Department of Pediatrics, University of California, San Francisco, USA.
Acad Pediatr. 2012 Jul-Aug;12(4):326-34. doi: 10.1016/j.acap.2012.03.004. Epub 2012 Jun 8.
Children with special health care needs (CSHCN) are at risk for decreased participation in educational and social activities, which can negatively impact their lives. The objectives of this study were to document the presence of participation restrictions for CSHCN compared with other children and to determine how personal and environmental factors are associated with participation restrictions for CSHCN.
The 2007 National Survey of Children's Health was analyzed to evaluate 2 participation outcomes for children aged 6 to 17 years, ie, school attendance and participation in organized activities, and 2 participation outcomes for children aged 12 to 17 years, ie, working for pay and volunteering. Adjusted prevalences of participation restrictions were calculated for children with and without special health care needs. Logistic regression was used to identify factors independently associated with participation restrictions for CSHCN.
After adjustment for sociodemographic characteristics, a greater proportion of CSHCN (27.9%) reported missing more than 5 days of school than other children (15.1%). In contrast, no differences were found for participation in organized activities, working for pay, or volunteering. CSHCN with functional limitations were more likely to experience all 4 types of participation restrictions compared with other CSHCN and non-CSHCN. For CSHCN, the odds of certain participation restrictions were greater for those with functional limitations, in fair/poor health, with depressed mood, living at or near the federal poverty level, and living in homes not headed by two parents.
CSHCN with functional limitations and those with worse health status are at elevated risk of experiencing participation restrictions than other children. Social disadvantage furthers the likelihood that CSHCN will experience participation restrictions.
有特殊健康需求的儿童（CSHCN）参与教育和社交活动的机会减少，这可能对他们的生活产生负面影响。本研究的目的是记录 CSHCN 与其他儿童相比参与受限的情况，并确定个人和环境因素如何与 CSHCN 的参与受限相关。
分析了 2007 年全国儿童健康调查，以评估 6 至 17 岁儿童的 2 项参与结果，即上学和参加有组织的活动，以及 12 至 17 岁儿童的 2 项参与结果，即带薪工作和志愿服务。计算了有和没有特殊健康需求的儿童的参与受限的调整后流行率。使用逻辑回归确定与 CSHCN 的参与受限独立相关的因素。
在调整了社会人口特征后，更多的 CSHCN（27.9%）报告缺课超过 5 天，而其他儿童（15.1%）。相比之下，参加有组织的活动、带薪工作或志愿服务没有差异。与其他 CSHCN 和非 CSHCN 相比，有功能限制的 CSHCN 更有可能经历所有 4 种类型的参与受限。对于 CSHCN，有功能限制、健康状况不佳、情绪低落、生活在或接近联邦贫困线以下以及生活在非双亲家庭的 CSHCN 经历某些参与受限的可能性更大。
有功能限制和健康状况较差的 CSHCN 比其他儿童更有可能经历参与受限。社会劣势增加了 CSHCN 经历参与受限的可能性。
