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ABSTRACT: Background. Although the causes of asthma are poorly understood, multiple factors (e.g., genetic, environmental, socioeconomic, and lifestyle) have been implicated in the development and exacerbation of the disease. Objectives. To identify potential predictive factors of current asthma and to assess if the predictive ability of some factors differ by race and ethnicity. Methods. We used the Centers for Disease Control and Prevention's 2009-2010 Behavioral Risk Factor Surveillance System data to estimate asthma prevalence and to examine the potential predictive factors for asthma (sex, age, educational attainment, household income, obesity, smoking, physical activity, and health insurance) by race and ethnicity. Results. Of the 869519 adult respondents in the survey, 8.6% reported having asthma. Overall asthma prevalence was significantly higher among adults with household income of <$15000 (13.3%; adjusted prevalence ratio [aPR] of 1.9) than those with income of ≥$75000 (6.8%). The prevalence was also higher among obese adults (11.6%; aPR=1.5) than non-obese (7.3%), current and former smokers (10.5%; aPR=1.2 and 8.5%;1.1) than non-smokers (7.8%), and adults with health insurance (8.6%; aPR=1.3) than adults without it (7.8%). However, the prevalence was lower among adults aged 65+ (7.8; aPR=0.7) than adults aged 18-24 (9.3%) and among adults who reported having leisure time physical activity (7.8%; aPR=0.8) than adults who did not report it (10.7%). When examined among race/ethnic groups, these associations were observed among whites and blacks but not for the other four race/ethnic groups. Conclusions. Predictive factors for asthma vary among racial/ethnic groups. Identifying race/ethnicity specific modifiable environmental and host-related factors (mold, pollens, house dust mites, cockroaches, animal allergens, other pollutants, education, income, obesity, smoking, physical activity, and health insurance status) can be important in developing targeted interventions to reduce the health and economic impact of asthma among disproportionately affected segments of the United States population.
Journal of Asthma 04/2013; · 1.52 Impact Factor
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ABSTRACT: Asthma prevalence increased from 2001 to 2010: An estimated 25.7 million persons had asthma in 2010. Certain demographic groups had higher asthma prevalence: children aged 0–17 years, females, black persons, persons of multiple race, Puerto Rican persons, and persons with a family income below the poverty level. This report examines rates for asthma outcomes (health care encounters and death) for persons with asthma rather than for the general population. Rates for the general population represent the burden of asthma in the United States. Rates for the population with asthma take into account changes in asthma prevalence over time and differences in asthma prevalence among demographic groups. From 2001 to 2009, rates for ED visits and hospitalizations per 100 persons with asthma remained stable, while rates for asthma visits in primary care settings (physician offices or hospital outpatient departments) and asthma deaths declined. For the period 2007–2009, asthma visit rates (per 100 persons with asthma) in primary care settings for black persons were similar to those for white persons, but rates for asthma ED visits, hospitalizations, and death (per 1,000) were higher. Compared with adults, children aged 0–17 years had a higher rate for asthma visits in primary care settings and EDs, but had a similar hospitalization rate and a lower asthma death rate.
NCHS data brief 05/2012;
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ABSTRACT: Patient self-management, besides expert care, is necessary to improve health outcomes among persons with asthma. Our objective was to describe the characteristics of persons with asthma likely to receive asthma self-management education.
The 2006 and 2007 Behavioral Risk Factor Surveillance System (BRFSS) Child and Adult Asthma Call-back Survey (ACBS) data were analyzed. Binary and multinomial response logistic regression models were used to examine the association between asthma self-management education and explanatory variables.
