Teens Getting Post 9/11 Asthma Care Also Need Mental Health Help

Comprehensive care of post-9/11 asthma in adolescents should include management of mental health-related comorbidities, according to a recent report.

Comprehensive care of post-9/11 asthma in adolescents should include management of mental health-related comorbidities, according to a recent report.

The paper, wrtten by Lisa Gargano, City Research Scientist III - Scientist for Disaster Outcomes at New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Queens, New York, and colleagues, appeared in the September issue of Nature.com.

The WTC Health Registry Adolescent Wave 3 survey (2011—2012) collected data on asthma diagnosed by a physician after September 11, 2001, extent of asthma control based on modified National Asthma Education and Prevention Program criteria, probable mental health conditions, and behavior problems. Parents reported healthcare needs and 9/11-exposures. Logistic regression was used to evaluate associations between asthma and level of asthma control and 9/11-exposure, mental health and behavioral problems, and unmet healthcare needs.

Poorly/very poorly controlled asthma was significantly associated with a household income of ≤$75,000 (adjusted odds ratio (AOR): 3.0; 95% confidence interval (CI): 1.1—8.8), having unmet healthcare needs (AOR: 6.2; 95% CI: 1.4–27.1), and screening positive for at least one mental health condition (AOR: 5.0; 95% CI: 1.4–17.7), but not with behavioral problems. The impact of having at least one mental health condition on the level of asthma control was substantially greater in females than in males.

The collapse and burning of the World Trade Center (WTC) towers on September 11, 2001 (9/11) exposed hundreds of thousands of people to a complex mixture of dust, debris, and jet fuel combustion by-products. It is estimated that over 25,000 persons in lower Manhattan developed asthma symptoms after exposure to the WTC terrorist attacks and the subsequent rescue and recovery efforts. In the years immediately following 9/11, new-onset asthma rates were elevated among exposed adults and many of those affected continued to experience respiratory symptoms (i.e., coughing, shortness of breath) years later.

Although the association between asthma and 9/11-exposure in children and adolescents has been documented, little is known about asthma control in this population. Large population-based surveys consistently show that poor asthma control is common in many children with asthma. Asthma control is affected by many factors, including healthcare access, socioeconomic status, and comorbid mental health conditions.

Previous studies of adult Registry enrollees found that those with unmet healthcare needs are more likely to have severe mental health symptoms, comorbid mental and physical health problems, and have lower quality of life. Unmet healthcare needs among adolescents have been shown to be associated with poorer health status and functioning, including asthma control. Poorly controlled asthma has also been associated with unmet healthcare needs related to cost or access barriers, such as an inability to pay for asthma medications and not having access to asthma specialists.

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