Elizabeth L McQuaid

Alpert Medical School - Brown University, Providence, Rhode Island, United States

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Publications (123)356.2 Total impact

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    ABSTRACT: Background: Families with food allergy (FA) are at risk of reduced quality of life and elevated anxiety. A moderate level of anxiety may be beneficial to sustain vigilance for food avoidance; however, excessive anxiety may increase risk for burden and maladjustment. The current study presents a framework for understanding patterns of adaptation to FA across families and to identify typologies of families that would benefit from intervention. Methods: Participants included 57 children, 6 to 12 years old with documented FA, and their mothers. Families were assessed using the Food Allergy Management and Adaptation Scale. Families also completed measures of quality of life, anxiety, FA management, and psychosocial impairment. Results: A hierarchical cluster analysis revealed that 56 of the 57 families of food allergic children were categorized into four groups that differed on their adequacy of family FA management, levels of anxiety, and balanced psychosocial functioning: Balanced Responders (n = 23; 41%), High Responders (n = 25; 45%), and Low Responders (n = 3; 5%). The fourth group, Anxious High Responders (n = 5; 9%), was characterized by extremely high maternal FA anxiety scores and low scores for balanced integration of FA management and psychosocial functioning. Families in clusters differed across illness and psychosocial outcome variables. Conclusion: Families with FA were characterized by patterns of FA management, anxiety, and ability to integrate FA demands into daily life. Identified adaptation patterns correspond with clinical impressions and provide a framework for identifying families in need of intervention. This article is protected by copyright. All rights reserved.
    No preview · Article · Dec 2015 · Allergy
  • Marisa E Hilliard · Elizabeth L McQuaid · Laura Nabors · Korey K Hood
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    ABSTRACT: This special issue of the Journal of Pediatric Psychology showcases a growing area of research with a collection of 16 contemporary studies of resilience in youth with chronic medical or developmental conditions and their families. The research reported in this special issue covers a broad range of pediatric populations, including cancer, type 1 diabetes, and chronic pain, among others, ranging in age from early childhood through early adulthood. This introduction to the special issue reviews the various ways the articles' authors conceptualize and define risk and resilience; most analyze protective processes in relation to resilient outcomes, including both achievement of explicitly positive experiences and avoidance of dysfunction or disruption. Challenges with measurement of resilience-related constructs is reviewed. Finally, the special issue editors offer a definition of resilience in the context of pediatric and health psychology. © The Author 2015. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
    No preview · Article · Aug 2015 · Journal of Pediatric Psychology
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    ABSTRACT: This study determined if secondhand smoke (SHS) exposure is related to asthma-related functional morbidity by examining racial/ethnic differences in non-Latino White (NLW), African American, and Latino families and whether racial/ethnic SHS exposure differences across families persist when accounting for smoking factors. Participants were 305 caregiver smokers of children with asthma. Two passive dosimeters measured secondhand smoke: one in the home and one worn by the child. Higher SHS exposure was related to greater asthma-related functional morbidity. African Americans had higher levels of home SHS exposure than did Latinos (p = .003) or NLWs (p = .021). SHS exposure as assessed by the child-worn dosimeter did not differ across race/ethnicity. African American families were less likely to report a household smoking ban (46.4%) compared to Latinos (79.2%) and NLWs (67.9%; p < .05). African Americans were less likely to report having two or more smokers in the home (37.2%) compared to NLWs (53.6%; p < .05). NLWs reported the highest number of cigarettes smoked daily (Mdn = 15.00) compared to Latinos (Mdn = 10.00; p = .001) and African Americans (Mdn = 10.00; p < .001). SHS home exposure levels were regressed on race/ethnicity and relevant covariates. Household smoking ban (p < .001) and only one smoker in the home (p = .005) were associated with lower levels of SHS in the home; race/ethnicity was not significant. Differences in SHS exposure across race/ethnicity exist among children with asthma, possibly due to differential presence of a household smoking ban and number of smokers in the home. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
    No preview · Article · Aug 2015 · Health Psychology
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    ABSTRACT: Objective: To present a brief review of the literature regarding potential racial/ethnic disparities in pediatric food allergy (FA). METHODS: Topical review considering data regarding FA prevalence, asthma comorbidity, epinephrine access/use, and psychosocial impact (e.g., burden, quality of life). RESULTS: Methodological variation precludes firm conclusions regarding disparities in prevalence; however, some data suggest Black children may be at particular risk. The comorbidity of FA and asthma among urban populations may increase risk of negative outcomes. There are clear racial/ethnic and socioeconomic disparities in epinephrine access and use. Psychosocial measures are frequently validated on samples that are not racially or ethnically diverse. Studies investigating FA's psychosocial impact are often composed of mostly White, non-Hispanic participants (>85% of study sample). CONCLUSIONS: Further research is needed to clarify prevalence patterns by race/ethnicity, to investigate the sources of disparity in epinephrine use, and to evaluate the differential impact of FA on diverse children.
