Urban School-aged Children Research Articles

Association between ultra-processed food consumption, sociodemographic characteristics, malnutrition and obesity among urban school-aged children in Lilongwe, Malawi: a cross-sectional study

IntroductionThe escalating consumption of ultra-processed foods (UPFs) among school-aged children in developing countries poses a significant threat to public health, contributing to the dual burden of malnutrition. In Malawi, where...

Blood cadmium level and the change of cadmium exposure risk in Chinese urban school-age children in 2002 and 2012

To investigate the blood cadmium concentrations and the related change in Chinese urban children derived from the China Nutrition and Health Survey 2002 and 2012(CNHS 2002 and CNHS 2012). The Chinese urban children aged 6-11 years were selected according to gender, age and regional distribution using the multi-stage stratified cluster random sampling method, as well as the corresponding whole blood samples. The blood cadmium concentration was carefully determined by the quadrupole inductively coupled plasma mass spectrometry(ICP-MS) and the percentage of blood cadmium over 2 μg/L was subsequently estimated. In addition, the upper limit values of the 95%CI of the 95th percentiles of available blood cadmium data was assessed as the threshold of cadmium exposure. Totally, 2182 Chinese urban children were included, and of these, 1036 children were from the CNHS 2002 and 1146 children were from the CNHS 2012. From the CNHS 2002 to the CNHS 2012, the median blood cadmium concentration was increased from 0.28 μg/L to 0.95 μg/L, and the percentage of blood cadmium with over 2 μg/L was elevated from 1.45% to 10.47%. In addition, the new estimated threshold of blood cadmium was ascended from 1.24 μg/L up to 2.89 μg/L. The risk of cadmium exposure in Chinese urban children aged 6-11 years was increasingly aggravated from the CHNS 2002 to the CNHS 2012.

Turkish children myopia progression in the urban area, a retrospective evaluation

Aims: To investigate myopia trends and progression in urban school-aged myopic children in Turkey.
 Methods: This retrospective study included myopic children aged 6-18 years attending the ophthalmology clinic for regular eye and refractive examinations between 2003 and 2021. Myopia progression was calculated as the difference between the baseline and the last visit spherical equivalent refractive (SER) values. Individuals were further categorized to determine the age-specific myopia progression as 6-11, 12-16, and 17-18 age groups based on the school periods of the country. According to the SER values, individuals were classified into mild, moderate, and high myopic groups. 
 Results: A total of 602 eyes of 301 children (191 female, 110 male) with a mean age of 11.64±2.81 (6-18) years were included in the study. The mean follow-up time of patients was 37.51±19.18 (6-98) months. The baseline mean SER value was -1.5±1.07 D (range: -0.50 and -5.62) and -2.55±1.50 at the final visit. The overall mean myopia progression was -0.35±0.37 D (range: +0.35 D and -3.75 D/year. There were 46 children between 6-11 years, 173 children between 12-16 years, 82 children between 17-18 years, and the annual SER changes were -0.46±0.40 D; -0.37±0.39 D and -0.26±0.29 D in the groups, respectively (p < 0.001). Baseline, final, and annual myopia progression were greater in females. Although there was no statistical significance, myopia progression was faster in moderate myopes (-0.39±0.33 D/a year), followed by mild (-0.35±0.37 D/a year) and high myopes (-0.21±0.20 D/a year) (p=0.37).
 Conclusion: The progression of myopia in school-aged Turkish children from the Western Black Sea Region is comparable to the world. Our study revealed the greater myopia progression in the youngest children, moderate myopia group, and females. Myopia prevention recommendations should be carefully advised to the youngest female ones to reduce myopia progression.

Factors driving underweight, wasting, and stunting among urban school aged children: Evidence from Merawi town, Northwest Ethiopia.

