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PEDIATRICS Vol. 102 No. 6 December 1998, p. e68
,,,
,, and
From the * Department of Pediatrics, University of California,
Los Angeles, and RAND Health, University of California, Los
Angeles/RAND Program on Latino Children with Asthma, Los Angeles,
California; the § University of California, Los Angeles, School of
Nursing, Los Angeles, California; and the Pediatric Diagnostic
Center, Ventura, California.
 |
ABSTRACT |
|---|
Top
Abstract
Methods
Results
Discussion
References
|
|---|
Objectives. To determine, in a population of predominantly Latino children with asthma 6 to 18 years old, whether parent and child reports of asthma symptoms with exercise differ and to evaluate the validity of child and parent reports of symptoms.
Design. Data obtained from child and parent interviews; pulmonary function tests (forced vital capacity, forced expiratory volume in 1 second, forced expiratory flow25-75, peak expiratory flow), and observation of symptoms after exercise.
Setting. Three summer camps for minority children with asthma in Los Angeles County.
Participants. A total of 97 children with asthma (78% Latino, 12% non-Latino White, 9% Other; 6 to 18 years of age) and their parents.
Intervention(s). None.
Primary Outcome Measures. Child and parent reports of cough and wheezing with exercise and pulmonary function tests before and after exercise. While at camp, children underwent spirometry after completing the self-administered survey. The pulmonary function tests were conducted and interpreted according to the pediatric specifications for spirometry, and results >80% of predicted, adjusted for gender, age, height, and race, were considered normal. Six peak expiratory flow rates (PEFR) by peak flow meter also were recorded by trained research assistants immediately before spirometry, and values >80% of predicted based on height were considered normal. To observe child symptoms with exercise, children participated in a relay running race of 200 feet followed by a swimming race of 300 feet. Research assistants measured heart rate and 6 PEFRs using ASSESS portable peak flow meters immediately before and after each exercise. A positive exercise challenge was defined as a 15% reduction in mean PEFR and/or observed asthma symptoms (cough, wheezing, chest pain, asthma attack).
Results. Of the children, 18% reported never having a
cough when they exercised, 46% reported having it occasionally when
they exercised, and 36% reported having it quite often or always when
they exercised. For wheezing, 20% of children reported never having
wheezing when they exercised, 35% having it occasionally when they
exercised, and 45% having it quite often or always when they
exercised. Parents reported fewer symptoms than did their children. Of
the parents, 34% reported that their children did not have cough with
exercise, 37% reported few to some days, and 29% reported most days
or every day. Forty-seven percent of parents reported that their child did not wheeze with exercise in the last 2 months, 35% reported wheezing on a few days to some days, and 17% reported wheezing most
days to every day.Parent and child reports of cough or wheezing after exercise correlated
mildly with each other (parent/child cough r = 0.23; 
= 0.03; parent/child wheezing r = 0.21; = 0.14). Children were more likely to report cough: 59 of 71 (83%) of
children versus 44 of 71 (62%) of parents. The 22 children who
reported cough when their parents did not account for most of the
disagreement between parents and children. Children were more likely
than were their parents to report wheezing; 55 of 69 (80%) children
versus 36 of 69 (52%) parents reported that the child wheezed. The 24 children who reported wheezing when their parents did not account for
most of the disagreement between parents and children. Forty-seven percent of the children had a value <80% of predicted for
at least one of the four spirometry tests; 29% of mean baseline PEFRs
were <80% of predicted. Overall, 86% of the children met one or more
of the following: any percent of predicted pulmonary function tests
<80% or any symptom or PEFR reduction of 15% after exercise, or
other occurrence of nonexercise symptoms during camp. Almost all child reports of cough and wheezing correlated significantly
with the criterion validity criteria. For example, child reports of
wheezing were, as expected, correlated negatively with the percent of
predicted FEV1 (r = 
0.28) and
correlated positively with observed symptoms after exercise
(r = 0.3). On the other hand, neither parent
reports of cough nor those of wheezing correlated significantly with
any of the pulmonary function tests or symptomatic validity criteria. Parent reports of wheezing were correlated positively with construct
validity variables such as 1) parent reports of child's bother
(r = 0.35) and activity limitation
(r = 0.23) because of asthma; 2) more use of
rescue or bronchodilator medications (r = 0.18); 3) more parent worry about asthma overall
(r = 0.29); and 4) parent perception of asthma
severity being moderate to very severe instead of mild or very mild
(r = 0.28). Child reports of cough and wheezing
were not correlated significantly with almost all of the
parent-reported factors hypothesized to be associated with asthma
morbidity.
