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1.  Factors associated with recruitment and retention of diverse children with asthma 
This study examines factors associated with recruitment and retention of Latino, Dominican (DR) and mainland Puerto Rican (PR), and non-Latino white (NLW) families into a pediatric asthma study. Over eleven hundred (n=1185) families were screened, and 489 (n= 174 NLW, n= 160 DR, n= 155 PR) were enrolled. Rates of recruitment by source of recruitment and rates of retention differed by ethnic group. Families whose caregiver had never married had lower odds of completing the study. The findings highlight the need for further study to examine the effectiveness of specific recruitment and retention strategies with Latino and non-Latino white families.
PMCID: PMC4084850  PMID: 25013244
2.  A Longitudinal Assessment of Sleep Timing, Circadian Phase, and Phase Angle of Entrainment across Human Adolescence 
PLoS ONE  2014;9(11):e112199.
The aim of this descriptive analysis was to examine sleep timing, circadian phase, and phase angle of entrainment across adolescence in a longitudinal study design. Ninety-four adolescents participated; 38 (21 boys) were 9–10 years (“younger cohort”) and 56 (30 boys) were 15–16 years (“older cohort”) at the baseline assessment. Participants completed a baseline and then follow-up assessments approximately every six months for 2.5 years. At each assessment, participants wore a wrist actigraph for at least one week at home to measure self-selected sleep timing before salivary dim light melatonin onset (DLMO) phase – a marker of the circadian timing system – was measured in the laboratory. Weekday and weekend sleep onset and offset and weekend-weekday differences were derived from actigraphy. Phase angles were the time durations from DLMO to weekday sleep onset and offset times. Each cohort showed later sleep onset (weekend and weekday), later weekend sleep offset, and later DLMO with age. Weekday sleep offset shifted earlier with age in the younger cohort and later in the older cohort after age 17. Weekend-weekday sleep offset differences increased with age in the younger cohort and decreased in the older cohort after age 17. DLMO to sleep offset phase angle narrowed with age in the younger cohort and became broader in the older cohort. The older cohort had a wider sleep onset phase angle compared to the younger cohort; however, an age-related phase angle increase was seen in the younger cohort only. Individual differences were seen in these developmental trajectories. This descriptive study indicated that circadian phase and self-selected sleep delayed across adolescence, though school-day sleep offset advanced until no longer in high school, whereupon offset was later. Phase angle changes are described as an interaction of developmental changes in sleep regulation interacting with psychosocial factors (e.g., bedtime autonomy).
PMCID: PMC4224451  PMID: 25380248
3.  Reliability of a Scale Assessing Depressed Mood in the Context of Sleep 
The current study assessed the reliability of Kandel & Davies mood scale with and without sleep-related items. 178 Brown University first-year students (mean age=18.1 years; 108 females) completed online biweekly surveys after weeks 2, 6, 8, and 10 and on 2 consecutive days after weeks 4 and 12 of their first semester. The scale was examined as a 1) full 6-item scale, 2) 5-item scale excluding the sleep item, and 3) 4-item scale excluding the sleep and tired items. Intraclass correlations (ICC) values for consecutive-day assessments and 6 biweekly surveys were similar and not a function of the weeks evaluated. Total-item correlations and inter-measure correlations with the Center for Epidemiologic Studies - Depressed Mood Scale (CES-D) supported the removal of the sleep-related items from the 6-item scale. These analyses confirm the reliability of the original Kandel and Davies depressed mood scale as well as without the sleep-related items.
PMCID: PMC4206909  PMID: 25346804
sleep; depressed mood scale; reliability; insomnia; mood
4.  Sex of college students moderates associations among bedtime, time in bed, and circadian phase angle 
Journal of biological rhythms  2013;28(6):425-431.