Prior research identified malnutrition as one of the most common causes of morbidity and mortality among children globally. Furthermore, research revealed that over two thirds of deaths associated with inappropriate feeding practices occurred during the early years of life. Improper feeding practices impact a child's health in many different ways. However, research on the possible factors driving underweight, wasting, and stunting among school aged children in developing countries is limited, hence warrant further attention. Against this backdrop, this research strives to identify and assess the determinants of underweight, wasting and stunting among school aged children of a developing country-Ethiopia. A community based cross-sectional study was conducted from April 1, 2018 to June 15, 2018 in Merawi town, Ethiopia. An interviewer-administered questionnaire was used to collect data from a sample of 422 children. Binary logistic regression technique was performed to examine the effect of each selected variable on the outcome measure. The prevalence of being underweight, wasting and stunting was found to be 5.7%, 9.8%, 10.4%, respectively. The age of the child [adjusted odds ratio (AOR) = 12.930 (2.350, 71.157)] and the number of children [AOR = 8.155 (1.312, 50.677)] were emerged as the key determinants for underweight, and the gender of the child was significantly associated with wasting [AOR = 0.455 (0.224, 0.927)]. Finally, the age of the child [AOR = 12.369 (2.522, 60.656)] was found to predict the risk of stunting. This study revealed the age, number of children and gender of the child to have a significant association with malnutrition. The findings of this research suggest that in improving the feeding practices of young school-aged children, special attention should be paid to female children and those coming from relatively large families.

A Comparative Study to Assess the Knowledge and Attitude of School Going Children Regarding Importance of Personal Hygiene in Selected Rural and Urban Schools of Ludhiana, Punjab

Background: The study’s objectives were to assess the knowledge, attitudes, and relationship between rural and urban school-aged children’s knowledge and attitudes about personal hygiene. Methods: The study used a comparative research design. A stratified random sample selection procedure was utilized. One hundred samples (50 from rural areas and 50 from cities) were selected. The population of the study was rural and urban school going children 9–11 years. To examine the data, descriptive and inferential statistics were employed. Results: The survey concluded that 40% (20) of rural schoolchildren and 44% (22) of urban schoolchildren had strong knowledge. About 96% (48) urban and 88% (44) rural schoolchildren valued personal cleanliness. The mean knowledge score of urban schoolchildren was 19.48, higher than rural children 16.52, and their mean attitude score was 74.18, much higher than rural children 68.10. The mean knowledge score of rural and urban children was statistically significant for age, mother’s education, and source of information, but not for household type or monthly income. In rural children, class was significant while gender was non-significant. The mean attitude score of rural and urban school children was statistically significant for age, gender, class, but not for mother education, type of family, family monthly income, or source of information. Based on the study, rural and urban school children received personal hygiene advice. When feasible, guidelines should be flexible. Conclusion: Children attending schools in urban areas had better knowledge than those attending schools in rural areas, but both groups of students shared a favorable outlook on the value of good personal hygiene.

Prevalence and Associated Factors of Stunting among School Age Children in Addis Ababa City, Ethiopia 2021.

Introduction:Stunting has long been regarded as one of the most important indicators of malnutrition, serving as a proxy for not just chronic nutritional deficiency but also long-term socioeconomic disadvantage among children and society as a whole. In 2016, stunting alone afflicted an estimated 154.8 million (22.9%) children under the age of five over the world. It is one of Ethiopia’s most serious undernutrition and health problems among school-aged children.Objective:To determine the prevalence and associated factors of stunting among school-aged children in Addis Ababa city, Ethiopia 2021.Methods:An institutional-based cross-sectional study was conducted among primary school students in Addis Ababa city. By using a single population proportion, a formula of 627 students was recruited. From 11 sub-cities, 4 sub-cities were selected by lottery method, and 21 (30%) of the schools from the sub-city were selected. Finally, from each school, study participants were selected by using systematic random sampling, using their attendance list as a frame. A self-administered questionnaire was used to collect data, and anthropometric measurements were taken. In order to see the association between the dependent (stunting) and independent variables, bi-variable and multi-variable logistic regression were used. During bi-variable analysis, variables that had p-values of less than 0.2 were entered into multivariable analysis to see the effect of confounding factors. Adjusted Odds Ratios with 95% confidence intervals and a P-value of less than 0.05 were used to see the level of significance.Result:The prevalence of stunting was 108/607 (18.0%) with a 95% CI of 14.5–20.9). Being a male child (AOR = 0.616, 95% CI, 0.34–0.96), type of water source (AOR = 3.4, 95% CI, 1.12–10.37), not feeding breast milk (AOR = 3.411, 95% CI, 1.09–10.07), educational status, and ability to read and write (AOR = 2.11, 95% CI, 1.15–3.88) were predictors of stunting.Conclusion:The study showed that the prevalence of stunting was high, and it explored that stunting remains a noticeable attribute of urban school-age children. The higher educational status of the mother, exclusive breast feeding, using ground water, and being a female child were negatively associated with the prevalence of stunting. The risk of stunting was higher among male than female school-aged children. Findings from the study suggest the need to strengthen the strategies that lead to Sustainable Development Goal 4 to ensure all girls and boys complete primary and secondary schooling by 2030.