Conclusions. Clinicians and researchers evaluating asthma morbidity in children should elicit child reports of symptoms. More research is necessary to understand discordance between child and parent reports of symptoms and its relationship to asthma morbidity experienced by the child. Key words: childhood asthma, Latino/Hispanic, exercise symptoms, parent perception, child perception.
Health care providers treating children with asthma should
be aware of differences between child and parent reports of symptoms. Previous research on asthma1-3 and other conditions4-7 demonstrates that parent and child reports
differ and suggests that children may be more valid reporters than
their caregivers.8,9 However, for the most part, clinicians
and researchers rely on the parent report and/or pulmonary function
tests to evaluate the impact of asthma experienced by the child.
Discordance in symptom reports may reflect differences between the
parent and child in awareness of the child's asthma symptoms and/or
psychosocial experience with the illness.10,11 Because it
is usually the parent who initiates care, these differences in
perspective may be associated with differences in use of health
services and compliance. Given the rise in child asthma morbidity among
poor and minority children,12-14 and Latino children in
particular,15-18 it is important to explore differences in
parent and child reports of symptoms among Latino children.
In a population of predominantly Latino children with asthma, 6 to 18 years of age, we 1) describe whether parent and child reports of asthma
symptoms with exercise differ from each other, and 2) evaluate the
validity of child and parent reports of symptoms.
Subject Recruitment
During the summer of 1994, we recruited children attending three
camps in Los Angeles for poor and minority children with asthma. This
method has been used previously.19,20 Children were
included only if parents indicated that their child had a physician
diagnosis of asthma.
Parent and Child Interview Data
A single half-hour parent interview was carried out by telephone
by trained bilingual interviewers 1 week or less before children attended camp and after they had been selected for attendance. Parents
were asked about 1) child asthma symptoms (frequency of cough and
wheezing with exercise in the last 2 months); 2) child functional
status and quality of life limitations attributable to asthma
(frequency of bother in the last 2 months, limitation of normal
activities in the last 2 months, school days lost in the last year); 3)
child health care use for asthma (type of medications used in the last
2 months, doctor and emergency department visits for asthma in the last
year, hospitalizations for asthma in the last year, whether regular
provider is an asthma specialist); 4) parental worry related to asthma
(overall, about child activity limitation, medications, and side
effects); 5) parental perception of the child's asthma severity; and
6) sociodemographics. We used a 2-month recall period to test
concordance between the child and parent report of symptoms and the
parent and the physiologic function tests. We used a 12-month recall to
evaluate the relationship of parent reports of symptoms to infrequent
events (use of emergency departments, hospitals). Children completed
self-administered questionnaires at camp before physiologic
testing;21 a trained bilingual research assistant was
available to answer children's questions (Appendix 1 and 2).
Pulmonary Testing and Clinical Data
While at camp, children underwent spirometry after completing
the self-administered survey. The pulmonary function tests (forced expiratory volume in 1 second [FEV1], forced vital
capacity [FVC], forced expiratory flow between 25% and 75% vital
capacity [FEF25-75], and peak expiratory flow [PEF]
were conducted and interpreted according to the pediatric
specifications for spirometry,22,23 and results >80% of
predicted adjusted for gender, age, height, and race24,25
were considered normal. Six peak expiratory flow rates (PEFR) by peak
flow meter also were recorded by trained research assistants
immediately before spirometry, and values >80% of predicted based on
height26 were considered normal.
To observe child symptoms with exercise, children participated in a
relay running race of 200 feet followed by a swimming race of 300 feet.
The running and swimming lasted ~1 to 2 minutes each. Research
assistants measured heart rate and six PEFRs using ASSESS portable peak
flow meters26 immediately before and after each exercise. A
positive exercise challenge was defined as a 15% reduction in mean
PEFR27 and/or observed asthma symptoms (cough, wheezing,
chest pain, asthma attack).
Children also were monitored twice a day on the day of and the day
after pulmonary testing for the presence of a standardized list of
asthma symptoms. Trained research assistants supervised by asthma
clinicians (ML or CL) asked children questions regarding their symptoms
that day. All investigators and research assistants were blinded to the
parent and child survey responses when they conducted and interpreted
the pulmonary function tests and observed the children. The research
protocol for the parent and child interviews and the physiologic
testing were approved by the UCLA Committee for the Protection of Human
Subjects.