Sex differences in circadian rhythms have been reported with some conflicting results. The timing of sleep and length of time in bed has not been considered, however, in previous such studies. The current study has three major aims: (1) replicate previous studies in a large sample of young adults for sex differences in sleep patterns and dim light melatonin onset (DLMO) phase; (2) in a subsample constrained by matching across sex for bedtime and time in bed, confirm sex differences in DLMO and phase angle of DLMO to bedtime; (3) explore sex differences in the influence of sleep timing and length of time in bed on phase angle. Three hundred and fifty-six (207 women) first year Brown University students ages 17.7–21.4 (mean=18.8, sd=.4) years were included in these analyses. Wake time was the only sleep variable that showed a sex difference. DLMO phase was earlier in women than men and phase angle wider in women than men Shorter time in bed was associated with wider phase angle in women and men. In men, however, a three way interaction indicated phase angles were influenced by both bedtime and time in bed, a complex interaction was not found for women. These analyses in a large sample of young adults on self-selected schedules confirm a sex difference in wake time, circadian phase, and the association between circadian phase and reported bedtime. A complex interaction with length of time in bed occurred for men but not women. We propose that these sex differences likely indicate fundamental differences in the biology of the sleep and circadian timing systems as well as in behavioral choices.
PMCID: PMC4166652  PMID: 24336420
5.  The Role of Prenatal Substance Exposure and Early Adversity on Parasympathetic Functioning from 3 to 6 Years of Age 
Developmental psychobiology  2013;56(4):821-835.
We employed latent growth curve analysis to examine trajectories of respiratory sinus arrhythmia (RSA) from 3 to 6 years among children with varying levels of prenatal substance exposure and early adversity. Data were drawn from a prospective longitudinal study of prenatal substance exposure that included 1,121 participants. Baseline RSA and RSA reactivity to an attention-demanding task were assessed at 3, 4, 5, and 6 years. Overall, there were significant individual differences in the trajectories of RSA reactivity, but not baseline RSA, across development. Greater levels of prenatal substance exposure, and less exposure to early adversity, were associated with increased RSA reactivity at 3 years, but by 6 years, both were associated with greater RSA reactivity. Prenatal substance exposure had an indirect influence through early adversity on growth in RSA reactivity. Results are in support of and contribute to the framework of allostatic load.
PMCID: PMC4132658  PMID: 24002807
allostatic load; prenatal substance exposure; early adversity; respiratory sinus arrhythmia
6.  Adolescence & Parental History of Alcoholism: Insights from the Sleep EEG 
Disrupted sleep is a common complaint of individuals with alcohol use disorder and in abstinent alcoholics. Furthermore, among recovering alcoholics, poor sleep predicts relapse to drinking. Whether disrupted sleep in these populations results from prolonged alcohol use or precedes the onset of drinking is not known. The aim of the present study was to examine the sleep EEG in alcohol naïve, parental history positive (PH+) and negative (PH−) boys and girls.
All-night sleep EEG recordings in two longitudinal cohorts (child and teen) followed at 1.5 – 3 year intervals were analyzed. The child and teen participants were 9/10 and 15/16 years old at the initial assessment, respectively. Parental history status was classified by DSM-IV criteria applied to structured interviews (CDIS-IV) resulting in 14 PH− and 10 PH+ children and 14 PH− and 10 PH+ teens. Sleep data were visually scored in 30-second epochs using standard criteria. Power spectra were calculated for EEG derivations C3/A2, C4/A1, O2/A1, O1/A2 for NREM and REM sleep.
We found no difference between PH+ and PH− individuals in either cohort for any visually scored sleep stage variable. Spectral power declined in both cohorts across assessments for NREM and REM sleep in all derivations and across frequencies independent of parental history status. With regard to parental history, NREM sleep EEG power was lower for the delta band in PH+ teens at both assessments for the central derivations. Furthermore, power in the sigma band for the right occipital derivation in both NREM and REM sleep was lower in PH+ children only at the initial assessment.
We found no gross signs of sleep disruption as a function of parental history. Modest differences in spectral EEG power between PH+ and PH− children and teens indicate that a marker of parental alcohol history may detectable in teens at risk for problem drinking.
PMCID: PMC4119930  PMID: 22486223
7.  Sleep Patterns Are Associated with Common Illness in Adolescents 
Journal of sleep research  2013;23(2):133-142.
