The 130th Annual Meeting of APHA

Abstract #47431

Ilan H. Meyer, PhD¹, Thomas Matte, MD², Joanne K. Fagan, PhD³, Jennifer Ahern, MPH², Sebastian Bonner, PhD², Robert B. Mellins, MD⁴, Beverley Sheares, MD⁵, Mitchell Rubin, MD⁶, and David Evans, PhD⁷. (1) Mailman School of Public Health, Department of Sociomedical Sciences, Columbia University, 722 West 168th Street, New York, NY 10032, 212.305.1952, im15@columbia.edu, (2) Center for Urban Epidemiologic Studies, New York Academy of Medicine, 1216 Fifth Avenue, Fifth floor, New York, NY 10029, (3) Joseph L. Mailman School of Public Health, Columbia University, 118 Essex Avenue, Glen Ridge, NJ 07028, (4) Department of Pediatrics, Columbia University College of Physicians & Surgeons, 630 West 168th Street, New York, NY 10032, (5) Department of Pediatrics, Columbia University, 630 West 168th Street, Room BHS-745, New York, NY 10032, (6) Department of Pediatrics, New York Medical College, 3 Washington Square Village, #14B, New York, NY 10012, (7) Pediatrics, Columbia University College of Physicians & Surgeons, 630 West 168th Street, Room CHS-745, New York, NY 10032

We tested a brief staff-administered questionnaire for identifying children with asthma at Head Start programs in New York City’s East and Central Harlem. 15 items assessed asthma-related symptoms, treatment, school absenteeism, and history of asthma diagnosis by a physician. Of 422 children, 197 (47%) screened positive for asthma or possible asthma. Validation of asthma was made by independent review by 3 pediatric physicians of results of a comprehensive interview conducted about a month after the screen. Respondents were parents or guardians of 150 (76%) of the children who screened positive and a random sample of 50 of the children who screened negative. Of these 200 children, 102 (51%) were girls; 78 (39%) Latino, 81 (41%) black, and 39 (20%) reported another ethnicity/race. The chance-corrected agreement between the screen and validation diagnoses was good: Kappa=0.72 (95% CI=0.61, 0.84), Positive Predictive Value=95%, and Negative Predictive Value=74%. Children who were true positives were more likely than false negatives to have been hospitalized overnight (54% vs. 8%; OR=14.0, 95% CI=1.8-110.5) and to have used bronchodilators (71% vs. 15%; OR=13.55, 95% CI=2.9-63.8), suggesting that true positives had clearer and more severe indicators of asthma than false negatives. Misclassification did not differ by gender, age, language (English vs. Spanish), or program site. We conclude that a brief screen for asthma accurately identifies children with asthma. Such a tool can be important for identifying children and parents who need asthma-related interventions.

Learning Objectives:

• Recognize problems in early screening for asthma among young children
• Describe alternative measurement tools to detect asthma using survey research questionnaires
• Identify a brief screen tool for detecting asthma in young children and describe its predicitve value
• Discuss challenges in adapting breif screen for asthma detection at head start programs

Keywords: Asthma, Child Health

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.