Comparison of Secondhand Smoke Exposure in Minority and Non-minority Children with Asthma

Objective—Determine if secondhand smoke exposure (SHSE) 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 SHSE differences across families persist when accounting for smoking factors. Methods—Participants were 305 caregiver smokers of children with asthma. Two passive dosimeters measured SHS: one in the home and one worn by the child. Results—Higher SHSE was related to greater asthma-related functional morbidity. African Americans had higher levels of home SHSE than Latinos (p = .003) or NLWs (p = .021). SHSE 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 \u3c .05). African Americans were less likely to report having two or more smokers in the home (37.2%) compared to NLWs (53.6%; p \u3c .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 \u3c .001). SHS home exposure levels were regressed on race/ethnicity and relevant covariates. Household smoking ban (p \u3c .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. Conclusions—Differences in SHSE 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

Assessing the Diagnostic Utility Of Proposed Adult Adhd Symptoms In A Young Adult Sample

Attention Deficit/Hyperactivity Disorder (ADHD) affects approximately 4 to 5% of adults. Adults diagnosed with ADHD experience more academic, social, and occupational difficulties than their same age counterparts To address the dearth of scientific knowledge concerning adult ADHD, Barkley and Murphy proposed nine items that had diagnostic utility for diagnosing adult ADHD. These nine items have not been tested in another sample. The current study was aimed to cross-validate the proposed adult ADHD items in a younger adult sample. Participants were recruited for an ADHD group, a clinical control group, and a typical control group. Participants were recruited from three large universities (i.e., one in the Southeast, one in the Southwest, and one in the Mountain West). Participants completed a demographic form, a DSM-IV symptom checklist and Barkley and Murphy's proposed criteria. Regression analyses were conducted to determine whether the DSM-IV criteria and/or the proposed adult criteria accounted for unique variance in impairment. Measures of impairment were a self-reported impairment checklist, high school and college GPA. When impairment was the DV, the proposed adult criteria (? = .28, p <.001), DSM-IV inattention (? = .37, p < .001), and DSM-IV hyperactivity (? = .20, p < .001) all accounted for unique variance. When high school GPA was the DV, the proposed adult criteria (? = -.08, p = .09) did not account for unique variance but DSM-IV inattention (? = -.24, p < .001) and hyperactivity (? = .11, p < .02) did. When college GPA was the DV, the proposed adult criteria (? = -.25, p < .001), DSM-IV inattention (? = -.11, p = .032) and hyperactivity (? = .15, p = .002) all accounted for unique variance. Barkley and Murphy (2006) demonstrated that their proposed criterion set, focusing on executive functioning, has diagnostic utility. However, they used a sample with a mean age of 32 to 37 years of age while the current sample had a range of 18 to 57 and a mean age of 20. Perhaps due to the younger sample, both the proposed adult and DSM-IV criteria have diagnostic utility. Therefore, the use of both the DSM-IV criteria and proposed adult criteria is recommended for college students.Department of Psycholog

Parents’ Perspectives on the Theoretical Domains Framework Elements Needed in a Pediatric Health Behavior App: A Crowdsourced Social Validity Study

