In 2000, children and adolescents under age 18 had over 212 million ambulatory health care visits, including 49 million visits to hospital outpatient and emergency departments (EDs). Only 15 percent of visits to physicians' offices were for well-child care, while a high number of visits were for acute care.
Fifty-four percent of visits to hospital EDs by 5- to 14-year-olds are due to injuries, and injuries are the leading cause of death among those 1 to 24 years of age in the United States. AHRQ's research portfolio on acute care and injuries focuses on the effectiveness, quality, safety, and costs of care for children and adolescents.
Anatomic factors may play an important role in pediatric traumatic brain injury.
Significant traumatic brain injury (TBI) occurs in 5 to 10 percent of all patients with blunt head trauma. Among emergency department patients who underwent computed tomography (CT) for blunt head trauma at 21 hospital EDs, men, children younger than age 10, and elderly people were most likely to have significant TBI. The researchers note that children have a larger head-to-body ratio that may allow more energy from a traumatic impact to be distributed to the head. Almost half of children under age 10 with TBI have a skull fracture. Also, certain mechanisms of injury (e.g., child abuse) are unique to children and may increase the risk of TBI.
Holmes, Hendey, Oman, et al., Am J Emerg Med 24:167-173, 2006 (AHRQ grant HS09699).
Certain clinical criteria can identify children with blunt head trauma who do not need a CT scan.
Seven clinical criteria can be used to identify pediatric victims of blunt head trauma who are at low risk for important intracranial injury (ICI) and thus are unlikely to need a CT scan. The seven factors are: evidence of significant skull fracture, altered level of alertness, neurologic deficit, persistent vomiting, presence of scalp hematoma, abnormal behavior, and blood coagulation problems. Children who do not meet at least one of these criteria are at low risk for ICI and thus are unlikely to require neurosurgical intervention or suffer significant long-term impairment.
Oman, Cooper, Holmes, et al., Pediatrics 117(2), 2006 online at www.pediatrics.org (AHRQ grant HS09699).
U.S. rates of Kawasaki syndrome are highest in Japanese American children living in Hawaii.
Kawasaki syndrome (KS), which primarily strikes children under age 5, can cause serious heart disease due to inflammation of the coronary arteries. The cause of KS is unknown. The disease currently affects Japanese American children living in Hawaii more than any other group, including children living in Japan. During the period 1996-2001, 267 individuals younger than age 18 living in Hawaii were hospitalized for KS; 85 percent of those affected were younger than 5. The mean hospital stay for children with KS was 2 days, and the median hospital charge was $9,379.
Holman, Curns, Belay, et al., Pediatr Infect Dis J 24(5):429-433, 2005
(AHRQ Publication No. 05-R073).*
Also: Holman, Curns, Belay, et at., Pediatrics 112(3):495-501, 2003
(AHRQ Publication No. 04-R002)*
(Intramural).
Placing children in a semi-recumbent position provides better images from echocardiography.
According to this study, placing children in a semi-recumbent position at a 70-degree angle with back support results in better quality images during exercise echocardiography procedures, compared with a 90-degree upright position. In the semi-recumbent posture with back support, children were able to maintain torso stability during cycling to facilitate better quality images in a shorter period of time.
Chang, Qi, Larson, et al., Am J Cardiol 95:918-921, 2005 (AHRQ grant HS13217).
Child abuse is linked with increased risk of death in young children with abdominal injuries.
Between 1995 and 2001, more than half (61 percent) of traumatic abdominal injuries in young children 0 to 4 years of age resulted from motor vehicle accidents. Other significant causes were child abuse (16 percent) and falls (14 percent). Children who were abused and had abdominal and central nervous system injury were more likely than other children with abdominal trauma to die while in the hospital, according to this analysis of data on 927 cases of blunt abdominal injuries in young children.
Trokel, DiScala, Terrin, and Sege, Child Maltreat 9(1):111-117, 2004 (AHRQ grant T32 HS00060).
Instrument provides reliable information about children with brain injuries.
Researchers developed and tested a measure of neurologic outcome for use in triage and clinical decisionmaking for children who have suffered traumatic brain injuries. They tested the instrument—the Neurologic Outcome Scale for Infants and Children—in 100 children of varying ages. They found the instrument to be practical and reliable and applicable to infants and children with a broad range of neurologic deficits.
Okada, Young, Baren, et al., Acad Emerg Med 10(10):1034-1039, 2003 (AHRQ grant F32 HS00091).
