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children, 4.9% were reported to have had asthmatic symptoms in the past 12 months, a prevalence higherin males than females (5.8% vs. 4%), but varying little by race/ethnicity (although slightly higher amongBlack children), maternal education, or income. Compared with asymptomatic children, children withasthma missed more days of schools (7.6 mean days in previous 12 months vs. 2.5), had slightly higherrates of grade failure (17.5% vs. 14.6%), and higher rates of learning disabilities (9.1% vs. 5.2%). Threetimes as many asthmatic children from families with incomes less than $20,000 were described as in pooror fair health when compared to asthmatic children from families with incomes equal to or greater than$20,000. Asthmatic children described as in poor or fair health were absent substantially more days in thepast year (17.4 days) than those in good or excellent health (6.7 days). Asthmatic children of poor familiesalso had twice the odds of grade failure compared to well children. In contrast, for asthmatic children fromhigher income households (>$20,000) there was little increased risk of grade failure or learning disabilities.There is substantial evidence that children with asthma are more likely to be absent from school(Fowler et al., 1992) (Freudenberg et al., 1980; Joseph et al., 1996) (Maier et al., 1998) (O'Neil et al.,1985) (Parcel et al., 1979) (Silverstein et al., 2001) (Yeatts & Shy, 2001). However, the relationshipbetween school absence and academic achievement for children with asthma has not been clarified inthese studies. Gutstadt (Gutstadt et al., 1989) and ONeill (O'Neil et al., 1985) reported that, while childrenwith asthma missed more days of school, academic performance was not necessarily related to schoolabsences. These two studies relied on cross sectional designs, compromising the reliability of theirconclusions. A longitudinal, case-control study of predominantly white, middle-class children fromRochester, Minnesota, relied on school records to document that asthmatic children missed an additional2 days of school as compared to non-asthmatic children, but that school achievement was not significantlydifferent between the two groups, as assessed by standardized test scores (Silverstein et al., 2001).Fowler’s (Fowler et al., 1992) analysis of national data from the National Health Interview Study found,however, that asthmatic children of poor families may be at increased risk of grade failure, suggesting thatpoor asthmatic children may be at greater risk for academic failure than their wealthier counterparts whoappear able to compensate for missed days of school.Several studies have raised concerns about the effect of medications used in the management ofchronic asthma on academic achievement. Gutstadt et al. (Gutstadt et al., 1989) conducted a studyamong 99 asthmatic children in grades 2-12 and found that a history of oral steroid use in the precedingyear was significantly associated with lower mathematics and reading scores on standardized tests, evenwhen controlling for socioeconomic status, age, and scores on the child behavior checklist. In contrast,Lindgren et al. (Lindgren & Lokshin, 1992) found that treatment with theophylline was not related todifferences in standardized achievement test scores between 101 asthmatic children aged 6 to 18 andtheir sibling controls. This limited research on medication for management of asthma raises concernabout treatment with oral steroids.Limitations. Research on asthmatic children in school settings is challenged by the reliable identificationof children with asthma, as shown in a Detroit study by Joseph et al. (Joseph et al., 1996) where therewere almost as many undiagnosed asthmatics as physician-diagnosed asthmatics. Disparities in accessto health care may impede the proper diagnosis of asthma and affect the conduct of research withasthmatic children. Children of very poor families with access to health care, for example, may be morelikely to be diagnosed than children of the lower middle class who lack insurance and access to healthcare.Implications. The evidence for the impact of asthma on academic achievement is complex but doessuggest that asthma is related to school absences and may adversely affect academic performance forchildren from poor households. In addition, obesity has been found to be a risk factor for asthma inchildren (Bibi et al., 2004).E-6