ࡱ > X Z I J K L M N O P Q R S T U V W s bjbj j j E l
4 B B B h B C d E 4K F zK zK zK ?N > }_ e w y y y y y y $ " B Z
g M | ?N g g j
zK zK I j j j g
zK
zK j g w j @ j s Ӗ
6
zK E N3 r7 B gi W F 4 0 d Ij j
Pediatric Asthma
in Massachusetts
2002 - 2003
Massachusetts Department of Public Health
Center for Environmental Health
Bureau of Environmental Health Assessment
250 Washington Street
Boston, MA 02108
May 2004
Table of Contents
HYPERLINK \l "intro" I. Introduction 1
HYPERLINK \l "methods" II. Methods 2
A. Target Population 2
B. Program Definition of Asthma 2
C. Data Collection 3
D. Data Management 3
E. Data Analysis 4
HYPERLINK \l "results" III. Results 4
A. Participation 4
B. Reported Asthma Prevalence 4
C. Other Variables 5
HYPERLINK \l "discussion" IV. Discussion 5
A. Comparison With Other Data Sources 5
B. Limitations 6
C. Strengths 7
HYPERLINK \l "summary" V. Summary 7
HYPERLINK \l "future" VI. Future Efforts Aimed at Pediatric Asthma Surveillance 8
HYPERLINK \l "advisory" VII. Advisory Committee Membership 9
HYPERLINK \l "reference" VIII. References 10
HYPERLINK \l "appendix" Appendix I. MDPH Pediatric Asthma Surveillance Form, 2002 - 2003 19
Appendix II. Summary Reports by School District ( HYPERLINK "http://www.mass.gov/dph/beha/asthma/appendixii.pdf" PDF) ( HYPERLINK "http://www.mass.gov/dph/beha/asthma/appendixii.pdf" XL) 23
TOC \h \z \c "Figure"
List of Figures and Tables
HYPERLINK \l "figures" Figures
Figure 1. Communities Included in the MDPH Pediatric Asthma
Surveillance Program 13
Figure 2. Distribution of Reported District-Wide Asthma Prevalence 14
HYPERLINK \l "tables" Tables
Table 1. Variables Collected on the Pediatric Asthma Surveillance Form 16
Table 2. Reported Asthma Prevalence by Grade 17
Table 3. Answers to Questions Related to School Nurses Records 18
Acknowledgements
Thanks to the U.S. Centers of Disease Control and Prevention Environmental Health Tracking Branch for providing the federal resources necessary to conduct this effort. The MDPH would also like to thank school nurses in both private and public school systems who contributed to the success of the first year of its pediatric asthma surveillance effort by completing a Pediatric Asthma Surveillance Form. We would also like to thank the Pediatric Asthma Surveillance Advisory Committee, for its valuable input during both the planning and implementation phases of the program. Finally, we appreciate the collaboration and assistance of staff in the Departments Bureau of Family and Community Health.
Pediatric Asthma In Massachusetts
2002-2003
I. Introduction
Asthma is a common chronic disease among children. It is a leading cause of
functional limitation in Americans under the age of 17 ADDIN EN.CITE U.S. Centers for Disease Control and Prevention (CDC)19951040104U.S. Centers for Disease Control and Prevention (CDC),1995Disabilities among children aged < or = 17 years--United States, 1991-1992MMWR Morb Mortal Wkly Rep4433609-13Aug 257637672AdolescentAge DistributionChildChild, PreschoolChronic Disease/*epidemiologyDisabled Persons/classification/rehabilitation/*statistics & numericaldataFemaleHumanInfantMalePrevalenceSex DistributionUnited States/epidemiologyhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=7637672[1], and costs 3.2 billion dollars in direct health care costs annually ADDIN EN.CITE American Lung AssociationMarch 200310516105American Lung Association,March 2003Asthma in Children Fact SheetFebruary 25, 2004[2]. The prevalence of pediatric asthma appears to have increased in prevalence over the past decades ADDIN EN.CITE U.S. Centers for Disease Control and Prevention (CDC)200090090U.S. Centers for Disease Control and Prevention (CDC),2000Measuring childhood asthma prevalence before and after the 1997 redesign of the National Health Interview Survey--United StatesMMWR Morb Mortal Wkly Rep4940908-11Oct 1311043644AdolescentAsthma/*epidemiologyChildChild, Preschool*Health SurveysHumanInfantPopulation SurveillancePrevalenceUnited States/epidemiologyhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11043644[3]. The magnitude of prevalence and cost of this disease have made asthma a priority concern among public health organizations across the country.
