Expert Panel Report 2: Guidelines for the Diagnosis and Management of Asthma

▪ Abstract Socioeconomic status (SES) is one of the most widely studied constructs in the social sciences. Several ways of measuring SES have been proposed, but most include some quantification of family income, parental education, and occupational status. Research shows that SES is associated with a wide array of health, cognitive, and socioemotional outcomes in children, with effects beginning prior to birth and continuing into adulthood. A variety of mechanisms linking SES to child well-being have been proposed, with most involving differences in access to material and social resources or reactions to stress-inducing conditions by both the children themselves and their parents. For children, SES impacts well-being at multiple levels, including both family and neighborhood. Its effects are moderated by children's own characteristics, family characteristics, and external support systems.

Socioeconomic status and child development.

Ten per cent of the world’s school-aged children are estimated to be carrying excess body fat (Fig. 1), with an increased risk for developing chronic disease. Of these overweight children, a quarter are obese, with a significant likelihood of some having multiple risk factors for type 2 diabetes, heart disease and a variety of other co-morbidities before or during early adulthood. The prevalence of overweight is dramatically higher in economically developed regions, but is rising significantly in most parts of the world. In many countries the problem of childhood obesity is worsening at a dramatic rate. Surveys during the 1990s show that in Brazil and the USA, an additional 0.5% of the entire child population became overweight each year. In Canada, Australia and parts of Europe the rates were higher, with an additional 1% of all children becoming overweight each year. The burden upon the health services cannot yet be estimated. Although childhood obesity brings a number of additional problems in its train – hyperinsulinaemia, poor glucose tolerance and a raised risk of type 2 diabetes, hypertension, sleep apnoea, social exclusion and depression – the greatest health problems will be seen in the next generation of adults as the present childhood obesity epidemic passes through to adulthood. Greatly increased rates of heart disease, diabetes, certain cancers, gall bladder disease, osteoarthritis, endocrine disorders and other obesityrelated conditions will be found in young adult populations, and their need for medical treatment may last for their remaining life-times. The costs to the health services, the losses to society and the burdens carried by the individuals involved will be great. The present report has been written to focus attention on the issue and to urge policy-makers to consider taking action before it is too late. Specifically, the report:

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1467-789X.2004.00133.x

Obesity in children and young people: a crisis in public health.

Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma

Although the health benefits of breastfeeding are acknowledged widely, opinions and recommendations are divided on the optimal duration of exclusive breastfeeding. We systematically reviewed available evidence concerning the effects on child health, growth, and development and on maternal health of exclusive breastfeeding for 6 months vs. exclusive breastfeeding for 3–4 months followed by mixed breastfeeding (introduction of complementary liquid or solid foods with continued breastfeeding) to 6 months. Two independent literature searches were conducted, together comprising the following databases: MEDLINE (as of 1966), Index Medicus (prior to 1966), CINAHL, HealthSTAR, BIOSIS, CAB Abstracts, EMBASE-Medicine, EMBASE-Psychology, Econlit, Index Medicus for the WHO Eastern Mediterranean Region, African Index Medicus, Lilacs (Latin American and Carribean literature), EBM Reviews-Best Evidence, the Cochrane Database of Systematic Reviews, and the Cochrane Controlled Trials Register. No language restrictions were imposed. The two searches yielded a total of 2,668 unique citations. Contacts with experts in the field yielded additional published and unpublished studies. Studies were stratified according to study design (controlled trials vs. observational studies) and provenance (developing vs. developed countries).

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Optimal duration of exclusive breastfeeding

BULLYING AMONG SCHOOL-AGED youth is increasingly being recognized as an important problem affecting well-being and social functioning. While a certain amount of conflict and harassment is typical of youth peer relations, bullying presents a potentially more serious threat to healthy youth development. The definition of bullying is widely agreed on in literature on bullying.1–4 Bullying is a specific type of aggression in which (1) the behavior is intended to harm or disturb, (2) the behavior occurs repeatedly over time, and (3) there is an imbalance of power, with a more powerful person or group attacking a less powerful one. This asymmetry of power may be physical or psychological, and the aggressive behavior may be verbal (eg, name-calling, threats), physical (eg, hitting), or psychological (eg, rumors, shunning/exclusion).

The majority of research on bullying has been conducted in Europe and Australia. Considerable variability among countries in the prevalence of bullying has been reported. In an international survey of adolescent health-related behaviors, the percentage of students who reported being bullied at least once during the current term ranged from a low of 15% to 20% in some countries to a high of 70% in others.5,6 Of particular concern is frequent bullying, typically defined as bullying that occurs once a week or more. The prevalence of frequent bullying reported internationally ranges from a low of 1.9% among 1 Irish sample to a high of 19% in a Malta study.1,7–12

Bullying takes many forms, and findings about the types of bullying that occur are fairly similar across countries. A British study involving 23 schools found that direct verbal aggression was the most common form of bullying, occurring with similar frequency in both sexes.13 Direct physical aggression was more common among boys, while indirect forms were more common among girls. Similarly, in a study of several middle schools in Rome, the most common types of bullying reported by boys were threats, physical harm, rejection, and name-calling.14 The most common forms for girls were name-calling, teasing, rumors, rejection, and taking of personal belongings.

