Childhood Asthma and Student Performance at School

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<ul><li><p>Childhood Asthma and Student Performance at School Howard Taras, William Potts-Datema </p><p>ABSTRACT: To better understand what is known about the association between childhood asthma, school attendance, and academic outcomes, the authors reviewed published studies investigating this topic. Tables with brief descriptions of each studys research methodology and outcomes are included. Research reveals evidence that rates of absenteeism are higher among students with asthma. The exact magnitude of absenteeism is dificult to ascertain. However; the studies have helped to identifj, characteristics of children with asthma that are most likely to be associated with the highest absenteeism rates. Some interventions to improve rates of absenteeism among school-aged children with asthma show promise, but it cannot yet be concluded that students who adhere to medical routines for controlling asthma will as a result increase their rates of attendance. Studies thus far have shown that there is either only a weak or nonexistent association between asthma and school achievement. Further studies are required to verifj, if certain subpopulations of children with asthma (eg, those with severe and ongoing symptoms, those with disturbed sleep, kindergarten children) are at higher risk for poor school achievement. ( J Sch Health. 2OO5;75(8):296-3 12) </p><p>ealth professionals frequently remind educators of H the correlation between childrens health and their academic potential. Such generalizations are not always accompanied by specific examples and more rarely accompanied by evidence. </p><p>To clarify and quantify the relationship between health and child performance and ability at school, the National Coordinating Committee on School Health and Safety (NCCSHS) called for a review of the state of this re- search. The project involves a literature search of peer- reviewed, published research reporting on the relationship between students health and their performance in school. The NCCSHS is an organization that comprises represen- tatives from several federal departments and national non- governmental organizations. This article summarizes what is known through data collection about the association of asthma among school-aged children with attendance and academic outcomes. The associations of school perfor- mance with other chronic diseases are summarized in a separate article. </p><p>Criteria for an article to be selected for review were that the article had to have been published within the past 15 years (1989 or later), the subjects of study were school-aged children (ages 5-18 years), and the research included school attendance or academic achievement. Studies were identified using MedLine and similar Inter- net-based searches. If a full article could not be retrieved, studies with detailed abstracts were included. Many stud- ies cited here had major outcome measures other than those pertinent to the objectives of this project. These alternative outcomes may not be described at all or are briefly mentioned. </p><p>Howard Taras, MD, Professor (htaras@ucsd.edu), Division of Community Pediatrics, University of California, San Diego, Gilman Drive #0927, La Jolla, CA 