Researchers are focusing on the distinctive health care needs of adolescents. Recent AHRQ-funded studies have focused on such adolescent prevention topics as screening for sexually transmitted diseases (STDs) and smoking cessation.
Quality improvement teams can improve screening among male adolescents.
Routine screening for Chlamydia trachomatis (CT) infection is recommended for sexually active young women aged 15-25 years. Only the American Medical Association recommends routine screening of sexually active male adolescents. This study involved more than 1,000 sexually active male adolescents aged 14 to 18 who were seen in pediatric clinics in the San Francisco Bay area. Those youths seen in clinics that had a quality improvement team were much more likely to be screened for CT infection than those seen in clinics without such a team. Researchers found that 4 percent of those screened had CT infection.
Tebb, Pantell, Wibbelsman, et al., Am J Public Health 95(10):1806-1810, 2005 (AHRQ grant HS10537).
Hospital type and location affect discharge disposition of adolescents hospitalized for suicide attempts.
Adolescents who are hospitalized after a suicide attempt are more likely to be discharged to a psychiatric, rehabilitation, or chronic care facility if they are hospitalized in a facility that caters to children and/or is located in the Northeast United States. This suggests that factors other than the medical and emotional needs of vulnerable adolescents are driving care.
Levine, Schwarz, Argon, et al., Arch Pediatr Adolesc Med 159:860-866, 2005 (AHRQ grant HS00002).
Two factors predict risk for repeat suicide attempts among youths.
Two factors predict which youths referred for emergency psychiatric hospitalization because of suicide attempts will try to commit suicide again: more severe clinical depression and caregivers who exert more parental control. This study involved 70 youths aged 10 to 17 who had attempted suicide and their families. Most of the families were economically disadvantaged.
Huey, Henggeler, Rowland, et al., J Clin Child Adolesc Psychol 34(3):582-589, 2005 (AHRQ grant HS10871).
Wisconsin study finds hundreds of hospitalizations for self-poisoning among adolescents.
The researchers analyzed Wisconsin hospital discharge files for 2000-2002. They focused on medication-related injuries for intention to commit suicide, medications used, discharge status, and risk factors for self-poisoning (such as mental illness and eating disorders). During the 3-year study period, there were nearly 3,000 hospitalizations for medication-related injuries—of which 1,150 involved self-poisoning—among Wisconsin youths 12 to 17 years of age.
Marbella, Yang, Guse, et al., Wis Med J 104(7):59-64, 2005 (AHRQ grant HS11893).
Physician attitudes and other factors affect decisions about use of growth hormone therapy.
Growth hormone (GH) therapy is usually reserved for the shortest 1.2 percent of U.S. children at about age 10. The height goal is usually average height for a 16-year-old male (68.3 inches) or 14-year-old female (62.6 inches). A GH-deficient youngster who has received GH for several years typically shows gradual tapering of growth beginning in mid-adolescence. Some physicians advocate discontinuing therapy when the potential for continued growth decreases, while others seem to value even small gains as the final height goal approaches. The average cost of GH therapy is $26,000 per year.
Cuttler, Silvers, Singh, et al., Med Care 43(12):1185-1193, 2005 (AHRQ grant HS00059).
Adolescents with special health care needs seldom receive adequate transition from pediatric to adult-oriented care.
About one in five adolescents in the United States has special health care needs. Each year, 750,000 of these adolescents become adults and must transition to adult-oriented health care. Researchers analyzed data for 4,332 adolescents aged 14 to 17 years and found that about 50 percent of parents had discussed transition issues with their child's doctor. Adolescents with special needs who were older, female, had more complicated needs, and had a high-quality relationship with their doctors were more likely to receive adequate health care transition.
Scal and Ireland, Pediatrics 115(6):1607-1612, 2005 (AHRQ grant HS15511).
Most teens with chlamydial infections get antibiotics but may not receive counseling and other care.
Researchers reviewed the medical charts of 111 sexually active teens, aged 14 to 19, who tested positive for Chlamydia trachomatis in 2001 at five pediatric clinics in California. All but four teens received appropriate antibiotics in a timely fashion, but counseling about high-risk sex, testing for other sexually transmitted diseases, and other services were provided less often. Only 36 percent of the patients were tested for other sexually transmitted diseases, and significantly fewer boys than girls received counseling about safer sex.
Hwang, Tebb, Shafer, and Pantell, Arch Pediatr Adolesc Med 159:1162-1166, 2005 (AHRQ grant HS10537).