    No preview · Article · Jun 2015 · Journal of Pediatric Psychology
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    ABSTRACT: Objectives: To identify children demonstrating "good" sleep health in a sample of urban children with persistent asthma; to compare sociocontextual, asthma clinical characteristics, and sleep behaviors in children with "good" versus "poor" sleep health; and to examine protective effects of family-based health behaviors on sleep health. METHODS: Participants were 249 Black (33%), Latino (51%) and non-Latino White (16%) children with asthma, ages 7-9 years, and their primary caregivers. RESULTS: 32 percent of children had "good" sleep health. Well-controlled asthma and better lung function were more likely in this group. In the context of urban risks, sleep hygiene appeared to be a protective factor associated with better sleep quality. The protective effect of asthma management functioned differently by ethnic group. CONCLUSIONS: This study identifies protective processes that may guard against urban risks to optimize sleep health in children with asthma. Intervention programs can be tailored to consider specific supports that enhance sleep health in this high-risk group.
    No preview · Article · May 2015 · Journal of Pediatric Psychology
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    ABSTRACT: Rationale Stress is associated with asthma morbidity in Puerto Ricans (PRs), who have reduced bronchodilator response (BDR). Objectives To examine whether stress and/or a gene regulating anxiety (ADCYAP1R1) is associated with BDR in PR/non-PR children with asthma. Methods Cross-sectional study of stress and BDR (percent change in FEV1 after BD) in 234 PRs ages 9-14 years with asthma. We assessed child stress using the Checklist of Children's Distress Symptoms (CCDS), and maternal stress using the perceived stress scale (PSS). Replication analyses were conducted in two cohorts. Polymorphisms in ADCYAP1R1 were genotyped in our study and six replication studies. Multivariable models of stress and BDR were adjusted for age, sex, income, environmental tobacco smoke and use of inhaled corticosteroids. Measurements and Main Results High child stress was associated with reduced BDR in three cohorts. PR children who were highly stressed (upper quartile, CCDS) and whose mothers had high stress (upper quartile, PSS) had a BDR that was 10.2% (95% CI= 6.1% to 14.2%) lower than children who had neither high stress nor a highly stressed mother. A polymorphism in ADCYAP1R1 (rs34548976) was associated with reduced BDR. This SNP is associated with reduced expression of the gene for the β2-adrenergic receptor (ADRB2) in CD4+ lymphocytes of subjects with asthma, and affects brain connectivity of the amygdala and the insula (a biomarker of anxiety). Conclusions High child stress and an ADCYAP1R1 SNP are associated with reduced BDR in children with asthma. This is likely due to down-regulation of ADRB2 in highly stressed children.
    Full-text · Article · Apr 2015 · American Journal of Respiratory and Critical Care Medicine
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    ABSTRACT: Objective: To compare asthma care roles of maternal and paternal caregivers, and examine associations between caregiver involvement and the outcomes of adherence, morbidity, and parental quality of life (QoL). Methods: Mothers and fathers in 63 families of children, ages 5-9 years, with persistent asthma completed semistructured interviews and questionnaires. Adherence was measured via electronic monitoring. Paired t tests compared parental asthma care roles, and analysis of covariance, controlling for socioeconomic status, evaluated associations of asthma outcomes with caregiver involvement scores. Results: Mothers had higher scores on measures of involvement, beliefs in medication necessity, and on four subscales of the Family Asthma Management System Scale interview (Asthma Knowledge, Relationship with Provider, Symptom Assessment, and Response to Symptoms). Maternal QoL was lowest when both maternal and paternal involvement was high. Paternal involvement was associated with increased morbidity. Conclusions: There is room for enhancement of fathers' asthma care roles. Higher levels of paternal involvement may be driven by family need.
    No preview · Article · Apr 2015 · Journal of Pediatric Psychology
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    ABSTRACT: Objective Develop a measure that evaluates effective pediatric food allergy (FA) management, child and parent FA anxiety, and integration of FA into family life. Methods A semistructured family interview was developed to evaluate FA management using a pilot sample (n = 27). Rating scales evaluated eight dimensions of FA management (FAMComposite), child anxiety, parent anxiety, and overall balanced integration (BI). Families of children with IgE-mediated food allergies (n = 60, child age: 6–12) were recruited for interview and rating scale validation. Results FAMComposite was correlated with physician ratings for families’ food avoidance and reaction response readiness. FA anxiety was correlated with general anxiety measures for children, but not parents. Parents’ FA anxiety was correlated with expectations of negative outcomes from FA. Low BI was associated with poor quality of life and negative impact on family functioning. Conclusions Preliminary analyses support Food Allergy Management and Adaptation Scale validity as a measure of family adaptation to pediatric FA.
    No preview · Article · Mar 2015 · Journal of Pediatric Psychology

