0
Original Research: ASTHMA |

Beginning School With Asthma Independently Predicts Low Achievement in a Prospective Cohort of Children FREE TO VIEW

Kathleen A. Liberty, PhD; Philip Pattemore, MD; James Reid, MBChB, FCCP; Michael Tarren-Sweeney, PhD
Author and Funding Information

From the Health Sciences Center (Drs Liberty and Tarren-Sweeney) and the School of Educational Studies and Human Development (Dr Liberty), University of Canterbury, Christchurch, New Zealand; the Department of Paediatrics (Dr Pattemore), Christchurch School of Medicine, University of Otago, Christchurch, New Zealand; the Department of General Practice and Rural Health (Dr Reid), Dunedin School of Medicine, University of Otago, Dunedin, New Zealand; and the Centre for Brain and Mental Health Research (Dr Tarren-Sweeney), University of Newcastle, Newcastle, NSW, Australia.

Correspondence to: Kathleen A. Liberty, PhD, Health Sciences Centre, University of Canterbury, PB 4800, Christchurch, New Zealand; e-mail: kathleen.liberty@canterbury.ac.nz


Funding/Support: This work was supported by the Asthma and Respiratory Foundation of New Zealand and (in part) by the internal grants program of the University of Canterbury.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;138(6):1349-1355. doi:10.1378/chest.10-0543
Text Size: A A A
Published online

Background:  Concerns about the achievement of children with asthma and respiratory conditions are especially important in New Zealand, which has one of the world’s highest rates of childhood asthma. The present study evaluated whether entering school with asthma was associated with low achievement after the first year.

Methods:  A child cohort was recruited to a prospective study at time of first enrollment into randomly selected schools in Christchurch. Parent interviews covered demographics and respiratory status. Physician reports were sought for children with asthma, and all respiratory information was clinically reviewed. The children’s achievement in reading and math was individually assessed at school entry and reassessed after 12 months. Schools reported absences. Intelligence subtests were administered.

Results:  Two hundred ninety-eight children were recruited, including 55 (18.5%) with current asthma. At 1-year follow-up, retention was 93.7%. Children who entered school with asthma were more likely to be ≥ 6 months behind other participants in reading words (P = .023) and books (P = .026), but not in math (P = .167) at the end of the first year of school. Achievement was not related to asthma severity. Entering school with asthma reliably predicted low reading achievement independent of other known covariates of low achievement (high absenteeism, minority status, male gender, single-parent family, poor academic skills at school entry, and low socioeconomic status).

Conclusions:  Entering school with asthma was a significant predictor of low achievement in reading at 12-month follow-up, independent of asthma severity, high absenteeism, or other covariates of low achievement.

Figures in this Article

New Zealand has high asthma prevalence: 28.4% of children aged 6 to 7 years old have ever been diagnosed with asthma,1,2 and 20%3 have asthma symptoms that are poorly controlled.4 Chronic health problems can impact educational attainment5 and literacy can affect the health care of asthmatic adults.6,7 Although it is crucial that health professionals understand how asthma can impact on achievement in order to improve patient care and communication,812 studies of achievement and asthma have produced mixed13 results and have not analyzed whether children with asthma are more likely to have low achievement.11,1418 Some studies have not separated asthma from other factors that impact on achievement, including socioeconomic status (SES), age/years in school, family composition, ethnicity, gender, skill level at school entry (“readiness”), and absenteeism.14,15,1923 We recruited a cohort of children as they started school, to determine if starting school with asthma was related to poor school achievement after 1 year of school. Our study differed from previous studies in several ways. First, children were recruited before they began school and, thus, before low academic achievement was manifested. Second, the design controlled for age, time in school, and readiness (skills learned prior to formal schooling). Third, we independently assessed individual achievement using standardized tests, rather than parent or school reports. Fourth, we analyzed low achievement by asthma status.

New Zealand children typically commence formal education at first grade on their fifth birthday (prereading and premath skills are not typically included in preschool activities in New Zealand). Study measures were obtained at school entry (Time 1) and repeated 12 months later (Time 2). The study thus spanned the participants’ first year of school. The design ensured that the children’s age and length of formal education were uniform at both time points. Ethical approvals were obtained from the National Health Research and the University of Canterbury Human Ethics Committees.

The Ministry of Education classifies schools based on SES.24 We clustered Christchurch schools into high, mid-, and low-SES groups based on the Ministry of Education classification prior to randomization (this same procedure was used in the International Study of Asthma and Allergies in Children [ISAAC]).25 From each SES cluster, schools were randomly sampled with replacement, with a view to recruiting 100 pupils from each cluster (schools with < 10 enrolments each year were excluded from randomization). (Fig 1 illustrates cohort recruitment.)