10-Year Changes in Adiposity in Cameroon School-Age Children: Evidence for Increasing Central Adiposity and Higher Adiposity Levels in Tallest-for-Age Children.

Objective To examine changes in measures of adiposity and determine the prevalence of excess adiposity in relation to height in school children between 2010 and 2020. Methods 5–12-year-old urban school-age children participated in two cross-sectional surveys in 2010 (n = 1274) and 2020 (n = 1550). Standard procedures were used for anthropometric measurements. Changes in BMI, waist circumference (WC), and waist-to-height ratio (WHtR) and the corresponding proportions of children with excess adiposity were analyzed and adjusted for design variables (class and school type) and age. Children were classified according to quartiles of height z-score and prevalence of excess adiposity estimated across each quartile. Results There was a 2.4% and 3.3% increase in adjusted mean BMI and WC, respectively, between 2010 and 2020. The prevalence of central overweight/obesity (WC) and WHtR ≥ 0.5 increased by 7.3% (X2 = 27.151, p < 0.001) and 5.3% (X2 = 26.117, p < 0.001), respectively, between the two surveys except BMI overweight/obesity. The odds of excess adiposity significantly increased in 2020 for central overweight/obesity (WC) (OR 2.8, 95% CI 2.0–3.6) and WHtR ≥ 0.5 (OR 1.8, 95% CI 1.3–2.4) and not for BMI overweight/obesity (OR 1.3, 95% CI 0.8–1.7). The prevalence of BMI overweight/obesity significantly increased from 33% in 2010 to 51.5% in 2020 in the fourth quartile of height z-score (X2 = 19.198, p < 0.001). Similarly, the prevalence of central overweight/obesity (WC) significantly increased from 23.5% in 2010 to 42.4% in 2020 in the fourth quartile of height z-score (X2 = 18.733, p < 0.001). Conclusion Central overweight/obesity has increased more than BMI overweight/obesity over the last decade. Children with a higher height-for-age tend to accumulate more adiposity. Objective monitoring of adiposity levels and height of children is needed in future to identify groups for targeted intervention and prevention of chronic diseases.

A cross sectional study to assess the prevalence of malocclusion in 08-12 years old school age children of the selected urban &amp; rural community of Bangladesh

Objective: To determine the prevalence of malocclusion in school-age children from a selective area of the urban and rural community of Bangladesh. Methods: A cross-sectional descriptive survey was conducted among 748 children aged 08-12 years old were examined from October 2019 to September 2020 in Sylhet Sardar Upazila, Bangladesh. Angle”s classification was used for recording molar relationship with malocclusion traits. The study participants were examined by disposable dental tools (calibrated probs and mirror) including torchlight. After the collection of all data, it was compiled and analyzed by Statistical Package for the Social Sciences (SPSS) Windows version 23. Chi-square test was used for categorical variables. P values &lt;0.05 were considered as statistically significant. Result: The prevalence of malocclusion in urban school-age children was 237(63.4%) and in rural 213(57.0%).In urban area, the prevalence of malocclusion was 109(58.3%) in boys and 128(68.4%) in girls group. The majority (70.5%) were found Angle’s class I in urban group and 148(69.5%) in rural. One forty three (60.3%) patients were found increased overbite with malocclusion in urban group and 124(58.2%) in rural. Angle’s class-I malocclusion and Increased overbite were the most commonly occurring malocclusion. Conclusion: Prevalence of malocclusion was more in urban school age children when compared with rural. Malocclusion was significantly more in girls than boys in both urban and rural area. Angle’s class-I malocclusion and Increased overbite were the most commonly occurring malocclusion of school age children from a selected urban and rural community of Bangladesh. Update Dent. Coll. j: 2021; 11(2): 10-15

