Lara J Akinbami

U.S. Department of Health and Human Services | HHS · Centers for Disease Control and Prevention (CDC)

Background The National Asthma Education and Prevention Program guidelines emphasize environmental control as an integral part of asthma management; however, limited national-level data exist on how clinicians implement environmental control recommendations. Objective We analyzed data on clinicians’ self-reported use of recommended environmental c...

Background Accurate Pediatric Reference Intervals (PRIs) are critical for assessing health, diagnosing disease, and establishing treatment efficacy. A recent literature review established that current PRIs are inconsistent, and partitioning reference intervals into arbitrary age groups may conceal the underlying biochemistry of child development. T...

CDC COVID-19 surveillance systems monitor SARS-CoV-2 antibody prevalence to collect information about asymptomatic, undiagnosed, and unreported disease using national convenience samples of blood donor data from commercial laboratories (1,2). However, nonrandom sampling of data from these systems could affect prevalence estimates (1-3). The Nationa...

In the United States, obesity and severe obesity in children and adolescents are defined using threshold values from the 2000 Centers for Disease Control and Prevention (CDC) sex-specific body mass index (BMI)- for-age growth charts. BMI z-scores and percentiles from the 2000 CDC BMI-for-age growth charts are also used to monitor children's weight...

Objectives This report describes the creation of the NHANES 2017-March 2020 prepandemic data files, including the selection of the appropriate NHANES sample design (2015-2018) to create sample weights and variance units for public-use data files. Additionally, the development of a factor applied to the primary sampling units to adjust the 2017-Marc...

Importance: Appropriately established pediatric reference intervals are critical to the clinical decision-making process and should reflect the physiologic changes that occur during healthy child development. Reference intervals used in pediatric care today remain highly inconsistent across a broad range of common clinical biomarkers. Observation...

Background SARS-CoV-2 virus testing among first responders and healthcare personnel who participated in a May-August 2020 serosurvey which assessed spike protein antibodies (S1 region) provided an opportunity to assess reinfection. Methods Serology survey data were merged with virus testing results from Rhode Island (March 1, 2020-February 17, 202...

We estimated the distributions of duration of SARS-CoV-2 nucleic acid shedding and time to reinfection among 137 persons with at least two positive nucleic acid amplification test (NAAT) results from March to September 2020. We analyzed gaps of varying length between subsequent positive and negative NAAT results and estimated a mean duration of nuc...

Healthcare personnel are recognized to be at higher risk for infection with severe acute respiratory syndrome coronavirus 2. We conducted a serologic survey in 15 hospitals and 56 nursing homes across Rhode Island, USA, during July 17-August 28, 2020. Overall seropositivity among 9,863 healthcare personnel was 4.6% (95% CI 4.2%-5.0%) but varied 4-f...

A SARS-CoV-2 serosurvey among first responder/healthcare personnel showed that loss of taste/smell was most predictive of seropositivity; percent seropositivity increased with number of COVID-19 symptoms. However, 22.9% with nine symptoms were seronegative, and 8.3% with no symptoms were seropositive. These findings demonstrate limitations of sympt...

We conducted a serologic survey in public service agencies in New York City, New York, USA, during May-July 2020 to determine prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among first responders. Of 22,647 participants, 22.5% tested positive for SARS-CoV-2-specific antibodies. Seroprevalence for police and fir...

Over the past two decades, a steady decline in response rates on national face-to-face surveys has been documented, with steeper declines observed in recent years. The impact of nonresponse on survey estimates is inconsistent and depends on the correlation between response propensity and the survey estimates. To better understand the impact of decl...

To estimate seroprevalence of severe acute respiratory syndrome 2 (SARS-CoV-2) among healthcare, first response, and public safety personnel, antibody testing was conducted in emergency medical service agencies and 27 hospitals in the Detroit, Michigan, USA, metropolitan area during May-June 2020. Of 16,403 participants, 6.9% had SARS-CoV-2 antibod...

Background Little is known about specialist-specific variations in guideline agreement and adoption. Objective To assess similarities and differences between allergists and pulmonologists in adherence to cornerstone components of the National Asthma Education and Prevention Program’s Third Expert Panel Report (EPR-3). Methods Self-reported guidel...

Objective-This report describes asthma visits to offices of nonfederally employed U.S. physicians. Methods-Asthma visits are defined by the first-listed diagnosis from National Ambulatory Medical Care Survey data. Asthma visit rates among the general population and among persons with asthma (at-risk rates) were estimated. Trends from 2001 through 2...