Certain practice factors are associated with more frequent screening and counseling of adolescents about risky behaviors.
In this study, specialized clinician training and charting tools were associated with increases in rates of screening and counseling of adolescents about risky behaviors, such as substance abuse, unsafe sex, and risky vehicle use.
Ozer, Adams, Lustig, et al., Pediatrics 115(4):960-968, 2005 (AHRQ grant HS11095).
Certain factors increase the likelihood of posttraumatic stress disorder (PTSD) in adolescents who suffer a serious injury.
Researchers surveyed adolescent trauma patients aged 12 to 19 who had been hospitalized following a serious injury to assess their outcomes at various points up to 24 months postdischarge. They found that perceived threat to life and intentional or violence-related injury doubled the likelihood that the youths would experience PTSD.
Other factors that often led to PTSD included having no control over the event leading to injury or death of a family member at the scene. Girls and older adolescents had higher rates of PTSD than boys and younger adolescents, and low socioeconomic status was strongly associated with long-term PTSD. Those with PTSD were more likely to have behavioral problems, abuse alcohol and drugs, have difficulty staying in school, and suffer from depression.
Holbrook, Hoyt, Coimbra, et al., J Trauma Injury Infect Crit Care 58:764-771, 2005 (AHRQ grant HS07611).
Adolescents underuse primary care and seldom receive counseling about risky behaviors.
Researchers used data from two surveys (1993-2000) to examine adolescents' use of outpatient care and receipt of preventive counseling. They found that adolescents (particularly boys and minorities) aged 13 to 18 had the lowest rates of outpatient visits among all age groups. The researchers examined counseling on three health topics:
and five risk-reduction topics:
Only 39 percent of routine visits included counseling for diet and/or exercise. Counseling for other topics ranged from a low of 3 percent to 20 percent, with skin cancer prevention, HIV/STD transmission, and family planning/contraception ranking the lowest.
Ma, Wang, and Stafford, J Adolesc Health 36:441e1-441e7, 2005 (AHRQ grant HS11313).
Physician confidence leads to increased screening of adolescents for risky behaviors.
This study found that providers' confidence in their ability to deliver preventive services was correlated with provider-reported screening of adolescents for tobacco use, alcohol use, sexual behavior, seat belt use, and helmet use.
Ozer, Adams, Gardner, et al., J Adolesc Health 35:101-107, 2004 (AHRQ grant HS11095).
Preparticipation physicals for high school athletes may be inadequate.
High school students must have physical exams before they can participate in school-sponsored sports. However, this study found that the preparticipation physical evaluation (PPE) as currently practiced is ineffective. Medical history taking and exams are inadequate to reliably detect and exclude rare life-threatening conditions, evaluations are seldom connected with followup care, and PPE programs are inconsistently and incompletely delivered.
Bundy and Feudtner, Ambulatory Pediatr 4(3):260-263, 2004 (AHRQ grant K08 HS00002).
Screening tool identifies adolescents at risk for carrying firearms.
Answers to four simple screening questions and male sex can be used to generate a score that is fairly sensitive and specific for identifying youths that carry firearms. A FiGHTS score reflects fighting (Fi), gender (G), hurt while fighting (H), threatened (T), and smoker (S). An extended 13-item FiGHTS that includes questions about sexual behavior, substance abuse, and criminal behavior is even more sensitive.
Hayes and Sege, Ann Emerg Med 42(6):198-207, 2003 (AHRQ grant T32 HS00060).
Qualitative research involving homeless adolescents is challenging.
The main challenges of conducting qualitative research with homeless youths include establishing and maintaining healthy researcher roles and boundaries, addressing the risks of researcher burn out and safety, assuring optimal confidentiality, and avoiding sensationalism and voyeurism. The author reviews professional guidelines for such research, describes potential data sources, and recounts personal experiences.
Ensign, J Adv Nurs 43(1):43-50, 2003 (AHRQ grant HS11414).
A specially designed screener helps identify adolescents who have a chronic condition.
The researchers validated the Children with Special Health Care Needs Screener among new enrollees in Florida's State Children's Health Insurance Program. The study involved 522 adolescents and their parents who generally agreed about the presence of a chronic condition and the need for specialized health care services for the adolescent.
Youngblade and Shenkman, J Pediatr Psychol 28(6):393-401, 2003 (AHRQ grant HS10465).
Adolescents who were extremely low birthweight (ELBW) infants seem to view themselves positively.