Organophosphate Ester (OPE) Exposures and Asthma Morbidity Among Urban School-Aged Children in Baltimore City, Maryland

BACKGROUND AND AIM: OPEs are used as flame retardants and plasticizers in many consumer products. Studies suggest OPEs may be linked with respiratory outcomes among children. We aimed to examine associations between OPEs and asthma morbidity among 179 mostly Black children (93%), aged 5-12 years with asthma enrolled in a panel study between 2009-2013¬ in Baltimore City. METHODS: The panel study included up to four seasonal, week-long in-home visits. We collected urine samples on visit-days 4 and 7 (n = 618 samples). We quantified concentrations of 9 OPE metabolites: bis(2-chloroethyl)phosphate(BCEtp), bis(1-chloro-2-propyl)phosphate(BCPP), bis(1-chloro-2-propyl)phosphate(BDCPP), di-benzylphosphate(DBuP), di-benzylphosphate(DBzP), di-o-cresylphosphate(DOCP), di-p-cresylphosphate(DPCP), diphenyl-phosphate(DPHP), and 2,3,4,5-tetrabromobenzoic acid(TBBA). At each visit, participants self-reported asthma symptoms. We calculated Spearman’s rank (continuous) and tetrachoric (binary) correlation coefficients to assess variability of concentrations on days 4 and 7 and intraclass correlation coefficients (ICCs) to assess variability by visit. We assessed associations between metabolite concentrations and asthma symptoms using logistic regression models with generalized estimating equations. We examined BDCPP and DPHP as continuous variables; dichotomized BCEtP, DBuP, and DPCP; and excluded others not frequently detected. We adjusted models for season, visit-day, age, race, sex, BMI, caregiver education, and household income. RESULTS:Detection frequencies were 95% for BDCPP and DPHP, 4.6-31.1% for BCEtP, DBuP and DPCP, respectively and 3% for all other metabolites. OPE concentrations on days 4 and 7 were moderately correlated (rho=0.3-0.6) with low reproducibility across visits (ICC=0.2-0.4). In adjusted models, higher DPHP concentrations were associated with greater odds of self-reported difficulty breathing (odds ratio [OR]: 2.0; 95%CI:1.1-3.6), activity limitation due to asthma (OR:1.6; 95%CI:1.0-2.8), and being bothered by asthma (OR:1.9; 95%CI:1.2-3.2). No associations were observed with other OPEs. CONCLUSIONS:In this predominantly pediatric Black cohort, higher DPHP concentrations were consistently associated with asthma symptoms. We did not observe consistent patterns of association between other OPE metabolites and asthma morbidity. KEYWORDS: Biomarkers of exposure, Respiratory outcomes, Children's environmental health, Environmental disparities, Environmental epidemiology

Food Insecurity, Food Environment and Obesity Among Urban School-Aged Children in Queretaro, Mexico

Abstract Objectives To evaluate the relationship between food insecurity, food environment and obesity in school-aged children in Queretaro. Methods In this cross-sectional study, weight, height and body fat % (BF%) were measured in 122 school-aged children (8.1 ± 1.5 y) from an urban area in Queretaro, Mexico. Additionally, household food insecurity was assessed using the Latin American and Caribbean Food Security Scale (ELCSA). Geolocation data of both food establishments (FE) and participants’ households (HH) were collected and uploaded into a GIS database. The distance to the closest FE within a 300 m radius from each participant's household was calculated using GIS. FE were categorized as follows: (1) FEPF, which mainly sold processed foods (e.g., convenient stores); and (2) FEnPF, which mainly sold non-processed foods (e.g., fruterías – only fruits and vegetables). Univariate analysis was used to assess the interaction of BF%, food insecurity and FE categories using SPSS v23.0. Results Almost half of the children showed high BF% (48%), while 43% lived in HH with some degree of food insecurity. Children in moderately/severely food insecure HH and who lived close to FEnPF had significantly lower BF% (18.9 ± 4.7%), compared to children in food secure HH (24.4 ± 2.5%) or HH experiencing mild food insecurity (25.0 ± 2.6%) (P &amp;lt; 0.05). However, children in moderately/severely food insecure HH, who lived close to FEPF had significantly higher BF% (29.4 ± 2.7%), compared to those experiencing mild food insecurity (23.7 ± 1.5%), or who were food secure (22.8 ± 1.1%) (P &amp;lt; 0.05). Conclusions Children living in moderately/severely food insecure HH showed an opposite BF% pattern when compared to those in food secure or mildly food insecure HH, depending on how close they live to FE that either mainly sold processed foods or unprocessed foods, indicating the potential relationship of food environment to childhood obesity mediated by food insecurity. Funding Sources Partially funded by FOFI, UAQ.