Of the 31,278 persons who ever had asthma, 3953 of the children (75.8%) and 19,723 of the adults (72.8%) were classified as having active asthma. For both children and adults, the three most commonly reported asthma education components were being taught how to use an inhaler (78.6% and 89.8%, respectively); being taught what to do during an asthma episode (86.3% and 74.6%); and to recognize early signs or symptoms of an asthma episode (82.0% and 64.4%). Children and adults who reported routine care visits, hospitalization, and asthma episodes in the past 12 months because of asthma were more likely to report several asthma education components and higher asthma education scores. Children aged 12-17 years were more likely to report having instruction in peak flow meter use (1.3; 1.1-1.6) and inhaler use (1.3; 1.2-1.4), whereas older adults (aged 54-64 years or 65+ years), adults who were not high school (HS) graduates, and smokers were less likely to report having asthma management education than the corresponding comparison groups.
Having a routine care visit, being hospitalized, and having an asthma episode were significantly associated with reporting multiple asthma education components, whereas being an older adult, having less than a HS degree, and being a smoker were associated with reporting fewer asthma education components. Asthma control programs should continue to monitor asthma self-management education and promote asthma education to all persons with asthma, especially for older adults, persons with less education, and smokers.
Journal of Asthma 01/2012; 49(1):98-106. · 1.52 Impact Factor
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ABSTRACT: We analyzed national data to estimate asthma prevalence among U.S. adults by urban-rural residence and to determine the relative contributions of sociodemographic and health behavior characteristics on the probability of reporting asthma.
We linked the 2005 Behavioral Risk Factor Surveillance System (BRFSS) to Urban Influence Codes (UICs), categorizing respondents into four urban-rural groups: metropolitan, adjacent metropolitan, micropolitan, and remote. BRFSS collects health data from all 50 states. UICs classify respondent's county as urban or rural based on population size and proximity to metropolitan areas. We calculated asthma prevalence estimates and generated odds ratios (ORs) for the probability of reporting asthma.
Overall asthma prevalence (7.9%; 95%CI = 7.73-8.08) was not statistically different (p = 0.28) by urban-rural residence. After adjusting for selected characteristics, adjacent metropolitan (OR = 0.96; 95%CI = 0.90-1.02) and remote (OR = 0.95; 95%CI = 0.85-1.05) residents were less likely--and micropolitan (OR = 1.04; 95%CI = 0.93-1.16) residents were more likely--to report asthma compared with metropolitan residents; but confidence intervals included null.
Asthma prevalence is as high in rural as in urban areas. Certain demographic, behavioral, and health care characteristics unique to place of residence might affect asthma prevalence. Because these results substantially change our understanding of asthma prevalence in rural areas, further investigation is needed to determine geographic-related risk factors.
Journal of Asthma 10/2009; 46(8):751-8. · 1.52 Impact Factor
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ABSTRACT: Despite the availability of effective treatment, minority children continue to experience disproportionate morbidity from asthma. Our objective was to identify and characterize racial and ethnic disparities in health-care utilization and medication usage among US children with asthma in a large multistate asthma survey.
We analyzed questions from the 2003-2004 four-state sample of the National Asthma Survey to assess symptom control, medication use, and health-care utilization among white, black, and Hispanic children < 18 years old with current asthma who were residing in Alabama, California, Illinois, or Texas.
Of the 1,485 children surveyed, 55% were white, 25% were Hispanic, and 20% were black. Twice as many black children had asthma-related ED visits (39% vs 18%, respectively; p < 0.001) and hospitalizations (12% vs 5%, respectively; p = 0.02) compared with white children. Significantly fewer black and Hispanic children reported using inhaled corticosteroids (ICSs) in the past 3 months (21% and 22%, respectively) compared to white children (33%; p = 0.001). Additionally, 26% of black children and 19% of Hispanic children reported receiving a daily dose of a short-acting beta-agonist compared with 12% of white children (p = 0.001). ED visits were positively correlated with short-acting beta-agonist use and were negatively correlated with ICS use when stratified by race/ethnicity.
Children with asthma in this large, multistate survey showed a dramatic underuse of ICSs. Black and Hispanic children compared with white children had more indicators of poorly controlled asthma, including increased emergency health-care utilization, more daily rescue medication use, and lower use of ICSs, regardless of symptom control.