This prospective, field-based study examined the association between actigraphically-measured total sleep time and incident illness including cold, flu, gastroenteritis, and other common infectious diseases (e.g., strep throat) in adolescents over the course of a school semester. Participants were 56 adolescents ages 14–19 years (mean = 16.6 (standard deviation = 1.2), 39% male) from 5 high schools in Rhode Island. Beginning in late January, adolescents wore actigraphs (mean 91 (19) days, range 16 – 112 days) and were assigned post-hoc to Longer or Shorter sleep groups based on median splits. Adolescents were interviewed weekly across as many as 16 weeks (modal number of interviews = 13) using a structured protocol that included 14 health event questions. Illness events and illness-related school absences were coded for 710 completed interviews, with 681 illness events and 90 school absences reported. Outcomes (illness bouts, illness duration, and absences) were compared among sex, sleep, and academic year groups using non-parametric regression. In a subset of 18 subjects, mean actigraphically estimated total sleep time 6 nights before matched illness/wellness events was compared using MANOVA. Longer sleepers and males reported fewer illness bouts; total sleep time effects were more apparent in males than females. A trend was found for shorter total sleep time before ill events. The present findings in this small naturalistic sample indicate that acute illnesses were more frequent in otherwise healthy adolescents with shorter sleep, and illness events were associated with less sleep during the prior week than comparable matched periods without illness.
PMCID: PMC4115328  PMID: 24134661
adolescent; total sleep time; common illness; actigraphy; sleep duration
8.  Perceptions of Emotion Expression and Sibling–Parent Emotion Communication in Latino and Non-Latino White Siblings of Children With Intellectual Disabilities 
Journal of Pediatric Psychology  2013;38(5):551-562.
Objective Examine general emotion expression and sibling–parent emotion communication among Latino and non-Latino white (NLW) siblings of children with intellectual disabilities (ID) and matched comparisons. Methods 200 siblings (ages 8–15 years) completed the newly developed Sibling–Parent Emotion Communication Scale and existing measures of general emotion expression and psychosocial functioning. Preliminary analyses evaluated scale psychometrics across ethnicity. Results Structure and internal consistency of the emotion expression and communication measures differed by respondent ethnicity. Latino siblings endorsed more general emotion expression problems and marginally lower sibling–parent emotion communication than NLW siblings. Siblings of children with ID reported marginally more general emotion expression problems than comparisons. Emotion expression problems and lower sibling–parent emotion communication predicted more internalizing and somatic symptoms and poorer personal adjustment, regardless of ID status. Siblings of children with ID endorsed poorer personal adjustment. Conclusion Cultural differences in emotion expression and communication may increase Latino siblings’ risk for emotional adjustment difficulties.
PMCID: PMC3666121  PMID: 23459309
emotion communication; emotion expression; intellectual disability; Latino; sibling
9.  The Home Environment and Family Asthma Management Among Ethnically Diverse Urban Youth with Asthma 
While the pediatric psychology literature underscores the importance of illness related aspects of the home environment for optimal family asthma management, little is known about the contribution of more global aspects of the home environment (e.g., family routines/schedule, quality of stimulation provided to child) to asthma management in ethnic minority and urban families. The goals of this study were to: 1) explore ethnic/racial group differences in global and specific dimensions of home environment quality among Latino, non-Latino white (NLW), and African American urban children with asthma; and 2) examine associations between the quality and quantity of support and stimulation within the home environment, as measured by the HOME Inventory, and family asthma management in this sample. Urban, low-income children (N=131) between the ages of 6 and 13 with asthma and a primary caregiver participated in a multi-modal assessment including an in home observation and semi structured interviews to assess aspects of home environment quality and family asthma management practices. While controlling for poverty, no ethnic group differences were found in the global home environment; however, there were significant differences in specific dimensions (e.g. Family Participation in Developmentally Stimulating Experiences, and Aspects of the Physical Environment) of home environment quality. Across the whole sample, home environment quality predicted family asthma management. When examining this association for specific ethnic groups, this finding did not hold for the Latino subsample. The results highlight the need to consider ethnic group differences in non-illness specific aspects of the home environment when addressing families’ asthma management strategies.