To date the information available regarding asthma prevalence in Massachusetts
has been limited to prevalence figures for the state as a whole. Statewide prevalence figures have been collected through the Behavioral Risk Factor Surveillance System (BRFSS), a random telephone survey implemented by state health departments in conjunction with the U.S. Centers for Disease Control and Prevention (CDC). Although BRFSS data are useful for estimating asthma prevalence for the state, they do not provide information regarding asthma at the community level. Historically, community-level data have been available only for a small number of communities in which specialized surveillance programs or research studies have been implemented.
While statewide prevalence figures are a convenient way to summarize the overall health of Commonwealth residents, there remains a need to better quantify the scope of the problem on the state and local level, particularly as it relates to the pediatric population, the population for which the largest increases in asthma prevalence have been detected over time ADDIN EN.CITE Mannino19989109195807464711998Apr 24Surveillance for asthma--United States, 1960-19951-27Division of Environmental Hazards and Health Effects.Mannino, D. M.Homa, D. M.Pertowski, C. A.Ashizawa, A.Nixon, L. L.Johnson, C. A.Ball, L. B.Jack, E.Kang, D. S.MMWR CDC Surveill SummAdolescentAdultAgedAsthma/*epidemiology/mortalityChildChild, PreschoolEmergenciesFemaleHospitalization/statistics & numerical dataHumanInfantMaleMiddle AgedOffice Visits/statistics & numerical data*Population SurveillancePrevalenceUnited States/epidemiologyhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=9580746[4]. A standardized pediatric asthma surveillance or tracking system that collects asthma prevalence data at the community level allows public health officials to identify populations with asthma on the local level, evaluate at risk groups, and evaluate the impact of interventions over time more effectively than state-level data.
Given the need for a comprehensive, systematic approach to pediatric asthma surveillance in the Commonwealth, the Massachusetts Department of Public Health (MDPH) developed a proposal to track pediatric asthma through school health offices. This program is being implemented as part of a larger effort aimed at tracking several health outcomes thought to be impacted by environmental exposures. The overall surveillance program, currently funded for three years through the U.S. Centers for Disease Control and Prevention (CDC) National Environmental Public Health Tracking Program, aims to track the prevalence of pediatric asthma in Massachusetts school children, lupus in the city of Boston, and developmental disabilities in Berkshire County. This report describes the methods used to implement the pediatric asthma surveillance effort, summarizes the surveillance data collected during its first year, and discusses program goals for years two and three.
II. Methods
A. Target Population
The MDPH piloted the Pediatric Asthma Surveillance Program during the
academic year 20022003 in 111 school districts participating in the MDPH Essential School Health Service (ESHS) program. There were 958 public schools that served any of grades K-8 in those districts and were therefore eligible to participate in the surveillance program.
B. Program Definition of Asthma
School nurses reported the number of students with asthma in each school by grade and gender on a standardized surveillance form (Appendix I). Potential sources for the nurses knowledge of a childs asthma status included emergency cards, parent resource centers, parent communications, student communications, health care provider documentation, or direct observation of an asthma attack. The percentage of cases with a documented provider diagnosis or medication orders was requested in the surveillance form.
C. Data Collection
During January 2002, the MDPH mailed letters introducing the surveillance program to school superintendents, principals, and nurse leaders in school districts participating in the ESHS. The following March, school nurse leaders were asked to distribute to nurses in their district a two-page surveillance form asking for aggregate numbers of children with asthma by grade, gender, and school building (Appendix I). The surveillance form also contained questions regarding the source of data reported (Table I). Surveillance forms were distributed via email, when possible, to facilitate electronic data submission. If electronic mail was not available, then forms were sent via the U.S. Postal Service. Follow-up telephone calls were placed to nurses who did not respond by April 2003. School enrollment data was collected from the Massachusetts Department of Education (DOE) or from a schools administrative staff. Schools that did not return a completed surveillance form or for which enrollment data could not be obtained by September 2002 were considered non-responders for year one.
D. Data Management
MDPH staff reviewed surveillance forms for completeness and accuracy, and attempted to resolve missing data or inconsistencies. Massachusetts DOE school identifier codes were assigned to each schools form. In the case of a school that was not listed in the DOE database, or was listed as part of a larger school, the MDPH assigned its own unique identifier code, following the DOE code structure. Complete surveillance data were manually input to the surveillance program database upon satisfactory review. Incomplete surveillance data were not input to the program database.