Chest 07/2009; 136(4):1063-71. · 5.25 Impact Factor
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ABSTRACT: Asthma, a chronic respiratory disease with episodic symptoms, increased in prevalence during 1980-1996 in the United States. Asthma has been the focus of numerous provider interventions (e.g., improving adherence to asthma guidelines) and public health interventions during recent years. Although the etiology of asthma is unknown, adherence to medical treatment regimen and environmental management should reduce the occurrence of exacerbations and lessen the hardship of this disease. CDC has outlined a public health approach to asthma that includes comprehensive analyses of national surveillance data on prevalence, health-care use and mortality, and a strategy to improve the timeliness and geographic specificity of asthma surveillance data.
This report presents national data on asthma for self-reported prevalence (1980-1996 and 2001-2004); self-reported attacks (1997-2004); visits to physicians' offices (1980-2004), hospital outpatient departments (1992-2004), and emergency departments (1992-2004); hospitalizations (1980-2004); and deaths (1980-2004).
The National Health Interview Survey includes questions about asthma prevalence and asthma attacks. Physicians' office visit data are collected in the National Ambulatory Medical Care Survey, emergency department and hospital outpatient data in the National Hospital Ambulatory Medical Care Survey, hospitalization data in the National Hospital Discharge Survey, and death data in the Mortality component of the National Vital Statistics System.
From 1980 to 1996, 12-month asthma prevalence increased both in counts and rates, but no discernable change was identified in asthma attack estimates since 1997 or in current asthma prevalence from 2001 to 2004. During the period of increasing prevalence, patient encounters (office visits, emergency department visits, outpatient visits, and hospitalizations) for asthma increased. However, rates for these encounters, when based on the population with asthma, did not increase. Although the rate of asthma deaths increased during 1980-1995, the rate of deaths has decreased each year since 2000. During 2001-2003, current asthma prevalence was higher in children (8.5%) compared with adults (6.7%), females (8.1%) compared with males (6.2%), blacks (9.2%) compared with whites (6.9%), those of Puerto Rican descent (14.5%) compared with those of Mexican descent (3.9%), those below the federal poverty level (10.3%) compared with those at or above the federal poverty level (6.4% to 7.9%), and those residing in the Northeast (8.1%) compared with those residing in other regions (6.7% to 7.5%). Among persons with current asthma, whites and blacks were equally likely to report an attack during the preceding 12 months. Women with current asthma were more likely to report asthma attacks than men, and children were more likely than adults. The rate for asthma health-care encounters, regardless of place (physician office, emergency department, outpatient department, or hospital), when based on the population with asthma, did not differ by race. However, whites with current asthma had higher rates for physician offices, and blacks had higher rates for hospital-based sites (e.g., outpatient clinics and emergency departments).
The findings in this report suggest that from 1980 through the mid-1990s, increases in asthma prevalence played a substantial role in the increases in patient encounter measures used in asthma surveillance. Because no primary strategies for preventing asthma have been identified, efforts to control asthma exacerbations through interventions that promote adhering to proper medical regimens and reducing exposures to causes of asthma exacerbations should continue to be pursued.
MMWR. Surveillance summaries: Morbidity and mortality weekly report. Surveillance summaries / CDC 11/2007; 56(8):1-54.
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ABSTRACT: Recently, there have been calls for health geographers to add critical and theoretical debate to 'post-medical' geographies, whilst at the same time informing 'new' public health strategies (Soc. Sci. Med. 50(9)1273; Area 33(4) (2002) 361). In this paper we reflect on how, alongside 'professional epidemiologies', 'citizen epidemiologies' can have credibility in informing public health policy and practice. We do this by drawing on mixed method and participatory research that used a citizens' panel to articulate the health and social outcomes of the 2001 foot and mouth disease disaster. We consider the difficulties of creating dialogue between on the one hand, time-limited, discrete, theoretical, visible and by implication legitimate, 'professional' knowledge and on the other, ongoing, holistic, experiential and often hidden 'citizen' knowledge of the foot and mouth disease epidemic. Despite significant evidence that in disaster and crisis situations, people need to be actively involved in key 'recovery' decisions (see for example At Risk Natural Hazards, People's Vulnerability, and Disasters, Routledge, London; A New Species of Trouble, Norton, New York), lay accounts, which may in themselves provide valuable evidence about the impact of the disaster, are often ignored. If health geographers are to critically inform 'new' public health policy then we need to consider research approaches that give voice to citizens' understanding of health outcomes as well as those of professionals. If 'new' public health is concerned with the material character of health inequalities, with fostering 'healthy' living and working environments, the promotion of community participation and individual empowerment (Area 33(4) (2002) 361), then we argue that situated, negotiated, everyday geographies of lay epidemiologies can and should inform public health policy.