A grant from the One-University Open Access Fund at the University of Kansas was used to defray the author's publication fees in this Open Access journal. The Open Access Fund, administered by librarians from the KU, KU Law, and KUMC libraries, is made possible by contributions from the offices of KU Provost, KU Vice Chancellor for Research & Graduate Studies, and KUMC Vice Chancellor for Research. For more information about the Open Access Fund, please see http://library.kumc.edu/authors-fund.xml.Background: Most pediatric studies do not include parent stakeholders in the design of the intervention itself and many pediatric mobile health (mHealth) interventions are not meaningfully disseminated after the trial period ends. Consequently, the consumer desire for mobile apps targeting pediatric health behavior is likely to be met by commercial products that are not based in theory or evidence and may not take stakeholder preferences into account. Objective: The aim was to assess parent preference for mobile app features that map onto specific Theoretical Domains Framework (TDF) elements. Methods: This study was a crowdsourced social validity study of 183 parents who were asked to rate their preferences for mobile app features that correspond to elements of the TDF. The TDF organizes a large number of theoretical models and constructs into three components: (1) capability, (2) motivation, and (3) opportunity. Parents of children were recruited through Amazon Mechanical Turk. Results: The majority of participants were Caucasian and mean age was 36.9 (SD 8.0) years. Results revealed broad acceptability of communication, motivation, and opportunity domains. However, the degree to which each domain was valued varied within behavioral category. Parents demonstrated a preference for increasing procedural knowledge for physical activity and diet behaviors over sleep (F2,545=5.18, P=.006). Similarly, parents valued self-monitoring as more important for physical activity than sleep (F2,546=4.04, P=.02). When asked about the value of features to help children develop skills, parents preferred those features for dietary behavior over sleep (F2,546=3.57, P=.03). Parents perceived that goal-setting features would be most useful for physical activity over sleep and diet (F2,545=5.30, P=.005). Incentive features within the app were seen as most useful for physical activity over sleep (F2,546=4.34, P=.01). Conclusions: This study presents a low-cost strategy for involving a large number of stakeholders in the discussion of how health behavior theory should be applied in a mHealth intervention. Our approach is innovative in that it took a scientific framework (ie, TDF) and made it digestible to parents so that they could then provide their opinions about features that might appear in a future app. Our survey items discriminated between various health behaviors allowing stakeholders to communicate the different health behaviors that they would like a TDF feature to change. Moreover, we were able to develop a set of consumer opinions about features that were directly linked to elements of the TDF

Caregiver perceptions of change in pediatric asthma control during the COVID-19 pandemic

PURPOSE: Although several indicators suggest that pediatric asthma control in the United States improved early in the pandemic, other indicators suggest not. Missing are reports from caregivers of the experiences of their children with asthma early in the pandemic. METHODS: Using the PP-ACT and other measures that we specifically constructed for our research, we conducted a cross-sectional national survey of US caregivers of children with asthma (N=595) to examine perceived change in their child\u27s asthma control and changes in reports of ED visits and use of emergency relief medicine and controller medicine pre-pandemic (January to March 2020) versus early-pandemic (June to September 2020). RESULTS: Caregivers fell into three groups: most caregivers perceived that their child\u27s asthma control was improved (50.3%) or unchanged (41.2%), and few reported worse control (8.5%). Surprisingly, all three groups of caregivers reported similar frequencies of early-pandemic and pre-pandemic ED visits and use of emergency relief medicine. Also surprising, caregivers who perceived their child\u27s asthma as more controlled (compared with the other two groups) reported more frequent ED visits and use of emergency relief medicine, yet also more use of controller medicine at both early-pandemic and pre-pandemic. CONCLUSION: The mismatch between caregivers\u27 perceptions of their child\u27s early-pandemic asthma control and their reports of ED visits and use of emergency relief medicine suggests that caregivers may rely on a gist (a global evaluation that can include nonbiomedical evidence) when estimating their child\u27s asthma control. Caregivers and their families could benefit from help from clinicians in understanding the discrepancy between subjective asthma control and asthma control indicators and in understanding what well-controlled asthma looks and feels like

Exploring caregiver interest in and preferences for interventions for children with risk of asthma exacerbation: Web-based survey

