title: Asthma-Like Symptoms in Homeless Children in the Greater Paris Area in 2013: Prevalence, Associated Factors and Utilization of Healthcare Services in the ENFAMS Survey.
abstract: BACKGROUND
  Asthma remains poorly studied in homeless children. We sought to estimate the prevalence of asthma-like symptoms (ALS) and to identify the factors associated with ALS and healthcare service utilisation.
  
  
  METHODS
  A cross-sectional survey of a random sample of sheltered homeless families was conducted by interviewing 801 parents of children (0-12 years) in 17 languages. ALS were defined as wheezing or night cough without fever during the previous year. Poisson regression models with robust error variance were used to compute prevalence ratios (PR) for factors associated with ALS and healthcare service utilisation for ALS.
  
  
  RESULTS
  The prevalence of ALS among the children was 19.9%. Poor housing sanitation was significantly associated with ALS, as being born in the European Union. Most of the children with ALS had used healthcare services (85.4%). The main barriers to accessing such services were having lived in France for less than 49 months, having difficulties in French and living in poor housing conditions.
  
  
  CONCLUSIONS
  ALS prevalence seemed lower than in the general child population, possibly because of the children's origins. Environmental factors associated with ALS point to the need to improve the indoor environment of family shelters. The relatively high rate of healthcare service utilisation should not overshadow existing barriers.
authors.affiliation: INSERM, Sorbonne Universités, UPMC Univ Paris 06, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP UMRS 1136), Department of social epidemiology, Paris, France.
authors.forename: Delphine
authors.initials: D
authors.lastname: Lefeuvre
authors.affiliation: French Institute for Public Health Surveillance, Saint-Maurice, France.
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Delmas
authors.affiliation: University Hospital of Rouen, Rouen, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Marguet
authors.affiliation: INSERM, Sorbonne Universités, UPMC Univ Paris 06, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP UMRS 1136), Department of social epidemiology, Paris, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Chauvin
authors.affiliation: INSERM, Sorbonne Universités, UPMC Univ Paris 06, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP UMRS 1136), Department of social epidemiology, Paris, France.|French Institute for Public Health Surveillance, Saint-Maurice, France.|Observatoire du Samusocial de Paris, Paris, France.
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Vandentorren
mesh_terms: D001249:Asthma / Q000175:diagnosis* / Q000453:epidemiology* / Q000208:ethnology; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000706:statistics & numerical data; D054242:Emigrants and Immigrants; D004777:Environment; D005260:Female; D006297:Health Services Accessibility; D018453:Homeless Youth; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015999:Multivariate Analysis; D010297:Paris; D016012:Poisson Distribution; D015995:Prevalence; D012044:Regression Analysis; D012923:Social Class; D035862:Vulnerable Populations