PMCID: PMC3746827  PMID: 23795627
10.  Underdiagnosed and Undertreated Allergic Rhinitis in Urban School-Aged Children with Asthma 
Allergic rhinitis (AR) is a risk factor for the development of asthma, and if poorly controlled, it may exacerbate asthma. We sought to describe AR symptoms and treatment in a larger study about asthma, sleep, and school performance. We examined the proportion (1) who met criteria for AR in an urban sample of school children with persistent asthma symptoms, (2) whose caregivers stated that they were not told of their child's allergies, (3) who had AR but were not treated or were undertreated for the disease, as well as (4) caregivers and healthcare providers' perceptions of the child's allergy status compared with study assessment, and (5) associations between self-report of asthma and AR control over a 4-week monitoring period. One hundred sixty-six children with persistent asthma participated in a clinical evaluation of asthma and rhinitis, including allergy testing. Self-report of asthma control and rhinitis control using the Childhood Asthma Control Test (C-ACT) and Rhinitis Control Assessment Test (RCAT) were measured 1 month after the study clinic session. Persistent rhinitis symptoms were reported by 72% of participants; 54% of rhinitis symptoms were moderate in severity, though only 33% of the sample received adequate treatment. AR was newly diagnosed for 53% during the clinic evaluation. Only 15% reported using intranasal steroids. Participants with poorly controlled AR had poorer asthma control compared with those with well-controlled AR. This sample of urban school-aged children with persistent asthma had underdiagnosed and undertreated AR. Healthcare providers and caregivers in urban settings need additional education about the role of allergies in asthma, recognition of AR symptoms, and AR's essential function in the comanagement of asthma. Barriers to linkages with allergy specialists need to be identified.
PMCID: PMC4062104  PMID: 24963455
11.  Integrating Asthma Education and Smoking Cessation for Parents: Financial Return on Investment 
Pediatric pulmonology  2012;47(10):950-955.
Caregivers who smoke and have children with asthma are an important group for intervention. Home-based interventions successfully reduce asthma morbidity, yet are costly. This study evaluated the financial return on investment (ROI) of the Parents of Asthmatics Quit Smoking (PAQS) program, a combined asthma education and smoking cessation intervention.
Participants included caregivers (n = 224) that smoked, had a child with asthma, and were enrolled in a Medicaid managed care plan. Participants received nurse-delivered asthma education and smoking counseling in three home visits. Program implementation costs were estimated, and health care expenses were obtained from insurance claims data 12 months pre- and 12 months post intervention. ROI was calculated for all participants, children < 6 years, children 6–18 years, and children with moderate/severe persistent asthma.
Total program implementation cost was $34,481. After intervention, there was increased mean annual refills of beta-agonist (0.51 pre, 1.64 post; p<0.001), and controller medications (0.65 pre, 2.44 post; p<0.001). Reductions were found in mean annual emergency department visits (0.33 pre, 0.14 post; p<0.001), hospitalizations (0.23 pre, 0.08 post; p<0.001), and outpatient visits (2.33 pre, 1.45 post, p<0.001). The program had negative ROI (−21.8%) for the entire sample. The ROI was positive (+106.9) for children < six years, negative (−150.3) for children 6–18, and negligible for moderate/severe persistent asthma (+6.9%).
PAQS was associated with increased medication use and decreased health care utilization. While the overall ROI for PAQS was negative, PAQS had a positive ROI for caregivers of young children with asthma.
PMCID: PMC3407822  PMID: 22467563
Asthma; Pediatrics; Smoking Cessation; Education
12.  Ethnic Differences in Caregiver Quality of Life in Pediatric Asthma 
The aim of this study was to determine ethnic and site differences in quality of life (QOL) in a sample of Latino (Puerto Rican and Dominican) and non-Latino White (NLW) caregivers of children with asthma in mainland US and Island PR. We also investigated ethnic and site differences in associations between caregiver QOL and indicators of asthma morbidity.
Seven-hundred and eighty-seven children with asthma (7–16 years of age) and their primary caregivers participated. Primary caregivers completed a measure of QOL, child asthma control, and emergency department utilization, among other measures.