Evaluating the Financial Sustainability of the School-Based Telemedicine Asthma Management Program.

Using telemedicine to improve asthma management in underserved communities has been shown to be highly effective. However, program operating costs are perceived as the main barrier to dissemination and scaling up. This study evaluated whether a novel, evidence-based School-Based Telemedicine Enhanced Asthma Management (SB-TEAM) program, designed to overcome barriers to care for families of urban school-aged children, can be financially sustainable in real-world urban school settings. Eligible children (n = 400) had physician-diagnosed asthma with persistent or poorly controlled symptoms at baseline. Total costs included the cost of implementing and running the SB-TEAM program, asthma-related health care costs, cost of caregiver lost productivity in wages related to child illness, and school absenteeism fees. Using data from the SB-TEAM study and national data on wages and equipment costs, the authors modeled low, actual, and high-cost scenarios. The actual cost of administering the SB-TEAM program averaged $344 per child. Expenses incurred by families for medical care ($982), caregiver productivity cost ($415), and school absenteeism costs ($284) in SB-TEAM were not different from the costs in the control group ($1594, $492, and $318 [P > 0.05]). The study findings remained robust under sensitivity analyses for various state- and school-specific regulations, staffing requirements, and wages. The authors concluded that the SB-TEAM program operating costs may be offset by the reduction in health care costs, caregiver lost wages, and school absenteeism associated with the program health benefit.

Low sports participation is associated with withdrawn and depressed symptoms in urban, school-age children

BackgroundThe association between sports participation and mental health has not been studied in primary care samples of school-age children, nor in underrepresented minority children. We assessed the relationship between number of sports played and psychiatric symptoms in children ages 6-11 at well-child visits in an urban clinic. MethodsGuardians of 206 children (85% Latinx) ages 6-11 completed Child Behavior Checklists (CBCL) in Spanish (66.5%) or English at well-child visits at an urban community health center. We performed linear regression between number of sports played and individual CBCL syndrome scores, and multiple logistic regression with normal (T-score <60) vs. elevated (T-score ≥60) CBCL syndrome scale score as the outcome. We conducted bivariate, multiple logistic regression, and linear regression analyses between low (1 or fewer) vs. high (2 or more) sports participators and subscales of interest. ResultsFewer sports played was associated with higher Withdrawn/Depressed CBCL syndrome scale T-scores (p = 0.019), but not with other CBCL syndrome scale scores nor number of syndrome scale elevations (p = 0.638). Low participators had higher odds of an elevated Withdrawn/Depressed T-score (p = 0.033) than high participators. LimitationsOur dataset did not contain certain details about sports played, nor information about income and insurance, and our results may not generalize to other populations. ConclusionsPlaying fewer sports is associated with higher withdrawn/depressed symptoms in urban, predominantly Latinx, school-age children. Therefore, urban school-age children with low sports participation may be at risk for depression, and sports participation might protect against depressive symptoms in childhood.

Linking elevated blood lead level in urban school-aged children with bioaccessible lead in neighborhood soil