92093-0927; and William Potts-Datema, MS, Director. (wpottsda@hsph.harvard.edu), Partnerships for Childrens Health, Har- vard School of Public Health, 677 Huntington Ave, 7th Floor; Boston, MA 02115. This article is I of 6 articles that are part of a project of the National Coordinating Committee on School Health and Safety (NCCSHS). This NCCSHS project was funded by the US Department of Health and Human Services, Department of Education, and US Depart- ment of Agriculture. Opinions expressed in this article are not necessarily shared by these federal agencies or other institutions that comprise NCCSHS membership. </p><p>ASTHMA AND SCHOOLS Children with asthma are conceivably at risk for </p><p>decreased school functioning due to acute exacerbations of this disease, increased absenteeism secondary to symp- toms, iatrogenic effects of students asthma medication (eg, oral steroids), poor medical management of the dis- ease, and/or the stress associated with having a chronic illness. Although teachers generally have accepting atti- tudes toward students with asthma, their knowledge about asthma is low2 and they do not feel adequately prepared to assist children with the management of asthma in the class- r00m.~ To help address this situation, many federal agen- cies and national organizations in the fields of health services, education, health education, and air quality have developed resources to assist schools to manage students with asthma and minimize symptoms of asthma by opti- mizing the school environment. These resources are listed on the Web site of the NCCSHS at http://www.healthy- students.org/resources/. </p><p>Absenteeism Of the 66 reviewed studies addressing asthma and </p><p>school attendance, virtually all showed a correlation between this disease and high rates of student absentee- ism. The number of missed school days that a child with a given severity of asthma is still unknown, as is the cause for missed school days (ie, doctors appointments, symp- toms of asthma, avoidance of environmental triggers). A little is known about the timing of missed school days (eg, season of the year, prevalence of flu) (Table I) . Although the relationship between asthma and school attendance may not have changed over the past couple of decades (Anthracopoulos et a1 2001; Centers for Disease Control and Prevention 2002; Table I), the increased number of school-aged children with asthma has meant that the abso- lute number of school days missed is larger (Weiss et al 2000; Table 1). </p><p>One reason for the inconsistency on the expected num- ber of days absent for a student with asthma is that stud- ies have used various definitions of asthma. Some studies define asthma based on respiratory symptoms. Others use a parental report of a diagnosis of asthma. Yet others use evidence found on medical chart review. Many articles do not have control groups (ie, there is no comparison of attendance among children with asthma against </p><p>296 Journal of School Health October 2005, Vol. 75, No. 8 </p></li><li><p>Tabl</p><p>e 1 </p><p>Pub</p><p>lishe</p><p>d R</p><p>esea</p><p>rch </p><p>Art</p><p>icle</p><p>s Th</p><p>at A</p><p>ddre</p><p>ss A</p><p>sthm</p><p>a an</p><p>d A</p><p>bsen</p><p>ce F</p><p>rom</p><p> Sch</p><p>ool (</p><p>Con</p><p>tinue</p><p>d on</p><p> nex</p><p>t pag</p><p>e) </p><p>Cita</p><p>tion </p><p>(Ori</p><p>gin </p><p>of P</p><p>rim</p><p>ary </p><p>Aut</p><p>hor)</p><p> R</p><p>esea</p><p>rch </p><p>Des</p><p>ign </p><p>Maj</p><p>or F</p><p>indi</p><p>ngs </p><p>Rel</p><p>ated</p><p> to A</p><p>bsen</p><p>teei</p><p>sm </p><p>Ad</p><p>am</p><p> RJ,</p><p> Wei</p><p>ss S</p><p>T, F</p><p>uhlb</p><p>rigge</p><p> A. 