Prevalence and correlates of paediatric asthma and wheezing in a largely rural USA population.

OBJECTIVE: The prevalence of asthma among children has been increasing in the United States and it is estimated that there are approximately 5 million children with asthma. This cross-sectional survey sought to estimate the prevalence of asthma and asthma symptoms and potential risk factors among children aged 16 and younger, in a largely rural population in the USA. METHODS: This study was a telephone survey of 1500 households in the South Plains/Panhandle region of Texas. Parents of children were interviewed with a response rate of 64%. Having been diagnosed with asthma by a physician and a report of wheezing in the last 12 months were used as dependent variables in multivariate logistic regressions with several sociodemographic and environmental factors as potential confounders. RESULTS: The age-adjusted prevalence of asthma and wheezing among children were approximately 15 and 18%, respectively. The prevalence of asthma was highest (20%) among children aged 11-16 (P < 0.001). Living in urban areas was associated significantly with asthma and wheezing. Non-Hispanic blacks reported significantly increased odds of asthma in their children (adjusted odds ratio (OR) = 2.04, 95%CI 1.02-4.08), whereas Mexican-Americans reported significantly reduced odds of asthma (adjusted OR = 0.48, 95%CI 0.29-0.78) and wheezing (adjusted OR = 0.58, 95%CI 0.37-0.89) in their children. The odds of asthma (adjusted OR = 1.78, 95%CI 1.09-2.92) and wheezing (adjusted OR = 2.45, 95%CI 1.52-3.95) was highest among children in the highest body mass index quartile. No significant association with pet ownership and exposure to second-hand smoke with asthma and wheezing was observed in this study. CONCLUSION: Urban residence, non-Hispanic black and Mexican-American race/ethnicity, and being overweight were significantly associated with the increased risk of asthma and/or wheezing.

Privatizing maternal and child health services in Texas: reinventing Title V programs.

In November 1994, the Texas Department of Health embarked upon a major initiative to "reinvent" maternal and child health services funded through the Title V Maternal and Child Health Block Grant and related state general revenue. This article describes the rationale, planning process, and implementation issues associated with the initiative to redefine the fundamental roles and priorities of the department and traditional public health entities in the delivery of maternal and child health services.

Firearm-related deaths among children in Texas: 1984-1988.

Although firearms are significant contributors to intentional and unintentional injuries among children in Texas, little information has been published on this topic. We reviewed all firearm-related deaths occurring among persons younger than 15 years of age in Texas from 1984-1988. There were 337 firearm-related deaths among Texas children 0-14 years of age in this 5-year period. Unintentional deaths and firearm homicides were approximately equal for this age group. Black males ages 10-14 years were at highest risk of firearm-related death. The death rate for males was three times that of females. Death rates from unintentional shootings were highest in rural areas, while firearm homicides and suicides were highest in the largest cities.

A study of medical costs associated with selected genetic disorders in Texas.

We estimated that the payments associated with the 11 selected diseases during 1987 in Texas included $88.2 million from Medicaid and $10.6 million from CIDC for a total of $98.8 million. Patients with these diseases represented 0.83% of Medicaid claims, but 4.68% of Medicaid payments. Medicaid payments for genetic services for patients with these 11 selected disorders in Texas during a nine-month period in 1987 were $10,122, or 0.02% of the total Medicaid payments for these claimants. We conclude that our estimate of the Medicaid payments for these disorders in 1987 of nearly $100 million represents a low estimate of the true medical costs for the care of these patients. This study also indicates that these 11 disorders represent a disproportionate share of Medicaid payments; i.e., these patients show a high ratio of payment per claim. We also conclude from these data that CIDC is a significant source of support for the medical care of these patients in Texas. And, finally, this study suggests that referral for genetic services represents a significant barrier for individuals in need of these services.

Needs assessment for genetic services in Texas.

In summary, we found that the availability of genetic services for the Medicaid patients with the 11 selected disorders follow the general population distribution for Texas. In general, there is no major geographic factor limiting availability of services. We also found that the calculation of Medicaid dollars paid according to the size of the metropolitan area in which the patient resides indicates that there are fewer Medicaid dollars spent on these 11 genetic disorders per person in the population in the larger metropolitan areas. We conclude that preliminary review of these data indicate that the urban poor may have a greater need for medical services that deal with genetic disease.

Firearms in the home and child safety.

One hundred fifty families who were seen in the pediatric outpatient clinics at The University of Texas Medical Branch, Galveston, were surveyed to learn about firearm possession in the home and its hazards to children. Thirty-eight percent of these families kept at least one gun in their home. Fifty-five percent of this group reported that the gun was loaded at all times, and 10% reported that the gun was kept loaded, unlocked, and within the reach of a child. We identified demographic characteristics of at-risk families and considered national statistics for gun safety. It was concluded that household firearms pose a significant risk to children and that intervention by physicians could help reduce this public health problem.

Hypercalciuria related to cadmium exposure.

A work force has been investigated for possible cadmium intoxication. One group who are coppersmiths have an 18.5 per cent prevalence of upper urinary tract stone disease associated with a statistically highly significant hypercalciuria and reduced serum inorganic phosphate. Proof of exposure to cadmium has been confirmed in all workers. The trace element cadmium should be kept in mind when investigating stone formers who exhibit an unexplained hypercalciuria.