Research ArticleAsthma-Related School Absenteeism, Morbidity, and Modifiable Factors
Introduction
Asthma is a common chronic disease of childhood, affecting one in 12 U.S. children.1, 2 Childhood asthma is a leading cause of chronic disease–related school absenteeism in the U.S., associated with more than 10 million missed school days annually.3 Asthma-related school absenteeism affects most (59%) children with asthma and is linked to lower academic performance, especially among urban minority youth.1, 4, 5, 6, 7, 8, 9 Most literature on asthma-related absenteeism and its consequences focuses on differences between children with and without asthma.7, 8, 10, 11, 12, 13, 14, 15, 16 Less is known about how absenteeism might be a useful health status indicator among children with asthma.14, 16, 17
Asthma-related school absenteeism can result from asthma exacerbations, lack of asthma control, or routine clinic visits.3, 18, 19, 20, 21 Some studies reported associations between absenteeism and secondhand smoke exposure among children with asthma.16, 22, 23 Other modifiable factors affecting asthma control (e.g., home environment, healthcare access) might be related to school absenteeism, although this possibility remains unexplored.16 Given the range of possibilities that can contribute to school absences, the utility of absenteeism for assessing asthma morbidity is not well described.16 If the implications of asthma-related absenteeism were better understood, this information could be useful to public health officials, educators, policymakers, investigators, and others charged with deciding who to include in school-based efforts to improve asthma control.24, 25, 26 Therefore, this study examined how asthma-related school absenteeism was associated with asthma control, asthma exacerbations, and associated modifiable risk factors using a sample of children from 35 states and the District of Columbia with 2006–2010 data.
Section snippets
Asthma Call-back Survey
Data were analyzed from the 2006–2010 Behavioral Risk Factor Surveillance System (BRFSS) Child Asthma Call-back Survey (ACBS).27, 28 BRFSS is an ongoing, state-based, random-digit-dialed telephone survey of non-institutionalized U.S. adults.27 Before 2011, BRFSS interviews were conducted via landline telephone.27 BRFSS respondents reporting a child with a diagnosis of asthma (ever) were eligible to participate in the Child ACBS; the child in the household was randomly selected and then asthma
Results
In this study, 8,881 unique children who had current asthma and attended school in the past 12 months were identified (Figure 1). Because sampling weights were incorporated into these analyses, this study population represents approximately 4.3 million children.
Approximately half of children in school with current asthma missed at least 1 school day because of asthma in the past 12 months (51%, 95% CI=48.2, 53.0, Table 1). The percentage of children who missed ≥1 school day for asthma varied
Discussion
In a survey of children in school with current asthma from 35 U.S. states and the District of Columbia, more than half of children missed at least 1 school day because of asthma in the past 12 months. Even after controlling for potential confounding variables, missing any school for asthma was associated with uncontrolled asthma, asthma episodes/attacks, urgent/emergent healthcare utilization for asthma, cost as a barrier to asthma-related health care, and reported signs of mold in the home.
Conclusions
This study analyzed data on children with current asthma from 35 U.S. states and the District of Columbia and found approximately half of children missed at least 1 school day because of asthma. Missing even 1 day of school for asthma over a 12-month period was associated with uncontrolled asthma, asthma episodes/attacks, asthma-related urgent/emergent healthcare utilization, reported signs of mold in the home, and reporting cost as a barrier to asthma-related medication and outpatient care.
Acknowledgments
We thank Jeanne Moorman and Hatice Zahran for contributing to the development of this study. We are grateful to the states and jurisdictions that contributed data for this study. The Asthma Call-back Survey is funded by the National Asthma Control Program in the Air Pollution and Respiratory Health Branch of the National Center for Environmental Health. In 2006–2010, the Asthma Call-back Survey was jointly administered with the Office of Surveillance, Epidemiology and Laboratory Services,
References (58)
- et al.
Beginning school with asthma independently predicts low achievement in a prospective cohort of children
Chest
(2010) - et al.
School attendance and school performance: a population-based study of children with asthma
J Pediatr
(2001) - et al.
The impact of inadequately controlled asthma in urban children on quality of life and productivity
Ann Allergy Asthma Immunol
(2007) - et al.
Changes in environmental tobacco smoke exposure and asthma morbidity among urban school children
Chest
(2009) - et al.
Implementing school asthma programs: lessons learned and recommendations
J Allergy Clin Immunol
(2014) - et al.
Establishing school-centered asthma programs
J Allergy Clin Immunol
(2014) - et al.
Age at asthma onset and subsequent asthma outcomes among adults with active asthma
Respir Med
(2013) - et al.
Food insecurity in children but not in their mothers is associated with altered activities, school absenteeism, and stunting
J Nutr
(2014) School absence rates as outcome measures in studies of children with chronic illness
J Chronic Dis
(1986)- Centers for Disease Control and Prevention. Asthma in the U.S. www.cdc.gov/vitalsigns/pdf/2011-05-vitalsigns.pdf....
Asthma prevalence, health care use, and mortality: United States, 2005–2009
Natl Health Stat Report
The relationship between school absence, academic performance, and asthma status
J Sch Health
Asthma status and severity affects missed school days
J Sch Health
Grade retention risk among children with asthma and other chronic health conditions in a large urban school district
Postgrad Med
School functioning of U.S. children with asthma
Pediatrics
Charleston AC. School-based pediatric asthma surveillance in Massachusetts from 2005 to 2009
J Sch Health
Tracking pediatric asthma: the Massachusetts experience using school health records
Environ Health Perspect
Addressing asthma in Texas: development of a school-based asthma surveillance program for Texas elementary schools
J Sch Health
A comparison of absentee rates of elementary schoolchildren with asthma and nonasthmatic schoolmates
Pediatrics
Absence, extended absence, and repeat tardiness related to asthma status among elementary school children
J Asthma
Assessing the potential influence of asthma on student attendance/absence in public elementary schools
J Asthma
School absence: a problem for the pediatrician
Pediatrics
Expert Panel Report 3 (EPR-3): guidelines for the diagnosis and management of asthma—Full Report 2007
The impact of uncontrolled asthma on absenteeism and health-related quality of life
J Asthma
School absence—a valid morbidity marker for asthma?
Health Bull (Edinb)
Environmental tobacco smoke and absenteeism related to respiratory illness in schoolchildren
Am J Epidemiol
Using school staff to establish a preventive network of care to improve elementary school students׳ control of asthma
J Sch Health
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