1 table omitted
Asthma is a leading chronic illness among children in the United States.1 To examine self-reported asthma and asthma attacks
among U.S. high school students, CDC analyzed data from the 2003 national
Youth Risk Behavior Survey (YRBS). This report summarizes the results of that
analysis, which indicated that 18.9% of high school students had been told
by a doctor or nurse that they had asthma, 16.1% had current asthma, and 37.9%
of those with current asthma had had an episode of asthma or an asthma attack
during the 12 months preceding the survey. These findings underscore the need
for health-care providers, schools, families, and public health practitioners
to be prepared to respond to asthma-related emergencies and to help students
manage their asthma.
YRBS is a component of CDC’s Youth Risk Behavior Surveillance
System and measures the prevalence of health risk behaviors among high school
students through biennial national, state, and local surveys. The 2003 national
survey used a three-stage cluster sample design to obtain cross-sectional
data representative of public- and private-school students in grades 9-12
in the 50 states and the District of Columbia. The school response rate was
81%, the student response rate was 83%, and the overall response rate was
67%. Students completed an anonymous, self-administered questionnaire that
included two questions about asthma. Question 1 was answered by 13,553 students
and asked, “Has a doctor or nurse ever told you that you have asthma?”
(response options were “yes,” “no,” and “not
sure”). Question 2 was answered by 13,232 students and asked, “During
the past 12 months, have you had an episode of asthma or an asthma attack?”
(response options were “I do not have asthma;” “No, I have
asthma, but I have not had an episode of asthma or an asthma attack during
the past 12 months;” “Yes, I have had an episode of asthma or
an asthma attack during the past 12 months;” and “not sure”).
Each student was expected to respond to both questions, and 13,222 did so.
“Lifetime asthma” was defined as ever having been told by a doctor
or nurse that the student had asthma. “Current asthma” was defined
as having lifetime asthma and, during the 12 months preceding the survey,
reporting either having asthma but no episode or attack or having an asthma
episode or attack. “Asthma episode or attack” was calculated among
students with current asthma and was defined as having had an asthma episode
or attack during the 12 months preceding the survey.
In this report, data are presented for black, white, and Hispanic* students;
the numbers of students from other racial/ethnic populations were too small
for meaningful analysis. Data were weighted to provide national estimates.
Statistical software that takes into account the complex sampling design was
used to calculate prevalence estimates and 95% confidence intervals and to
conduct t tests for subgroup comparisons.
Overall, 18.9% of high school students reported lifetime asthma (Table).
Significantly fewer Hispanic (15.6%) than black (21.3%; t = 4.0, p<0.01) or white (19.3%; t = 3.4,
p<0.01) students reported lifetime asthma. Approximately one in six students
(16.1%) reported current asthma. Significantly fewer Hispanic (12.9%) than
black (16.8%; t = 3.0, p<0.01) or white (17.0%; t = 3.5, p<0.01) students and significantly fewer 10th-grade
(15.0%) than 9th-grade students (17.5%; t = 2.2,
p<0.05) reported current asthma.
Among students with current asthma, 37.9% reported an asthma episode
or attack during the 12 months preceding the survey. Significantly more female
(44.5%) than male (31.1%; t = 4.3, p<0.01) students
with current asthma and significantly more 9th-grade students (45.0%) than
10th- (36.4%; t = 2.1, p<0.05), 11th- (34.6%; t = 3.0, p<0.01), and 12th-grade (33.0%; t = 2.9, p<0.01) students with current asthma reported having an
asthma episode or attack.
S Merkle, MPH, S Everett Jones, PhD, L Wheeler, MD, Div of Adolescent
and School Health, National Center for Chronic Disease Prevention and Health
Promotion; D Mannino, MD, Div of Environmental Hazards and Health Effects,
National Center for Environmental Health, CDC.
YRBS provides a national source for self-reported asthma prevalence
among U.S. high school students. The findings in this report indicate that
18.9% of high school students reported lifetime asthma, and 16.1% had current
asthma. Among students with current asthma, 37.9% reported having had an asthma
episode or attack during the 12 months preceding the survey. In the 2003 National
Health Interview Survey (NHIS), parents reported that 14.5% of their children
aged 14-17 years had lifetime asthma, 8.9% had current asthma, and among students
with current asthma, 57.0% had had an asthma episode or attack during the
preceding year (CDC, unpublished data, 2005). The differences between the
two surveys in estimates for lifetime asthma, current asthma, and asthma episode
or attack might be attributable to differences in age (grades 9-12 versus
ages 14-17 years), reporting source (self-report versus parent report), and
question wording. Further research is needed to better understand the reasons
for these differences and their implications for asthma management.
YRBS data indicate no significant difference between the percentages
of black and white students reporting current asthma or having an asthma episode
or attack during the preceding 12 months. Other national data sources have
revealed higher asthma prevalence among black children than white children
and have indicated that, compared with white children, black children were
more than three times as likely to be hospitalized because of asthma and more
than four times as likely to die from asthma.2
Why significantly more female students than male students with asthma
and significantly more 9th-grade students than 10th-, 11th-, or 12th-grade
students with asthma reported having an asthma episode or attack during the
preceding 12 months is not clear. Additional research might help explain sex
and grade differences in asthma episodes.
The findings in this report are subject to at least three limitations.
First, these data apply only to adolescents enrolled in high school. Nationwide,
in 2001, among persons aged 16-17 years, approximately 5% were not enrolled
in a high school program and had not completed high school.3 Second,
the extent of underreporting or overreporting of asthma and asthma episodes
or attacks cannot be determined. Asthma status was not confirmed by medical
records, and asthma episode and attack were not defined. Third, data for Hispanic
respondents represent responses from an unknown combination of Mexican-American,
Puerto Rican, and other Hispanic students. Other reports have demonstrated
variation in asthma prevalence among these subpopulations. According to NHIS
data, Puerto Ricans have reported three times higher lifetime and current
asthma prevalence than Mexican-Americans.4
A primary prevention strategy for asthma does not exist, but asthma
can be controlled.5 Schools can help improve
asthma management among students whose asthma is not well-controlled by providing
health services, education, and control of environmental triggers. CDC, other
federal agencies, the National Asthma Education and Prevention Program, and
national nongovernmental organizations have developed resources to support
asthma management activities at schools.6 CDC’s Strategies for Addressing Asthma Within a Coordinated School Health
Program7 recommends research-based activities
for schools to help students manage their asthma, such as obtaining a written
asthma action plan for all students with asthma, ensuring that those with
asthma receive education on asthma basics, asthma management, and emergency
response, and prohibiting tobacco use at all times among students, staff,
and visitors to schools. Students, families, schools, and health-care and
public health practitioners working together can improve asthma management
*Black and white students are all non-Hispanic. Students identified
as Hispanic might be of any race.
Self-Reported Asthma Among High School Students—United States,
2003. JAMA. 2005;294(15):1891-1892. doi:10.1001/jama.294.15.1891