a sample of urban and ethnic minority families. Participants included 147 children (ages 6-13) and their primary caregiver from Latino, African American and Non-Latino White (NLW) backgrounds. When controlling for poverty, caregivers' perceptions of home and neighborhood safety predicted family asthma management for the overall sample and for the NLW families. Additionally, for caregivers who endorsed higher levels of perceived discrimination, home and neighborhood safety predicted family asthma management. This study demonstrates the utility of considering caregivers' perceptions of home and neighborhood safety when examining urban families' day-to-day engagement with asthma management tasks.
    Journal of Child Health Care 03/2013; · 0.97 Impact Factor
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    ABSTRACT: BACKGROUND:: Symptoms of inflammatory bowel disease (IBD) include bloody diarrhea, fatigue, abdominal pain, and weight loss. Long-term management of remission for most patients requires adherence to taking 1 or more oral medications daily, in the absence of symptoms. We investigated whether disease characteristics and behavioral characteristics predict adherence to prescribed medical regimens. METHODS:: Patients aged 8 to 17.5 years, newly diagnosed with IBD, and a matched cohort previously diagnosed were studied over a 6-month period. Adherence was assessed using medication electronic monitoring devices (Medication Event Monitoring Systems); participants and parents completed questionnaires regarding emotional and behavioral functioning, and biological parameters were monitored. RESULTS:: Adherence was monitored for 45 newly and 34 previously diagnosed patients. In total, 16,478 patient-days (including 12,066 discrete days) were electronically monitored. Overall, 70.6% of 5-aminosalicylic acid and 65.4% of 6-mercaptopurine doses were taken. Only 25% and 15% of older adolescents took at least 80% of their 5-aminosalicylic acid and 6-mercaptopurine, respectively, compared with about 83% and 64% of 8-year-olds to 11-year-olds. Only age and behavioral issues were statistically linked to rates of adherence. CONCLUSIONS:: Adherence to commonly prescribed oral medications for IBD is challenging for patients. Screening for emotional and behavioral problems, especially among older adolescents, would be important in identifying patients at risk of poor adherence, who might benefit from interventions. Biological solutions, although critical, when applied without attention to behavioral issues, are not likely to provide the level of therapeutic benefit that can be provided in a combined biobehavioral approach.
    Inflammatory Bowel Diseases 02/2013; · 5.12 Impact Factor
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    ABSTRACT: : The aim of this study was to determine ethnic and site differences in quality of life (QOL) in a sample of Latino (Puerto Rican [PR] and Dominican) and non-Latino white caregivers of children with asthma in mainland US and Island PR. We also investigated ethnic and site differences in associations between caregiver QOL and indicators of asthma morbidity. : Seven hundred and eighty-seven children with asthma (7-16 years of age) and their primary caregivers participated in the study. Primary caregivers completed a measure of QOL, child asthma control, and emergency department utilization, among other measures. : Ethnic and site differences were found on total QOL scores ([INCREMENT]F(1,783) = 29.46, p < .001). Island PR caregivers reported worse QOL scores than Rhode Island (Rl) Latino and non-Latino white caregivers; Rl Latino caregivers reported significantly worse QOL scores than non-Latino white caregivers. In Rl Latino and Island PR children, worse caregiver QOL was associated with asthma that was not in control and with one or more emergency department visits. : Latino caregivers may be experiencing a greater level of burden related to their child's asthma than non-Latino white caregivers. Caregiver QOL in pediatric asthma may be a reflection of broader contextual stress that some Latino caregivers experience on a daily basis (e.g., cultural beliefs, acculturation). Future research should continue to investigate mechanisms that explain the burden associated with pediatric asthma in Latino families, as well as whether QOL assessments should consider the impact of everyday stressors on caregiver QOL in pediatric asthma.
    Journal of developmental and behavioral pediatrics: JDBP 10/2012; 33(8):599-607. · 2.12 Impact Factor
  • Elizabeth L McQuaid, Lamia P Barakat
    Journal of Pediatric Psychology 07/2012; 37(8):827-31. · 2.91 Impact Factor
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    ABSTRACT: Asthma is difficult to diagnose in young children, and the subjective experience of caregivers varies. Clinicians' ability to meet caregiver expectations during the diagnostic process improves the caregiver-clinician relationship, and effectiveness of disease management strategies. We performed thematic analysis of seven focus groups (FGs) with 38 caregivers of children 1-6 years old diagnosed with asthma in the preceding 12 months. Caregivers were classified as satisfied or dissatisfied with clinicians during the asthma diagnostic process. Differential themes in these two groups identified caregiver expectations that determined satisfaction with the diagnostic process. Caregiver expectations during the asthma diagnostic process included (1) provision of a diagnostic strategy, (2) acknowledgment of caregiver advocacy, (3) addressing caregiver's beliefs about treatment with asthma medications before a diagnosis was confirmed, and (4) discussing asthma specialist involvement in the diagnosis. Higher perceived severity of a child's illness made caregiver expectations more difficult to meet. We conclude that clinicians considering an asthma diagnosis in young children must include a diagnostic strategy that is congruent with the caregiver's beliefs about the underlying illness, use of medication, and asthma specialist involvement. Perceived illness severity must also be accounted for when designing a diagnostic strategy.
    Journal of Asthma 06/2012; 49(7):703-11. · 1.83 Impact Factor
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    ABSTRACT: Latino children of Caribbean descent remain at high risk for poorly controlled asthma. Controller medications improve asthma control; however, medication adherence remains suboptimal, particularly among minorities. This study assessed socioeconomic, family-based, and parent factors in medication adherence among children with asthma from Rhode Island (RI; Latino and non-Latino white [NLW]) and Puerto Rico. Data collection occurred as part of a multicenter study of asthma disparities. Our sample included children (ages 7-16) prescribed objectively monitored controller medications (n = 277; 80 island Puerto Rico, 114 RI Latino, 83 RI NLW). Parents completed questionnaires regarding family background and beliefs about medications. Families participated in an interview regarding asthma management. Multilevel analyses (maximum likelihood estimates) accounting for children being nested within site and ethnic group assessed the contribution of social context, family, and parent variables to medication adherence. Medication adherence differed by ethnic group (F(2, 271) = 7.46, P < .01), with NLW families demonstrating the highest levels of adherence. Multilevel models indicated that parental beliefs about medication necessity and family organization regarding medication use were significant predictors of adherence, even for families below the poverty threshold. With family factors in the model, a substantial improvement in model fit occurred (Akaike Information Criterion change of 103.45). Adherence to controller medications was lower among Latino children in our sample. Targeted interventions that capitalize on existing family resources, emphasize structure, and address parental beliefs about the importance of medications may be of benefit to families from different cultural backgrounds.
    PEDIATRICS 05/2012; 129(6):e1404-10. · 5.30 Impact Factor
  • American Thoracic Society 2012 International Conference, May 18-23, 2012 • San Francisco, California; 05/2012