E. Data Analysis
Data analysis was performed with Statistical Analysis Software (SAS) and Microsoft Access. The percent participation of the target population was calculated, along with the breakdown of participation by type of school. The prevalence of asthma with 95% confidence intervals was calculated for the state, for each participating school district, and by grade level. The range of asthma prevalence among individual schools was also calculated for this report.
III. Results
A. Participation
MDPH received completed surveillance forms from a total of 760 schools, about 46% of the schools serving any of grades K-8 in the Commonwealth during that time. Of the 760 participating schools, 668 were targeted ESHS schools, translating to 70% participation by target schools. The remaining 92 schools were private schools (52), charter schools (9), and public schools not included in the ESHS, but that submitted information on their own (31). Figure 1 highlights the communities belonging to school districts that participated in the surveillance program. Less than 1% of the returned surveillance forms were incomplete after follow-up by the completion deadline of June 2003.
B. Reported Asthma Prevalence
The reported prevalence of asthma among the 311,600 students enrolled in the 760 participating schools was 9.2% (95% CI* 9.1% - 9.3%). Sixty percent of students reported to have asthma were male. Reported prevalence by school ranged from 0 30.8%, while reported asthma prevalence by school district ranged from 2.7% - 16.2%. Figure 2 presents the frequency distribution of district-wide reported asthma prevalence figures. See Appendix II for the corresponding summary reports produced for each participating school district. Reported asthma prevalence by grade ranged from 7.7% to 10.3 % (Table 2).
C. Other Variables
Responses to questions relating to the school health records are summarized in Table 3. Of the 96% of respondents that answered question number 11, regarding provider diagnoses of asthma, 50% reported that most of their students with asthma (i.e. 90% - 100%) had documentation in the health record of a provider diagnosis of asthma and/or asthma medication orders. Parent or student communications were identified as an alternate source of knowledge regarding a students asthma status. Direct observation of an asthma attack and parent resource centers were indicated least frequently as alternate sources of knowledge regarding a students asthma status.
IV. Discussion
A. Comparison With Other Data Sources
While the reported prevalence of asthma observed in this program ranged as high as 16.2% by district, and 30.8% by school, the statewide prevalence was 9.2%. This figure is similar to the 8.8% prevalence of current childhood asthma in Massachusetts reported recently by the New England Asthma Regional Council (ARC) based on BRFSS data collected in 2001 ADDIN EN.CITE New Enland Asthma Regional Council2004971097New Enland Asthma Regional Council,2004Asthma in New England, Part II: Children[5]. Different methodologies and target populations between the two surveillance approaches make BRFSS data less than ideal for comparison with data generated through the MDPH pediatric asthma surveillance initiative. However, BRFSS data is currently the only statewide pediatric asthma prevalence data available.
A school-based surveillance effort similar to the one implemented in Massachusetts may be more appropriate for comparison, and is discussed in a recent report describing nurse-reported asthma in Connecticut students. The report describes a 9.7% asthma prevalence among Connecticut students in grades K-5 ADDIN EN.CITE Storey2003851085Storey, E.Cullen, M.Schwab, NAlderman, N2003A Survey of Asthma Prevalence in Elementary School ChildrenNorth Haven, CT[6], slightly higher than the 8.8% found in Massachusetts K-5 graders. Prevalence data for grade 6-8 students in Connecticut are not available for comparison.