In this study, ELBW adolescents aged 12 to 16 years did not perceive themselves to have significantly greater behavioral problems than control teens in the following six areas: conduct disorder, oppositional-defiant disorder, ADHD, overanxious state, separation anxiety, and depression. Parents, however, reported significantly higher scores for depression and ADHD for their ELBW teens than parents of control teens.
Saigal, Pinelli, Hoult, et al., Pediatrics 111(5):969-975, 2003 (AHRQ grant HS08385).
Asthma is a chronic inflammatory disease of the airways that affects approximately 5 million U.S. children a year. An estimated 400,000 of these children have moderate to severe asthma. It is the most common chronic disease of childhood, with about one-fourth of those affected being less than 5 years of age. Reducing asthma-related illness continues to be a major objective for the U.S. Public Health Service.
Parental use of a computer-based asthma kiosk in the emergency department elicits mixed results.
Researchers asked parents to use a computer-based kiosk in the hospital ED to enter their child's asthma symptoms, current medications, and unmet care needs. The asthma kiosk printed out a tailored plan of recommended asthma care based on the parental input. The intent was for parents to share the recommendations with their child's ED clinicians.
So far, the kiosk has had a small and variable impact on asthma care quality. Physicians' limited use of kiosk-generated asthma care recommendations may explain this disappointing result. A mismatch between an activated parent and a less-than-proactive provider may have widened a gap in parent-provider partnership that the kiosk was meant to narrow, note the researchers.
Porter, Forbes, Feldman, and Goldmann, Pediatrics 117(1), 2006; online at www.pediatrics.org (AHRQ grant HS11660).
Enrollment in SCHIP can improve quality of care and access for children with asthma.
This study of more than 2,600 children with asthma in New York State found that after enrollment in the State Children's Health Insurance Program (SCHIP), quality of care improved for the children, and asthma-related attacks, medical visits, and hospitalizations declined. Also, the number of children lacking a usual source of care declined from 5 percent to 1 percent.
Szilagy, Dick, Klein, et al., Pediatrics 117(2):486-496, 2006 (AHRQ grant HS10450).
Study uncovers higher rate of asthma among Puerto Rican children compared with other U.S. children.
Researchers analyzed 1997-2001 data on the prevalence of asthma diagnosis and asthma attacks in a sample of more than 46,500 U.S. children aged 2 to 17. They found that over one-fourth of Puerto Rican children in the study group were diagnosed with asthma at some point, compared with 16 percent of black children, 13 percent of white children, and 10 percent of Mexican children.
Similarly, 12 percent of Puerto Rican children had suffered a recent asthma attack, compared with 7 percent of black children, 6 percent of white children, and 4 percent of Mexican children. These disparities were not explained by asthma risk factors (such as household smoking) or other sociodemographic characteristics.
Lara, Akinbami, Flores, and Morgenstern, Pediatrics 117(1)43-53, 2006 (AHRQ grant HS00008).
Interventions that improve pediatric asthma outcomes in clinical trials may not translate to the practice level.
Education for practice-based peer leaders and the presence of asthma nurse educators improved the use of asthma controller medications and reduced hospital visits for children with asthma who were enrolled in a randomized trial. However, when measured on all patients in the participating practices, these same interventions had no detectable impact on asthma medication use or asthma-related hospital and ER visits. The authors call for more research to develop interventions that will help practices and health plans improve chronic and preventive care for children with asthma.
Finkelstein, Lozano, Fuhlbrigge, et al., Health Services Res 40(6):1737-1757, 2005 (AHRQ grant HS08368).
Having a usual source of care increases wellness visits among children with asthma.
Researchers analyzed data from the 1996-2000 Medical Expenditure Panel Survey (MEPS) to assess wellness visits, bronchodilator fills/refills, and ER visits of 1,726 children with asthma. They also looked at the children's usual source of care, including characteristics such as ease of getting an appointment on short notice. Overall 95 percent of children had a usual source of care.
Over the course of a year, one in ten children made at least one asthma-related visit to the ER, four in ten had at least one wellness visit, and half (50 percent) filled a rescue bronchodilator prescription. The researchers conclude that children who have a usual source of care are twice as likely as those who do not to have a wellness examination during the year.
Kieckhefer, Greek, Joesch, et al., J Pediatr Health Care 19(5):285-292, 2005 (AHRQ grant HS13110).
Parents' use of a computerized asthma kiosk improves ER treatment of children's asthma.
