Academic journal article Journal of School Health

Comparison of Parent and Student Responses to Asthma Surveys: Students Grades 1-4 and Their Parents from an Urban Public School Setting

Academic journal article Journal of School Health

Comparison of Parent and Student Responses to Asthma Surveys: Students Grades 1-4 and Their Parents from an Urban Public School Setting

Article excerpt


Data from a study to validate an asthma case-detection procedure were used to examine the agreement between parents and children on questions about the child's asthma symptoms, medication use, and asthma diagnosis. A detailed description of the multistage case-detection procedure and its results has been previously published. (12)

Study Population

This study was conducted in 10 elementary schools of 4 inner-city public school systems. Data were collected September 2001 to May 2003 from children in grades 1-4 and from their parents. Children in these school systems were predominantly African American and low income. Study enrollment was a 2-stage process. Asthma symptom questionnaires (Table l) were distributed to the entire school population (n = 3539). Children were asked to deliver the questionnaire to their parents. Children returning completed questionnaires (n = 3463, 98%) were asked to enroll in the study. Written informed consent was obtained from the child's parent or guardian, and assent was obtained from each child. This study was approved and monitored by the Institutional Review Board of the University of Alabama at Birmingham (UAB).

Case-Detection Procedure

The UAB asthma case-detection procedure (1,2) had 3 stages--a symptom questionnaire, spirometry testing, and a submaximal exercise challenge. The case-detection procedure began with a 5-item questionnaire that was completed by the parent (Table 1). Because the procedure was multistage, the questionnaire was designed to be as inclusive as possible. Based on parental responses, children were categorized as probable asthma, possible asthma, and negative for asthma. A child was considered to have a previous diagnosis of asthma (probable asthma) when the answers to question 4 (Has a doctor ever said your child has asthma?) and question 5a (Has your child taken asthma medicine prescribed by a doctor in the past 12 months?) were "yes." Children were considered to be negative for asthma when answers to all questions were "no." Any other answer combination indicated possible asthma.

Parent questionnaires were sent home with the children. Children were asked to return parent-completed questionnaires to their classroom teachers. Frequent follow-up by study staff and incentives for teachers and children resulted in a high participation rate (98%). Implementation of the screening procedure began when 80% of parent questionnaires had been returned. Therefore, there was a 4- to 8-week delay between parent and child questionnaire completion. Children completed their questionnaires at school with the assistance of the study staff. Spirometry to assess for airflow obstruction and step testing to evaluate bronchial hyperresponsiveness followed the questionnaire.

Physician Assessment

The gold standard (3,4) for validating the case-detection procedure was a diagnosis of asthma by a pediatric asthma specialist. One of 4 pediatric asthma specialists examined all children with a positive indication of asthma (ie, those classified as probable asthma by questionnaire, spirometry, or step test). In addition, the physicians examined a random sample of children who had been classified as having no evidence of asthma. All children who were examined by physicians completed spirometry testing. Although physicians had access to spirometry results, they were blinded to whether students had been identified as positive or negative for asthma by spirometry and/or step test.


McNemar's test and kappa coefficients were used to examine parent-child agreement. Suggested interpretations of kappa coefficients for agreement include poor = <0.20, fair = 0.21 to 0.40, moderate = 0.41 to 0.60, good = 0.61 to 0.80, and very good = 0.81 to 1.00. (5) Gender, age, and existence of previous asthma diagnosis were examined using the test for equal kappa coefficients. Sensitivity and specificity of the case-detection procedure, using the physician diagnosis as the gold standard, were calculated using both the parent's and child's answers to symptom questionnaires. …

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