The observation that more students reported with asthma were male is consistent with the findings of epidemiological studies that report male gender as a risk factor for pediatric asthma ADDIN EN.CITE Miller200110001001147918915432001Aug 1Predictors of asthma in young children: does reporting source affect our conclusions?245-50Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, NJ 08901-5070, USA. jem@rci.rutgers.eduMiller, J. E.Am J EpidemiolAdultAfrican Continental Ancestry GroupAsthma/*epidemiologyBias (Epidemiology)Breast Feeding/statistics & numerical dataChildCohort StudiesComparative StudyDemographyEuropean Continental Ancestry GroupFemaleFollow-Up StudiesGestational AgeHealth SurveysHumanLogistic ModelsLongitudinal StudiesMaleMothers/statistics & numerical dataOdds RatioPrevalenceRisk FactorsSmoking/epidemiologySocial ClassSupport, Non-U.S. Gov'tUnited States/epidemiologyhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11479189[7] ADDIN EN.CITE Schatz20031010101147004399162003DecThe relationship of sex to asthma prevalence, health care utilization, and medications in a large managed care organization553-8Department of Allergy, Kaiser-Permanente Medical Care Program, San Diego, California 92111, USA. michael.x.schatz@kp.orgSchatz, M.Camargo, C. A., Jr.Ann Allergy Asthma ImmunolAdolescentAdultAge FactorsAnti-Asthmatic Agents/*therapeutic useAsthma/classification/epidemiology/*therapyCalifornia/epidemiologyChildChild, PreschoolCohort StudiesComparative StudyEmergency Service, Hospital/utilizationFemaleFollow-Up StudiesHospitalization/statistics & numerical dataHumanMaleManaged Care Programs/*organization & administration/utilizationMiddle AgedMultivariate AnalysisPredictive Value of TestsPrevalenceQuality of Health CareRetrospective StudiesSeverity of Illness IndexSex FactorsStatisticsSupport, Non-U.S. Gov'tSupport, U.S. Gov't, P.H.S.Treatment Outcomehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=14700439[8] ADDIN EN.CITE de Marco200010301031090322216212000JulDifferences in incidence of reported asthma related to age in men and women. A retrospective analysis of the data of the European Respiratory Health Survey68-74Division of Epidemiology and Medical Statistics, University of Verona, Verona, Italy. demarco@biometria.univr.itde Marco, R.Locatelli, F.Sunyer, J.Burney, P.Am J Respir Crit Care MedAdolescentAdultAge DistributionAge FactorsAsthma/*epidemiologyCase-Control StudiesChildChild, PreschoolComparative StudyEuropeFemaleHumanIncidenceInfantMaleRetrospective StudiesSex DistributionSex Factorshttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=10903222[9]. There is little data available for comparison with this programs prevalence estimates by grade. One explanation for the observed increase in reported asthma by grade could be that a longer period of time in school leaves more time for asthma diagnosis, making the nurse more likely to be aware of a diagnosis of asthma in the health record by the time a student enters the eight grade.
B. Limitations
While there was notable variation in reported asthma prevalence between school districts during the Surveillance Programs first year, caution should be used when comparing district prevalence estimates. Some district-wide prevalence estimates were based on reporting by only a small percentage of the districts schools, and may not be representative of that districts actual asthma prevalence. The MDPH expects to obtain more complete, representative data in subsequent years of the surveillance program. Differences in school health systems between districts further complicate the issue of comparability between district asthma prevalence estimates as reported by school nurses.
It is also important to note that a higher prevalence of asthma within one district compared with another does not necessarily indicate the presence of environmental problems within that districts schools. Pediatric respiratory symptoms have been associated with a number of factors including exposures in the outdoor environment ADDIN EN.CITE Boezen1999310311009397935391561999Mar 13Effects of ambient air pollution on upper and lower respiratory symptoms and peak expiratory flow in children874-8Department of Epidemiology and Statistics, University of Groningen, Netherlands. h.m.boezen@med.rug.nlBoezen, H. M.van der Zee, S. C.Postma, D. S.Vonk, J. M.Gerritsen, J.Hoek, G.Brunekreef, B.Rijcken, B.Schouten, J. P.LancetAir Pollutants/*adverse effects/analysisAir Pollution/adverse effectsBronchialHyperreactivity/epidemiology/*etiology/immunology/physiopathologyChildComparative StudyFemaleHealth SurveysHumanImmunoglobulin E/bloodLogistic ModelsMaleNetherlands/epidemiologyNitrogen Dioxide/adverse effects/analysisPeak Expiratory Flow RatePrevalenceRural HealthSeasonsSmoke/adverse effectsSulfur Dioxide/adverse