Reducing Asthma Morbidity in High Risk Minority Preschool Children

描述（由申请人提供）：尽管哮喘治疗取得了进步，哮喘临床指南也得到了广泛传播，但低收入、少数民族儿童的哮喘发病率和死亡率仍然高得不成比例。国家贫困儿童中心强烈认为，改善哮喘健康差距和减少危害的有效干预措施必须从儿童早期开始。先前的疗效研究表明，哮喘教育项目可以有效地改善学龄前儿童哮喘的整体管理。然而，为了使这些有希望的哮喘干预策略对低收入、少数民族儿童产生可持续的公共卫生影响，它们必须与那些为这些年轻的高风险儿童服务的医疗、教育和社会结构相结合，例如社区诊所、学校和日托项目。由于联邦政府资助的启智计划的核心任务之一是为低收入的学龄前学生提供预防性健康服务和筛查，启智计划代表了传播早期哮喘教育的理想社区环境。我们建议利用我们与巴尔的摩市Head Start项目建立的健康和研究伙伴关系来测试这种基于家庭的哮喘教育干预的有效性，并在Head Start范围内的哮喘教育项目中进行验证。我们进一步建议与启智计划合作，以支持和评估从该项目中获得的新知识的采用、维护和传播。具体来说，我们假设接受ABC干预并接受HS水平哮喘教育的参与者在6个月、9个月和12个月评估时的无症状天数比单独接受HS水平哮喘教育的参与者要多。我们计划招募406名患有症状性哮喘的2-6岁儿童参加Head Start。次要结局指标包括哮喘发病率的其他指标（即住院、急诊科就诊、口服类固醇药物、缺勤和照顾者生活质量）。我们还将评估结果预期、自我效能、哮喘知识、动机和哮喘管理实践的中介效应，以及调节效应，如健康素养、照顾者抑郁、邻里凝聚力、哮喘的家庭管理，以及哮喘教育课程的采用和传播。

DESCRIPTION (provided by applicant): Despite advances in asthma therapies and the wide-spread dissemination of asthma clinical guidelines, low-income, minority children have disproportionately high morbidity and mortality from asthma. The National Center for Children in Poverty has strongly argued that effective interventions to improve asthma health disparities and reduce harm must begin in early childhood. Previous efficacy studies have suggested that asthma education programs can be effective in improving overall management of asthma for preschool children. However, for these promising asthma intervention strategies to have sustainable public health impact for low-income, minority children they must be integrated within those medical, educational and social structures that serve these young high risk children, such as community clinics, schools and day care programs. Because one of the core missions of federally- funded Head Start programs is to provide preventive health services and screening to their low-income preschool students, Head Start represents an ideal community setting for disseminating early asthma education. We propose to draw on our established health and research partnership with Head Start programs in Baltimore City to test the effectiveness of this home-based asthma education intervention with demonstrated efficacy, when delivered in the context of a Head Start-wide asthma education program. We further propose to partner with Head Start to support and evaluate adoption, maintenance and dissemination of new knowledge gained from this project. Specifically we hypothesize that participants receiving the ABC intervention combined with a HS-level asthma education will have more symptom free days at the 6-, 9-, and 12-month evaluation when compared with participants in the HS- level asthma education alone. We plan to enroll of 406 children age 2-6 years old enrolled in Head Start with symptomatic asthma. Secondary outcome measures include other measures of asthma morbidity (i.e., hospitalizations, ED visits, oral steroid bursts, school absences, and caregiver quality of life). We will also evaluate the mediating effects of outcomes expectancies, self-efficacy, asthma knowledge, motivation, and asthma management practices, as well as moderator effects, such as health literacy, caregiver depression, neighborhood cohesion, family management of asthma, and Head Start adoption and dissemination of an asthma education curriculum. PUBLIC HEALTH RELEVANCE: Despite advances in asthma therapies and the wide-spread dissemination of asthma clinical guidelines, low-income, minority children have disproportionately high morbidity and mortality from asthma. The current study will test the effectiveness of this home-based asthma education intervention with demonstrated efficacy, when delivered in the context of a Head Start-wide asthma education program in improving asthma morbidity. If successful, this project could have significant public health implications for reducing health disparities for minority children with asthma.