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Running the Numbers on Asthma

Biostatistician Sheniz Moonie zeroes in on the factors that influence the health of Nevadans, particularly those with asthma.
Research  |  Jul 23, 2013  |  By Brian Sodoma
Professor of epidemiology and biostatistics Sheniz Moonie (R. Marsh Starks/UNLV Photo Services)

If you're researching how Nevada stacks up against the rest of the nation in various health statistics categories, chances are you'll come across Sheniz Moonie's work. The UNLV professor of epidemiology and biostatistics is more than adept at the numbers game.

As the southern director for the Nevada Behavioral Risk Factor Surveillance Survey, Moonie helps oversee an annual program, done in cooperation with the University of Nevada, Reno, that collects vital health statistics for the state. The project is funded by the Centers for Disease Control and Prevention (CDC). The annual survey of about 4,000 Nevadans gives insights into how the state fares with issues like asthma rates, diabetes, heart disease and numerous other diseases.

Moonie also collaborated on a CDC-funded Healthy Homes grant, which evaluated the safety of homes of Clark County residents and offered suggestions and resources for fixing them. A longtime asthma researcher, Moonie helped with that portion of the study. For another collaboration, she is working on intervention efforts for obese people with asthma.

What are some of the surprises about Nevada in particular when you look at health statistics?

A lot of folks assume we're the worst in everything. We do fare higher in tobacco rates, also relatively higher than the nation in heart disease rates. But in terms of obesity and diabetes, we're about equivalent, not higher, than the nation. It changes when you start looking at pockets of populations. American Indian rates are through the roof for diabetes.

Adult asthma is higher in Nevada than in the nation (15 percent compared to 13.8 percent). Why?

We know environmental triggers are the dry weather, dust, and a climate that goes from hot to cold very quickly. Of course, cold and flu season and times with heavy wind yield a lot of emergency room visits for asthma. Particulate matter, dust, and pollens get kicked up in the wind. Wind is just very difficult for the respiratory system to deal with.

Hospital admissions and under-reporting

We looked at some University Medical Center data in the past and found that, while hospital admissions for asthma are decreasing, emergency room visits are increasing in Nevada. There are clinical tests for asthma diagnoses and treatment, but they don't tend to perform them in the emergency or urgent care settings. The patients are treated with rescue medication and often times sent away without a diagnosis. They'll say 'airway hyper-responsiveness, a bronchial response,' or use one of the codes for respiratory disease, but they won't necessarily check asthma. I think the rates in Nevada are underestimated because we're not capturing a lot of the uninsured population that go to emergency rooms for care.

The asthmatic at home and school

Many asthma triggers come up around the home. Aerosol air fresheners indoors are being linked to respiratory problems. If a cat or dog sleeps with your child, the dander in the fur could be a trigger. Stuffed animals can become full of dust so you have to wash them. Bed sheets must be washed in hot water to kill dust mites. Don't clean with bleach around an asthmatic. It will send them to the emergency room.

Children with asthma also miss a lot of school. On average, kids with asthma miss more mean school days than any other chronic condition. And a recent study published by Moonie show they're statistically more likely to be held back a grade.

There are pockets of schools in Clark County School District (CCSD) with asthma rates between 16 and 21 percent. The district rate is 9 percent. You're looking at almost a quarter of the population at that particular school.

Next steps

I'm currently working with a professor of pediatrics at the University of Nevada, School of Medicine in the area of asthma and obesity. We're facing an issue with kids with asthma that are on corticosteroids and have limited activity, so there's a predisposition for diabetes and obesity.

There is this fallacy that if you have asthma you can't be active, and that's simply not true. It's really tough because the steroids definitely contribute to weight gain. Parents also are scared to let kids exercise. So we are trying to work on some activity interventions for asthmatic children. We just received a funding award for pilot study with the University of Nevada School of Medicine to look at the obesity profile among asthmatic patients. This will provide the data we need to then apply for grant through the National Institutes of Health to expand this work and test activity interventions.