Methods

This study used secondary data from a randomized controlled trial of an asthma intervention conducted between June 2015 and November 2016. ^{Reference Sleath, Carpenter and Davis11} Adolescents were eligible if they were: ages 11 to 17 y; spoke and read English or Spanish; had persistent asthma; were present for an acute or follow-up asthma visit or a well-child visit; had previously visited the clinic at least once for asthma; and the parent present with them at the office visit was a legal guardian who had knowledge of their asthma. Using information from the eligibility screener that parents completed with the research assistant, persistent asthma was defined as experiencing asthma-related daytime symptoms more than twice a week, asthma-related nighttime symptoms more than twice a month, or receiving 1 or more long-term controller therapies for asthma. ¹⁵ As part of the 12-mo parent survey, ^{Reference Sleath, Carpenter and Davis11} caregivers at 2 rural clinics were asked questions about how the hurricane had affected them. These questions were added to a larger survey midway through the larger study when the hurricane struck. As part of the larger study, the hurricane questions were only administered to families at the 2 clinics in southeastern North Carolina, which was more severely affected by the hurricane than other parts of the state. Forty-two families had already completed the 12-mo visit before the hurricane, and therefore, were not included in the analyses. The study was approved by the University of North Carolina Institutional Review Board, and informed consent or assent was obtained from all participants.

Demographics were measured at baseline, including child’s age in years, child gender (male or female), child race/ethnicity (Hispanic, non-Hispanic White, African American, American Indian, or Alaska Native, or other), language spoken at home (English or Spanish), and whether the child had Medicaid (yes or no). Asthma severity was also measured at baseline as mild persistent or moderate/severe persistent. The hurricane survey questions included whether the family’s home was flooded or damaged, whether the family’s home had mold or mildew as a result of flooding or damage, whether the child’s school was damaged or flooded, whether the family had problems with access to care, and whether the family experienced the following problems: running out of asthma medication, missing asthma medication doses, and obtaining asthma medicine from the pharmacy. The 12-mo visit occurred a mean of 6 mo after the hurricane (standard deviation [SD]: 3 mo; range: less than 1 to 13 mo). Asthma quality of life was measured using the Juniper scale and was treated as a continuous variable, using the 23-item standardized version of the Juniper pediatric asthma quality-of-life questionnaire, with the total score calculated as the mean of the 23 items scored on a scale of 1 to 7. ^{Reference Juniper16}

All analyses were performed using Statistical Product and Service Solutions (SPSS) version 26 (IBM SPSS, Armonk, NY). First, descriptive statistics were calculated for all the hurricane survey questions. Then the bivariate relationships between demographics and the hurricane survey answers were assessed using Pearson’s chi-squared or t-tests. The bivariate relationships between hurricane survey responses and asthma quality of life were also assessed using Pearson’s chi-squared or t-tests. Finally, linear regression was used to predict 12-mo asthma quality of life as a function of baseline quality of life, hurricane impact, and interaction between the 2 variables. For this purpose, hurricane impact was calculated as the total number of “yes” answers to the 7 hurricane impact questions.