BACKGROUND: Maintaining control of asthma symptoms is the cornerstone of asthma treatment guidelines in the United States. However, suboptimal asthma control and asthma exacerbations among young people are common and are associated with many negative outcomes. Interventions to improve asthma control are needed. For such interventions to be successful, it is necessary to understand the types of interventions that are appealing to caregivers of children with different levels of risk of exacerbation. OBJECTIVE: This study aimed to evaluate whether caregivers of children with high (vs low) risk of asthma exacerbation show different levels of interest in and preferences for potential intervention programs and delivery methods. METHODS: We contracted with Ipsos to administer a web-based survey to caregivers of children with asthma who were residing in the United States. Caregivers (N=394) reported their interest (1=not at all; 3=a lot) in 9 possible intervention programs and 8 possible intervention delivery methods. Caregivers also indicated their preferences by selecting the 3 intervention programs and 3 delivery methods that most interested them. Finally, caregivers completed 2 open-ended questions asking what other resources might be useful for managing their children\u27s asthma. We classified children as having a high risk of exacerbation if they had an exacerbation in the past 3 months (n=116) and a low risk of exacerbation if otherwise (n=278). RESULTS: Caregivers reported higher levels of interest in all intervention programs and delivery methods if they cared for a child with a high risk rather than a low risk of exacerbation. However, regardless of the child\u27s risk status, caregivers expressed the highest levels of interest in programs to increase their child\u27s self-management skills, to help pay for asthma care, and to work with the school to manage asthma. Caregivers expressed the highest levels of interest in delivery methods that maintained personal control over accessing information (websites, videos, printed materials, and smartphone apps). Caregivers\u27 preferences were consistent with their interests; programs and delivery methods that were rated as high in interest were also selected as one of the 3 that most interested them. Although most caregivers did not provide additional suggestions for the open-ended questions, a few caregivers suggested intervention programs and delivery methods that we had not included (eg, education about avoiding triggers and medication reminders). CONCLUSIONS: Similar interests and preferences among caregivers of children with high and low risk of exacerbation suggest a broad need for support in managing childhood asthma. Providers could help caregivers by directing them toward resources that make asthma care more affordable and by helping their children with asthma self-management. Interventions that accommodate caregivers\u27 concerns about having personal control over access to asthma information are likely to be more successful than interventions that do not

Youth and caregiver asthma functioning and quality of life throughout the COVID-19 pandemic

ObjectivesThe COVID-19 pandemic resulted in daily functioning changes for many families. Adjustments in daily functioning may have impacted asthma management and subsequent morbidity. The current study seeks to build upon extant literature by exploring differences in youth asthma exacerbations and control, as well as youth and caregiver asthma-related quality of life (ArQOL) throughout COVID-19 transitional points.MethodsNinety-three youth (9–17 years old) with asthma and their caregivers completed measures of demographic/medical information, asthma control, and ArQOL. Participants were recruited between January 2020 and October 2021 via their medical appointments and a hospital registry. We conducted Kruskal–Wallis H-tests to examine differences in youth asthma exacerbations (measured by short-acting beta agonist use), asthma control, and ArQOL, as well as caregiver ArQOL, across phases of the COVID-19 pandemic.ResultsAsthma exacerbations were higher prior to the onset of the pandemic compared to “during lockdown” and “post-lockdown,” H(2) = 7.31, p &lt; .05. Youth's asthma control was lower prior to the onset of the pandemic compared to youth enrolled “post-lockdown,” H(2) = 7.04, p &lt; .05. There were no differences in youth ArQOL across the duration of the pandemic. Caregiver ArQOL was significantly higher in the “post-lockdown,” period, compared to caregivers enrolled prior to the pandemic onset, H(2) = 9.86, p &lt; .01.ConclusionYouth and caregiver asthma functioning improved following the onset of the pandemic. These findings build upon existing literature to highlight higher ArQOL in caregivers following the pandemic onset, likely related to improvements in youth asthma control and morbidity. Future research should explore trajectories of asthma and psychosocial functioning throughout the pandemic for families

Primary Caregivers of Children Affected by Disorders of Sex Development: Mental Health and Caregiver Characteristics in the Context of Genital Ambiguity and Genitoplasty

Purpose. To determine the relationship between having a child with a DSD including ambiguous external genitalia, as well as the decision of whether or not to have early genitoplasty for that child, on the mental health and parenting characteristics of caregivers. Materials and Methods. Caregivers were recruited from centers that specialize in DSD medicine and completed the Beck Depression Inventory 2nd Edition (BDI-2), Beck Anxiety Index (BAI), Parent Protection Scale (PPS), Child Vulnerability Scale (CVS) and Parenting Stress Index/Short Form (PSI/SF). Results and Conclusions. Sixty-eight caregivers provided informed consent and completed the study. Among female caregivers whose children never received genitoplasty, greater parenting stress was reported (F(1, 40) = 5.08, p = .03). For male caregivers, those whose children received genitoplasty within the first year of life reported more overprotective parenting and parenting stress than those whose children received genitoplasty later than 12 months of age (F(1, 13) = 6.16, p = 0.28); F(1, 15) = 6.70, p = .021), respectively)

