SCHOOL-BASED ASTHMA INTERVENTION PROGRAM

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While validated guidelines exist for the management of childhood asthma, effective asthma intervention in low-income populations suffers from poor access to the health care and inadequate asthma education. The objectives of this proposal are to determine if a standardized asthma intervention program at school reduces asthma morbidity and if medical intervention (drug therapy) combined with educational-behavioral intervention is superior to medical intervention alone. In seven elementary schools serving children of predominantly Hispanic, low-income families, 180 (5-8 year old) children with asthma will be identified and randomized into two groups (60 children each) in which medical intervention will be compared to medical intervention plus educational-behavioral intervention in a cross-over design, and compared with a historical control group (60 children) receiving currently available community treatment. The evaluations and interventions will take place at school using a mobile health van. The duration of the interventions will be 12 months and their short-term and carry-over effects will be assessed by measures of asthma related morbidity (number of hospitalizations, ER visits, days absent from school), quality of life, spirometry and peak-flow variability, growth and regimen adherence. The relationship between outcome variables and sociodemographics and environmental factors will also be examined. With this approach we will determine if school-based medical and educational- behavioral intervention programs are an effective means of reducing asthma morbidity in and improving school attendance of children of low-income, medically under-served families.