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展，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不成比例地高。国家贫困儿童中心强烈认为，改善哮喘健康差异和减少危害的有效干预措施必须开始于幼儿期。以往的疗效研究表明，哮喘教育计划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的少数民族儿童产生可持续的公共卫生影响，他们必须融入为这些年轻的高危儿童服务的医疗，教育和社会结构，如社区诊所，学校和日托计划。由于联邦政府资助的开端计划的核心任务之一是为低收入学龄前学生提供预防性健康服务和筛查，开端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的Head Start计划建立的健康和研究合作伙伴关系，在Head Start范围内的哮喘教育计划的背景下，测试这种以家庭为基础的哮喘教育干预的有效性。我们还建议与Head Start合作，支持和评估从该项目中获得的新知识的采用，维护和传播。具体而言，我们假设与仅接受HS级哮喘教育的受试者相比，接受ABC干预联合HS级哮喘教育的受试者在6个月、9个月和12个月评估时的无症状天数更多。我们计划招募406名2-6岁的有症状哮喘的儿童参加Head Start。次要结果指标包括哮喘发病率的其他指标（即，住院、艾德就诊、口服类固醇爆发、缺课和护理者生活质量）。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、哮喘的家庭管理和哮喘教育课程的抢先采用和传播。 公共卫生相关性：尽管哮喘治疗取得了进展，哮喘临床指南也得到了广泛传播，但低收入的少数民族儿童哮喘发病率和死亡率高得不成比例。目前的研究将测试这种以家庭为基础的哮喘教育干预的有效性，并证明其有效性，当在Head Start范围内实施哮喘教育计划时，可改善哮喘发病率。如果成功，该项目可能对减少少数民族哮喘儿童的健康差距产生重大的公共卫生影响。

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.