Lead (Pb) exposure is known to affect the health of children while soil Pb is an important contributor to human Pb exposure. To analyze the effects of both environmental and other factors, especially total and bioaccessible Pb in neighborhood soil, on school-aged urban children’s blood lead level (BLL), 75 children (6–11 years old) were recruited from an industry city in eastern China for BLL measurement and questionnaire survey. Soil samples were collected from their living neighborhoods and measured for total and bioaccessible Pb. The mean BLL was 4.82 μg dL−1, with 42 out of 75 children having BLL exceeding the international guideline of 5 μg dL−1. Low Pb contamination was observed in soil with total Pb ranging from 12.5 to 271 mg kg−1 (mean 34.3 mg kg−1). Based on the in vitro Solubility Bioaccessibility Research Consortium (SBRC) gastric fluid extraction, bioaccessible Pb in soil ranged from 0.40 to 79.1 mg kg−1 (mean 7.58 mg kg−1) with Pb bioaccessibility ranging from 1.74 to 68.1 (mean 19.9%). When BLL was correlated with total Pb in soil, insignificant linear relationship was observed (P > 0.05, correlation coefficient 95%CI = −0.047–0.40, R2 = 0.07). However, when BLL was correlated with soil bioaccessible Pb or Pb bioaccessibility, much stronger linear relationships were observed (P < 0.01, correlation coefficient 95%CI = 0.28–0.64, R2 = 0.16–0.20), suggesting that bioaccessible Pb was a much stronger predictor of BLL. In addition, strong associations were also observed between BLL and social factors such as house decoration, residence time, and personal habits, suggesting that both soil Pb contamination and social factors play important roles in elevating BLL for city children.

Dietary diversity among school age children in Merawi town, Amhara region, Ethiopia, 2018: a community based cross-sectional study

BackgroundMalnutrition with its constituents of protein energy malnutrition and micro-nutrient deficiencies continues to be a major health burden in low and middle-income countries. To end all forms of malnutrition, we need to address poverty, which is associated with the insecure supply of food and diversified nutrition. The objective of this study was to determine the level of dietary diversity and household food security among urban school-age children in Merawi town, Ethiopia.MethodsA community based cross-sectional study was conducted in Merawi town among 422 households having school age children from April 1 to June 15, 2018. The association between dietary diversity and determinants was assessed using binary logistic regression analysis. Socio-demographic, maternal and child related variables; food security and diversity determinants were studied.ResultsThe overall level of good dietary diversity was 91.7%, i.e.; 8.3% had a low, 59.1% had a good, 32.6% had better dietary diversity, respectively. Most households (95.2%) were secured with food access. The factors associated with good dietary diversity were the age of the child [AOR = 0.31 (0.14, 0.70)], and access to information [AOR = 3.18 (1.07,9.47)].ConclusionThe prevalence of good dietary diversity was relatively high. Among different socio-cultural and economic factors studied, age of the child and access to information were the factors associated with dietary diversity. Increasing maternal and child awareness towards good dietary diversity practices through the mass media (radio and Television) and working with mothers with early school-age children to improve dietary diversity are recommended.

Mental health status compared among rural-to-urban migrant, urban and rural school-age children in Guangdong Province, China

BackgroundPrevious research has documented mental health status among rural-to-urban migrant children (labeled as “migrant children” henceforth) and urban children. However, the findings remain unclear. In addition, far less attention has been paid to rural children’s psychological outcomes. The purpose of this study was to compare mental health status among migrant, urban and rural school-age children in Guangdong Province, China.MethodsThis was a cross-sectional study involving 372 migrant, 254 urban and 268 rural children selected respectively from 3 private schools, 4 public schools and 2 village schools in Guangdong Province, China. Participants provided their socio-demographic information and completed the Strengths and Difficulties Questionnaire (SDQ) to assess mental health. One-way analyses of variance (ANOVAs) and Bonferroni post hoc test were used to evaluate SDQ scores differences. A multiple linear regression analysis was conducted to measure mental health differences among children after controlling for socio-demographics. Chi-square analyses were used to assess differences in the prevalence of mental health problems among children.ResultsBonferroni post hoc test showed that migrant and rural children reported significantly higher scores than urban peers in emotional symptoms, hyperactivity/inattention and total difficulties score (p < 0.01). In addition, migrant children reported a higher peer problems score compared to urban children (p < 0.001). In multiple linear regression analysis, rural and migrant children reported significantly a higher total difficulties score than urban children (p = 0.046 and 0.024, respectively). Additionally, female gender, having insurance, seldom communicating with parents, and higher monthly household income were negatively associated with a higher total difficulties score. Conversely, children’s father with secondary education was positively associated with a higher total difficulties score. The prevalence of mental health problems among rural, migrant and urban children were 26.5, 18.8 and 15.0% (χ2 = 11.41, p = 0.003), respectively.ConclusionsRural and migrant children reported poorer mental health than urban children. Female gender, having insurance, seldom communicating with parents, and higher monthly household income were associated with better mental health of children. However, children’s father with secondary education was associated with poorer mental health of children. Given the different effects of socio-demographics, further support might be provided accordingly to improve the mental health of school-age children.