Researchers asked parents to use a multimedia, touch screen interface to provide their child's medication history while the child was receiving emergency care for an asthma exacerbation. They compared the parents' kiosk entries to the documentation of ED physicians and nurses and found that the parents' reports improved the validity of documentation by physicians across all medication details (except for medication name) and was more valuable than nursing documentation at triage.
Porter, Kohane, and Goldmann, JAMIA 12(3):299-305, 2005 (AHRQ grant
HS11660).
Also: Porter, Cai, Gribbons, et al., JAMIA 11:458-467, 2004 (AHRQ
grant K08 HS11660).
Primary care programs that include nurse case managers and physician peer leaders can reduce children's asthma symptoms.
According to this study, a primary care program that uses nurse case managers to educate children about their asthma and physician peer leaders to educate primary care practitioners about asthma treatment guidelines can reduce children's asthma symptoms. Children who were in the program had an average of two additional symptom-free weeks per year. The study involved 638 children aged 3 to 17 with mild to moderate persistent asthma. The program did have an impact on the annual costs of asthma care, which were $1,292 for intervention patients, compared with $385 for patients who received usual asthma care.
Sullivan, Lee, Blough, et al., Arch Pediatr Adolesc Med 159:428-434, 2005 (AHRQ
grant HS08368).
Also: Homer, Forbes, Horvitz, et al., Arch Pediatr Adolesc Med 159:464-460,
2005 (AHRQ grant HS10411).
Ethnicity, environmental factors, and reduced pulmonary function can predict asthma severity in children.
Black or Puerto Rican ethnicity, sensitization to cockroach allergens, and spirometry tests showing reduced pulmonary function greatly increased the likelihood of severe asthma in children aged 4 to 18 who were enrolled in an asthma care program in Hartford, CT. This is the first study to show an association between asthma severity and both Puerto Rican ethnicity and decreased forced expiratory volume.
Ramsey, Celedon, Sredl, et al., Pediatr Pulmonol 39:268-275, 2005 (AHRQ grant HS11147).
Exposure to tobacco smoke and underuse of controller medications exacerbate asthma symptoms among preschoolers.
This study involved 368 children ages 3 to 5 in an Arkansas Head Start program for disadvantaged preschoolers. Four out of five of the children suffered from persistent asthma, but only one-third of the children received appropriate medication to control asthma. Many of the children (52 percent of families) also were exposed to asthma triggers such as cigarette smoke. Only about one-third of children were receiving appropriate treatment for asthma.
Vargas, Simpson, Wheeler, et al., J Allergy Clin Immunol 114:499-504, 2004 (AHRQ grant HS11062).
Researchers call for standardized measures of asthma severity.
Parents of children who have asthma associate missed school days and absences from work with more severe asthma, which are different measures of asthma severity than those used by physicians and researchers. The authors of this article conclude that more widely understood asthma measures are needed.
Yawn, Fryer, and Lanier, J Asthma 41(6):623-630, 2004 (AHRQ Publication No. 05-R047)* (Intramural).
Certain features of primary care practice enhance pediatric asthma care.
The quality of asthma care could be improved for poor, Medicaid-insured children if primary care practices would promote cultural competence among their staff, provide feedback reports to individual clinicians, and ensure easy access to and continuity of care. Primary care for asthma is also improved when one practice physician is trained in asthma care guidelines as a peer leader, and nurses visit patients and provide support for patient self-management.
Lieu, Finkelstein, Lozano, et al., Pediatrics 114(1), 2004 online at
www.pediatrics.org (AHRQ grant HS09935).
Also: Lozano, Finkelstein, Carey, et al., Arch Pediatr Adolesc Med
158:875-883, 2004 (AHRQ grant HS08363).
Regular use of controller medication improves outcomes for children with persistent asthma.
The researchers used health plan claims data and interviewed parents of children enrolled in five Medicaid managed care plans. They found that children with persistent asthma who were dispensed inhaled antiinflammatory medications one to three times during the year were much more likely to use hospital-based asthma care than those who received the medication six or more times during the year.
Farber, Chi, Capra, et al., Ann Allergy Asthma Immunol 92:319-328,
2004 (AHRQ grant HS09935).
Also: Yoos, Kitzman, and McMullen, Ambulatory Pediatr 3:181-190, 2003
(AHRQ grant HS10689).
Also: Annett, Bender, DuHamel, and Lapidus, J Asthma 40(5):577-587, 2003
(AHRQ grant HS09123).
Asthma symptom days determine annual costs of care for children with persistent asthma.
