Elizabeth L McQuaid

The Children's Hospital of Philadelphia, Filadelfia, Pennsylvania, United States

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Publications (133)

  • Belinda Borrelli · Elizabeth L. McQuaid · Erin M. Tooley · [...] · Shira Dunsiger
    [Show abstract] [Hide abstract] ABSTRACT: Aims: We tested two aims: (1) the teachable moment (TM): whether second-hand smoke exposure (SHSe) feedback motivates cessation in parents of children with asthma versus parents of healthy children (HC); and (2) whether greater intervention intensity [enhanced-precaution adoption model (PAM)] produces greater cessation than a previously tested intervention (PAM). Design and interventions: Aim 1: two home visits (asthma education or child wellness), and cessation induction using motivational interviewing and SHSe feedback. Aim 2: post-home-visits, parents with asthmatic children were randomized to PAM (n = 171; six asthma education calls) or enhanced-PAM (n = 170; six asthma education/smoking cessation calls + repeat SHSe feedback). Setting: Rhode Island, USA. Participants: Parents of asthmatic (n = 341) or healthy (n = 219) children who did not have to want to quit smoking to enroll. Measurements: Measurements were given at baseline, 2, 4, 6 and 12 months. Abstinence was bioverified. Outcomes were 7-day and 30-day point prevalence abstinence (ppa) and SHSe (primary) and asthma morbidity (secondary). Findings: Aim 1: the TM was supported: parents of asthmatic children were more than twice as likely to achieve 30-day [odds ratio (OR) = 2.60, 95% confidence interval (CI) = 1.22-5.54] and 7-day ppa (OR = 2.26, 95% CI = 1.13-4.51) at 2 months (primary end-point) and have non-detectable levels of SHSe than HCs. Greater treatment intensity yielded stronger TM effects (OR = 3.60; 95% CI = 1.72-7.55). Aim 2: enhanced-PAM was more likely to achieve 30-day ppa at the primary end-point, 4 months (OR = 2.12, 95% CI 1.09-4.12) and improved asthma outcomes versus PAM. Conclusions: Smoking cessation intervention (Motivational Interviewing plus biomarker feedback) appear to motivate smoking cessation more strongly among parents of asthmatic children than among parents of healthy children. Increased intervention intensity yields greater smoking cessation among parents of asthmatic children and better asthma outcomes.
    Article · May 2016 · Addiction
  • Celia M. Lescano · Daphne Koinis-Mitchell · Elizabeth L. McQuaid
    Article · May 2016 · Journal of Pediatric Psychology
  • [Show abstract] [Hide abstract] ABSTRACT: Objective: To provide an overview of qualitative methods, particularly for reviewers and authors who may be less familiar with qualitative research. Methods: A question and answer format is used to address considerations for writing and evaluating qualitative research. Results and conclusions: When producing qualitative research, individuals are encouraged to address the qualitative research considerations raised and to explicitly identify the systematic strategies used to ensure rigor in study design and methods, analysis, and presentation of findings. Increasing capacity for review and publication of qualitative research within pediatric psychology will advance the field's ability to gain a better understanding of the specific needs of pediatric populations, tailor interventions more effectively, and promote optimal health.
    Article · Apr 2016 · Journal of Pediatric Psychology
  • Ashley H Clawson · Belinda Borrelli · Elizabeth L McQuaid · Shira Dunsiger
    [Show abstract] [Hide abstract] ABSTRACT: Objective: Caregiver depressed mood and stress are associated with increased child asthma functional morbidity (AFM) and secondhand smoke exposure (SHSe), whereas social support (SS) reduces risk. This study extends previous literature by examining (1) longitudinal patterns of pediatric AFM and SHSe and (2) how caregiver stress, depressed mood, and SS are related to child SHSe and AFM changes. Method: Participants were 334 caregivers who smoked, had a child with asthma, and were enrolled in a smoking cessation induction/asthma intervention. SHSe and AFM were measured at baseline and 4, 6, and 12 months. All measures were caregiver self-report. We used an autoregressive latent trajectory model to examine the intercept, linear, and