Improving teacher comfort and self-efficacy in asthma management

Background: Asthma is common among urban school-age children. Though teachers should be prepared to assist children during an asthma attack, studies show they lack self-efficacy in managing asthma.Objective: To assess feasibility of implementing an asthma workshop for elementary school teachers, describe themes of questions raised, and determine workshop’s impact on teachers’ comfort and self-efficacy in asthma management.Methods: We developed and implemented an asthma workshop for teachers from four Bronx elementary schools (2012–2014). Teachers completed a questionnaire evaluating their comfort and self-efficacy in asthma management before and after the workshop. Questions asked during the sessions were recorded and analyzed for themes. Paired t-test and McNemar tests compared before/after scores.Results: 65 out of 70 teachers (92.9%) participated in the educational sessions. Teachers asked questions about school policy for inhalers, medication administration guidelines, and physical activity and asthma. 64/65 (98.5%) teachers completed pre/post surveys (mean age 39.7 years; mean years at the school 8.0). Post-intervention, more teachers reported knowing how to manage an asthma attack (93.8% vs. 64.1%, p < .0001); and felt comfortable assessing (50.8% vs. 30.8%, p = 0.019) and handling an asthma attack (52.3% vs. 33.8%, p = .023). The overall mean self-efficacy score increased post-intervention (43.0 vs. 38.1, p < .0001), as did 8/12 individual self-efficacy items. Post-workshop, 95.3% of teachers agreed that teacher in-service asthma education should be done annually.Conclusions: An asthma workshop was successfully implemented in the school setting and improved teacher comfort and self-efficacy in managing asthma. Annual training may improve teachers’ confidence in assisting students with asthma.

Effect of a Breakfast in the Classroom Initiative on Obesity in Urban School-aged Children

Serving breakfast in the classroom is promoted to increase participation in the federal School Breakfast Program. However, little is known about the effect of breakfast in the classroom on children's weight status. To evaluate the effect of a breakfast in the classroom initiative, which combined breakfast in the classroom with breakfast-specific nutrition education, on overweight and obesity among urban children in low-income communities. A cluster-randomized clinical trial among 1362 fourth- through sixth-grade students from low-income urban communities across 2.5 years. Sixteen kindergarten through eighth grade Philadelphia public schools with universal breakfast participated. Participants were recruited in September 2013, and the intervention began in January 2014. Data analysis took place from April 1, 2018, to August 30, 2018. Intervention schools received a program that included breakfast in the classroom and breakfast-specific nutrition education. Control schools continued breakfast before school in the cafeteria and standard nutrition education. The primary outcome was the combined incidence of overweight and obesity. Secondary outcomes included the combined prevalence of overweight and obesity, incidence and prevalence of obesity, changes in body mass index (BMI) z score, and School Breakfast Program participation. Among the 1362 students, mean (SD) age was 10.8 (0.96) years and 700 (51.4%) were female; 907 (66.6%) were black, 233 (17.1%) were Hispanic, 100 (7.3%) were white, 83 (6.1%) were Asian, and 39 were of multiple or other race/ethnicity. After 2.5 years, students in intervention schools had participated in the School Breakfast Program 53.8% of days, compared with 24.9% of days among students in control schools (β = 0.33; 95% CI, 0.22-0.42). There was no difference between intervention and control schools in the combined incidence of overweight and obesity after 2.5 years (11.7% vs 9.3%; odds ratio [OR] 1.31; 95% CI, 0.85-2.02; P = .22). However, the incidence (11.6% vs 4.4%; OR, 2.43; 95% CI, 1.47-4.00) and prevalence (28.0% vs 21.2%; OR, 1.46; 95% CI, 1.11-1.92) of obesity were higher in intervention schools than in control schools after 2.5 years. A breakfast in the classroom initiative increased participation in the School Breakfast Program and did not affect the combined incidence of overweight and obesity. However, the initiative had an unintended consequence of increasing incident and prevalent obesity. Further research is needed to identify approaches to increase participation in the School Breakfast Program that do not increase obesity among students. ClinicalTrials.gov identifier: NCT01924130.