  • No preview · Article · Feb 2015 · Journal of Allergy and Clinical Immunology

  • No preview · Conference Paper · Jan 2015
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    Full-text · Article · Jan 2015
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    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.
    No preview · Article · Oct 2014 · Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine
  • Robyn Wing · Annie Gjelsvik · Elizabeth L. McQuaid
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    ABSTRACT: Numerous studies suggest that psychosocial factors could contribute to pediatric asthma. To examine the relation between single and cumulative adverse childhood experiences (ACEs), a measurement of household dysfunction, on parent report of lifetime asthma in children. This cross-sectional study used data from the 2011 to 2012 National Survey of Children's Health, a nationally representative sample of children 0 to 17 years old (n = 92,472). The main exposure was parent or guardian report of 6 ACE exposures (eg, witnessing domestic violence). The relation between ACE exposures and parent-reported diagnosis of childhood asthma was examined using multivariable logistic regression after controlling for demographic, socioeconomic, and behavioral covariates. Overall asthma prevalence was 14.6%. Exposure prevalence to any ACE was 29.2%. Increased number of ACE exposures was associated with increased odds of asthma. In the adjusted model, the odds of reporting asthma were 1.28 (95% confidence interval [CI] 1.14-1.43) for those reporting 1 ACE, 1.73 (95% CI 1.27-2.36) for those with 4 ACEs, and 1.61 (95% CI 1.15-2.26) for those with 5 or 6 ACEs compared with those with no ACE exposures. Effects were moderated by Hispanic ethnicity. Hispanic children exposed to 4 ACEs had a 4.46 times increase in lifetime asthma (95% CI 2.46-8.08); white children had a 1.19 times increase (95% CI 0.80-1.79) compared with those exposed to 0 ACE. This study supports the growing evidence for the biopsychosocial model of asthma onset. Future studies should examine the association between ACEs and specific asthma-related health outcomes. Copyright © 2015 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.
    No preview · Conference Paper · Oct 2014
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    ABSTRACT: Objective: Objectives of this study were to survey parents and children independently regarding feelings of helplessness specific to asthma and to examine the relationship between helplessness and the child's symptom-free days. Methods: Parent-child dyads (children 7-12 years) from Rochester, NY were enrolled (November 2011-August 2012) from general pediatric clinics, pulmonary clinics, an Emergency Department, and area youth and asthma programs. Assessments included demographics, symptoms, ratings of helplessness related to asthma and parent social support. A multivariate linear regression was conducted to examine the relationship between feelings of helplessness and symptoms-free days: post hoc analysis assessed the moderating role of social support. Results: Overall, 107 parent-child dyads enrolled (participation rate: 72%); 104 were included in analysis. Most children were male (58%), 7-9 years (58%) and White (46%). The child's feelings of helplessness scores were positively correlated with symptom-free days indicating less feelings of helplessness as symptom-free days increased (rs = 0.273, p = 0.01). In a stratified analysis, among parents who reported minimal social support (<1 sources of support), child's helplessness scores were positively correlated with symptom-free days (rs = 0.335, p = 0.02). Conversely, among parents reporting >2 supports, no relationship was found (rs = 0.195, p = 0.15). Conclusions: This study found less feelings of helplessness among children with asthma as symptom-free days increased. Social support appears to moderate this relationship; however further studies to confirm these findings are needed.
    Full-text · Article · Sep 2014 · Journal of Asthma