effects/analysisSupport, Non-U.S. Gov'tUrban Healthhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=10093979[10] ADDIN EN.CITE Delfino20024204212361942110102002OctAssociation of asthma symptoms with peak particulate air pollution and effect modification by anti-inflammatory medication useA607-17Epidemiology Division, Department of Medicine, University of California, Irvine, Irvine, California 92697-7550, USA. rdelfino@uci.eduDelfino, R. J.Zeiger, R. S.Seltzer, J. M.Street, D. H.McLaren, C. E.Environ Health PerspectActivities of Daily LivingAdolescentAdultAir Pollutants, Environmental/*adverse effectsAllergensAnti-Inflammatory Agents, Steroidal/*pharmacology/therapeutic useAsthma/drug therapy/*etiology/*pathologyChild*Environmental ExposureFemaleHumanInflammationMaleParticle SizeRural PopulationSeverity of Illness IndexSupport, U.S. Gov't, P.H.S.Time FactorsUrban Populationhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12361942[11] ADDIN EN.CITE Tolbert2000480481096597715182000Apr 15Air quality and pediatric emergency room visits for asthma in Atlanta, Georgia, USA798-810Rollins School of Public Health, Emory University, Atlanta, GA, USA.Tolbert, P. E.Mulholland, J. A.MacIntosh, D. L.Xu, F.Daniels, D.Devine, O. J.Carlin, B. P.Klein, M.Dorley, J.Butler, A. J.Nordenberg, D. F.Frumkin, H.Ryan, P. B.White, M. C.Am J EpidemiolAdolescentAir Pollutants, Environmental/*adverse effectsAsthma/epidemiology/*therapyChildChild, PreschoolEmergency Service, Hospital/*utilizationEnvironmental ExposureFemaleGeorgia/epidemiologyHumanIncidenceInfantInfant, NewbornMaleOxidants, Photochemical/adverse effectsOzone/adverse effectsRetrospective StudiesSupport, Non-U.S. Gov'thttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=10965977[12], exposures in the home environment ADDIN EN.CITE Sturm200492092147599479422004FebEffects of tobacco smoke exposure on asthma prevalence and medical care use in north Carolina middle school children308-13At the time this study was conducted, Jesse J. Sturm was with the Department of Epidemiology, University of North Carolina at Chapel Hill. Karin Yeatts and Dana Loomis are with the Department of Epidemiology, University of North Carolina at Chapel Hill.Sturm, J. J.Yeatts, K.Loomis, D.Am J Public Healthhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=14759947[13] ADDIN EN.CITE Rosenstreich19977079134876336191997May 8The role of cockroach allergy and exposure to cockroach allergen in causing morbidity among inner-city children with asthma1356-63Department of Medicine, Albert Einstein College of Medicine, Bronx, NY 10461, USA.Rosenstreich, D. L.Eggleston, P.Kattan, M.Baker, D.Slavin, R. G.Gergen, P.Mitchell, H.McNiff-Mortimer, K.Lynn, H.Ownby, D.Malveaux, F.N Engl J MedAllergens/*adverse effects/analysisAnimalAsthma/*immunology/physiopathologyCats/immunologyChildChild, PreschoolCockroaches/*immunologyEnvironmental Exposure/adverse effects/analysisFemaleHospitalization/statistics & numerical dataHumanHypersensitivity, Immediate/*complications/diagnosis/immunologyMaleMites/immunologyPoverty AreasSupport, U.S. Gov't, P.H.S.United StatesUrban Healthhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=9134876[14] ADDIN EN.CITE Smith2000909111535871652000NovHealth effects of daily indoor nitrogen dioxide exposure in people with asthma879-85Dept of Medicine, University of Adelaide.Smith, B. J.Nitschke, M.Pilotto, L. S.Ruffin, R. E.Pisaniello, D. L.Willson, K. J.Eur Respir JAdolescentAdultAir Pollution, IndoorAsthma/*physiopathology*Environmental ExposureFemale*Health StatusHousingHumanMaleMiddle AgeNitrogen Dioxide/*adverse effectsOxidants, Photochemical/*adverse effectsProspective StudiesRespiration/drug effectsSupport, Non-U.S. Gov'thttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11153587[15], genetic factors ADDIN EN.CITE Lee2003930931459508211252003NovIndoor and outdoor environmental exposures, parental atopy, and physician-diagnosed asthma in Taiwanese schoolchildrene389Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.Lee, Y. L.Lin, Y. C.Hsiue, T. R.Hwang, B. F.Guo, Y. L.PediatricsAdolescentAdultAir Pollutants, Environmental/*adverse effectsAir Pollution, Indoor/*adverse effectsAnimalsAsthma/diagnosis/epidemiology/*etiology/geneticsChildCockroachesCross-Sectional Studies*Environmental ExposureFemaleFungiHealth SurveysHousingHumanHumidityHypersensitivity, Immediate/complications/*geneticsMaleRisk FactorsSupport, Non-U.S. Gov'tTaiwan/epidemiologyTobacco Smoke Pollutionhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=14595082[16] ADDIN EN.CITE El-Sharif200312012125809093322003FebFamilial and environmental determinants for wheezing and asthma in a case-control study of school children in Palestine176-86Laboratorium voor Pneumologie (Eenheid voor Longtoxicologie), K.U. Leuven, Belgium.El-Sharif, N.Abdeen, Z.Barghuthy, F.Nemery, B.Clin Exp