title: Evidence of high rates of undiagnosed asthma in central Ohio elementary schoolchildren.
abstract: BACKGROUND
  In Ohio, 14.5% of 5- to 9-year-olds and 17.3% of 10- to 17-year-olds have asthma. Moreover, there is concern that these numbers may underestimate the true disease burden. We sought to evaluate variability in asthma rates and respiratory symptoms among central Ohio fourth graders as a means to assess potential undiagnosed and undertreated asthma and its determinants.
  
  
  METHODS
  We recruited 13 central Ohio elementary schools representing a broad range of nonurban settings and surveyed fourth graders to estimate school-level physician-diagnosed asthma (PDA), respiratory morbidity, and home exposures to smoking and pets. We used generalized linear mixed models with random intercept for school to examine relationships among exposures, respiratory symptoms, and PDA.
  
  
  RESULTS
  Across the 13 schools, 94% of students participated in the survey, and the estimated asthma prevalence rate was 10.2% (N = 101 of 987). An additional 41% reported not having PDA but then went on to report symptoms consistent with asthma potentially suggestive of undiagnosed asthma. Of students with PDA, 21% reported symptoms suggestive of poorly controlled asthma. High levels of secondhand smoke (SHS) exposure were associated both with PDA (p = .05) and with respiratory symptoms (p < .0001). Students who owned a cat or a bird were more likely to report respiratory symptoms (p = .02 and p = .04, respectively).
  
  
  CONCLUSIONS
  We provide evidence that the already high childhood asthma public health burden in central Ohio may be underreported. Schools may be an ideal location to conduct screenings and implement environmental interventions oriented toward SHS and household pets that will yield respiratory morbidity benefits.
authors.affiliation: Lecturer, (bclark@cph.osu.edu), College of Public Health, Division of Environmental Health Sciences, The Ohio State University, 1841 Neil Avenue, Columbus, OH 43210.
authors.forename: Brenda R
authors.initials: BR
authors.lastname: Clark
authors.forename: S Amanda
authors.initials: SA
authors.lastname: Burkett
authors.forename: Rebecca R
authors.initials: RR
authors.lastname: Andridge
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Buckley
mesh_terms: D000818:Animals; D001249:Asthma / Q000175:diagnosis* / Q000453:epidemiology*; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D009820:Ohio / Q000453:epidemiology; D057805:Pets; D012959:Socioeconomic Factors; D014028:Tobacco Smoke Pollution / Q000009:adverse effects
chemical_list: D014028:Tobacco Smoke Pollution
keywords: asthma; children; elementary school