Reducing Asthma Morbidity in High Risk Minority Preschool Children

描述(由申请人提供)：尽管哮喘治疗方法取得了进步，哮喘临床指南也得到了广泛传播，但低收入、少数族裔儿童的哮喘发病率和死亡率高得不成比例。国家贫困儿童中心强烈主张，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。以前的疗效研究表明，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，这些有希望的哮喘干预战略要对低收入少数族裔儿童产生可持续的公共健康影响，就必须将它们纳入为这些年轻的高危儿童提供服务的医疗、教育和社会结构，如社区诊所、学校和日托计划。由于联邦资助的Head Start项目的核心使命之一是为低收入学龄前学生提供预防性健康服务和筛查，Head Start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合作伙伴关系，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广泛开展的哮喘教育计划的背景下进行时。我们还建议与Head Start合作，支持和评估从该项目获得的新知识的采用、维护和传播。具体地说，我们假设接受ABC干预并接受HS级哮喘教育的参与者在6个月、9个月和12个月的评估中与单独接受HS级哮喘教育的参与者相比，将有更多的无症状天数。我们计划招募406名2-6岁的儿童参加Head Start有症状的哮喘。次要结果指标包括哮喘发病率的其他指标(即住院、急诊室就诊、口服类固醇发作、缺课和照顾者的生活质量)。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、社区凝聚力、哮喘的家庭管理，以及Head Start采用和传播哮喘教育课程。 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、少数族裔儿童的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措施的有效性，当在Head Start范围的哮喘教育计划的背景下实施时，证明了这种干预措施在改善哮喘发病率方面的有效性。如果成功，该项目可能对减少患有哮喘的少数族裔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.