AllergyAir Pollution, Indoor/adverse effectsAllergens/immunologyAnimalAnimals, Domestic/immunologyAsthma/etiology/*genetics/immunologyCase-Control StudiesChildDust/immunology*EnvironmentFemaleHumanImmunoglobulin E/bloodLogistic ModelsMaleMites/immunologyRespiratory Sounds/etiology/*genetics/immunologyRisk FactorsSkin Tests/methodsSupport, Non-U.S. Gov'thttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12580909[17], and lifestyle factors ADDIN EN.CITE Aligne200096096109880981623 Pt 12000SepRisk factors for pediatric asthma. Contributions of poverty, race, and urban residence873-7Strong Children's Research Center, Rochester General Hospital, and American Academy of Pediatrics Center for Child Health Research, Rochester, New York, USA. andrew.aligne@viahealth.orgAligne, C. A.Auinger, P.Byrd, R. S.Weitzman, M.Am J Respir Crit Care MedAdolescent*African Continental Ancestry GroupAsthma/epidemiology/*etiologyCausalityChildChild, PreschoolComparative StudyCross-Sectional Studies*European Continental Ancestry GroupFemaleHumanIncidenceInfantMalePoverty/*statistics & numerical dataRisk FactorsSupport, U.S. Gov't, P.H.S.Urban Population/*statistics & numerical datahttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=10988098[18] ADDIN EN.CITE Heinrich2002202121088541962002JunTrends in prevalence of atopic diseases and allergic sensitization in children in Eastern Germany1040-6GSF-National Research Centre for Environment and Health Institute of Epidemiology, Neuherberg, Germany. joachim.heinrich@gsf.deHeinrich, J.Hoelscher, B.Frye, C.Meyer, I.Wjst, M.Wichmann, H. E.Eur Respir JAdolescentAsthma/*epidemiologyChildChild, PreschoolCross-Sectional StudiesDermatitis, Atopic/*epidemiologyFemaleGermany, East/epidemiologyHay Fever/*epidemiologyHumanHypersensitivity/epidemiologyMalePrevalenceSupport, Non-U.S. Gov'thttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12108854[19]. The MDPH pediatric asthma surveillance system does not currently collect information regarding risk factors related to the development of asthma, and therefore the data cannot be used to draw conclusions regarding the causes of reported asthma prevalence in any district or school.
C. Strengths
The value of the Massachusetts approach to asthma surveillance is several-fold. Data collected through school health records are reliable, as shown in a separate MDPH investigation of asthma in the Merrimack Valley. Further, tracking the prevalence of asthma through the schools will make it possible for the first time to assess the magnitude of the problem of pediatric asthma at the local level. While the statewide prevalence of pediatric asthma observed through this program was similar to that seen in other types of surveillance initiatives, surveillance at the community level makes it possible to observe a wide range of different prevalence values by school district, information that was previously unavailable through data sources that focused on statewide or nationwide data.
V. Summary
760 schools representing 311,600 students in grades K-8 participated in the MDPH Pediatric Asthma Surveillance Program.
Reported asthma prevalence in Massachusetts K-8 students ranged from 2.7% to 16.2% among participating school districts.
Reported asthma prevalence in Massachusetts K-8 students ranged from 0 30.8% among participating schools.
The statewide reported asthma prevalence in Massachusetts K-8 students targeted by this surveillance initiative was 9.2%.
Caution should be used when comparing prevalence figures at the school district level because complete data were not available for all districts.
VI. Future Efforts Aimed at Pediatric Asthma Surveillance
This report summarizes the first of a three year effort that the MDPH is scheduled to carry out as part of its Environmental Public Health Surveillance Program. During the second and third years of the program, the MDPH is expanding its target population to include all public, private, and charter schools serving any of grades K-8 in each of the Commonwealths 372 school districts. Through a separate Environmental Public Health Surveillance effort, the MDPH plans to collect indoor air quality data in a selected number of schools statewide in conjunction with the collection of asthma surveillance data. This report represents an important first step in the establishment of a permanent statewide asthma surveillance system in the Commonwealth of Massachusetts.
Pediatric Asthma Surveillance Advisory Committee
Marcia Buckminster
Peg Burton
Linda Cochenour
Mary Jane OBrien
Sarah Poirier
Catherine Porcello
Mary Ellen Shriver
Nancy Sullivan
Katie Vozeolas
VI. References
ADDIN EN.REFLIST 1. U.S. Centers for Disease Control and Prevention (CDC), Disabilities among children aged < or = 17 years--United States, 1991-1992. MMWR Morb Mortal Wkly Rep, 1995. 44(33): p. 609-13.