Health & Place 07/2006; 12(2):157-66. · 2.67 Impact Factor
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ABSTRACT: To understand the health and social consequences of the 2001 foot and mouth disease epidemic for a rural population.
Longitudinal qualitative analysis.
North Cumbria, the worst affected area in Britain.
Purposive sample of 54 respondents divided in six demographically balanced rural occupational and population groups.
3071 weekly diaries contributed over 18 months; 72 semistructured interviews (with the 54 diarists and 18 others); 12 group discussions with diarists
The disease epidemic was a human tragedy, not just an animal one. Respondents' reports showed that life after the foot and mouth disease epidemic was accompanied by distress, feelings of bereavement, fear of a new disaster, loss of trust in authority and systems of control, and the undermining of the value of local knowledge. Distress was experienced across diverse groups well beyond the farming community. Many of these effects continued to feature in the diaries throughout the 18 month period.
The use of a rural citizens' panel allowed data capture from a wide spectrum of the rural population and showed that a greater number of workers and residents had traumatic experiences than has previously been reported. Recommendations for future disaster management include joint service reviews of what counts as a disaster, regular NHS and voluntary sector sharing of intelligence, debriefing and peer support for front line workers, increased community involvement in disposal site or disaster management, and wider, more flexible access to regeneration funding and rural health outreach work.
BMJ (Clinical research ed.). 12/2005; 331(7527):1234.
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ABSTRACT: to examine cultural expectations and experiences of breast feeding amongst first time mothers from low-income areas, in order to improve understanding of why many cease breast feeding in the early days of their babies' lives.
qualitative interviews were carried out with 16 women, who expressed an intention to breast feed, at 37 weeks in their pregnancy and again at 3-9 weeks postnatally.
women were interviewed in their own homes in low-income areas of North Tyneside, north-east England.
decisions about breast-feeding cessation were usually made within the first few days as women negotiated the pathways of informal cultures of feeding babies and the availability and quality of formal care. A 'give it a go' breast-feeding culture is identified, where women who intended to breast feed had a strong expectation of difficulties and even failure. Expertise and confidence with bottle feeding were more widespread among family and friends. The many influences on the mothers' decision-making were interconnected and contingent upon each other: if one aspect of breast feeding 'goes wrong', other reasons were often brought into play and the underlying pessimism that was felt antenatally was borne out.
positive experiences of formal support could make a crucial difference in the early days of breast feeding. However non-breast-feeding cultures permeated and found expression in negative discourses. Support needs to take account of the cultural contexts in which mothers make decisions and the fact that breast feeding is affected by a multitude of factors simultaneously. Access to advice at the right time is a key issue for some low-income women.