Publication Stats

2k Citations
260.55 Total Impact Points


  • 2014
    • Virginia Commonwealth University
      Richmond, Virginia, United States
  • 1997–2014
    • Alpert Medical School - Brown University
      • • Department of Pediatrics
      • • Department of Psychiatry and Human Behavior
      Providence, Rhode Island, United States
  • 1996–2014
    • Brown University
      • • Department of Medicine
      • • Centers for Behavioral and Preventive Medicine
      • • Department of Psychiatry and Human Behavior
      Providence, Rhode Island, United States
  • 2012
    • University of Pennsylvania
      • Department of Pediatrics
      Philadelphia, PA, United States
  • 2009
    • Emory University
      • Department of Psychiatry and Behavioral Sciences
      Atlanta, GA, United States
    • Yeshiva University
      • Ferkauf Graduate School of Psychology
      New York City, New York, United States
  • 2007
    • Lifespan
      Providence, Rhode Island, United States
  • 2004
    • The Ohio State University
      • Division of Health Behavior and Health Promotion
      Columbus, OH, United States
  • 1996–2004
    • Rhode Island Hospital
      Providence, Rhode Island, United States
  • 2003
    • Yale University
      New Haven, Connecticut, United States
  • 1998
    • National Research Center (CO, USA)
      Boulder, Colorado, United States