2. American Lung Association, Asthma in Children Fact Sheet. March 2003.
3. U.S. Centers for Disease Control and Prevention (CDC), Measuring childhood asthma prevalence before and after the 1997 redesign of the National Health Interview Survey--United States. MMWR Morb Mortal Wkly Rep, 2000. 49(40): p. 908-11.
4. Mannino, D.M., et al., Surveillance for asthma--United States, 1960-1995. MMWR CDC Surveill Summ, 1998. 47(1): p. 1-27.
5. New England Asthma Regional Council, Asthma in New England, Part II: Children. 2004.
6. Storey, E., et al., A Survey of Asthma Prevalence in Elementary School Children. 2003: North Haven, CT.
7. Miller, J.E., Predictors of asthma in young children: does reporting source affect our conclusions? Am J Epidemiol, 2001. 154(3): p. 245-50.
8. Schatz, M. and C.A. Camargo, Jr., The relationship of sex to asthma prevalence, health care utilization, and medications in a large managed care organization. Ann Allergy Asthma Immunol, 2003. 91(6): p. 553-8.
9. de Marco, R., et al., Differences in incidence of reported asthma related to age in men and women. A retrospective analysis of the data of the European Respiratory Health Survey. Am J Respir Crit Care Med, 2000. 162(1): p. 68-74.
10. Boezen, H.M., et al., Effects of ambient air pollution on upper and lower respiratory symptoms and peak expiratory flow in children. Lancet, 1999. 353(9156): p. 874-8.
11. Delfino, R.J., et al., Association of asthma symptoms with peak particulate air pollution and effect modification by anti-inflammatory medication use. Environ Health Perspect, 2002. 110(10): p. A607-17.
12. Tolbert, P.E., et al., Air quality and pediatric emergency room visits for asthma in Atlanta, Georgia, USA. Am J Epidemiol, 2000. 151(8): p. 798-810.
13. Sturm, J.J., K. Yeatts, and D. Loomis, Effects of tobacco smoke exposure on asthma prevalence and medical care use in north Carolina middle school children. Am J Public Health, 2004. 94(2): p. 308-13.
14. Rosenstreich, D.L., et al., The role of cockroach allergy and exposure to cockroach allergen in causing morbidity among inner-city children with asthma. N Engl J Med, 1997. 336(19): p. 1356-63.
15. Smith, B.J., et al., Health effects of daily indoor nitrogen dioxide exposure in people with asthma. Eur Respir J, 2000. 16(5): p. 879-85.
16. Lee, Y.L., et al., Indoor and outdoor environmental exposures, parental atopy, and physician-diagnosed asthma in Taiwanese schoolchildren. Pediatrics, 2003. 112(5): p. e389.
17. El-Sharif, N., et al., Familial and environmental determinants for wheezing and asthma in a case-control study of school children in Palestine. Clin Exp Allergy, 2003. 33(2): p. 176-86.
18. Aligne, C.A., et al., Risk factors for pediatric asthma. Contributions of poverty, race, and urban residence. Am J Respir Crit Care Med, 2000. 162(3 Pt 1): p. 873-7.
19. Heinrich, J., et al., Trends in prevalence of atopic diseases and allergic sensitization in children in Eastern Germany. Eur Respir J, 2002. 19(6): p. 1040-6.
Figures
EMBED Excel.Chart.8 \s
Tables
Table 1.
Variables collected on the Pediatric Asthma Surveillance Form. MDPH Pediatric Asthma Surveillance Program, 2002-2003.Variable NameDescriptionMaleNumber of male K-8 students with asthmaFemaleNumber of female K-8 students with asthmaGrade K Grade 8Number of students in each grade with asthma (9 variables, 1 for each grade)% DocumentedPercentage of students with documentation of asthma in health recordSourcesSource(s) that gave nurses knowledge of childrens asthma status
Table 2.
Reported asthma prevalence by grade. MDPH Pediatric Asthma Surveillance Program, 2002-2003.
MDPH Pediatric Asthma Survey, 2002-2003GradePrevalence (%)95% CI (%)K8.1 (2,561)7.8 8.417.7 (2,598)7.4 - 8.028.3 (2,780)8.0 8.639.0 (3,052)8.7 9.349.5 (3,266)9.2 9.8510.0 (3,535)9.7 10.3610.3 (3,692)10.0 10.6710.0 (3,656)9.6 10.289.8 (3,598)9.5 10.2Total9.2 (28,738)9.1 9.3
*Total K-8 students enrolled in participating schools = 311,610.