Analysis
To evaluate the criterion validity of both parent and child
report, we calculated Pearson's correlation coefficients between the
reports of cough and wheezing and 1) percent of predicted value of
FEV1, 2) percent of predicted value for mean PEFR, 3) direct observation of exercise intolerance, and 4) presence of other
asthma symptoms. Presence of daily asthma symptoms was defined as a
positive child report of symptoms to the research assistant or presence
of signs or symptoms recorded by the camp asthma clinician that day. In
addition, we compared parent and child reports of symptoms to one
composite "clinically symptomatic" criterion that was met when any
of the percent of predicted spirometry tests (FEV1,
FEF25-75, FVC, PEF) was <80% predicted, mean PEFR was
<80% predicted, or when criterion three or four was met.
To evaluate construct validity, we correlated parent and child reports
of symptoms to other measures of asthma morbidity. We hypothesized that
parent and child report of symptoms would be related to health care use
(medications for asthma, outpatient and emergency department visits,
hospitalizations, having an asthma specialist), and functional
impairment attributable to asthma (bother, activity limitation, school
days lost). In addition, we hypothesized that parent reports of
symptoms would correlate with parent worry10 and perception
of the child's asthma severity.
To evaluate agreement between parent and child reports of asthma
symptoms, we: 1) calculated Pearson's correlation coefficients between
the parent response (scaled 1 to 5) and child responses (scaled 1 to 4)
for the cough and wheezing questions with exercise, and 2) calculated
Characteristics of Population
We recruited 100% of all 97 children with a parent-reported
diagnosis of asthma. Ninety-five (98%) of the parents completed the
telephone survey, and 82 (85%) of children completed the camp survey
and 84 (87%) participated in the pulmonary testing and exercise
challenge. The majority of children in our sample were boys (60%),
reported by their parents as Latino (78%), and born in the United
States (94%). The mean age was 10.1 years (SD, 2.2; range, 6 to 18),
with 65% being younger than 11 years of age (Table
1). During the previous 2 months,
approximately two thirds of children were bothered by asthma, and
slightly greater than half were limited by asthma in their normal
activities. Approximately half of the parents perceived their child's
asthma to be at least moderate. Almost all children used inhaled
bronchodilators for asthma symptoms. During the last year, three
quarters of the children had seen a doctor for asthma, and 7% had been
hospitalized. Forty-one percent had a regular provider who was a
children's asthma specialist (Table 2).
TABLE 1 TABLE 2
METHODS
Top
Abstract
Methods
Results
Discussion
References
statistics for cross-tabulations of dichotomized parent and child
reports of cough and wheezing. We assigned a value of 0 for a response
of "never" for parent and child reports and a value of 1 for a
parent's response of "a few days, some days, most days, and every
day" and for a child's response of "not very often, quite often,
and always." We classified the level of agreement as follows: 
0
(no agreement); 0 < 0.2 (poor agreement); 0.2 < 0.4 (mild agreement); > 0.4 (moderate to good
agreement).28,29
RESULTS
Top
Abstract
Methods
Results
Discussion
References
Sociodemographic Characteristics of Population
Child Asthma Morbidity and Health Care Use as Reported by Parents
Disagreement Between Parent and Child Reports of Asthma Symptoms
Eighteen percent of children reported never having a cough when they exercised, 46% having it occasionally when they exercised, and 36% having it quite often or always when they exercised. Twenty percent of children reported never having wheezing when they exercised, 35% having it occasionally when they exercised, and 45% having it quite often or always when they exercised. Parents reported fewer symptoms than did their children; 34% of parents reported that their children did not have cough with exercise, 37% reported few to some days, and 29% reported most days or everyday. Forty-seven percent of parents reported that their child did not wheeze with exercise in the last 2 months, 35% reported a few days to some days, and 17% reported most days to every day.
Parent and child reports of cough or wheezing after exercise correlated
mildly with each other (parent/child cough, r = 0.23, P = .05, = 0.03; parent/child wheezing,
r = 0.21, P = .08, = 0.14).