Figure Jump LinkFigure 1. Sample recruitment and retention. SES = socioeconomic status.Grahic Jump Location

The inclusion criteria were children who enrolled in school on their fifth birthday or, if their birthday fell during a school vacation, enrolled on the next school day; who did not require special education for high or very high needs, such as severe intellectual disability or cerebral palsy; and who had at least one respondent caregiver and whose own first language was either English, Maori, or a Pacific Island language. Children not satisfying these criteria were excluded. School personnel gave caregivers of eligible children study information, and they were invited by a research assistant to participate. Formal informed consent was obtained.

Information on demographics and asthma symptoms using questions from the ISAAC26 was collected during face-to-face parent interviews at Time 1. The Word Reading and Mathematical Reasoning subtests of the Wechsler Individual Achievement Test, Second Edition (WIAT)27 were administered to children at Time 1 (Readiness) and at Time 2 (Achievement). The Vocabulary and Block Design subtests of the Wechsler Intelligence Scale for Children, Fourth Edition (WISC)28 and running records of oral reading from standard school texts2932 (Text Reading) were obtained at Time 2. Because New Zealand children do not receive reading instruction in preschool and would not be able to read school texts, the word reading score was used to indicate text reading readiness at Time 1. Schools reported attendance in half-days at Time 2. Achievement scores were age adjusted using test norms to control for any differences in age at the second assessment.

If the parent answered “yes” to any ISAAC question regarding respiratory conditions, the interviewer sought consent to contact the family physician; If obtained, the physician was mailed the parent’s consent form and a short questionnaire. The second author, a pediatric respiratory specialist, classified current asthma using a pediatric clinical review of information from answers, additional information volunteered by parents (recorded verbatim) during interviews, and the doctor’s report. “Current” refers to symptoms in the 12 months before the interview. Children with “current asthma” had a diagnosis of asthma and wheezing symptoms. Children with a diagnosis of asthma based on coughing symptoms but who had never had wheezing or shortness of breath were not classified as current asthma, because current research indicates that coughing on its own is not a sign of airway obstruction or asthma in children.33 Thus, the category of current asthma was stringently defined after detailed examination of the children’s records and did not include children who had no wheezing or shortness of breath in the previous 12 months. Children without current asthma as defined above were designated as “control.” A score of functional asthma severity was determined using parent-reported information.34

Independent sample t tests, χ2, and logistic regression analyses were conducted using Predictive Analytics software, version 18 (SPSS, Inc; Chicago, IL), with significance set at P ≤ .05. Z scores were calculated using cohort mean standard scores to provide a common metric for low achievement. “Low achievement” was defined as ≤ -0.50 z for word reading, ≤ -0.50 z for text reading, and a reading age of ≤ 66 months. (The lowest possible reading age was 61 months.)35 All variables in χ2 and logistic regression were treated as binomials. Continuous variables were coded as dichotomous variables as follows36,37: the top quartile indicated high absenteeism; low WISC subtests scores were 2 SD below the indicated population mean;28 the lowest three deciles identified low SES; and “poor readiness” was defined as ≥ 6 months lower than cohort peers (≤ –0.50 z). WISC subtest scores were not entered into the logistic regression analysis because these tests are highly correlated with the WIAT scores27 and would therefore confound this analysis. However, the use of the age 5 word reading score from the WIAT as an indicator of low readiness provided a covariate of the WISC tests in the logistic regression analysis.

In addition to the demographic data collected from parents, a New Zealand Deprivation Decile Score38 was determined for each participant’s address. This score is based on data on family income, income source, home ownership, employment, qualifications, living space, and access to telephone and car, collected in a small neighborhood area during the 2006 Census. Scores were assigned using a standard government-controlled database available to researchers.39 In the present study, the deprivation score represented individual SES.

Recruitment

A 93.7% participant recruitment rate was achieved (Fig 1). The demographic characteristics are shown in .Table 1.

Table Graphic Jump Location
Table 1 —Characteristics of Cohort (N = 298) at School Entry (Time 1)

WIAT = Wechsler Individual Achievement Test, Second Edition; WISC = Wechsler Intelligence Scale for Children, Fourth Edition.

a 

Correlated with socioeconomic status (Deprivation Score) P = .0001.

b 

For at least 12 mo before beginning school.

c 

Administered at age 6 y.