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    ABSTRACT: Objective: Objectives of this study were to survey parents and children independently regarding feelings of helplessness specific to asthma and to examine the relationship between helplessness and the child's symptom-free days. Methods: Parent–child dyads (children 7–12 years) from Rochester, NY were enrolled (November 2011–August 2012) from general pediatric clinics, pulmonary clinics, an Emergency Department, and area youth and asthma programs. Assessments included demographics, symptoms, ratings of helplessness related to asthma and parent social support. A multivariate linear regression was conducted to examine the relationship between feelings of helplessness and symptoms-free days: post hoc analysis assessed the moderating role of social support. Results: Overall, 107 parent–child dyads enrolled (participation rate: 72%); 104 were included in analysis. Most children were male (58%), 7–9 years (58%) and White (46%). The child's feelings of helplessness scores were positively correlated with symptom-free days indicating less feelings of helplessness as symptom-free days increased (rs = 0.273, p = 0.01). In a stratified analysis, among parents who reported minimal social support (<1 sources of support), child's helplessness scores were positively correlated with symptom-free days (rs = 0.335, p = 0.02). Conversely, among parents reporting >2 supports, no relationship was found (rs = 0.195, p = 0.15). Conclusions: This study found less feelings of helplessness among children with asthma as symptom-free days increased. Social support appears to moderate this relationship; however further studies to confirm these findings are needed.
    Full-text · Article · Sep 2014
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    Full-text · Article · Aug 2014 · Journal of Pediatric Psychology
  • Erin M Tooley · Andrew Busch · Elizabeth L McQuaid · Belinda Borrelli
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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.
    No preview · Article · Jun 2014 · Behavioral Medicine
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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.
    No preview · Article · Jun 2014 · Pediatric Allergy, Immunology, and Pulmonology
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    ABSTRACT: Objective: The current study examined the role of alternate caregivers (i.e., caregivers living outside of the home who spend at least 6 hr per week caring for the child) in a sample of Latino and non-Latino White (NLW) families with a child with asthma. Methods: Participants included 665 families of children with asthma from NLW, Puerto Rican, and Dominican backgrounds from Rhode Island and Puerto Rico. All caregivers completed a validated semistructured family interview assessing asthma management strategies in the family context. Results: 22 percent of families identified an alternate caregiver. Alternate caregiver involvement was highest among Island Puerto Rican families. Island Puerto Rican families who reported alternate caregiver involvement were rated as having higher medication adherence and more balanced adaptation to the demands of asthma management. Conclusions: Alternate caregivers may play an important role in family asthma management, especially among some Latino subgroups.
    Full-text · Article · May 2014 · Journal of Pediatric Psychology
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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.
    No preview · Article · Apr 2014 · Journal of the Association for the Care of Children's Health

Publication Stats

2k Citations
356.20 Total Impact Points

Institutions

  • 2002-2015
    • Alpert Medical School - Brown University
      • • Department of Psychiatry and Human Behavior
      • • Department of Pediatrics
      Providence, Rhode Island, United States
  • 1996-2015
    • Brown University
      • • Alpert Medical School
      • • Department of Medicine
      • • Department of Pediatrics
      • • Department of Psychiatry and Human Behavior
      Providence, Rhode Island, United States
  • 2014
    • Virginia Commonwealth University
      Richmond, Virginia, United States
    • The Children's Hospital of Philadelphia
      • Department of Psychology
      Filadelfia, Pennsylvania, United States
  • 1995-2013
    • Rhode Island Hospital
      Providence, Rhode Island, United States
  • 2010
    • University of Massachusetts Medical School
      • Division of Preventive and Behavioral Medicine
      Worcester, Massachusetts, United States
  • 2009
    • Yeshiva University
      • Ferkauf Graduate School of Psychology
      New York City, New York, United States
  • 2008
    • Bradley University
      Peoria, Illinois, United States
  • 2004
    • The Ohio State University
      • Division of Health Behavior and Health Promotion
      Columbus, Ohio, United States