Cross-tabulations and analyses confirmed these findings (Table
3). Children were more likely to report
cough: 59 of 71 (83%) children versus 44 of 71 (62%) parents. Most of the disagreement between parents and children is accounted for by the
22 children who reported cough when their parents did not. Children
were more likely than were their parents to report wheezing: 55 of 69 (80%) children versus 36 of 69 (52%) parents reported that the child
wheezed. Most of the disagreement between parents and children is
accounted for by 24 children who reported wheezing when their parents
did not.
|
Pulmonary Testing and Clinical Observation
Forty-seven percent of the children had a value <80% of predicted for at least one of the four spirometry tests; 29% of the children had a PEFR <80% of predicted. The correlation coefficients among the pulmonary function tests ranged from r = 0.5 to r = 0.8.
The standardized exercise challenge was effective in raising the
child's heart rate (34% postrunning and 19% postswimming). Cough was
the most common observed symptom after exercise and 9% of the children
experienced a 
15% reduction of PEFR. Overall, 86% percent of the
children met one or more of the following: any percent of predicted
pulmonary function tests <80% while at rest, presence of any symptom
or PEFR reduction of 15% after exercise, or other occurrence of
nonexercise symptoms during camp (Table
4).
|
Criterion and Construct Validity
Almost all child reports of cough and wheezing correlated
significantly with the criterion validity criteria. For example, child
reports of wheezing were, as expected, correlated negatively with the
percent of predicted FEV1 (r = 0.28; P = .03) and correlated positively with
observed symptoms after exercise (r = 0.3;
P = .02). However, neither parent reports of cough nor
those of wheezing correlated significantly with any of the pulmonary
function tests or symptomatic validity criteria (Table
5).
|
Parent reports of wheezing were correlated positively with construct validity variables such as 1) parent reports of child's bother (r = 0.35; P = .0008) and activity limitation (r = 0.23; P = .03) attributable to asthma; 2) more use of rescue or bronchodilator medications (r = 0.18; P = .09; 3) more parent worry about asthma overall (r = 0.29; P = .005); and 4) parent perception of asthma severity being moderate to very severe, instead of mild or very mild (r = 0.28; P = .008). Child reports of cough and wheezing were not correlated significantly with almost all of the parent-reported factors hypothesized to be associated with asthma morbidity.
| |
DISCUSSION |
|---|
|
Top
Abstract
Methods
Results
Discussion
References
|
|---|
In a predominantly Latino sample of children with asthma, we found that parents and children do not report the same symptoms and that children's reports appear to be more valid than their parent's reports. To our knowledge, this is the first study that has evaluated the validity of parent and child reports of symptoms in a Latino population. Our study provides evidence of the criterion validity of child reports and the need to question children directly about their symptoms instead of only depending on the parent as a proxy.
Our findings are consistent with previous studies8 indicating that children can be more valid reporters than their parents. In a sample of 52 Canadian children 7 to 17 years old with asthma Guyatt found that for children older than age 11, the child's global rating of symptoms was correlated more significantly with pulmonary function test results and report of symptoms and medication use than were the parents' global ratings of the child's symptoms. With the measures discussed above, we have replicated these findings in a predominantly Latino sample.
Our findings also are consistent with other studies2,30,31
demonstrating a relationship between parent reports of symptoms and
nonphysiologic measures of asthma morbidity. In a sample of 105 children, 6 to 18 years of age, with asthma, Fritz2
demonstrated that parent factor scores of symptom ratings
but not
children's ratingswere related to parent reported measures of
functional morbidity and health care use. Other
investigators30,31 also have found that parent reports of
health status in children with asthma are related to health care use.
There are a number of limitations to our study. We were not able to compare time-related changes in symptom report to changes in physiologic function. We did not interview children in settings identical to their daily environments nor simultaneously with parents. It is possible that children learned to be more correctly aware of their symptoms than did their parents because of their educational experiences in camp. If parents had received similar "educational experiences," agreement between child and parent might have been better. Because of feasibility constraints, we did not administer parent and child survey items with exactly the same recall time nor conduct time-consuming, more specialized physiologic testing such as a longer exercise challenge or a bronchodilator reversibility test.
More research is necessary both to understand the causes of disagreement between parent and child reports of asthma symptoms and to assess the validity of parent and child reports. Preliminary studies indicate that a child's capacity to detect asthma symptoms may vary and may be related to cognitive or emotional domains. Fritz19 found that children with higher IQs were better predictors of their PEFRs. Given the reported prevalence of emotional and mental health disorders in children with asthma,32,33 future research could test the hypothesis that children's report of symptoms are associated with their psychosocial state.