Approximately 24% of U.S. adolescents attempted to lose weight during 2009-2010, and studies show that girls are more likely than boys to attempt weight loss (1,2). Adolescents are known to use multiple weight loss and weight control practices (3). This report describes the percentage of U.S. adolescents who tried to lose weight in the past year fr...

Introduction: National objectives recommend healthcare professionals provide physical activity advice. This study examined health and demographic characteristics associated with receipt of medical advice to increase physical activity among U.S. health care-utilizing adults and differences in associations by age group. Methods: Analyses included...

Background and objectives: Although primary care clinicians provide >60% of U.S. asthma care, no nationally representative study has examined variation in adherence among primary care groups to four cornerstone domains of the Expert Panel Report-3 asthma guidelines: assessment/monitoring, patient education, environmental assessment, and medication...

Active transportation (AT), or walking or bicycling for transportation, represents one way individuals can achieve recommended physical activity (PA) levels. This study describes AT prevalence and temporal trends, and examines associations between AT levels and measured CVD risk factors (hypertension, hypercholesterolemia, low high-density [HDL] ch...

Background The 2007 Guidelines for the Diagnosis and Management of Asthma provide evidence-based recommendations to improve asthma care. Limited national-level data are available about clinician agreement and adherence to these guidelines. Objective To assess clinician-reported adherence with specific guideline recommendations, as well as agreemen...

Background: Obesity is a risk factor for asthma. However, it is unclear if increased obesity prevalence contributed to rising childhood asthma prevalence. Objective: To assess if population-level changes in weight status impacted asthma prevalence over time. Methods: Using nationally representative 1988-2014 National Health and Nutrition Exami...

Objective Gross motor development in early childhood is important in fostering greater interaction with the environment. The purpose of this study is to describe gross motor skills among US children aged 3-5 years using the Test of Gross Motor Development (TGMD-2). Methods We used 2012 NHANES National Youth Fitness Survey (NNYFS) data, which includ...

Purpose Racial disparities in childhood asthma prevalence increased after the 1990s. Obesity, which also varies by race/ethnicity, is an asthma risk factor but its contribution to asthma prevalence disparities is unknown. Methods We analyzed nationally representative National Health Examination and Nutrition Survey data for 2-19 year olds with log...

Background: High fractional exhaled nitric oxide (FeNO) is an indicator of poor asthma control and has been proposed as a non-invasive assessment tool to guide asthma management. Objective: We aimed to describe the prevalence of and factors associated with high FeNO among US youth with asthma. Methods: Data from 716 children and adolescents wi...

Key findings: Data from the National Health and Nutrition Examination Survey •The prevalence of low high-density lipoprotein (HDL) cholesterol was significantly higher among adults who did not meet recommended physical activity guidelines (21.0%) than adults who met the guidelines (17.7%). •Low HDL cholesterol prevalence differed significantly for...

Background and objectives: The surveillance of children's growth reflects a population's nutritional status and risk for adverse outcomes. This study aimed to describe trends in length-for-age, weight-for-age, weight-for-length, and early childhood weight gain among US children aged 6 to 23 months. Methods: We analyzed NHANES data from 1976-1980...

Background: Adequate water intake is critical to physiologic and cognitive functioning. Although water requirements increase with body size, it remains unclear whether weight status modifies the relation between water intake and hydration status. Objective: We examined how the association between water intake and urine osmolality, which is a hydr...

Background: Warmer temperature can alter seasonality of pollen as well as pollen concentration, and may impact allergic diseases such as hay fever. Recent studies suggest that extreme heat events will likely increase in frequency, intensity, and duration in coming decades in response to changing climate. Objective: The overall objective of this...

Objectives: Sugar-sweetened beverage (SSB) intake among U.S. adults is associated with obesity and type 2 diabetes. An association between SSB intake and asthma has been shown among U.S. children and Australian adults, but scant published information exists for U.S. adults. We examined associations between SSB intake and current asthma among U.S....

Key findings: Data from the National Health and Nutrition Examination Survey, 2001-2014 •In 2011-2014, current asthma prevalence was 8.8% among adults. It was higher among adults with obesity (11.1%) compared with adults in normal weight (7.1%) and overweight (7.8%) categories. •Women with obesity had higher current asthma prevalence (14.6%) than...

Key findings: Data from the National Health and Nutrition Examination Survey •During 2009-2012, 32.4% of youth consumed nuts (including seeds and nut butters) on a given day. •A higher percentage of non-Hispanic white youth (37.6%) than non-Hispanic black (24.3%) or Hispanic (25.0%) youth consumed nuts. •Almost 44.0% of youth in households at or a...

