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Can A Parents Numeracy Skills Affect Their Child’s Asthma Symptoms/Severity? New Study from UPMC Children’s Explores the Possibility

May 27, 2023

A Research team from the Division of Pediatric Pulmonary Medicine at UPMC Children’s Hospital of Pittsburgh in a newly published study explored the connection between the mathematical ability of parents, specifically related to understanding health care instructions, and the severity of asthma symptoms in their children. This study focused on children from San Juan, Puerto Rico, who have been diagnosed with asthma.

The study was published in Annals of Allergy, Asthma & Immunology in March 2023. Division fellow Amanda Gutwein, DO, MS, was the lead author. Dr. Gutwein is a postdoctoral research fellow in the Division's T32 Training Grant, which is funded by National Institutes of Health grant HL129949.

Division chief Juan C. Celedón, MD, DrPH, ATSF, was the investigation’s senior author.

The study was conducted in collaboration with researchers from the Behavioral Sciences Research Institute, University of Puerto Rico, San Juan, Puerto Rico

What is Numeracy?

Numeracy refers to the ability to understand and work with numbers. It includes skills like basic arithmetic, understanding percentages, fractions, and probabilities, and the ability to interpret graphs, charts, and tables. In essence, numeracy is the mathematical equivalent of literacy and entails the practical application of numerical knowledge in activities of daily living.

Numeracy is highly important to health-care related information and one’s ability to make informed decisions about their own or another’s care. Information around health care and disease states universally involves numerical concepts: dosages of medication, interpreting blood pressure readings, understanding nutritional information, or assessing risk probabilities related to different treatments or health behaviors.

Low health numeracy can lead to misunderstanding medical instructions or interpreting the information incorrectly, which can have serious consequences for an individual’s health and well-being.

Study Overview and Findings

The study involved 225 young participants with asthma from San Juan, Puerto Rico. These participants were part of two study visits roughly 5.3 years apart, with the first visit occurring when they were between 6 and 14 years old, and the second visit happening between the ages of 9 and 20.

During these visits, researchers assessed the parents' ability to understand and use numerical health care information, using an adapted version of a test called the Asthma Numeracy Questionnaire. Parents who scored low at both visits (a score of 1 or less) were considered to have consistently low numeracy skills.

The study looked at several health outcomes for the children in the year before their second visit, such as whether the child had to visit the emergency room, was hospitalized, or had a severe asthma attack requiring a hospital visit or inpatient admission.

The results of the investigation revealed a significant link between consistently low numeracy skills in the parents and the likelihood of their child having a severe asthma attack, needing to visit the emergency room, or being hospitalized due to asthma. This remained true even when other factors like age, gender, parental education, and use of asthma medication were considered.

However, the study did not find a significant link between low parental numeracy skills and any change in the child's lung function.

The study underscores the importance of parental numeracy skills in managing children's asthma and could guide future health programs and interventions designed to decrease severe asthma cases in children.


Gutwein A, Han Y-Y, Colón-Semidey A, Alvarez M, Acosta-Pérez E, Forno E, Canino G, Apter A, Celedón JC. Low Parental Numeracy and Severe Asthma Exacerbations in a Prospective Study of Puerto Rican Youth. Ann Allergy Asthma Immunol. 2023 Mar 8; S1081-1206. Epub ahead of print.