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      Association between Household Income and Asthma Symptoms among Elementary School Children in Seoul


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          This study examined the association between socioeconomic factors and asthma symptoms.


          A total of 6,919 elementary school children in Seoul were enrolled in the study. Data were obtained from a web-based questionnaire survey. The questionnaire was based on the International Study of Asthma and Allergies in Childhood core module. The prevalence of wheeze in the past 12 months and severe asthma symptoms were obtained. The potential risk factors for asthma symptoms included household income and the number of siblings. A multiple logistic regression analysis was used to calculate the odds ratios (OR) and 95% confidence interval (CI) for the risk factors of asthma symptoms.


          The prevalence of current wheeze (wheeze in the past 12 months) was 5.2%. Household income and asthma symptoms were inversely associated after adjusting for other potential risk factors ( p for trend=0.03). This association was modified by the number of siblings. With two or more siblings, the effect of household income on asthma symptoms was not significant. However, low household income was still a significant variable for patients with fewer than two siblings (OR 1.41; 95% CI, 1.09-1.81).


          It appears that childhood asthma disparity is dependent on household income. Therefore, policies to improve childhood health inequities should be emphasized.

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          Most cited references35

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          The international study of asthma and allergies in childhood (ISAAC): phase three rationale and methods.

          The International Study of Asthma and Allergies in Childhood (ISAAC) programme commenced in 1991 to study the aetiology of asthma, allergic rhinoconjunctivitis and atopic eczema in children in different populations using standardised methodology and facilitating international collaboration. ISAAC Phase One (1992-1996) found marked differences in the prevalence of symptoms of asthma and allergic disease throughout the world which have not been explained by the current understanding of these diseases. ISAAC Phase Two (1998-2004) uses intensive investigations to further examine the potential role of risk and protective factors that may contribute to the international difference observed in Phase One. Phase Three (2000-2003) essentially represents a repeat of Phase One, in which more detailed standardised data are obtained to enable the time trends of symptom prevalence to be determined as well as the development of a more comprehensive 'world map'. The ISAAC Phase Three rationale and methods are described in this paper. With over 280 centres in 106 countries, we anticipate that ISAAC Phase Three will comprehensively determine the prevalence of symptoms of asthma and allergic disease worldwide, explore recent time trends in the prevalence of these symptoms and cast new light on the aetiology of asthma and allergic disease.
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            The effects of poverty on child health and development.

            Poverty has been shown to negatively influence child health and development along a number of dimensions. For example, poverty-net of a variety of potentially confounding factors-is associated with increased neonatal and postneonatal mortality rates, greater risk of injuries resulting from accidents or physical abuse/neglect, higher risk for asthma, and lower developmental scores in a range of tests at multiple ages. Despite the extensive literature available that addresses the relationship between poverty and child health and development, as yet there is no consensus on how poverty should be operationalized to reflect its dynamic nature. Perhaps more important is the lack of agreement on the set of controls that should be included in the modeling of this relationship in order to determine the "true" or net effect of poverty, independent of its cofactors. In this paper, we suggest a general model that should be adhered to when investigating the effects of poverty on children. We propose a standard set of controls and various measures of poverty that should be incorporated in any study, when possible.
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              The role of acute and chronic stress in asthma attacks in children.

              High levels of stress have been shown to predict the onset of asthma in children genetically at risk, and to correlate with higher asthma morbidity. Our study set out to examine whether stressful experiences actually provoke new exacerbations in children who already have asthma. A group of child patients with verified chronic asthma were prospectively followed up for 18 months. We used continuous monitoring of asthma by the use of diaries and daily peak-flow values, accompanied by repeated interview assessments of life events and long-term psychosocial experiences. The key measures included asthma exacerbations, severely negative life events, and chronic stressors. Severe events, both on their own and in conjunction with high chronic stress, significantly increased the risk of new asthma attacks. The effect of severe events without accompanying chronic stress involved a small delay; they had no effect within the first 2 weeks, but significantly increased the risk in the subsequent 4 weeks (odds ratio 1.71 [95% CI 1.04-2.82], p < or = 0.05 for weeks 2-4 and 2.17 [1.32-3.57], p < or = 0.01 for weeks 4-6). When severe events occurred against the backdrop of high chronic stress, the risk increased sharply and almost immediately within the first fortnight (2.98 [1.20-7.38], p < or = 0.05). The overall attack frequency was affected by several factors, some related to asthma and some to child characteristics. Female sex, higher baseline illness severity, three or more attacks within 6 months, autumn to winter season, and parental smoking were all related to increased risk of new exacerbations; social class and chronic stress were not. Severely negative life events increase the risk of children's asthma attacks over the coming few weeks. This risk is magnified and brought forward in time if the child's life situation is also characterised by multiple chronic stressors.

                Author and article information

                Environ Health Toxicol
                Environ Health Toxicol
                Environmental Health and Toxicology
                The Korean Society of Environmental Health and Toxicology
                30 November 2012
                : 27
                [1 ]Department of Occupational and Environmental Medicine, Gachon University Gil Medical Center, Incheon, Korea.
                [2 ]Atopy Research Institute, Seoul Medical Center, Seoul, Korea.
                [3 ]Atopy Asthma Center, Seoul Medical Center, Seoul, Korea.
                [4 ]Department of Preventive Medicine, Dankook University College of Medicine, Cheonan, Korea.
                Author notes
                Correspondence: Hojang Kwon, PhD. 119 Dandae-ro, Dongnam-gu, Cheonan 330-714, Korea. Tel: +82-41-550-3879, Fax: +82-41-556-6461, hojang@ 123456dankook.ac.kr
                © 2012 The Korean Society of Environmental Health and Toxicology

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Original Article

                Occupational & Environmental medicine
                income,children,interaction,asthma,sibling effect
                Occupational & Environmental medicine
                income, children, interaction, asthma, sibling effect


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