Ethnic and site differences were found on total QOL scores (ΔF(1, 783) = 29.46, p < .001). Island PR caregivers reported worse QOL scores than RI Latino and NLW caregivers; RI Latino caregivers reported significantly worse QOL scores than NLW caregivers. In RI Latino and Island PR children, worse caregiver QOL was associated with asthma that was not in control and with 1 or more ED visits.
Latino caregivers may be experiencing a greater level of burden related to their child’s asthma than NLW caregivers. Caregiver QOL in pediatric asthma may be a reflection of broader, contextual stress that some Latino caregivers experience on a daily basis (e.g., cultural beliefs, acculturation). Future research should continue to investigate mechanisms that explain the burden associated with pediatric asthma in Latino families, as well as whether QOL assessments should consider the impact of everyday stressors on caregiver QOL in pediatric asthma.
PMCID: PMC3463809  PMID: 23027132
pediatric asthma; quality of life; caregivers; disparities; ethnicity
13.  Embedding the Family Check Up and Evidence-Based Parenting Programs in Head Start to Increase Parent Engagement and Reduce Conduct Problems in Young Children 
Parent engagement (i.e., enrollment, ongoing attendance, participation quality) remains a major obstacle to fully realizing the benefits of evidence-based preventive parent management training in community settings. We describe an approach to parent engagement that addresses the myriad motivational, cognitive, and pragmatic barriers parents face by embedding services in Head Start and applying a parent engagement model, the Family Check Up, as a pre-intervention to augment parent training. In this article, we present the rationale for applying FCU to advance parent readiness for engagement and we describe the process by which we partnered with the community to modify FCU to be most impactful for enhancing parent engagement in one specific program, the Incredible Years Parenting Series. We conclude with preliminary data from our ongoing pilot trial that supports our approach.
PMCID: PMC3422548  PMID: 22912648
Parent engagement; parent management training; school-based prevention; early childhood
14.  Acute Sleep Restriction Effects on Emotion Responses in 30- to 36-Month-Old Children 
Journal of Sleep Research  2011;21(3):235-246.
Early childhood is a period of dramatic change in sleep and emotion processing, as well as a time when disturbance in both domains are first detected. Although sleep is recognized as central in emotion processing and psychopathology, the great majority of experimental data have been collected in adults. We examined the effects of acute sleep restriction (nap deprivation) on toddlers’ emotion expression. Ten healthy children (7 females; 30–36 months) followed a strict sleep schedule (≥12.5 hrs time in bed/24 hrs) for 5 days before each of two randomly-assigned afternoon emotion assessments following Nap and No-Nap conditions (resulting in an 11-day protocol). Children viewed emotion-eliciting pictures (5 positive, 3 neutral, 3 negative) and completed puzzles (1 solvable, 1 unsolvable). Children’s faces were video-recorded, and emotion displays were coded. When sleep restricted, children displayed less confusion in response to neutral pictures, more negativity to neutral and negative pictures, and less positivity to positive pictures. Sleep restriction also resulted in a 34% reduction in positive emotion responses (solvable puzzle), as well as a 31% increase in negative emotion responses and a 39% decrease in confused responses (unsolvable puzzle). These findings suggest sleep is a key factor in how young children respond to their world. When sleep restricted, toddlers are neither able to take full advantage of positive experiences nor are they as adaptive in challenging contexts. If insufficient sleep consistently “taxes” young children’s emotion responses, they may not manage emotion regulation challenges effectively, potentially placing them at risk for future emotional/behavioral problems.
PMCID: PMC3258474  PMID: 21988087
Sleep Restriction; Napping; Emotion; Facial Coding; Early Childhood; Toddlers
15.  Medication Adherence Among Latino and Non-Latino White Children With Asthma 
Pediatrics  2012;129(6):e1404-e1410.
Latino children of Caribbean descent remain at high risk for poorly controlled asthma. Controller medications improve asthma control; however, medication adherence remains suboptimal, particularly among minorities. This study assessed socioeconomic, family-based, and parent factors in medication adherence among children with asthma from Rhode Island (RI; Latino and non-Latino white [NLW]) and Puerto Rico.