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Par</p><p>ent r</p><p>epor</p><p>t of s</p><p>choo</p><p>l atte</p><p>ndan</p><p>ce w</p><p>as </p><p>com</p><p>pare</p><p>d to</p><p> par</p><p>ent r</p><p>epor</p><p>t of a</p><p>sthm</p><p>a hi</p><p>stor</p><p>y. </p><p>Par</p><p>ents</p><p> of 1199 </p><p>child</p><p>ren </p><p>(age</p><p>s 4-9) with</p><p> ast</p><p>hma,</p><p> recr</p><p>uite</p><p>d fro</p><p>m </p><p>emer</p><p>genc</p><p>y de</p><p>partm</p><p>ents</p><p> and</p><p> rese</p><p>arch</p><p> cent</p><p>ers i</p><p>n m</p><p>ultip</p><p>le ci</p><p>ties,</p><p> w</p><p>ere </p><p>inte</p><p>rvie</p><p>wed</p><p> 4 tim</p><p>es o</p><p>ver a</p><p> 9-m</p><p>onth</p><p> per</p><p>iod.</p><p> Incl</p><p>uded</p><p> in th</p><p>e in</p><p>terv</p><p>iew</p><p> wer</p><p>e qu</p><p>estio</p><p>ns to</p><p> mea</p><p>sure</p><p> adh</p><p>eren</p><p>ce to</p><p> med</p><p>ical</p><p> re</p><p>gim</p><p>ens </p><p>and </p><p>risk </p><p>for n</p><p>onad</p><p>here</p><p>nce </p><p>(cha</p><p>ract</p><p>eris</p><p>tics t</p><p>hat r</p><p>esea</p><p>rch </p><p>has </p><p>dem</p><p>onst</p><p>rate</p><p>d to </p><p>be a</p><p>ssoc</p><p>iate</p><p>d with</p><p> non</p><p>adhe</p><p>renc</p><p>e) a</p><p>nd </p><p>pare</p><p>nt re</p><p>port </p><p>of n</p><p>umbe</p><p>r of s</p><p>choo</p><p>l day</p><p>s m</p><p>isse</p><p>d as </p><p>a re</p><p>sult </p><p>of </p><p>asth</p><p>ma </p><p>in th</p><p>e pr</p><p>evio</p><p>us 3 m</p><p>onth</p><p>s. </p><p>Mis</p><p>sing</p><p> 6 or</p><p> mor</p><p>e da</p><p>ys fr</p><p>om s</p><p>choo</p><p>l was</p><p> one</p><p> of t</p><p>he fa</p><p>ctor</p><p>s in</p><p> a </p><p>mul</p><p>tiple</p><p> logi</p><p>stic</p><p> regr</p><p>essi</p><p>on m</p><p>odel</p><p> that</p><p> was</p><p> ass</p><p>ocia</p><p>ted w</p><p>ith u</p><p>se </p><p>of a</p><p>n an</p><p>ti-in</p><p>flam</p><p>mat</p><p>ory,</p><p> cont</p><p>rolle</p><p>r med</p><p>icat</p><p>ion.</p><p> Gre</p><p>ater</p><p> ast</p><p>hma </p><p>mor</p><p>bidi</p><p>ty (i</p><p>nclu</p><p>ding</p><p> lost</p><p> sch</p><p>ool d</p><p>ays)</p><p>, you</p><p>ng a</p><p>ge, </p><p>whi</p><p>te, r</p><p>ecen</p><p>t hos</p><p>pita</p><p>lizat</p><p>ion,</p><p> and </p><p>regu</p><p>lar d</p><p>octo</p><p>r vis</p><p>its w</p><p>here</p><p> as</p><p>thm</p><p>a is</p><p> wel</p><p>l tau</p><p>ght a</p><p>re a</p><p>ll as</p><p>soci</p><p>ated</p><p> with</p><p> us</p><p>e of</p><p> ant</p><p>i-inf</p><p>lam</p><p>mat</p><p>ory c</p><p>ontro</p><p>ller m</p><p>edic</p><p>atio</p><p>ns. </p><p>Stu</p><p>dent</p><p>s with</p><p> ast</p><p>hma </p><p>sym</p><p>ptom</p><p>s, b</p><p>ut n</p><p>o pr</p><p>evio</p><p>us p</p><p>hysi</p><p>cian</p><p> di</p><p>agno</p><p>sis,</p><p> wer</p><p>e ab</p><p>sent</p><p> 13.6 d</p><p>ays </p><p>per y</p><p>ear. </p><p>Stu</p><p>dent</p><p>s w</p><p>ith </p><p>phys</p><p>icia</p><p>n-di</p><p>agno</p><p>sed a</p><p>sthm</p><p>a w</p><p>ere </p><p>abse</p><p>nt 