文章基本信息

标题：Asthma and Enrollment in Special Education Among Urban Schoolchildren
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作者：Jeanette A. Stingone ; Luz Claudio
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2006
卷号：96
期号：9
页码：1593-1598
DOI：10.2105/AJPH.2005.075887
语种：English
出版社：American Public Health Association
摘要：Objectives. We assessed whether asthma is associated with urban children’s use of special education services. Methods. We conducted a cross-sectional study in 24 randomly selected New York City public elementary schools using a parent-report questionnaire focusing on sociodemographic characteristics, special education enrollment, asthma diagnosis and symptoms, school absences, and use of health care services. Results. Thirty-four percent of children enrolled in special education had been diagnosed with asthma, compared with 19% of children in the general student population. After control for sociodemographic factors, children with asthma were 60% more likely than children without asthma to be enrolled in special education (odds ratio [OR] = 1.62; 95% confidence interval [CI] = 1.22, 2.16). Asthmatic children in special education were significantly more likely to be from low-income families and to have been hospitalized in the previous 12 months than asthmatic children in general education. Conclusions. Inadequate asthma control may contribute to a greater risk of asthmatic children residing in urban areas being placed in special education. School health programs should consider targeting low-income urban children with asthma at risk for enrollment in special education through increased asthma interventions and medical support services. School-based cohorts and school-related outcomes are important to understanding the epidemiology of disease in children 5 to 12 years of age. One highly prevalent disease among schoolchildren is asthma. Asthma is the most common chronic childhood disease in the United States, and it is the leading cause of school absences. 1 It has been estimated that health care expenditures are almost 3 times as high among children with asthma as among children without the disease. 2 In addition, asthma severity, low family income, and non-White race/ethnicity have been associated with increased asthma-related costs to both families and managed care companies as a result of increased use of health care services. 3 However, cost estimates do not take into account expenditures associated with special requirements associated with the education of asthmatic children. School absences and other effects of asthma may lead to children requiring special education services, compounding asthma-related costs. The average yearly cost per special education student in New York City for the 2001 school year was $28810, compared with $8944 for the average general education student. 4 Compounding this situation is the fact that once children are placed in special education, it is unlikely that they will enter or reenter the general education environment. Although the reasons are unclear, New York City has the lowest rate of reentry of special education students in the state, regardless of disability. 5 Children are enrolled in special education for a number of reasons. For example, in New York, students are eligible to receive special education services if their educational performance is adversely affected by a state-recognized disability such as autism, hearing impairments, emotional disturbances, learning disabilities, mental retardation, orthopedic impairments, speech or language impairments, traumatic brain injuries, or visual impairments. 6 The relation between asthma and learning disability is not clear. One study showed that asthmatic children whose parents reported them to be in fair or poor health were more likely to have a learning disability than asthmatic children in good or excellent health. 7 Because low-income urban children are more likely to experience higher levels of asthma morbidity, these results suggest that they are at a higher risk of school and learning difficulties as well. 7 A study conducted in New York City showed that 40% of parents enrolled in an asthma management program reported school problems among their asthmatic children. 8 However, the researchers did not define what they considered to be “school problems,” nor did they examine other factors associated with such problems. In New York City, approximately 163000 students are enrolled in some form of special education. 9 Special education services range from a period of extra help in a resource room program during the school day to fully segregated special education classrooms. Children enrolled in special education generally exhibit worse academic outcomes than their general education counterparts. For example, only 44% of fourth graders in special education achieved a score of proficient or higher on the 2005 New York State mathematics examination, compared with 77.4% of general education students. 10 Our objective was to assess the relation between asthma among urban children and enrollment in special education in New York City public elementary schools. We also sought to examine the socioeconomic and disease-related factors associated with enrollment in special education programs among asthmatic children living in this urban area.