Data collection occurred as part of a multicenter study of asthma disparities. Our sample included children (ages 7–16) prescribed objectively monitored controller medications (n = 277; 80 island Puerto Rico, 114 RI Latino, 83 RI NLW). Parents completed questionnaires regarding family background and beliefs about medications. Families participated in an interview regarding asthma management. Multilevel analyses (maximum likelihood estimates) accounting for children being nested within site and ethnic group assessed the contribution of social context, family, and parent variables to medication adherence.
Medication adherence differed by ethnic group (F2, 271 = 7.46, P < .01), with NLW families demonstrating the highest levels of adherence. Multilevel models indicated that parental beliefs about medication necessity and family organization regarding medication use were significant predictors of adherence, even for families below the poverty threshold. With family factors in the model, a substantial improvement in model fit occurred (Akaike Information Criterion change of 103.45).
Adherence to controller medications was lower among Latino children in our sample. Targeted interventions that capitalize on existing family resources, emphasize structure, and address parental beliefs about the importance of medications may be of benefit to families from different cultural backgrounds.
PMCID: PMC3362901  PMID: 22566417
asthma; patient nonadherence; disparities
16.  Identifying Individual, Cultural and Asthma-Related Risk and Protective Factors Associated With Resilient Asthma Outcomes in Urban Children and Families 
Journal of Pediatric Psychology  2012;37(4):424-437.
Objective The goal of this study is to identify individual, family/cultural, and illness-related protective factors that may minimize asthma morbidity in the context of multiple urban risks in a sample of inner-city children and families. Methods Participating families are from African-American (33), Latino (51) and non-Latino white (47) backgrounds. A total of 131 children with asthma (56% male), ages 6–13 years and their primary caregivers were included. Results Analyses supported the relationship between cumulative risks and asthma morbidity across children of the sample. Protective processes functioned differently by ethnic group. For example, Latino families exhibited higher levels of family connectedness, and this was associated with lower levels of functional limitation due to asthma, in the context of risks. Conclusions This study demonstrates the utility of examining multilevel protective processes that may guard against urban risks factors to decrease morbidity. Intervention programs for families from specific ethnic groups can be tailored to consider individual, family-based/cultural and illness-related supports that decrease stress and enhance aspects of asthma treatment.
PMCID: PMC3415979  PMID: 22408053
asthma outcomes; cultural factors; inner city; pediatric asthma; protective factors
18.  Security of Attachment and Quality of Mother-Toddler Social Interaction in a High-Risk Sample 
Infant behavior & development  2011;35(1):83-93.
The quality of children’s social interactions and their attachment security with a primary caregiver are two widely studied indices of socioemotional functioning in early childhood. Although both Bowlby and Ainsworth suggested that the parent-child interactions underlying the development of attachment security could be distinguished from other aspects of parent-child interaction (e.g., play), relatively little empirical research has examined this proposition. The aim of the current study was to explore this issue by examining concurrent relations between toddler’s attachment security in the Strange Situation Procedure and quality of mother-child social interaction in a high-risk sample of toddlers characterized by prenatal cocaine exposure and low levels of maternal education. Analyses of variance suggested limited relations between attachment security and quality of social interaction. Further research examining the interrelations among various components of the parent-child relationship is needed.
PMCID: PMC3249523  PMID: 21981901
Child; Attachment; Social Interaction; Prenatal Cocaine Exposure
19.  Recruiting Latino and Non-Latino Families in Pediatric Research: Considerations from a Study on Childhood Disability 
Journal of Pediatric Psychology  2011;36(10):1093-1101.
Objective To improve representation of minorities in research, we examined recruitment methods from our study of Latino and non-Latino families of children with Intellectual Disability (ID). Method We compared recruitment strategies that yielded the enrollment target of 200 matched Latino and nonLatino families of children with ID and controls. Active recruitment strategies involved direct contact with potential participants; passive strategies included disseminating study information. Results Effective outreach focused on community agencies where children had ongoing involvement and utilizing bilingual/bicultural staff. Latino families were significantly more likely to be recruited by an active strategy than non-Latino families. Active and passive strategies were both effective with non-Latino ID families. Asking research participants to inform other families about the study and sharing consent to contact lists with other investigators was productive with control families. Conclusions Bilingual staff and active recruitment through familiar community services were successful in recruiting Latino families for research.