We believe that more work needs to be performed in symptom perception to understand how differences in parent and child reports of symptoms influence patient compliance and behavior. Prospective clinical trials and intervention studies that measure morbidity through parent and child report and physiologic testing are necessary. Qualitative studies that ask parents and children to discuss or resolve their reported differences also can shed light on how to interpret parent and child disagreement. In the meantime, to monitor and improve asthma control, clinicians should elicit cough and wheezing reports directly from children. We need to listen more to children with asthma. Only in this way can we evaluate fully the morbidity they experience, optimize health care management, and thus improve their quality of life and capacity to function normally.
| |
APPENDIX 1. Bilingual Parent Survey Measures Used |
|---|
For the parent questionnaire, we drew from already translated
survey items included in the National Health Interview
Survey34 and the UCLA Community-based Education Program for
Latino Children with Asthma.35 For parent questions, we
kept the 2-month and 12-month recall time frames used in the source
questionnaires. Before administration, the items were pilot-tested with
small focus groups of predominantly Mexican-American parents to
evaluate comprehension and cultural and Spanish language
appropriateness.
ASTHMA MORBIDITY
Exercise-induced Symptoms
How often has (child's name) been troubled by the following
symptoms when hurrying, or running, or playing sports in the last 2 months?
a. cough
never
a few days
some
days
most days
every
day
1
2
3
4
5
b. wheezing
never
a few days
some days
most days
every
day
1
2
3
4
5
¿Cuántas veces le han molestado los siguientes
síntomas a (nombre del niño/a) cuando se apura, corre o
juega deportes en los últimos 2 meses?
a. tos
nunca
pocos días
algunos días
la mayor parte de los días
todos los días
1
2
3
4
5
b. silbido
nunca
pocos días
algunos días
la mayor parte de los
días
todos los días
1
2
3
4
5
Functional Status and Quality of Life
In the last 2 months, how often has his/her asthma caused pain,
discomfort or upset?
Never
Once in a while
Often
All of the time
1
2
3
4
¿Durante los últimos 2 meses, cuántas
veces su asma le causó sufrimiento, incomodidad o molestia?
Nunca
De vez en cuando
Muchas veces
Toda la
parte del tiempo
1
2
3
4
During the past 2 months, how often did asthma limit or
prevent (child's name) from doing usual childhood activities, such as
playing with other children or participating in games or sports?
None of the time
A little of the time
Some of the time
Most of the time
All of the time
1
2
3
4
5
¿Durante los últimos 2 meses, cuántas
veces el asma limitó o impidió a (nombre del niño/a)
de hacer actividades habituales para los niños/as, tal como jugar
con otros niños/as o participar en juegos o deportes?
Ninguna parte del tiempo
Una poca parte del tiempo
Alguna parte del tiempo
La mayor parte del tiempo
Toda la parte
del tiempo
1
2
3
4
5
How many days of school did (child's name) miss in the past 12 months because of asthma?
___days
¿Cuantos días (nombre del niño/a) faltó a la escuela en los últimos 12 meses por asma?
___días
HEALTH CARE USE
Medications
Please get the medications (child's name) has taken for asthma in the last 2 months. For each medication, I will ask you the name, instructions for use in the label, the form of medication (e.g. pills, syrup, inhaler), and when the child took it.
a. Name of medication:
b. Dosage as appears on label:
c. Form of medication:
d. Did the doctor suggest (child's name) take medication
prior to exercise
prior to environment exposure
as
needed
1
2
3
other:
e. During the past 2 months, how many days did (child's name actually take the medication ___ # of days
Comments:
Por favor busque las medicinas que (nombre del niño/a) ha tomado para el asma en los últimos 2 meses. Para cada medicina, le preguntaré el nombre, las instrucciones para su uso que aparecen en la etiqueta, el tipo de medicina (pastillas, jarabe, inhalador) y cuando el niño/a la tomó.
a. Nombre de la medicina:
b. Dósis según la etiqueta:
c. Tipo de medicina:
d. ¿El médico sugirió que (nombre del niño/a)
tomara la medicina:
antes de hacer ejercicio
antes
de ser expuesto a provoca ciones ambientales
cuando sea
necesario
1
2
3
Otro:
e. ¿Durante los últimos 2 meses, cuántos días realmente tomó la medicina?
___ # de días
Comentarios:
Doctor Visits
During the past 12 months, about how many times did (child's name)/you see or talk to a medical doctor or assistant about (child's name)'s asthma? (Do not count doctors seen while in an overnight patient in the hospital).