Baseline Comparisons

The children’s respiratory status at school entry was categorized as current asthma or not current asthma (control group). There were 55 participants with current asthma (N = 55, 18.5%). Asthma severity scores were low (23.6%), mild (32.7%), moderate (34.5%), and high (9.1%). All children categorized as current asthma also had doctor-prescribed medication for asthma. There were no significant differences between the current asthma and control groups in mean achievement test scores at school entry at age 5 (Table 2). There were also no significant differences at baseline between the current asthma and control groups in the variables associated with low achievement (Table 3).

Table Graphic Jump Location
Table 2 —Achievement Test Scores at Age 5 (School Entry) and Age 6 (End First Year of School) and Absenteeism During the First Year of School

See Table 1 for expansion of abbreviations.

a 

P ≤ .05.

Table Graphic Jump Location
Table 3 —Baseline and Outcome Comparisons Between Current Asthma and Control Groups

Data presented as No. (%).

a 

N = 55 for baseline comparisons; N = 51 for outcome comparisons.

b 

N = 243 for baseline comparisons; N = 227 for outcome comparisons.

c 

P ≤ .05

Outcome Comparisons

A retention rate of 93.3% was achieved (Fig 1). There were no significant differences between retained and nonretained participants in the distributions at Time 1 in gender (P = .819), ethnicity (P = .125), SES (P = .121), word reading (P = .493), or math reasoning (P = .936). The modal interval between the Time 1 and Time 2 assessments was 12.5 months.

There were significant differences in the mean scores of the current asthma group compared with the control group at Time 2 in word reading and text reading (Table 2). To estimate the clinical impact of these differences, we next determined whether children with current asthma were more likely to be low achieving (see “Materials and Methods” for definition). Contingency table analyses (Table 3) demonstrated that children entering school with current asthma were more likely than control children to be categorized at Time 2 as low achieving in word reading and text reading but not in math. Because current asthma was not associated with a greater probability of low achievement at age 6 in math, no further examination of math achievement was made.

Current Asthma and Low Achievement

We next analyzed common factors (covariates) associated with low achievement to identify which of these factors were significantly associated with low achievement in our cohort as a whole. For low achievement in word reading, current asthma (χ2 = 5.20, P = .023), poor readiness (χ2 = 65.80, P = .0001), low SES (χ2 = 15.36, P = .001), and high absenteeism (χ2 = 6.10, P = .013) were significantly associated. Although “single-parent family” was borderline (χ2 = 3.75, P = .053), it was retained in the analysis of word reading because it is frequently identified as a covariate of low achievement.23 For text reading, current asthma (χ2 = 4.99, P = .026), as well as poor readiness (χ2 = 51.13, P = .0001), low SES (χ2 = 18.18, P = .0001), and high absenteeism (χ2 = 8.467, P = .004) were significantly associated with low achievement.

Stepwise logistic regression analyses (Table 4) were conducted to identify independent predictors of low achievement, entering significant variables from the analyses above. The only predictors that reached significance in the final model for word reading were current asthma and poor reading readiness. In the final model for text reading, the significant predictors were current asthma, low SES, and poor readiness. Current asthma was independent of the typical predictors of low achievement (Table 4), and children with current asthma were not more likely than control children to be from low SES or to have high absenteeism or poor readiness (Table 3).

Table Graphic Jump Location
Table 4 —Multivariate Logistic Regression Models for Low Achievement in Word and Text Reading on Selected Covariates

SES = socioeconomic status.

Asthma has additional associations with low achievement. First, an analysis showed that 39.2% of children with current asthma were ≥ 9 months behind their peers in word reading (extremely low achieving), compared with 22.5% of control children (χ2 = 6.143; P = .013; OR, 2.226; 95% CI, 1.178-4.213). Similarly, 45.1% of children with current asthma were extremely low achieving in text reading compared with 25.6% of control children (χ2 = 7.707; P = .006; OR, 2.393; 95% CI, 1.285-4.460). Second, analysis showed that 24 children with current asthma and 58 control children were low achieving in both word reading and text reading. Thus, of the 51 children with current asthma assessed at Time 2, 47% were low achieving in both measures of reading compared with 25.6% of control children (χ2 = 9.264; P = .002; OR, 2.590; 95% CI, 1.393-4.819).

Children entering school with current asthma had significantly lower mean scores than others in the cohort on two measures of reading achievement, and were more likely to have fallen 6 months or more behind in reading by the end of their first year in school. In addition, significantly more children entering school with current asthma were extremely low achieving, and more likely than control children to be low achieving in both areas of reading after the first year of school. Current asthma was a significant predictor of achievement status at the end of the first year in school, independent of the standard factors associated with reading achievement, including high absenteeism, poor readiness, gender, ethnicity, and low SES. These variables have all been consistently identified as correlates of low achievement in other research studies.13,22,40 However, current asthma as an independent predictor of low achievement has not been identified in other studies.