PMCID: PMC3199442  PMID: 21685459
family; Latino; minority recruitment
20.  Immigration and Acculturation-Related Factors and Asthma Morbidity in Latino Children* 
Journal of Pediatric Psychology  2011;36(10):1130-1143.
Objective This article presents a summary of findings from asthma studies focusing on immigration and acculturation-related factors. A study examining associations between these processes, family cohesion and social support networks, and asthma morbidity in a sample of Dominican and Puerto Rican caregivers residing in the mainland U.S., is also described. Methods Latino children with asthma (n = 232), ages 7–16 (49% female) and their caregivers completed interview-based questionnaires on immigration and acculturation-related processes, family characteristics, and asthma morbidity. Results The frequency of ED use due to asthma may be higher for children of caregivers born in Puerto Rico. Acculturative stress levels were higher for Puerto Rican born caregivers residing in the mainland U.S. Conclusion Asthma-related educational and intervention programs for Latino children and families should be tailored to consider the effects that the immigration and acculturation experience can have on asthma management. Specific family-based supports focused on decreasing stress related to the acculturation process, and increasing social and family support around the asthma treatment process may help to reduce asthma morbidity in Latino children.
PMCID: PMC3247793  PMID: 21745811
acculturation; asthma morbidity; immigration
21.  Infant development in family context: call for a genetically informed approach 
Frontiers in Genetics  2012;3:167.
We call for a genetically informed approach in the examination of infant social and emotional development in family context. We recommend that scholars conceptualize family functioning as occurring on three unique levels: the parent-child dyad, the inter-parental dyad, and whole family functioning. Although advances in the area of understanding genetic variation in infants as a potential moderator of the influence of parent-child dyadic functioning have been made over the past decade, it is time to widen this inquiry to consider genetic variation in infants as a potential moderator of the influence of inter-parental dyadic and whole family functioning as well. A critical review of the literature also calls for additional examination of genetic variation in infants as a moderator of positive contextual influences, the integration of unique temperament variables with studies of infant genotype, consideration of the role of the gene-environment correlation, and epigenetic effects. Furthermore, we call for the application of genetically-informed research methods to these questions. Expanding knowledge in this area has the potential to refine treatment and prevention efforts aimed at promoting infant social and emotional development.
PMCID: PMC3432496  PMID: 22969793
family functioning; infancy; temperament; gene-environment interactions; development
22.  Conundrums in childhood asthma severity, control, and health care use: Puerto Rico versus Rhode Island 
The lifetime prevalence of self-reported asthma among Puerto Ricans is very high, with increased asthma hospitalizations, emergency department visits, and mortality rates. Differences in asthma severity between the mainland and island, however, remain largely unknown.
We sought to characterize differences in asthma severity and control among 4 groups: (1) Island Puerto Ricans, (2) Rhode Island (RI) Puerto Ricans, (3) RI Dominicans, and (4) RI whites.
Eight hundred five children aged 7 to 15 years completed a diagnostic clinic session, including a formal interview, physical examination, spirometry, and allergy testing. Using a visual grid adapted from the Global Initiative for Asthma, asthma specialists practicing in each site determined an asthma severity rating. A corresponding level of asthma control was determined by using a computer algorithm.
Island Puerto Ricans had significantly milder asthma severity compared with RI Puerto Ricans, Dominicans, and whites (P < .001). Island Puerto Ricans were not significantly different from RI whites in asthma control. RI Puerto Ricans showed a trend toward less control compared with island Puerto Ricans (P = .061). RI Dominicans had the lowest rate of controlled asthma. Paradoxically, island Puerto Ricans had more emergency department visits in the past 12 months (P < .001) compared with the 3 RI groups.
Potential explanations for the paradoxic finding of milder asthma in island Puerto Ricans in the face of high health care use are discussed. Difficulties in determining guideline-based composite ratings for severity versus control are explored in the context of disparate groups.
