Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #105194

Lois Chandler Howland, DrPH, MS¹, Sybil L. Crawford, PhD², Katherine Gendreau, MS², Steven L. Gortmaker, PhD³, and James M. Oleske, MD MPH⁴. (1) Graduate School of Nursing, University of Massachusetts, 55 Lake Avenue North, S1-853, Worcester, MA 01655, (508)856-5290, lois.howland@umassmed.edu, (2) Department of Preventive and Behavioral Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, (3) Department of Society, Human Development, and Health, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115, (4) Department of Pediatrics, University of Medicine and Dentistry of New Jersey, F-570A Medical Science Building, 185 S. Orange Ave., Newark, NJ 07103

Background: Children with HIV infection are more likely to experience negative life events (NLE's) due to social factors. NLE's have been associated with low quality of life (QOL), and increased health care utilization (HCU) in adults; similar research on children is more limited. This study's objective was to examine the risk of lower scores in three QOL outcomes (health perceptions, behavior problems, and symptom distress), and increased HCU associated with NLE exposure among children with documented HIV infection. Methods: Using data from 1501 children age 5-21 years enrolled in Pediatric AIDS Clinical Trials Protocol 219, we estimated the odds of low QOL scores and increased HCU (ER visits, clinic visits, calls to MD/RN, home visits by MD/RN occurring in the past month) for baseline and concurrent annually reported NLE's (e.g. loss of housing, family member hospitalized, caretaker change) categorized as 0, 1, and 2+ events. Multivariate logistic regression adjusted for baseline age, gender, race/ethnicity, and CD4%. Results: Even adjusting for other factors, concurrent NLE's were consistently predictive of increased HCU and low QOL. One or more NLE's were associated with more phone calls (p<0.01) and more home visits (p<0.001); 2+ NLE's were associated with more clinic visits (p<0.01), and more hospitalizations (p<0.001). NLE's were associated with symptom distress (p<0.0001), behavior problems (p<0.002), and low health perceptions (p<0.0002). Baseline NLE's showed similar, but weaker, associations. Conclusions: Recent NLE's appear to represent significant and independent risks for increased HCU and lower QOL among children with HIV infection.

Learning Objectives: At the conclusion of the session, participants will be able to

• Describe the conceptual framework linking negative life events with lower quality of life (QOL) and increased health care utilizaton (HCU).
• List 3 negative life events associated with increased health care utilization and lower QOL.
• Identify 3 factors which place children with HIV infection at risk for NLE exposure.

Keywords: Children and Adolescents, Stress

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.