School Variation in Asthma Compositional or Contextual 英文参考文献.docVIP

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School Variation in Asthma Compositional or Contextual 英文参考文献.doc

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SchoolVariationinAsthma:Compositionalor Contextual? TracyK.Richmond1.*,S.V.Subramanian2. 1Division of Adolescent Medicine, Children’s Hospital Boston, Boston, Massachusetts, United States of America, 2Department of Society, Human Development, and Health(SVS),HarvardSchoolofPublicHealth,Boston,Massachusetts,UnitedStatesofAmerica Abstract Background:Childhoodasthmaprevalenceandmorbidityhavebeenshowntovarybyneighborhood.Lessisknownabout between-schoolvariationinasthmaprevalenceandwhetheritexistsbeyondwhatonemightexpectduetostudentsat higherriskofasthmaclusteringwithindifferentschools.Ourobjectivewastodeterminewhetherbetween-schoolvariation inasthmaprevalenceexistsandifso,ifitisrelatedtothedifferentialdistributionofindividualriskfactorsforandcorrelates ofasthmaortocontextualinfluencesofschools. Methods: Cross-sectional analysis of 16,640 teens in grades 7–12 in Wave 1 (data collected in 1994–5) of the National LongitudinalStudyofAdolescentHealth.Outcomewascurrentdiagnosisofasthmaasreportedbyrespondents’parents. Two-level random effects models were used to assess the contribution of schools to the variance in asthma prevalence beforeandaftercontrollingforindividualattributes. Results:Thehighestquartileschoolshadmeanasthmaprevalenceof21.9%comparedtothelowestquartileschoolswith mean asthma prevalence of 7.1%. In our null model, the school contributed significantly to the variance in asthma (s2 =0.27, CI: 0.20, 0.35). Controlling for individual, school and neighborhood attributes reduced the between-school u0 variancemodestly(s2u0=0.19CI:0.13–0.29). Conclusion: Significant between-school variation in current asthma prevalence exists even after controlling for the individual, school and neighborhood factors. This provides evidence for school level contextual influences on asthma. Furtherresearchisneededtodeterminepotentialmechanismsthroughwhichschoolsmayinfluenceasthmaoutcomes. Citation: Richmond TK, Subramanian SV (2009) School Variation in Asthma: Compositional or Cont