Several limitations in the study design suggest caution when interpreting the present findings. First, the sample of children entering school with asthma is relatively small. Second, the sample is limited to children in the first year of school, and is not necessarily generalizable to older children. Finally, the extent to which the present findings can be generalized to countries with a lower prevalence of childhood asthma remains uncertain, because asthma is a complex, multifactorial disease that may differ across countries. This points to the desirability of replicating our study in a location with lower asthma prevalence, as well as with a larger sample and with older children.

The findings of an association between current asthma at school entry and low achievement in reading a year later is at odds with New Zealand10,11 and international studies,12,15,17 which have concluded that there is no difference in achievement by asthma status, with the exception of one study that concluded that children with asthma were more likely to be categorized as “below progressing.”16 School absence is the factor identified as most likely to affect the achievement of children with asthma,14,16,21,41 although high absenteeism has not always been reported for children with asthma14,42 and our study did not find an association between high absence and low achievement in children with asthma. Additionally, although asthma severity and poor readiness in children with asthma have been given as possible explanations for low achievement,5,9,21 these explanations were not supported in our study.

Our findings may differ from other studies14,15 owing to methodologic differences. We used direct and individual measurements of reading, rather than school or parent reports. We also controlled for age differences by focusing on children of the same age, with the same amount of time in school. We also focused on a younger-aged population, because children start school at a younger age in New Zealand. In addition, previously reported findings have possibly focused on group comparisons of mean achievement scores, without considering the significance of low achievement.17,43 A final difference in our study is that samples in other studies may have excluded children with learning disabilities or drawn samples from mainstream classes in school systems where children with reading difficulties are likely to have been streamed into separate programs.1416 Our study did not exclude these children because (1) they could not be identified prior to starting school and (2) New Zealand does not separately stream children with learning disabilities. Studies that excluded children with learning disorders may have underestimated the impact of asthma on achievement.44,45 All of these differences may have affected findings.

Our findings warrant further study of low achievement in children with asthma entering school. Possible reasons for low achievement in children with asthma include the presence of comorbid health problems (such as sleep deprivation, rhinitis, and increased BMI), asthma control, medication effects, and psychosocial factors.

We reached the following conclusions: (1) children with current asthma entering school in New Zealand may be at increased risk of low achievement in reading after 1 year of school in comparison with their peers and independent of other factors commonly associated with low achievement and (2) understanding of achievement by children with asthma can be strengthened by analyses of low achievement in relation to cohort peers in addition to comparison of mean achievement scores.

Author contributions:Dr Liberty: contributed to oversight of data entry, statistical analysis of achievement data, χ2 analysis, logistic regression analysis, literature review, data interpretation, and preparation of manuscript drafts.

Dr Pattemore: contributed to clinical review of respiratory data, classification of respiratory status, data interpretation, and preparation of manuscript drafts.

Dr Reid: contributed to data interpretation and preparation of manuscript drafts.

Dr Tarren-Sweeney: contributed to data interpretation and preparation of manuscript drafts.

Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Other contributions: We acknowledge the contributions of Carol Croy and Beth Ferguson in organizing and supervising interviews and assessments and general record keeping; the excellent support from 16 graduate research assistants; and the support of Arindam Basu and Pat Coope in providing comments on the draft and revision. We acknowledge the donation of materials from the Ministry of Education (Learning Media). We are extremely grateful to the children, parents, and schools whose contributions made this study possible.

ISAAC

International Study of Asthma and Allergic Conditions

SES

socioeconomic status

WIAT

Wechsler Individual Achievement Test, Second Edition

WISC

Wechsler Intelligence Scale for Children, Fourth Edition

Holt S, Beasley R. The burden of asthma in New Zealand.Accessed February 11, 2002 Wellington, NZ Asthma and Respiratory Foundation of New Zealand December, 2001.http://www.asthmafoundation.org.nz/burden_of_asthma_in_nz.php.
 