Adaptive Mobile Health Intervention for Adolescents with Asthma: Iterative User-Centered Development

Background: Adolescents diagnosed with persistent asthma commonly take less than 50% of their prescribed inhaled corticosteroids (ICS), placing them at risk for asthma-related morbidity. Adolescents’ difficulties with adherence occur in the context of normative developmental changes (eg, increased responsibility for disease management) and rely upon still developing self-regulation and problem-solving skills that are integral for asthma self-management. We developed an adaptive mobile health system, Responsive Asthma Care for Teens (ReACT), that facilitates self-regulation and problem-solving skills during times when adolescents’ objectively measured ICS adherence data indicate suboptimal rates of medication use. Objective: The current paper describes our user-centered and evidence-based design process in developing ReACT. We explain how we leveraged a combination of individual interviews, national crowdsourced feedback, and an advisory board comprised of target users to develop the intervention content. Methods: We developed ReACT over a 15-month period using one-on-one interviews with target ReACT users (n=20), national crowdsourcing (n=257), and an advisory board (n=4) to refine content. Participants included 13-17–year-olds with asthma and their caregivers. A total of 280 adolescents and their caregivers participated in at least one stage of ReACT development. Results: Consistent with self-regulation theory, adolescents identified a variety of salient intrapersonal (eg, forgetfulness, mood) and external (eg, changes in routine) barriers to ICS use during individual interviews. Adolescents viewed the majority of ReACT intervention content (514/555 messages, 93%) favorably during the crowdsourcing phase, and the advisory board helped to refine the content that did not receive favorable feedback during crowdsourcing. Additionally, the advisory board provided suggestions for improving additional components of ReACT (eg, videos, message flow). Conclusions: ReACT involved stakeholders via qualitative approaches and crowdsourcing throughout the creation and refinement of intervention content. The feedback we received from participants largely supported ReACT’s emphasis on providing adaptive and personalized intervention content to facilitate self-regulation and problem-solving skills, and the research team successfully completed the recommended refinements to the intervention content during the iterative development process

Dust Settling in Magnetorotationally-Driven Turbulent Discs II: The Pervasiveness of the Streaming Instability and its Consequences

We present a series of simulations of turbulent stratified protostellar discs with the goal of characterizing the settling of dust throughout a minimum-mass solar nebula. We compare the evolution of both compact spherical grains, as well as highly fractal grains. Our simulations use a shearing-box formulation to study the evolution of dust grains locally within the disc, and collectively our simulations span the entire extent of a typical accretion disc. The dust is stirred by gas that undergoes MRI-driven turbulence. This establishes a steady state scale height for the dust that is different for dust of different sizes. This sedimentation of dust is an important first step in planet formation and we predict that ALMA should be able to observationally verify its existence. When significant sedimentation occurs, the dust will participate in a streaming instability that significantly enhances the dust density. We show that the streaming instability is pervasive in the outer disc. We characterize the scale heights of dust whose size ranges from a few microns to a few centimeters. We find that for spherical grains, a power-law relationship develops for the scale height with grain size, with a slope that is slightly steeper than -1/2. The sedimentation is strongest in the outer disc and increases for large grains. The results presented here show that direct measurements of grain settling can be made by ALMA and we present favorable conditions for observability. The streaming instability should also be directly observable and we provide conditions for directly observing it. We calculate collision rates and growth rates for the dust grains in our simulations of various sizes colliding with other grains, and find that these rates are significantly enhanced through the density enhancement arising from the streaming instability.Comment: 39 pages, 13 figures, submitted to MNRAS. Abstract is abridge