Published online February 1, 2006
PEDIATRICS Vol. 117 No. 2 February 2006, pp. e192-e199 (doi:10.1542/peds.2005-1140)
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Behavior Problems Among Inner-City Children With Asthma: Findings From a Community-Based Sample

Jill S. Halterman, MD, MPHa,b, Kelly M. Conn, MPHa, Emma Forbes-Jones, PhDb, Maria Fagnano, BAa, A. Dirk Hightower, PhDb and Peter G. Szilagyi, MD, MPHa

a Department of Pediatrics, University of Rochester School of Medicine and Dentistry and the Golisano Children's Hospital at Strong, Rochester, New York
b Children's Institute, Inc, Rochester, New York

OBJECTIVE. Previous studies have suggested a relationship between childhood asthma and behavior problems. However, few studies have used community-based samples to assess the prevalence of behavior problems among urban children with asthma symptoms. The objective of this study was to evaluate the relationship between asthma symptoms and behavior among a population-based sample of inner-city children and to determine the prevalence of behavioral comorbidity among children with asthma symptoms.

METHODS. In 2003, parents of children who were entering kindergarten in the city of Rochester completed a detailed survey regarding the child's background, medical history (with specific questions about asthma symptoms), and behavior. We compared children with no asthma symptoms, intermittent symptoms, and persistent symptoms with regard to positive peer social skills (eg, makes friends easily), negative peer social skills (eg, fights with other children), task orientation (eg, concentrates well), and shy/anxious behavior (eg, is withdrawn) (validated scales; range: 1–4). We used multivariate regression to determine the independent association between symptom severity and behavioral outcomes.

RESULTS. A total of 1619 children were included (response rate: 80%; mean age: 5.1 year), and 15% had asthma symptoms (8% persistent, 7% intermittent). Average negative peer scores were worse for children with persistent asthma symptoms compared with children with intermittent and no symptoms (mean scores: 1.88, 1.70, and 1.65). Children with persistent symptoms also scored worse than children with no symptoms on the assessment of task orientation (2.85 vs 3.03) and shy/anxious behavior (2.11 vs 1.89). Among children with persistent asthma symptoms, >20% scored >1 SD below average on 2 or more scales, compared with 16% of children with intermittent symptoms and 10% with no symptoms.

CONCLUSIONS. Urban children with persistent asthma symptoms demonstrate more behavior problems across several domains compared with children with no symptoms. These findings suggest a clear need for an early biopsychosocial approach to care for vulnerable children with asthma.

Key Words: childhood asthma • inner-city • behavior • co-morbidity

Abbreviations: PACE—Parent's Appraisal of Children's Experiences

Accepted Jul 26, 2005.


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