___Number of doctor visits in last 12 months
¿Durante los últimos 12 meses, como cuántas veces (nombre del niño/a) o usted fué o habló con un doctor u otro asistente médico por el asma de (nombre del niño/a)? (No cuente a los doctores que vió cuando se quedó en el hospital por la noche).
___Número de visitas al doctor en los últimos 12 meses
Emergency Room Use
How many times has (child's name) gone to the emergency room for asthma?
___times in the last 2 months
___times in the last 12 months
¿Cuántas veces (nombre del niño/a) ha ido a la sala de emergencia por su asma?
___veces en los últimos 2 meses
___veces en los últimos 12 meses
Hospitalizations
How many times has (child's name) been hospitalized for asthma?
___times in the last 2 months
___times in the last 12 months
¿Cuántas veces (nombre del niño/a) ha sido hospitalizado por su asma?
___veces en los últimos 2 meses
___veces en los últimos 12 meses
Type of Regular Doctor
What kind of doctor regularly takes care of (child's name)'s
asthma?
Pedíatrician
Allergist or
pulmonologist
Family doctor
Emergency room doctor
Other:
___
Does not have a regular
doctor
1
2
3
4
5
6
¿Que tipo de doctor cuida regularmente el asma de
(nombre del niño/a)?
Pedíatra
Alergista
o pneumólogo
Doctor de familia
Doctor de sala de
emergencia
Otro: ___
No tiene doctor
regular
1
2
3
4
5
6
ENVIRONMENTAL EXPOSURES
Is anyone in the household currently smoking cigarettes?
Yes
No
1
2
¿Alguién en la casa fuma cigarillos
actualmente?
Sí
No
1
2
Do you have any of the following inside your home?
|
|||||||||||||||||||
¿Tiene cualquiera de lo siguiente dentro de su casa?
|
|||||||||||||||||||
OTHER PARENT PERCEPTIONS
Worry Overall
During the past 2 months, how much has your child's asthma
worried or concerned you?
Not at all
A little
Somewhat
A great deal
Extremely
1
2
3
4
5
¿Durante los últimos 2 meses, cuanto le
preocupó o inquietó el asma de su hijo/a?
Nada
Un poco
Algo
Muchísimo
Extremadamente
1
2
3
4
5
Worry About Medicines
During the past week, how worried or concerned were you about
your child's asthma medications and side effects?
Very, very worried/concerned
Very worried/concerned
Fairly worried/concerned
Somewhat worried/concerned
A little worried/concerned
Hardly worried/concerned
Not
worried/concerned
1
2
3
4
5
6
7
Durante la última semana, ¿cuán
preocupado/a o inquieto/a estuvo usted sobre las medicinas de su hijo/a
y sus posibles efectos?
Muy, muy
preocupado/inquieto
Muy preocupado/inquieto
Bastante
preocupado/inquieto
Algo preocupado/inquieto
Un poco
preocupado/inquieto
Apenas preocupado/inquieto
Nada
preocupado/inquieto
1
2
3
4
5
6
7
Worry About Activities
During the past week, how worried or concerned were you about
your child's performance of normal daily activities?
Very, very worried/concerned
Very worried/concerned
Fairly worried/concerned
Somewhat worried/concerned
A little
worried/concerned
Hardly worried/concerned
Not
worried/concerned
1
2
3
4
5
6
7
Durante la última semana, ¿cuán
preocupado/a o inquieto/a estuvo usted sobre el desempeño de
actividades normales de cada día de su hijo/a?
Muy, muy preocupado/inquieto
Muy
preocupado/inquieto
Bastante preocupado/inquieto
Algo
preocupado/inquieto
Un poco preocupado/inquieto
Apenas
preocupado/inquieto
Nada preocupado/inquieto
1
2
3
4
5
6
7
Severity
Overall, how would you rate the severity of (child's name)
asthma?
Very mild
Mild
Moderate
Severe
Very severe
1
2
3
4
5
¿En general, cómo estima usted es de severa el
asma de (nombre del niño/a)?
Muy leve
Leve
Moderada
Severa
Muy severa
1
2
3
4
5
SOCIODEMOGRAPHICS
Child Ethnicity
To what ethnic group does (child's name) belong?
Latino/Hispanic-American
Black/African-American
White, non-Latino/Hispanic
Asian-American
Other:
___
1
2
3
4
5
¿A que grupo étnico pertenece (nombre del
niño/a)?
