Family structure and the treatment of childhood asthma.
BACKGROUND
Family structure is known to influence children's behavioral, educational, and cognitive outcomes, and recent studies suggest that family structure affects children's access to health care as well. However, no study has addressed whether family structure is associated with the care children receive for particular conditions or with their physical health outcomes.


OBJECTIVE
To assess the effects of family structure on the treatment and outcomes of children with asthma.


METHODS
Our data sources were the 1996-2003 Medical Expenditure Panel Survey (MEPS) and the 2003 National Survey of Children's Health (NSCH). The study samples consisted of children 2-17 years of age with asthma who lived in single-mother or 2-parent families. We assessed the effect of number of parents and number of other children in the household on office visits for asthma and use of asthma medications using negative binomial regression, and we assessed the effect of family structure on the severity of asthma symptoms using binary and ordinal logistic regression. Our regression models adjusted for sociodemographic characteristics, parental experience in child-rearing and in caring for an asthmatic child and, when appropriate, measures of children's health status.


RESULTS
Asthmatic children in single-mother families had fewer office visits for asthma and filled fewer prescriptions for controller medications than children with 2 parents. In addition, children living in families with 3 or more other children had fewer office visits and filled fewer prescriptions for reliever and controller medications than children living with no other children. Children from single-mother families had more health difficulties from asthma than children with 2 parents, and children living with 2 or more other children were more likely to have an asthma attack in the past 12 months than children living with no other children.


CONCLUSIONS
For children with asthma, living with a single mother and the presence of additional children in the household are associated with less treatment for asthma and worse asthma outcomes.
Chen
Alex Y
AY
Division of Research on Children, Youth, and Families, Children's Hospital Los Angeles, University of Southern California Keck, School of Medicine, Los Angeles, California, USA. achen@chla.usc.edu
Escarce
José J
JJ
D000293:Adolescent; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use; D001249:Asthma / Q000191:economics / Q000628:therapy*; D002648:Child; D002662:Child Health Services / Q000191:economics / Q000706:statistics & numerical data*; D002668:Child Rearing; D002675:Child, Preschool; D004363:Drug Utilization; D005191:Family Characteristics; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data; D006297:Health Services Accessibility; D006306:Health Surveys; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D009819:Office Visits / Q000706:statistics & numerical data*; D017063:Outcome Assessment, Health Care; D012044:Regression Analysis; D012720:Severity of Illness Index; D014481:United States
D018927:Anti-Asthmatic Agents