Table 3
Answers to questions related to school nurses records. MDPH Pediatric Asthma Surveillance Program, 2002-2003QuestionAnswersFrequency (%)Number of Surveillance Forms with this Question Completed
11. For what percentage of the students with asthma do you have documentation in the health record of a provider diagnosis of asthma and/or asthma medication orders?
Less than 75%
25.3730
75% - 85%
24.590% - 100%50.1
12. How else did you (the school nurse) know these students had asthma?Emergency cards
9.0734Parent resource center
0.3Parent communications
41.4Student communications
47.7Direct observation of an asthma attack
0.4Other1.2Appendix I
MDPH Pediatric Asthma Surveillance Form, 2002-2003
Appendix I
Pediatric Asthma Survey Online Form
2002-2003 School Year
The school nurse should complete this form whenever possible. Please provide the following information about the students in your school building who have asthma (of any type or severity).
Include information about students in grades K 8 only.
Complete a separate form for each school building (Do NOT combine data from different schools on one form).
Please answer questions with current information for school year 2002-2003, and return the completed form by May 30, 2003.
Please fill in all of the blanks.
Online instructions
This form can be successfully completed on-screen only if you use "Microsoft Word" version 97 or later (If you do not have Word 97 or later, print the form and write your answers on the paper copy).
Enter information by typing in the "shaded" areas of the form, or by clicking the check-boxes (.
Use the "Tab" key or your mouse to move to different areas of the form (Do not use the "Enter" key).
Carefully follow the instructions at the end of the form for saving your data.
(Office Use Only)
1. School building name: FORMTEXT F O R M T E X T
2 . S t r e e t : F O R M T E X T ( O f f i c e U s e O n l y )
C i t y o r T o w n : F O R M T E X T F O R M T E X T
3 . I s t h i s s c h o o l ( c h e c k ( o n e ) : F O R M C H E C K B O X P a r t o f t h e l o c a l p u b l i c s c h o o l d i s t r i c t F O R M C H E C K B O X A c h a r t e r s c h o o l
F O R M C H E C K B O X P a r t o f a r e g i o n a l s c h o o l d i s t r i c t F O R M C H E C K B O X A n o n p u b l i c s c h o o l
( I f t h i s i s a p u b l i c s c h o o l ) W h i c h p u b l i c s c h o o l d i s t r i c t i s t h i s s c h o o l a p a r t o f ? : ( O f f i c e U s e O n l y )
F O R M T E X T F O R M T E X T
5 . N a m e o f p e r s o n f i l l i n g o u t f o r m : F O R M T E X T
T i t l e : F O R M T E X T
6 . T e l e p h o n e n u m b e r : T e l e p h o n e n u m b e r : F O R M T E X T
7 . F A X n u m b e r : T e l e p h o n e n u m b e r : F O R M T E X T
A p p e n d i x I . ( c o n t inued)
In Questions 8 - 9, please record the number of K-8 students attending this school who have
asthma, using the sex and grade categories listed. Leave no category blank: Enter 0 to indicate there are No students in that category with asthma (or that no students in that category attend your school). Mark the box ( in the right-hand column if you Don't Know the number requested.
Don't Know
8. Sex Telephone number:Male FORMTEXT F O R M C H E C K B O X F e m a l e F O R M T E X T F O R M C H E C K B O X T O T A L
F O R M T E X T F O R M C H E C K B O X
D o n ' t K n o w
9 . G r a d e L e v e l T e l e p h o n e n u m b e r : K i n d e r g a r t e n F O R M T E X T F O R M C H E C K B O X G r a d e 1 F O R M T E X T F O R M C H E C K B O X G r a d e 2 F O R M T E X T F O R M C H E C K B O X G r a d e 3 F O R M T E X T F O R M C H E C K B O X G r a d e 4 F O R M T E X T F O R M C H E C K B O X G r a d e 5 F O R M T E X T F O R M C H E C K B O X G r a d e 6 F O R M T E X T F O R M C H E C K B O X G r a d e 7 F O R M T E X T F O R M C H E C K B O X G r a d e 8 F O R M T E X T F O R M C H E C K B O X T O T A L F O R M T E X T F O R M C H E C K B O X
P l e a s e n o t e t h a t t h e T O T A L S i n q u e s t i o n s 8 &