Latino/Hispanoamericano
Negro/Afroamericano
Blanco, no Latino/Hispano
Asiático-americano
Otro: ___
1
2
3
4
5
Child's Country of Origin
Where was your child born?
City
Country
¿Dónde nació su hijo/a?
Ciudad
País
Parent Ethnicity
To what ethnic group do you belong?
Latino/Hispanic-American
Black/African-American
White, non-Latino/Hispanic
Asian-American
Other:
___
1
2
3
4
5
¿A que grupo étnico pertenece usted?
Latino/Hispanoamericano
Negro/Afroamericano
Blanco,
no Latino/Hispano
Asiático-americano
Otro:
___
1
2
3
4
5
Parent's Country of Origin
In what country were you born?
City
Country
¿En que país nació usted?
Ciudad
País
Educational Level
What is the highest grade or year of school that you completed? (circle one)
Elementary 00 01 02 03 04 05 06 07 08
High School 09 10 11 12
College 13 14 15 16 17+
¿Cuál es el grado más alto o año que completó en la escuela? (marque uno)
Primaria 00 01 02 03 04 05 06 07 08
Secundaria 09 10 11 12
Universidad 13 14 15 16 17+
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APPENDIX 2. Bilingual Child Survey Measures Used |
|---|
The following survey items were selected from
Weston21 and translated by Marielena Lara (bilingual
Spanish native speaker) into Spanish. The English and Spanish items
were pilot-tested before use. We did not modify the items to include a
specific time frame for child recall of exercise-induced symptoms.
Previous research indicates that a child's capacity to conceptualize
illness and symptoms36-38 is related to age and that
preadolescent children can have difficulty with time-related information.39 We believed that more error would be introduced by using previously untested child items and that the younger children in our sample would not be able to understand a
specific time frame.
Exercise-induced Wheeze
1. Do you get wheezy breathing when you exercise or play
sports?
Never
Not very often
Quite often
Always
1
2
3
4
1. ¿Te da silbido o pito cuando haces ejercicio?
Nunca
No muchas veces
Bastante
Siempre
1
2
3
4
Exercise-induced Cough
2. Do you cough a lot when you exercise or play sports?
Never
Not very often
Quite often
Always
1
2
3
4
2. ¿Toses mucho cuando haces ejercicio?
Nunca
No muchas veces
Bastante
Siempre
1
2
3
4
| |
FOOTNOTES |
|---|
Dr Lara was a Clinical Scholar and a Minority Medical Faculty Fellow with the Robert Wood Johnson Foundation and a recipient of a National Research Service Award by the Agency for Health Care Policy and Research when this study was performed.
An earlier version of this article was presented at the National Meeting of the Ambulatory Pediatric Association in 1995.
Received for publication Mar 3, 1998; accepted Jul 6, 1998.
Reprint requests to (M.L.) RAND Health, 1700 Main St, Box 2138, Santa Monica, CA 90401-2138.
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ACKNOWLEDGMENTS |
|---|
We thank Karen Spritzer, MS, for her diligent performance of the analyses; Amanda Kerbs, Adolfo Aguilera, Ramón Díaz, Hilda Fernández, René Rizo, and the staff of the UCLA Community-based Education Program for Latino Children with Asthma for their help collecting the data; Marlene Nishimoto, Linda Escalante, Ana Ríos, Peter Scott, and Carrie Imai for their administrative assistance; Fisons Pharmaceuticals, Rochester, NY, and Healthscan Products, Inc, Cedar Grove, NJ, for donating the peak flow meters used; and Multispiro, Inc, Irvine, CA, for lending us the portable spirometers.
This work is dedicated to the children with asthma and their parents who participated in this study and, in particular, to the memory of one of these children, who has since died of asthma.
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ABBREVIATIONS |
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FEV1, forced expiratory volume in 1 second; FVC, forced vital capacity; FEF25-75, forced expiratory flow between 25% and 75% vital capacity; PEFR, peak expiratory flow rate.
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REFERENCES |
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Top
Abstract
Methods
Results
Discussion
References
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Mexican-American, white and black. I. Spirometry.
J Pediatr.
1979;
95:14-23 [CrossRef][Medline]This article has been cited by other articles:
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  S Panditi and M Silverman Perception of exercise induced asthma by children and their parents Arch. Dis. Child., September 1, 2003; 88(9): 807 - 811. [Abstract] [Full Text] [PDF]
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