Midwifery 10/2004; 20(3):240-50. · 1.78 Impact Factor
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ABSTRACT: This paper illustrates the rich possibilities of narrative analysis. It explores the inter-play between what is being told and how it is being told, so that analytical themes remain mindful of meaning in practice (Gubrium & Holstein 1998). We draw on an on-going 2 year research study 1 into the health and social consequences of the 2001 UK Foot and Mouth Disease epidemic (FMD). 2 A citizen panel of 54 people from the worst affected area, who lived through the crisis in different ways have provided the data: weekly diaries over an 18 month period. These contributions allow us to excavate representation, meaning and salience within past, present and ongoing experiences of the epidemic. The panel also participated in 12 focus group discussions, once before diary keeping began and once to bring closure to the project. Each member also gave us an in-depth interview near the start of the study -in this way both individual, group and longitudinal reflective accounts are included in our data. We draw on participants' narratives to illustrate how their rich, diverse and sometimes contradictory, personal experiences of the crisis, are nevertheless coherent accounts (Hermans 2000) when brought together. Such narratives reveal indexical recollections of FMD (references to concrete events in time and place), so that the stories themselves may be framed by local and cultural understandings of these events. In this way plot, content and context of storytelling may embody both personally meaningful accounts of trauma and recovery and the localised, cultural context of experience. 1 This study was undertaken by the Institute for Health Research, Lancaster University who received funding from the Department of Health. The views expressed in the publication are those of the authors and not necessarily those of the Department of Health. 2 Foot and Mouth Disease (FMD) is a highly infectious viral disease that mainly affects cloven-hoofed animals, including cattle, sheep, pigs and goats. Fever is typically followed by the development of blisters -chiefly in the animal's mouth or on the feet. It can spread by direct or indirect contact with infected animals, and whilst the disease is rarely fatal, the effects are serious and debilitating. In dairy cattle these include loss of milk yield, abortion, sterility, chronic mastitis, and chronic lameness. Secondary bacterial infections may also lead to further complications. Advice from the UK Department of Health is that FMD is very rare in humans. There has only been one recorded case of FMD in a human being, in Great Britain in 1966. The general effects of the disease in that case were similar to influenza with some blisters.
Auto/Biography 01/2004; 11:37-46.
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ABSTRACT: In this paper, we draw on the concept of ‘lifescape’ (Somé and McSweeney, ILEIA Newsletter, ETC Leusden, The Netherlands, 1996; Howorth, Rebuilding the Local Landscape, Ashgate, Aldershot, 1999) to capture the spatial, emotional and ethical dimensions of the relationship between landscape, livestock and farming community and to elucidate the heterogeneity of agricultural emotional landscapes. In so doing, we illustrate complex and contradictory spatial, emotional and ethical relations between humans and non-humans. Farm animals may exist simultaneously as ‘friends’ and sources of food, leading to a blurring of socially constructed categories such as ‘livestock’ and ‘pet’ (Holloway, J. Rural Stud. 17 (2001) 293). Livestock as ‘economic machines’ for converting roughage to meat, milk and by-products (Briggs and Briggs, Modern Breeds of Livestock, fourth ed., Macmillan Publishing Co. Inc., New York, 1980) represents one strand of these relations; the sight of farmers crying and farm animals being blessed during the 2001 Cumbrian foot and mouth outbreak, yet another. As (Franklin, Anthropology Today 17 (3) (2001) 3) indicates, ‘the farmer weeping beside the blazing pyre of dead sheep is a complex portrait of a breach in the relationships between animals and humans’. By drawing on experiences of the 2001 foot and mouth epidemic, for farmers and the wider rural community in North Cumbria, we try to articulate the ambiguities of this breach.
Journal of Rural Studies.
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ABSTRACT: The 2001 UK foot and mouth disease (FMD) crisis is commonly understood to have been a nonhuman animal problem, an economic industrial crisis that was resolved after eradication. By using a different lens, a longitudinal ethnographic study of the health and social consequences of the epidemic, the research reported here indicates that 2001 was a human tragedy as well as an animal one. In a diary-based study, it can be seen that life after the FMD crisis was accompanied by distress, feelings of bereavement, fear of a new disaster, loss of trust in authority and systems of control, and the undermining of the value of local knowledge. Diverse groups experienced distress well beyond the farming community. Such distress remained largely invisible to the range of "official" inquiries into the disaster. That an FMD epidemic of the scale of 2001 could happen again in a developed country is a deeply worrying prospect, but it is to be hoped that contingency plans are evolving along with enhanced understanding of the human, animal, and financial cost.
Journal of Applied Animal Welfare Science 11(2):133-48. · 0.73 Impact Factor