A Median Analysis of Factors Influencing Body Fatness in Urban School-Age Children in Cameroon.

Background Childhood overweight/obesity is a fast growing public health problem in developing countries. The adverse health consequences of obesity have been attributed to higher body fat levels and this has drawn overwhelming attention towards more accurate assessment of body fat. The goal of this study is to evaluate the relationships between selected behavioral factors and percentage body fat (%BF) estimated using bioelectrical impedance analysis in school-age children. Methods A cross-sectional analysis was carried out in randomly selected 6- to 11-year-old children (507 boys and 501 girls). Percentage body fat was assessed using bioelectrical impedance analysis. The behavioral factors were reported by parents using a structured questionnaire. Multiple quantile regression analysis was used to evaluate the relationship between the selected behavioral factors and %BF. Results With quantile regression, the daily consumption of fruits and vegetables, daily breakfast consumption, and high physical activity (>4–7 times/week) were significantly (p < 0.001) associated with a 4.95, 3.29, and 3.66 decrease in median %BF, respectively. Also, consumption of snacks (>3 times a day) (p < 0.001), high sedentary lifestyle (>3–6 hours/day) (p < 0.001), and motorization to school (p < 0.005) significantly increased the median %BF by 3.69, 3.01, and 1.39, respectively. The largest changes in median %BF were observed in girls. Conclusions Efforts are needed using longitudinal studies to clarify the effects of these behavioral factors on %BF in different regions and ethnic groups of Cameroon and also to assess whether any observed differences are of clinical relevance.

Authors' response

We appreciate the comments on our manuscript. Our study [1] Esteban C.A. Everhart R.S. Kopel S.J. et al. Allergic sensitization and objective measures of sleep in urban school-aged children with asthma. Ann Allergy Asthma Immunol. 2017; 119: 238-245 Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar investigated the association between allergic sensitization and sleep outcomes in a sample of urban children with persistent asthma. In response to the submitted comments, we would like to clarify our rationale for the specific data analyses mentioned. Allergic sensitization and sleep in children with asthmaAnnals of Allergy, Asthma & ImmunologyVol. 120Issue 2PreviewEsteban et al1 investigated the association between increased allergic sensitization and sleep outcomes in 196 urban schoolchildren, aged 7 to 9 years, with persistent asthma. By hierarchical regression analysis, the number of positive allergy test results significantly predicted variability in sleep efficiency. In addition, variability in forced expiratory volume in 1 second was a significant moderator in the association between number of positive allergy test results and variability in sleep efficiency. Full-Text PDF

Allergic sensitization and objective measures of sleep in urban school-aged children with asthma

BackgroundAllergic sensitization is associated with increased child asthma morbidity and decreased pulmonary function. Nocturnal symptoms and/or awakenings typically are measured by self-report from diary data, whereas objective assessments of sleep in child asthma studies are lacking. ObjectiveTo investigate the association between increased allergic sensitization (number of positive allergy test results measured by skin prick test or specific immunoglobulin E) and sleep outcomes (sleep efficiency, sleep duration, and mean number of awakenings measured by actigraphy) in urban schoolchildren with persistent asthma. MethodsOne hundred ninety-six children with persistent asthma (7–9 years old) attending public school in 1 of 4 large urban school districts completed allergy testing during a study clinic visit. Forced expiratory volume in 1 second was monitored at home using a handheld spirometer. Sleep outcomes were measured with a wrist Actiwatch during a 1-month period in the fall and winter seasons. ResultsNumber of positive allergy test results significantly predicted mean sleep efficiency (P = .02), such that children with more positive test results experienced less efficient sleep. Number of positive allergy test results significantly predicted mean number of night awakenings (P = .05), such that children with more positive allergy test results experienced more night awakenings. Variability in forced expiratory volume in 1 second was a significant moderator in the association between number of positive allergy test results and variability in sleep efficiency (P = .04). Racial and ethnic differences in allergic sensitization and sleep outcomes were found between African Americans and Latinos. ConclusionMore positive allergy test results were associated with poorer sleep outcomes measured objectively in this sample of urban children. Implications for environmental control interventions and asthma treatments in different racial and ethnic groups are discussed.