Research examining characteristics of youth involved in bullying has consistently found that both bullies and those bullied demonstrate poorer psychosocial functioning than their noninvolved peers. Youth who bully others tend to demonstrate higher levels of conduct problems and dislike of school, whereas youth who are bullied generally show higher levels of insecurity, anxiety, depression, loneliness, unhappiness, physical and mental symptoms, and low self-esteem.1–4,8,15–25 Males who are bullied also tend to be physically weaker than males in general.2 The few studies that have examined the characteristics of youth who both bully and are bullied found that these individuals exhibit the poorest psychosocial functioning overall.15,17,19,26

The current research provides a foundation for an understanding of the bullying problem. However, it is insufficient to guide intervention and policy development. Moreover, little is known specifically about bullying among US youth.6 In one county-wide middle school survey, 24.1% of youth reported bullying others at least once in the past semester26; it is not known whether this is characteristic of the rest of the nation.

The purpose of this study was to report the prevalence of bullying in a nationally representative sample of US youth in grades 6 through 10, along with information on differences in the prevalence of bullying by sex, grade, and race. In addition, the relationships among bullying, being bullied, and psychosocial adjustment are explored for 3 distinct groups: bullies only, those bullied only, and those who both bully and are bullied.

https://jamanetwork.com/journals/jama/articlepdf/193774/JOC01746.pdf

Bullying Behaviors Among US Youth: Prevalence and Association With Psychosocial Adjustment

Objectives:
(1) To compare the prevalence of bullying and victimization among boys and girls and by age in 40 countries. (2) In 6 countries, to compare rates of direct physical, direct verbal, and indirect bullying by gender, age, and country.

/pdf/a-cross-national-profile-of-bullying-and-victimization-among-1g4ekwdwdn.pdf

A cross-national profile of bullying and victimization among adolescents in 40 countries

Objective To determine whether the relationship between bullying and psychosocial adjustment is consistent across countries by standard measures and methods. Design Cross-sectional self-report surveys were obtained from nationally representative samples of students in 25 countries. Involvement in bullying, as bully, victim, or both bully and victim, was assessed. Setting Surveys were conducted at public and private schools throughout the participating countries. Participants Participants included all consenting students in sampled classrooms, for a total of 113 200 students at average ages of 11.5, 13.5, and 15.5 years. Main Outcome Measures Psychosocial adjustment dimensions assessed included health problems, emotional adjustment, school adjustment, relationships with classmates, alcohol use, and weapon carrying. Results Involvement in bullying varied dramatically across countries, ranging from 9% to 54% of youth. However, across all countries, involvement in bullying was associated with poorer psychosocial adjustment ( P Conclusions The association of bullying with poorer psychosocial adjustment is remarkably similar across countries. Bullying is a critical issue for the health of youth internationally.

https://jamanetwork.com/journals/jamapediatrics/articlepdf/485786/POA30469.pdf

Cross-national consistency in the relationship between bullying behaviors and psychosocial adjustment.

reported depressive symptoms, as compared with 22% of Hispanic, 18% of white, 17% of Asian American, and 15% of African American youths. Youths who were frequently involved in bullying, either as perpetrators or as victims, were more than twice as likely to report depressive symptoms than those who were not involved in bullying. A significantly higher percentage of youths who reported usingsubstancesreporteddepressivesymptomsascompared with other youths. Similarly, youths who reported experiencingsomaticsymptomsalsoreportedsignificantlyhigher proportions of depressive symptoms than other youths. Conclusions:Depressionisasubstantialandlargelyunrecognized problem among young adolescents that warrants an increased need and opportunity for identification and intervention at the middle school level. Understanding differences in prevalence between males and females and among racial/ethnic groups may be important to the recognition and treatment of depression among youths. Arch Pediatr Adolesc Med. 2004;158:760-765

https://jamanetwork.com/journals/jamapediatrics/articlepdf/485787/POA30539.pdf

Prevalence of and risk factors for depressive symptoms among young adolescents.

Objective To determine the extent to which bullying and being bullied, both in and away from school, is associated with involvement in violent behavior. Design, Setting, and Participants A US representative cross-sectional sample of 15 686 students in grades 6 through 10 in public and private schools completed the World Health Organization's Health Behaviour in School-aged Children survey in 1998. Main Outcome Measures Self-report of weapon carrying, weapon carrying in school, physical fighting, and being injured in a physical fight. Results Involvement in each of the violence-related behaviors ranged from 13% to 23% of boys and 4% to 11% of girls. Bullying others and being bullied were consistently related to each violence-related behavior for both boys and girls. Greater odds of involvement occurred with bullying others than being bullied, and greater odds of involvement occurred with bullying that took place away from school than that occurring in school. For example, the adjusted odds ratio for weapon carrying associated with being bullied in school weekly was 1.5, for bullying others in school 2.6, for being bullied away from school 4.1, and for bullying others away from school 5.9. Conclusion Bullying should not be considered a normative aspect of youth development, but rather a marker for more serious violent behaviors, including weapon carrying, frequent fighting, and fighting-related injury.

https://jamanetwork.com/journals/jamapediatrics/articlepdf/481307/poa20341_348_353.pdf

Mary D. Overpeck

Papers

Bullying Behaviors Among US Youth: Prevalence and Association With Psychosocial Adjustment

A cross-national profile of bullying and victimization among adolescents in 40 countries

Cross-national consistency in the relationship between bullying behaviors and psychosocial adjustment.

Prevalence of and risk factors for depressive symptoms among young adolescents.

Relationships between bullying and violence among US youth