quadratic growth factors and autoregressive and cross-lagged effects of SHSe and AFM. Results: After an asthma exacerbation, decreases in child AFM and SHSe were followed by respective increases over time. Child SHSe at 4 months and 6 months predicted subsequent child AFM. Autoregressive paths were significant for only AFM. Higher baseline caregiver depressed mood and stress predicted higher baseline child AFM but not other growth factors. Higher baseline caregiver self-esteem SS was associated with only lower baseline child AFM and fewer increases in AFM across time. Exploratory analyses indicated higher baseline caregiver depressed mood and stress were associated with less-favorable changes in child SHSe and AFM. Conclusions: Caregiver depressed mood, stress, and SS should be considered when addressing pediatric SHSe and AFM. Caregiver support may be needed to maintain intervention gains. (PsycINFO Database Record
    Article · Feb 2016 · Health Psychology
  • David A Fedele · Elizabeth L McQuaid · Anna Faino · [...] · Mary D Klinnert
    [Show abstract] [Hide abstract] 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.
    Article · Dec 2015 · Allergy
  • Marisa E Hilliard · Elizabeth L McQuaid · Laura Nabors · Korey K Hood
    [Show abstract] [Hide abstract] 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.
    Article · Aug 2015 · Journal of Pediatric Psychology
  • [Show abstract] [Hide abstract] 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).
    Article · Aug 2015 · Health Psychology
  • Elizabeth L McQuaid · Michael L Farrow · Cynthia A Esteban · [...] · Susan A Rudders
    [Show abstract] [Hide abstract] 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.
    Article · Jun 2015 · Journal of Pediatric Psychology
  • [Show abstract] [Hide abstract] 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.
    Article · May 2015 · Journal of Pediatric Psychology
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    [Show abstract] [Hide abstract] 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
  • Deborah Friedman · Bruce Masek · Esteban Barreto · [...] · Elizabeth L McQuaid
    [Show abstract] [Hide abstract] 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.
    Article · Apr 2015 · Journal of Pediatric Psychology
  • Mary D Klinnert · Elizabeth L McQuaid · David A Fedele · [...] · Hannah Fransen
    [Show abstract] [Hide abstract] 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.
    Article · Mar 2015 · Journal of Pediatric Psychology
  • Elizabeth L. McQuaid · Michael L. Farrow · Cynthia Esteban · [...] · Josh Spitalnick
    Article · Feb 2015 · Journal of Allergy and Clinical Immunology
  • Conference Paper · Jan 2015
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    Tonya M. Palermo · David M. Janicke · Elizabeth L. McQuaid · [...] · Yelena P. Wu
    Full-text Article · Jan 2015
  • [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.
    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
    [Show abstract] [Hide abstract] 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.
    Conference Paper · Oct 2014
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    Kelly M Conn · Dena Swanson · Elizabeth McQuaid · [...] · Susan G Fisher
    [Show abstract] [Hide abstract] 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
  • Kelly M. Conn · Dena Swanson · Elizabeth McQuaid · [...] · Susan G. Fisher
    [Show abstract] [Hide abstract] 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.
    Article · Sep 2014
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    Full-text Article · Aug 2014 · Journal of Pediatric Psychology

Publication Stats

2k Citations

Institutions

  • 2014
    • The Children's Hospital of Philadelphia
      • Department of Psychology
      Filadelfia, Pennsylvania, United States
  • 2013
    • Rhode Island Hospital
      Providence, Rhode Island, United States
  • 2008
    • Bradley University
      Peoria, Illinois, United States
  • 2002-2008
    • Alpert Medical School - Brown University
      • • Department of Pediatrics
      • • Department of Psychiatry and Human Behavior
      Providence, Rhode Island, United States
  • 2004
    • Brown University
      • Department of Pediatrics
      Providence, Rhode Island, United States