SOCIAL FACTORS & THE ENVIRONMENT IN PEDIATRIC ASTHMA

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DESCRIPTION (Taken from the Investigators' Abstract) Asthma is an increasingly common, complex condition with rising morbidity and mortality. Racial disparities in pediatric asthma prevalence and severity indicate higher rates among indigent, non-Caucasians living in urban communities. The greatest proportional increase in deaths due to asthma has occurred in the 10-14 year-old age range. This proposal studies the racial disparities in pediatric asthma outcome among low income African American, Latino, and Caucasian elementary school-aged children. The goal is to clarify the biologic and environmental, as well as the social and behavioral, processes that lead to these disparities. Asthma screening will be done at three sets of six elementary schools as a service to the schools. Parents returning the screen will serve as the population from which three cohorts of elementary school-aged children will be recruited, one in each of the first three years of the project. The screen yields three groups of children in each cohort: one group that has previously diagnosed asthma, a second group that has possible, undiagnosed asthma (positive screens), and a third group that has no evidence of asthma symptoms (negative screen). The children screening positive will be followed every six months for 12 months to obtain three additional points of data. A random sample from those who screen negative for asthma will be recruited as a comparison group for the first data point only. Information gathered at the three time points include 1) information on childhood asthma control (health services utilization and symptoms) and general physical health, and 2) caregiver life stressors, physical health, and depression. Time points 1 and 3 (T1 and T3) are telephone interviews. Also at T1, children who screened positive for asthma will have allergy testing at school for common respiratory allergies. The interview at time point 2 (T2) is conducted during a home visit, at which time a home environmental screen is conducted and two dust samples collected and later analyzed for dust mite, cockroach, and cat antigens. Also at T3 (one year after the screening results are returned), parents will be interviewed about how they made the decision whether or not to seek care, from whom, and with what success. Selected healthcare providers will be sent a questionnaire regarding the children's care. All stages of the project include a Community Outreach and Education Plan, culminating in community meetings in the final year to share results and consider next steps.