Hodges I, Maskill C, Coulson J, et al. Our Children’s Health: Key Findings on the Health of New Zealand Children. 1999; Wellington, NZ Ministry of Health
 
Asher MI, Montefort S, Björkstén B, et al; ISAAC Phase Three Study Group ISAAC Phase Three Study Group Worldwide time trends in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in childhood: ISAAC Phases One and Three repeat multicountry cross-sectional surveys. Lancet. 2006;3689537:733-743. [CrossRef] [PubMed]
 
Holt S, Kljakovic M, Reid J. POMS Steering Committee POMS Steering Committee Asthma morbidity, control and treatment in New Zealand: results of the Patient Outcomes Management Survey (POMS), 2001. N Z Med J. 2003;1161174:U436. [PubMed]
 
Thies KM. Identifying the educational implications of chronic illness in school children. J Sch Health. 1999;6910:392-397. [CrossRef] [PubMed]
 
Williams MV, Baker DW, Honig EG, Lee TM, Nowlan A. Inadequate literacy is a barrier to asthma knowledge and self-care. Chest. 1998;1144:1008-1015. [CrossRef] [PubMed]
 
Paasche-Orlow MK, Riekert KA, Bilderback A, et al. Tailored education may reduce health literacy disparities in asthma self-management. Am J Respir Crit Care Med. 2005;1728:980-986. [CrossRef] [PubMed]
 
Bender BG. Measurement of quality of life in pediatric asthma clinical trials. Ann Allergy Asthma Immunol. 1996;776:438-445. [CrossRef] [PubMed]
 
Halterman JS, Montes G, Aligne CA, Kaczorowski JM, Hightower AD, Szilagyi PG. School readiness among urban children with asthma. Ambul Pediatr. 2001;14:201-205. [CrossRef] [PubMed]
 
Ford R, Dawson K, Cowie A. Asthma: does an accurate diagnosis influence school attendance and performance? Aust N Z J Med. 1988;182:134-136
 
McNaughton S, Smith L, Rea H, et al. The management of childhood asthma: Attendance and school performance. N Z J Educ Stud. 1993;282:155-164
 
Celano MP, Geller RJ. Learning, school performance, and children with asthma: how much at risk? J Learn Disabil. 1993;261:23-32. [CrossRef] [PubMed]
 
Liederman J, Kantrowitz L, Flannery K. Male vulnerability to reading disability is not likely to be a myth: a call for new data. J Learn Disabil. 2005;382:109-129. [CrossRef] [PubMed]
 
Clark NM, Brown R, Joseph CLM, Anderson EW, Liu M, Valerio MA. Effects of a comprehensive school-based asthma program on symptoms, parent management, grades, and absenteeism. Chest. 2004;1255:1674-1679. [CrossRef] [PubMed]
 
Eide ER, Showalter MH, Goldhaber DD. The relation between children’s health and academic achievement. Child Youth Serv Rev. 2010;322:231-238. [CrossRef]
 
Moonie S, Sterling DA, Figgs LW, Castro M. The relationship between school absence, academic performance, and asthma status. J Sch Health. 2008;783:140-148. [CrossRef] [PubMed]
 
McNelis AM, Dunn DW, Johnson CS, Austin JK, Perkins SM. Academic performance in children with new-onset seizures and asthma: a prospective study. Epilepsy Behav. 2007;102:311-318. [CrossRef] [PubMed]
 
Joe S, Joe E, Rowley LL. Consequences of physical health and mental illness risks for academic achievement in grades K-12. Rev Res Educ. 2009;331:283-309. [CrossRef]
 
Fiscella K, Kitzman H. Disparities in academic achievement and health: the intersection of child education and health policy. Pediatrics. 2009;1233:1073-1080. [CrossRef] [PubMed]
 
High PC. American Academy of Pediatrics Committee on Early Childhood, Adoption, and Dependent Care and Council on School Health American Academy of Pediatrics Committee on Early Childhood, Adoption, and Dependent Care and Council on School Health School readiness. Pediatrics. 2008;1214:e1008-e1015. [CrossRef] [PubMed]
 
Currie J. Health disparities and gaps in school readiness. Future Child. 2005;151:117-138. [CrossRef] [PubMed]
 
Brooks-Gunn J, Duncan GJ. The effects of poverty on children. Future Child. 1997;72:55-71. [CrossRef] [PubMed]
 
Goldberg WA, Prause J, Lucas-Thompson R, Himsel A. Maternal employment and children’s achievement in context: a meta-analysis of four decades of research. Psychol Bull. 2008;1341:77-108. [CrossRef] [PubMed]
 
Ministry of EducationMinistry of Education Socio-economic decile band. Education counts glossary.Accessed February 20, 2007 http://www.educationcounts.edcenter.govt.nz/metadata/glossary.html#ses.
 
