Factors Related to Undiagnosed Asthma in Urban Adolescents: A Multilevel Approach
Received 10 July 2009; received in revised form 17 November 2009; accepted 18 November 2009. published online 04 February 2010. Corrected Proof
Abstract
Purpose
We report the results of a school-based asthma case-identification survey to determine the prevalence and predictors of possible undiagnosed asthma in a population of urban adolescents.
Methods
During school years 2006–2008, middle school students in Oakland, California, completed a brief survey adapted from the International Study of Asthma and Allergy in Children. Students were classified into one of three categories: no asthma, current asthma, or possible undiagnosed asthma. Students reported demographic information and residential address, which was geocoded and matched tract-level data from the US Census 2000, Oakland land use designations, public and assisted housing locations, and distance from closed-access roadways. Logistic regression was used to examine factors associated with possible undiagnosed asthma.
Results
Of the 4,017 students who completed the survey, 4.8% (95% confidence interval [CI]: 4.1, 5.5) were classified as possible undiagnosed asthma. Female students (odds ratio: 1.53, 95% CI: 1.07, 2.19) and students who resided in an urban residential area (odds ratio: 2.05, 95% CI: 1.05, 4.05) had significantly increased odds of classification as “possible undiagnosed asthma” compared to current asthma. Percentage of noncitizen recent immigrants in a census tract was related to increased odds of possible undiagnosed asthma. Residence in a census tract with older residential units was significantly associated with decreased odds of undiagnosed asthma.
Conclusions
In urban settings, school-based asthma surveillance can aid in the identification of children with possible undiagnosed asthma. Implementation of a geographic information systems framework can enhance the identification of demographic and physical environmental factors associated with possible undiagnosed asthma.
aDivision of Epidemiology, School of Public Health, University of California, Berkeley, California
bRobert Wood Johnson Foundation Health & Society Scholars Program, University of Wisconsin, Madison, Wisconsin
Address correspondence to: Sheryl Magzamen, Ph.D., M.P.H., Department of Environmental and Occupational Health Sciences, University of Washington, 4225 Roosevelt Way NE, Suite 302, Seattle, WA 98105.
ABSTRACT