The researchers used medical records and missed parent workdays to determine asthma symptom burden and resource use for 638 children with mild to moderate persistent asthma in four managed care systems in three U.S. geographic regions. The median total annual asthma-related cost for the group was $564, with medications accounting for more than half of direct costs. Symptom days predicted costs better than tests of lung function.
Gendo, Sullivan, Lozano, et al., Ann Allergy Asthma Immunol 91:251-257, 2003 (AHRQ grant HS08368).
Enrollment in Medicaid managed care improved pediatric asthma care.
Massachusetts children covered by Medicaid and enrolled in an HMO were only half as likely as those in a State-administered primary care case manager plan to end up in the ER or be hospitalized for asthma. Also, the HMO provided greater access to specialists and more timely followup care after asthma ED visits than the case manager plan. For the study, the researchers used claims and encounter data on 2,365 children enrolled in the Massachusetts Medicaid program in 1994.
Shields, Comstock, Finkelstein, and Weiss, Ambulatory Pediatr 3(5):253-262, 2003 (AHRQ grant HS09327).
Parents need more education about asthma.
Researchers interviewed parents to examine their beliefs, knowledge, and attitudes about asthma management. Nearly half of the parents had received minimal or no instruction when their child was first diagnosed. Half of those who were taught about their children's medications could not remember the mechanism of action.
Peterson-Sweeney, McMullen, Yoos, et al., J Pediatr Health Care 17:118-125, 2003 (AHRQ grant HS10689).
Parents misunderstand the role of antiinflammatory medicines.
Investigators interviewed 1,663 parents of asthmatic children, focusing on the 571 who had persistent asthma. The children were enrolled in Medicaid managed care programs in California, Washington, and Massachusetts. Nearly one-fourth of the parents thought that inhaled antiinflammatory medication should be used to treat the symptoms of persistent asthma instead of daily to prevent symptoms.
Farber, Capra, Finkelstein, et al., J Asthma 40(1):17-25, 2003 (AHRQ HS09935).
Pediatric asthma admissions are examined in two States.
In this study, claims data on pediatric asthma admissions to children's and general hospitals in New York and Pennsylvania were used to compare length of stay, the probability of prolonged stay (more than 3 days), conditional length of stay, and the probability of readmission. There were no differences in the discharge rate after hospital day three. However, Pennsylvania hospitals appear more efficient in the treatment of less severely ill children.
Silber, Rosenbaum, Even-Soshan, et al., Health Serv Res 38(3):867-886, 2003 (AHRQ HS09983).
School-based health centers reduce asthma-associated costs.
Researchers evaluated whether the availability of school-based health center (SBHC) services measurably affected the health and school performance of 949 inner-city children with asthma. The rate of hospitalization was higher among children attending non-SBHC schools (17 vs. 11 percent) as was the number of school days missed (21 vs. 18 days). SBHCs may offer a practical response to the limited access that poor and uninsured children have to health care.
Webber, Carpiniello, Oruwariye, et al., Arch Pediatr Adolesc Med 157:125-129, 2003 (AHRQ grant HS10136).
SBHCs can improve management of asthma among poor children.
This study of school-based health centers in four elementary schools in New York City shows that they are providing primary care, including asthma management, to low-income, inner-city children who often have no other regular source of primary care and end up in the ED with uncontrolled asthma. However, the school care providers do not closely adhere to established asthma care guidelines.
Oruwariye, Webber, and Ozuah, J School Health 73(5):186-190, 2003 (AHRQ grant HS10136).
Parents of hospitalized children change smoking behaviors after intervention.
The Stop Tobacco Outreach Program was offered to 71 parents who smoked and whose children were hospitalized for asthma, pneumonia, or other respiratory illness. Eighty percent of parents completed the counseling sessions, 49 percent had a stop-smoking attempt of 24 hours or more, and 21 percent had not smoked a cigarette in the last 7 days. Also, 71 percent of the parents prohibited smoking in the home after the program (vs. 29 percent at enrollment).
Winickoff, Hillis, Palfrey, et al., Pediatrics 111(1):140-145, 2003 (AHRQ grant T32 HS00063).
Many children are using asthma medications inappropriately.
Parents of 638 children with asthma who were cared for at one of 42 managed care primary care practices in three U.S. regions were interviewed. Results showed that 64 percent of the children with persistent asthma were inadequately controlled. Older age, minority race, and household poverty were significantly associated with inadequate control.
Lozano, Finkelstein, Hecht, et al., Arch Pediatr Adolesc Med 157:81-88, 2003 (AHRQ grant HS08368).