Pattemore PK, Ellison-Loschmann L, Asher MI, et al. Asthma prevalence in European, Maori, and Pacific children in New Zealand: ISAAC study. Pediatr Pulmonol. 2004;375:433-442. [CrossRef] [PubMed]
 
Asher MI, Keil U, Anderson HR, et al. International study of asthma and allergies in childhood (ISAAC): rationale and methods. Eur Respir J. 1995;83:483-491. [CrossRef] [PubMed]
 
Wechsler D. Wechsler Individual Achievement Test, Second Edition: Australian Standardised Edition: Scoring and Normative Supplement for Preschool-year 12. 2007; Sydney, Australia Pearson
 
Wechsler D. Wechsler Intelligence Scale for Children, Fourth Edition: Australian Standard Edition. 2006; Sydney, Australia Harcourt Assessment
 
Clay M. An Observation Survey of Early Literacy Achievement. 1993; Auckland, NZ Heinemann
 
Davies D. School Entry Assessment June 1997-Dec 2000. 2001; Wellington, NZ Ministry of Education:39
 
Clay M. Running Records for Classroom Teachers. 2000; Auckland, NZ Heinemann
 
Gay LR, Airasian P. Educational Research. 2000;6th ed Upper Saddle River, NJ Prentice Hall
 
Chang AB, Landau LI, Van Asperen PP, et al; Position statement of the Thoracic Society of Australia and New Zealand Position statement of the Thoracic Society of Australia and New Zealand Cough in children: definitions and clinical evaluation. Med J Aust. 2006;1848:398-403. [PubMed]
 
Rosier MJ, Bishop J, Nolan T, Robertson CF, Carlin JB, Phelan PD. Measurement of functional severity of asthma in children. Am J Respir Crit Care Med. 1994;1496:1434-1441. [PubMed]
 
Shapiro BK, Palmer FB, Antell S, Bilker S, Ross A, Capute AJ. Precursors of reading delay: neurodevelopmental milestones. Pediatrics. 1990;853 Pt 2:416-420. [PubMed]
 
Sameroff A, Seifer R, Zax M, Barocas R. Early indicators of developmental risk: Rochester Longitudinal Study. Schizophr Bull. 1987;133:383-394. [PubMed]
 
Sameroff AJ, Seifer R, Baldwin A, Baldwin C. Stability of intelligence from preschool to adolescence: the influence of social and family risk factors. Child Dev. 1993;641:80-97. [CrossRef] [PubMed]
 
Salmond C, Crampton P, Atkinson J. NZDep2006 Index of Deprivation User’s Manual. 2007; Wellington, NZ Department of Public Health, University of Otago
 
Statistics New ZealandStatistics New Zealand Microdata Access. 2010; Wellington, NZ Statistics New Zealand Vol. 2010.
 
Gutman LM, Sameroff AJ, Cole R. Academic growth curve trajectories from 1st grade to 12th grade: effects of multiple social risk factors and preschool child factors. Dev Psychol. 2003;394:777-790. [CrossRef] [PubMed]
 
Rietveld S, Colland VT. The impact of severe asthma on schoolchildren. J Asthma. 1999;365:409-17. [CrossRef] [PubMed]
 
Millard MW, Johnson PT, Hilton A, Hart M. Children with asthma miss more school: fact or fiction? Chest. 2009;1352:303-306. [CrossRef] [PubMed]
 
Milton B, Whitehead M, Holland P, Hamilton V. The social and economic consequences of childhood asthma across the lifecourse: a systematic review. Child Care Health Dev. 2004;306:711-728. [CrossRef] [PubMed]
 
Blackman JA, Gurka MJ. Developmental and behavioral comorbidities of asthma in children. J Dev Behav Pediatr. 2007;282:92-99. [CrossRef] [PubMed]
 
Austin JK, Huberty TJ, Huster GA, Dunn DW. Does academic achievement in children with epilepsy change over time? Dev Med Child Neurol. 1999;417:473-479. [CrossRef] [PubMed]
 

Figures

Figure Jump LinkFigure 1. Sample recruitment and retention. SES = socioeconomic status.Grahic Jump Location

Tables

Table Graphic Jump Location
Table 1 —Characteristics of Cohort (N = 298) at School Entry (Time 1)

WIAT = Wechsler Individual Achievement Test, Second Edition; WISC = Wechsler Intelligence Scale for Children, Fourth Edition.

a 

Correlated with socioeconomic status (Deprivation Score) P = .0001.

b 

For at least 12 mo before beginning school.

c 

Administered at age 6 y.

Table Graphic Jump Location
Table 2 —Achievement Test Scores at Age 5 (School Entry) and Age 6 (End First Year of School) and Absenteeism During the First Year of School

See Table 1 for expansion of abbreviations.

a 

P ≤ .05.

Table Graphic Jump Location
Table 3 —Baseline and Outcome Comparisons Between Current Asthma and Control Groups

Data presented as No. (%).

a 

N = 55 for baseline comparisons; N = 51 for outcome comparisons.

b 

N = 243 for baseline comparisons; N = 227 for outcome comparisons.

c 

P ≤ .05

Table Graphic Jump Location
Table 4 —Multivariate Logistic Regression Models for Low Achievement in Word and Text Reading on Selected Covariates

SES = socioeconomic status.

