IMPROVING ASTHMA CARE FOR MINORITY CHILDREN IN HEADSTART

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DESCRIPTION (provided by applicant): Asthma-related morbidity and mortality are disproportionately high among low-income African-American children. The impact of this asthma burden is particularly great on very young children and their families, resulting in high rates of emergency department care, hospitalization, decreased quality of life, and the risk of fatal asthma. Our research and that of others suggests that the contributing factors to this high morbidity include under-use of asthma primary preventive care, sub-optimal medical management, and inappropriate asthma management behaviors. Despite the importance of early, regular asthma preventive care for children this goal has proved elusive. Head Start programs offer an ideal venue for accessing high-risk, low income pre-school children and improving asthma morbidity. We hypothesize that removing barriers to preventive asthma care and facilitating communication between parents and primary care providers (PCP) are necessary prerequisites to optimally influence caregivers' asthma management practices. We propose to remove barriers by use of the Breathmobile, a community-based service that is specifically designed to deliver asthma screening, and special consultation directly to families and children in high-risk neighborhoods. In addition, we will evaluate a caregiver/PCP communication intervention designed to facilitate communication between parents and PCPs about a child's asthma severity and recommended therapy. The proposed 2x2 modified factorial study design will compare the effectiveness of a Breathmobile Intervention combined with a Facilitated Asthma Communication Intervention (FACI) to a Facilitated Asthma Communication Intervention alone, the Breathmobile Intervention alone, or a Control Group in reducing asthma morbidity and improving asthma management. We will recruit 360 Head Start students aged 3 and 4 years with symptomatic doctor-diagnosed asthma. The primary study outcome measure will by Symptom-Free Days over 18 months. Secondary outcomes include school absences, health care utilization (emergency department visits, hospitalizations, primary care visits), asthma medications, parents' asthma related quality of life, parent asthma management practices, and cost-effectiveness. We hypothesize that a Facilitated Asthma Communication Intervention combined with the Breathmobile Intervention will be most effective in improving parent and PCP management of the child's asthma and reducing asthma morbidity.