Objective: To examine national trends in the receipt of asthma action plans, an intervention recommended by the National Asthma Education and Prevention Program guidelines. Study design: We used data from the sample child component of the National Health Interview Survey from 2002, 2003, 2008, and 2013 to examine the percentage of children 2-17...

Background: Childhood asthma prevalence doubled from 1980 to 1995 and then increased more slowly from 2001 to 2010. During this second period, racial disparities increased. More recent trends remain to be described. Methods: We analyzed current asthma prevalence using 2001-2013 National Health Interview Survey data for children ages 0 to 17 year...

Objectives: Children with asthma and allergies-particularly food and/or multiple allergies--are at risk for adverse asthma outcomes. This analysis describes allergy prevalence trends among US children by asthma status. Methods: We analyzed 2001-2013 National Health Interview Survey data for children aged 0-17 years. We estimated trends for repor...

Background: Children with asthma face higher risk of complications from influenza. Trends in influenza vaccination among children with asthma are unknown. Methods: We used 2005-2013 National Health Interview Survey data for children 2-17 years of age. We assessed, separately for children with and without asthma, any vaccination ( received August...

National Asthma Education and Prevention Program (NAEPP) guidelines recommend that periodic spirometry be performed in youth with asthma. NAEPP uses different spirometry criteria to define uncontrolled asthma for children (6-11 years) and adolescents (12+ years). To describe differences in spirometry between US children and adolescents with current...

Background: Racial disparities in childhood asthma have been a long-standing target for intervention, especially disparities in hospitalization and mortality. Objectives: Describe trends in racial disparities in asthma outcomes using both traditional population-based rates and at-risk rates (based on the estimated number of children with asthma)...

Objective: Local-area studies demonstrate that preventive asthma medication discontinuation among Medicaid and Children's-Health-Insurance-Program (CHIP) enrolled children leads to adverse outcomes. We assessed time-to-discontinuation for preventive asthma medication and its risk factors among fee-for-service Medicaid/CHIP child beneficiaries. Me...

Given widespread interventions to reduce environmental tobacco smoke (ETS) exposure and improve asthma control, we sought to assess the current impact of ETS exposure on children with asthma. We analyzed 2003-2010 data for nonsmoking children aged 6 to 19 years with asthma from the National Health and Nutrition Examination Survey. Outcomes (sleep d...

Key findings: Data from the National Health and Nutrition Examination Survey, 1999-2010. From 1999 to 2010, the percentage of children without asthma exposed to environmental tobacco smoke (ETS) decreased from 57.3% to 44.2%, while children with asthma showed no change, with 57.9% exposed to ETS in 1999-2002 and 54.0% exposed in 2007-2010. In 2007...

Data from the National Health Interview Survey, 1997-2011 The prevalence of food and skin allergies increased in children under age 18 years from 1997-2011. The prevalence of skin allergies decreased with age. In contrast, the prevalence of respiratory allergies increased with age. Hispanic children had a lower prevalence of food allergy, skin alle...

To examine exposure to tobacco smoke products (TSPs), environmental tobacco smoke (ETS), and in-home smoke among youth with asthma in the United States. Nationally representative, cross-sectional data from 2250 youth aged 4 to 19 years with current asthma in the 1988-1994, 1999-2004, and 2005-2010 National Health and Nutrition Examination Survey (N...

Background: National Asthma Education and Prevention Program recommended emergency department (ED) asthma treatment includes both providing systemic corticosteroids in the ED and a steroid prescription at discharge. Objective: To examine the prevalence of three types of substandard ED asthma care-providing a discharge prescription only, providin...

Asthma is prevalent but treatable: adherence to evidence-based treatment lessens impairment and lowers the risk of future exacerbations. This report details recent trends in asthma prevalence, health care use, and mortality since 2001 and presents an overview of trends since 1980. Asthma prevalence estimates were obtained from the National Health I...

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 asthm...

Measures of healthcare utilization and indirect impact of asthma morbidity are used to assess clinical interventions and estimate cost. National Institutes of Health institutes and other federal agencies convened an expert group to propose standardized measurement, collection, analysis, and reporting of healthcare utilization and cost outcomes in f...

To examine trends in preventive asthma medication (PAM) use among children with current asthma in the United States from 1988 to 2008. We performed a cross-sectional analysis of PAM use among 2499 children aged 1 to 19 years with current asthma using nationally representative data from the National Health and Nutrition Examination Survey (NHANES) d...

Attention deficit hyperactivity disorder (ADHD) is one of the most common mental health disorders of childhood. The symptoms of ADHD (inattention, impulsive behavior, and hyperactivity) begin in childhood and often persist into adulthood. These symptoms frequently lead to functional impairment in academic, family, and social settings. The causes an...