References

Holt S, Beasley R. The burden of asthma in New Zealand.Accessed February 11, 2002 Wellington, NZ Asthma and Respiratory Foundation of New Zealand December, 2001.http://www.asthmafoundation.org.nz/burden_of_asthma_in_nz.php.
 
Hodges I, Maskill C, Coulson J, et al. Our Children’s Health: Key Findings on the Health of New Zealand Children. 1999; Wellington, NZ Ministry of Health
 
Asher MI, Montefort S, Björkstén B, et al; ISAAC Phase Three Study Group ISAAC Phase Three Study Group Worldwide time trends in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in childhood: ISAAC Phases One and Three repeat multicountry cross-sectional surveys. Lancet. 2006;3689537:733-743. [CrossRef] [PubMed]
 
Holt S, Kljakovic M, Reid J. POMS Steering Committee POMS Steering Committee Asthma morbidity, control and treatment in New Zealand: results of the Patient Outcomes Management Survey (POMS), 2001. N Z Med J. 2003;1161174:U436. [PubMed]
 
Thies KM. Identifying the educational implications of chronic illness in school children. J Sch Health. 1999;6910:392-397. [CrossRef] [PubMed]
 
Williams MV, Baker DW, Honig EG, Lee TM, Nowlan A. Inadequate literacy is a barrier to asthma knowledge and self-care. Chest. 1998;1144:1008-1015. [CrossRef] [PubMed]
 
Paasche-Orlow MK, Riekert KA, Bilderback A, et al. Tailored education may reduce health literacy disparities in asthma self-management. Am J Respir Crit Care Med. 2005;1728:980-986. [CrossRef] [PubMed]
 
Bender BG. Measurement of quality of life in pediatric asthma clinical trials. Ann Allergy Asthma Immunol. 1996;776:438-445. [CrossRef] [PubMed]
 
Halterman JS, Montes G, Aligne CA, Kaczorowski JM, Hightower AD, Szilagyi PG. School readiness among urban children with asthma. Ambul Pediatr. 2001;14:201-205. [CrossRef] [PubMed]
 
Ford R, Dawson K, Cowie A. Asthma: does an accurate diagnosis influence school attendance and performance? Aust N Z J Med. 1988;182:134-136
 
McNaughton S, Smith L, Rea H, et al. The management of childhood asthma: Attendance and school performance. N Z J Educ Stud. 1993;282:155-164
 
Celano MP, Geller RJ. Learning, school performance, and children with asthma: how much at risk? J Learn Disabil. 1993;261:23-32. [CrossRef] [PubMed]
 
Liederman J, Kantrowitz L, Flannery K. Male vulnerability to reading disability is not likely to be a myth: a call for new data. J Learn Disabil. 2005;382:109-129. [CrossRef] [PubMed]
 
Clark NM, Brown R, Joseph CLM, Anderson EW, Liu M, Valerio MA. Effects of a comprehensive school-based asthma program on symptoms, parent management, grades, and absenteeism. Chest. 2004;1255:1674-1679. [CrossRef] [PubMed]
 
Eide ER, Showalter MH, Goldhaber DD. The relation between children’s health and academic achievement. Child Youth Serv Rev. 2010;322:231-238. [CrossRef]
 
Moonie S, Sterling DA, Figgs LW, Castro M. The relationship between school absence, academic performance, and asthma status. J Sch Health. 2008;783:140-148. [CrossRef] [PubMed]
 
McNelis AM, Dunn DW, Johnson CS, Austin JK, Perkins SM. Academic performance in children with new-onset seizures and asthma: a prospective study. Epilepsy Behav. 2007;102:311-318. [CrossRef] [PubMed]
 
Joe S, Joe E, Rowley LL. Consequences of physical health and mental illness risks for academic achievement in grades K-12. Rev Res Educ. 2009;331:283-309. [CrossRef]
 
Fiscella K, Kitzman H. Disparities in academic achievement and health: the intersection of child education and health policy. Pediatrics. 2009;1233:1073-1080. [CrossRef] [PubMed]
 
High PC. American Academy of Pediatrics Committee on Early Childhood, Adoption, and Dependent Care and Council on School Health American Academy of Pediatrics Committee on Early Childhood, Adoption, and Dependent Care and Council on School Health School readiness. Pediatrics. 2008;1214:e1008-e1015. [CrossRef] [PubMed]
 
Currie J. Health disparities and gaps in school readiness. Future Child. 2005;151:117-138. [CrossRef] [PubMed]
 
Brooks-Gunn J, Duncan GJ. The effects of poverty on children. Future Child. 1997;72:55-71. [CrossRef] [PubMed]
 
Goldberg WA, Prause J, Lucas-Thompson R, Himsel A. Maternal employment and children’s achievement in context: a meta-analysis of four decades of research. Psychol Bull. 2008;1341:77-108. [CrossRef] [PubMed]
 
Ministry of EducationMinistry of Education Socio-economic decile band. Education counts glossary.Accessed February 20, 2007 http://www.educationcounts.edcenter.govt.nz/metadata/glossary.html#ses.
 