3.7 da</p><p>ys p</p><p>er y</p><p>ear. </p><p>You</p><p>nger</p><p> chi</p><p>ldre</p><p>n lo</p><p>st m</p><p>ore </p><p>scho</p><p>ol d</p><p>ays </p><p>than</p><p> old</p><p>er c</p><p>hild</p><p>ren,</p><p> as</p><p> did</p><p> stu</p><p>dent</p><p>s with</p><p> low</p><p>er s</p><p>ocio</p><p>econ</p><p>omic</p><p> cla</p><p>ss, p</p><p>ets a</p><p>t hom</p><p>e, </p><p>smok</p><p>ers </p><p>at h</p><p>ome,</p><p> and</p><p> abs</p><p>ence</p><p> of a</p><p>n ap</p><p>prop</p><p>riate</p><p> con</p><p>trolle</p><p>r m</p><p>edic</p><p>atio</p><p>n and</p><p> his</p><p>tory</p><p> of h</p><p>ospi</p><p>taliz</p><p>atio</p><p>n or e</p><p>mer</p><p>genc</p><p>y vi</p><p>sit. </p><p>The </p><p>perc</p><p>enta</p><p>ges </p><p>of c</p><p>hild</p><p>ren </p><p>mis</p><p>sing</p><p> bet</p><p>wee</p><p>n 1 </p><p>and 3 </p><p>wee</p><p>ks o</p><p>f sc</p><p>hool</p><p> and</p><p> mis</p><p>sing</p><p> grea</p><p>ter t</p><p>han 3 </p><p>wee</p><p>ks o</p><p>f sch</p><p>ool, </p><p>resp</p><p>ectiv</p><p>ely,</p><p> w</p><p>ere 6% a</p><p>nd 7% </p><p>for s</p><p>tude</p><p>nts w</p><p>ith m</p><p>ild a</p><p>sthm</p><p>a, 23% a</p><p>nd 12% f</p><p>or </p><p>thos</p><p>e w</p><p>ith m</p><p>oder</p><p>ate </p><p>asth</p><p>ma,</p><p> and</p><p> 39% a</p><p>nd 17% f</p><p>or th</p><p>ose </p><p>with</p><p> se</p><p>vere</p><p> ast</p><p>hma.</p><p>The </p><p>prev</p><p>alen</p><p>ce of</p><p> a c</p><p>urre</p><p>nt d</p><p>iagn</p><p>osis</p><p> of a</p><p>sthm</p><p>a in</p><p>crea</p><p>sed f</p><p>rom</p><p> 4.6% t</p><p>o 6% b</p><p>etw</p><p>een 1991 a</p><p>nd 1998; th</p><p>e m</p><p>ean </p><p>num</p><p>ber o</p><p>f sch</p><p>ool </p><p>days</p><p> lost</p><p> bec</p><p>ause</p><p> of a</p><p>sthm</p><p>a di</p><p>d no</p><p>t cha</p><p>nge </p><p>sign</p><p>ifica</p><p>ntly</p><p> betw</p><p>een </p><p>1991 (6.75 da</p><p>ys o</p><p>ver 2 ye</p><p>ars)</p><p> and</p><p> 1998 (5.7 da</p><p>ys o</p><p>ver 2 ye</p><p>ars)</p><p> am</p><p>ong </p><p>thos</p><p>e w</p><p>ith a</p><p>sthm</p><p>a. </p><p>Bet</p><p>wee</p><p>n 26% </p><p>and 30% </p><p>of a</p><p>ll stu</p><p>dent</p><p>s wer</p><p>e re</p><p>porte</p><p>d abs</p><p>ent a</p><p>t lea</p><p>st </p><p>1 da</p><p>y in</p><p> the </p><p>prev</p><p>ious</p><p> mon</p><p>th, c</p><p>ompa</p><p>red </p><p>to 40% o</p><p>f tho</p><p>se w</p><p>ith </p><p>mon</p><p>thly</p><p> ast</p><p>hma </p><p>sym</p><p>ptom</p><p>s. </p><p>On </p><p>aver</p><p>age,</p><p> chi</p><p>ldre</p><p>n m</p><p>isse</p><p>d 6.5 d</p><p>ays </p><p>in th</p><p>e pr</p><p>evio</p><p>us 100 </p><p>days</p><p>. C</p><p>hild</p><p>ren </p><p>of p</p><p>aren</p><p>ts w</p><p>ho a</p><p>dmitt</p><p>ed to</p><p> hig</p><p>h no</p><p>nadh</p><p>eren</p><p>ce to</p><p> m</p><p>edic</p><p>al re</p><p>gim</p><p>ens </p><p>mis</p><p>sed 8.9 da</p><p>ys v</p><p>ersu</p><p>s on</p><p>ly 5.4 da</p><p>ys fo</p><p>r ch</p><p>ildre</p><p>n of</p><p> par</p><p>ents</p><p> with</p><p> low</p><p> non</p><p>adhe</p><p>renc</p><p>e. C</p><p>hild</p><p>ren </p><p>of p</p><p>aren</p><p>ts w</p><p>ho h</p><p>ad h</p><p>igh </p><p>risk </p><p>of n</p><p>onad</p><p>here</p><p>nce </p><p>mis</p><p>sed </p><p>8.1 </p><p>days</p><p> as </p><p>com</p><p>pare</p><p>d to</p><p> onl</p><p>y 4.1 </p

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