PMCID: PMC3380616  PMID: 19615729
Asthma; severity; control; clinical guidelines; Global Initiative for Asthma; Latino; Puerto Rican; Dominican; Rhode Island; health care use
23.  Psychological and school functioning of Latino siblings of children with intellectual disability 
Siblings of children with disabilities are at risk for internalizing psychological disorders; however little is known about how culture influences this effect. This study examined the psychological and school functioning of Latino siblings of children with Intellectual Disability (ID).
Participants were 100 Latino (L) and nonLatino (NL) siblings (8–15 years) of children with ID (50 LID, 50 NLID) and 100 Latino and nonLatino control siblings (50 LC, 50 NLC). Siblings, parents, and teachers completed standard questionnaires regarding sibling emotional and behavioral functioning; sibling school report cards were obtained. Analyses of variance were conducted, controlling for parent age and family income; planned contrasts compared LID siblings to the other sibling groups.
LID siblings reported significantly more internalizing (t(1) = 2.41, p <.05) and emotional t(1) = 3.06, p <.05) symptoms, poorer awareness of (t(1) = 2.26, p <.01) and greater reluctance to express (t (1) = 3.12, p <.01) their emotions, and more problems in personal adjustment and relationships with parents (t(1) = −2.50, p <.05). Significantly higher percentages of LID siblings scored in the at-risk or clinical range for internalizing and emotional symptoms, and were more likely to score above the clinical cut-off for separation anxiety disorder and to endorse global impairment. LID siblings experienced more school absences and lower academic performance. There were no group differences in externalizing behavior problems, somatic symptoms, or teacher-reported internalizing symptoms.
Latino siblings of children with ID are at greater risk for internalizing psychological disorders and greater impairment in personal and school functioning. Results are discussed in terms of their sociocultural significance and clinical implications.
PMCID: PMC3096688  PMID: 21204835
Siblings; intellectual disability; Latino; culture
24.  Ethnic Differences in Somatic Symptom Reporting in Children With Asthma and Their Parents 
The purpose of this study is to examine the association between child and parent somatic symptom reporting and pediatric asthma morbidity in Latino and non-Latino white children.
The study consists of 786 children, 7 to 15 years of age, in Rhode Island (RI) and Puerto Rico. Children’s and parents’ levels of general somatic symptoms were assessed with well-established self-report measures. Clinician-determined asthma severity was based on reported medication use, asthma symptom history, and spirometry results. Asthma-related health care use and functional morbidity was obtained via parent self-report.
Child and parent reports of general somatic symptoms were significantly related to pediatric asthma functional morbidity when controlling for poverty, parent education, child’s age, and asthma severity. In controlling for covariates, Latino children in RI reported higher levels of somatic symptoms than Island Puerto Rican children, and RI Latino parents reported more somatic symptoms than RI non-Latino white parents (p < .05).
This study replicates and extends to children in previous research showing higher levels of symptom reporting in Latinos relative to whites. Results also provide new insight into the relation between general somatic symptom reports and pediatric asthma. Ethnic differences in somatic symptom reporting may be an important factor underlying asthma disparities between Latino and non-Latino white children.
PMCID: PMC3278967  PMID: 19564802
asthma; health disparities; somatization
25.  Asthma symptom perception and obesity in children☆ 
Biological Psychology  2009;84(1):135-141.
This study examined the relationship between obesity and asthma symptom perception in 200 youth with asthma. Repeated subjective and objective peak flow measurements were summarized using the Asthma Risk Grid (Klein et al., 2004), resulting in Accurate, Symptom Magnification and Danger Zone scores. Analyses were stratified by age and included ethnicity.
For younger children, obesity was not significantly related to perception scores. For older children, a significant obesity-by-ethnicity interaction for Accurate Symptom Perception scores indicated that obese white children had lower accuracy than white nonobese children, while there was no difference for obese versus nonobese minority children. Obesity was also related to higher Symptom Magnification scores regardless of ethnicity for older children.
These findings suggest that obesity may complicate asthma management by interfering with the ability to accurately perceive symptoms for some patients. More remains to be learned about the role of sociodemographic factors underlying this relationship.
PMCID: PMC3278964  PMID: 19941934
Asthma; Body mass index; Obesity; Symptom perception; Children

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