Pattemore PK, Ellison-Loschmann L, Asher MI, et al. Asthma prevalence in European, Maori, and Pacific children in New Zealand: ISAAC study. Pediatr Pulmonol. 2004;375:433-442. [CrossRef] [PubMed]
 
Asher MI, Keil U, Anderson HR, et al. International study of asthma and allergies in childhood (ISAAC): rationale and methods. Eur Respir J. 1995;83:483-491. [CrossRef] [PubMed]
 
Wechsler D. Wechsler Individual Achievement Test, Second Edition: Australian Standardised Edition: Scoring and Normative Supplement for Preschool-year 12. 2007; Sydney, Australia Pearson
 
Wechsler D. Wechsler Intelligence Scale for Children, Fourth Edition: Australian Standard Edition. 2006; Sydney, Australia Harcourt Assessment
 
Clay M. An Observation Survey of Early Literacy Achievement. 1993; Auckland, NZ Heinemann
 
Davies D. School Entry Assessment June 1997-Dec 2000. 2001; Wellington, NZ Ministry of Education:39
 
Clay M. Running Records for Classroom Teachers. 2000; Auckland, NZ Heinemann
 
Gay LR, Airasian P. Educational Research. 2000;6th ed Upper Saddle River, NJ Prentice Hall
 
Chang AB, Landau LI, Van Asperen PP, et al; Position statement of the Thoracic Society of Australia and New Zealand Position statement of the Thoracic Society of Australia and New Zealand Cough in children: definitions and clinical evaluation. Med J Aust. 2006;1848:398-403. [PubMed]
 
Rosier MJ, Bishop J, Nolan T, Robertson CF, Carlin JB, Phelan PD. Measurement of functional severity of asthma in children. Am J Respir Crit Care Med. 1994;1496:1434-1441. [PubMed]
 
Shapiro BK, Palmer FB, Antell S, Bilker S, Ross A, Capute AJ. Precursors of reading delay: neurodevelopmental milestones. Pediatrics. 1990;853 Pt 2:416-420. [PubMed]
 
Sameroff A, Seifer R, Zax M, Barocas R. Early indicators of developmental risk: Rochester Longitudinal Study. Schizophr Bull. 1987;133:383-394. [PubMed]
 
Sameroff AJ, Seifer R, Baldwin A, Baldwin C. Stability of intelligence from preschool to adolescence: the influence of social and family risk factors. Child Dev. 1993;641:80-97. [CrossRef] [PubMed]
 
Salmond C, Crampton P, Atkinson J. NZDep2006 Index of Deprivation User’s Manual. 2007; Wellington, NZ Department of Public Health, University of Otago
 
Statistics New ZealandStatistics New Zealand Microdata Access. 2010; Wellington, NZ Statistics New Zealand Vol. 2010.
 
Gutman LM, Sameroff AJ, Cole R. Academic growth curve trajectories from 1st grade to 12th grade: effects of multiple social risk factors and preschool child factors. Dev Psychol. 2003;394:777-790. [CrossRef] [PubMed]
 
Rietveld S, Colland VT. The impact of severe asthma on schoolchildren. J Asthma. 1999;365:409-17. [CrossRef] [PubMed]
 
Millard MW, Johnson PT, Hilton A, Hart M. Children with asthma miss more school: fact or fiction? Chest. 2009;1352:303-306. [CrossRef] [PubMed]
 
Milton B, Whitehead M, Holland P, Hamilton V. The social and economic consequences of childhood asthma across the lifecourse: a systematic review. Child Care Health Dev. 2004;306:711-728. [CrossRef] [PubMed]
 
Blackman JA, Gurka MJ. Developmental and behavioral comorbidities of asthma in children. J Dev Behav Pediatr. 2007;282:92-99. [CrossRef] [PubMed]
 
Austin JK, Huberty TJ, Huster GA, Dunn DW. Does academic achievement in children with epilepsy change over time? Dev Med Child Neurol. 1999;417:473-479. [CrossRef] [PubMed]
 
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543