Chronic obstructive pulmonary disease (COPD) causes substantial morbidity and mortality and may be unrecognized in its early stages. Chronic lower respiratory disease (CLRD), which includes both COPD and asthma, was the third leading cause of death in the United States in 2008. COPD includes chronic bronchitis and emphysema, which both make emptyin...

This report presents recent data on asthma prevalence and health care use. Additional data on school and work absences and asthma management practices are also presented. Where possible, differences are examined by age, sex, race or ethnicity, geographic region, poverty status, and urbanicity. Data from the National Health Interview Survey, the Nat...

Children with asthma miss nearly 13 million school days annually due to asthma. We sought to examine risk factors for asthma-related school absence among children with symptomatic asthma to discern risks uniquely associated with symptomatic asthma. We analyzed 2002-2003 National Health Interview Survey data for children ages 5-17 years with symptom...

Air pollution exposure has been linked to adverse respiratory health outcomes among children, primarily in studies of acute exposures that are often in limited geographic areas. We sought to assess the association between chronic outdoor air pollution exposure, as measured by 12-month averages by county, and asthma among children in metropolitan ar...

To examine the association between prenatal smoking cessation and delivery of a preterm or small-for-gestational-age (SGA) newborn in a large U.S. subpopulation using the revised (2003) birth certificate, which now assesses maternal smoking status by trimester. We analyzed a cohort of U.S.-resident, singleton births in the 11 states that used the r...

Parent-reported height and weight are often used to estimate BMI and overweight status among children. The quality of parent-reported data has not been compared to measured data on a national scale for all race/ethnic groups in the United States. Parent-reported height and weight for 2-17-year-old children in two national health interview surveys--...

Centers for Disease Control and Prevention data were used to describe 1980-2007 trends among children 0 to 17 years of age and recent patterns according to gender, race, and age. Asthma period prevalence increased by 4.6% per year from 1980 to 1996. New measures introduced in 1997 show a plateau at historically high levels; 9.1% of US children (6.7...

Childhood respiratory allergies, which contribute to missed school days and other activity limitations, have increased in recent years, possibly due to environmental factors. In this study we examined whether air pollutants are associated with childhood respiratory allergies in the United States. For the approximately 70,000 children from the 1999-...

The goal of this study is to describe linkages between the National Health Interview Survey (NHIS) and Environmental Protection Agency (EPA) air monitoring data, specifically how the linkage method affects characteristics and exposure estimates of study samples and estimated associations between exposure and health. In the USA, nationally represent...

Diabetes is a chronic disease with a U.S. prevalence of 18 cases per 10,000 youths aged <20 years. With proper management and access to care, morbidity and mortality from diabetes are preventable, particularly in the pediatric population. Although diabetes is more common among non-Hispanic white youths, some studies report higher death rates among...

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 medic...

To estimate differences in asthma prevalence among Hispanic subgroups and non-Hispanic children living in the United States and to explore the association between these differences and risk factors. Weighted logistic regression analyses of merged 1997 to 2001 National Health Interview Survey data were used to estimate the prevalence of asthma diagn...

Racial and ethnic disparities exist in reported childhood asthma prevalence, but it is unclear if disparities stem from true prevalence differences or a different likelihood of receiving a diagnosis from a health professional. Concern has been raised that asthma may be underdiagnosed, particularly among minority children who have more restricted ac...

The 1997 redesign of the National Health Interview Survey (NHIS) affected US childhood asthma prevalence estimates. The 1997 asthma attack prevalence estimate for children 0-17 years was 5.4%. Pre-redesign NHIS childhood asthma period prevalence estimates peaked in 1995 at 7.5%. It is unclear whether the difference reflects the change in survey met...

Little is known about availability of services and confidential care for adolescents in primary care practices or how availability among pediatric practices compares to that among other primary care practices. The objective of this study was to assess self-reported availability of services for medically emancipated conditions and confidential care...

Chronic obstructive pulmonary disease (COPD) includes chronic bronchitis and emphysema but has been defined recently as the physiologic finding of nonreversible pulmonary function impairment. This surveillance summary reports trends in different measures of COPD during 1971-2000. This report presents national data regarding objectively determined C...

To examine racial and income disparities in asthma prevalence in US children, and disparities in morbidity and ambulatory health care use among children with asthma. Using 1993-1996 National Health Interview Survey data, we measured asthma prevalence and morbidity in children aged 3 to 17 years (N = 14 211) stratifying by race and poverty status. M...