Kim Juhee, Greaney Mary L
Department of Public Health, Center for Health Disparities, East Carolina University, 1800 W. 5th Street, Medical Pavilion Suite 9, MS-643, Greenville, NC 27834, USA.
Department of Kinesiology, University of Rhode Island, Kingston, RI, USA.
Disabil Health J. 2014 Jul;7(3):318-24. doi: 10.1016/j.dhjo.2014.02.005. Epub 2014 Feb 20.
Children with special health care needs (SHCN) may be at greater risk of obesity than children without SHCN. A new classification system categorizes SHCN among children by service type using the following categories: No-SHCN, medication use only, services use only, medication + service use, and functional limitations. Research is needed to examine obesity and obesity-related behaviors among children using the new classification system.
To determine the prevalence of inadequate vigorous physical activity (VPA), high screen time and obesity by SHCN category using the new classification system.
Multivariate regression models were fitted for inadequate VPA, high screen time, and obesity to determine if there were differences in these outcomes by SHCN category, adjusting for multistage-sampling and survey-design effects using a nationally representative sample of children in the National Survey of Children's Health 2007.
22.9% of the sample was classified as having SHCN: 9% medication use only, 5% medication + service use, 4% service use only, and 5% functional limitations. Children in the medication use only and medication + service use groups were not at increased risk for inadequate VPA, high screen time, or obesity. Children in the service use only and functional limitation groups had increased odds of high screen time and obesity, which disappeared after controlling for confounders. However, the higher odds of inadequate VPA remained significant in the service use only [OR (95% CI) = 2.00 (1.34-3.00)] and the functional limitations groups with 2.21 (1.55-3.15).
Physical activity promotion programs are needed for children with SHCN, especially children with functional limitations and those who require service use only and do not use prescribed medication.
有特殊医疗需求（SHCN）的儿童可能比无特殊医疗需求的儿童面临更高的肥胖风险。一种新的分类系统根据服务类型将儿童中的特殊医疗需求分为以下几类：无特殊医疗需求、仅使用药物、仅使用服务、药物+服务使用以及功能受限。需要开展研究以使用新的分类系统来调查儿童中的肥胖及肥胖相关行为。
使用新的分类系统按特殊医疗需求类别确定剧烈身体活动（VPA）不足、高屏幕使用时间和肥胖的患病率。
针对VPA不足、高屏幕使用时间和肥胖拟合多变量回归模型，以确定这些结果在特殊医疗需求类别之间是否存在差异，并使用2007年全国儿童健康调查中具有全国代表性的儿童样本对多阶段抽样和调查设计效应进行调整。
22.9%的样本被分类为有特殊医疗需求：9%仅使用药物，5%药物+服务使用，4%仅使用服务，5%功能受限。仅使用药物和药物+服务使用组的儿童在VPA不足、高屏幕使用时间或肥胖方面风险未增加。仅使用服务和功能受限组的儿童高屏幕使用时间和肥胖的几率增加，在控制混杂因素后消失。然而，VPA不足的较高几率在仅使用服务组[比值比（95%置信区间）=2.00（1.34 - 3.00）]和功能受限组[2.21（1.55 - 3.15）]中仍然显著。
需要为有特殊医疗需求的儿童开展身体活动促进项目，尤其是有功能受限的儿童以及那些仅需要使用服务且未使用处方药的儿童。
