While NHLBI guidelines recommend daily preventive medications for all children with persistent asthma, poor adherence to these recommendations is common, particularly among poor urban children. The goal of the proposed project is to reduce morbidity for impoverished children with asthma by improving adherence to guidelines for care. This study builds on our experience with a pilot sample of 180 urban children that suggested that school-based administration of preventive asthma medications reduces asthma symptoms. However, the beneficial effects of the program were seen only among children not exposed to environmental tobacco smoke (ETS). We propose a full-scale randomized trial with a comprehensive intervention that consists of both administration of preventive asthma medications in the school (with dose adjustments according to NHLBI guidelines), and, for smoke-exposed children, an ETS reduction program in the home. We hypothesize that children receiving the comprehensive school-based intervention will experience less asthma-related morbidity compared to children receiving usual care. The secondary hypothesis is that, among the subgroup of smoke-exposed children, those receiving the comprehensive intervention will experience less asthma morbidity than those receiving usual care. Five hundred and thirty children ages 3- 10 years will be identified from 50 schools in the Rochester City School District, and will be assigned randomly to the school-based care group or a usual care group. Data will be analyzed to assess the overall effectiveness of the school-based intervention in reducing asthma morbidity (including symptom-free days as the primary outcome, as well as additional secondary outcome measures), evaluate whether smoke-exposed children who receive the intervention have lower asthma morbidity than smoke-exposed children who receive usual care, and establish the program's cost-effectiveness. This project may have a profound impact on public health because it presents a practical system change to assure adherence to therapy and decrease ETS exposure among impoverished children with asthma. Should it prove successful in reducing symptoms and improving the health of young urban children with asthma, it has the potential to serve as a model for improved asthma care in urban communities. ? ?

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Research Project (R01)
Project #
5R01HL079954-02
Application #
7183497
Study Section
Behavioral Medicine, Interventions and Outcomes Study Section (BMIO)
Program Officer
Smith, Robert A
Project Start
2006-02-13
Project End
2010-01-31
Budget Start
2007-02-01
Budget End
2008-01-31
Support Year
2
Fiscal Year
2007
Total Cost
$755,267
Indirect Cost
Name
University of Rochester
Department
Pediatrics
Type
Schools of Dentistry
DUNS #
041294109
City
Rochester
State
NY
Country
United States
Zip Code
14627
Diep, Judy; Fagnano, Maria; Tremblay, Paul et al. (2018) The relationship between caregivers' subjective social status and asthma symptoms and management for urban children. J Asthma :1-7
Halterman, Jill S; Fagnano, Maria; Tajon, Reynaldo S et al. (2018) Effect of the School-Based Telemedicine Enhanced Asthma Management (SB-TEAM) Program on Asthma Morbidity: A Randomized Clinical Trial. JAMA Pediatr 172:e174938
Bhagat, Dhristie; Fagnano, Maria; Halterman, Jill S et al. (2018) Asthma symptoms, interactive physical play and behavioral and academic outcomes in urban children with persistent asthma. J Asthma :1-8
Goldman, Hillary; Fagnano, Maria; Perry, Tamara T et al. (2018) Recruitment and retention of the Hardest-to-Reach families in community-based asthma interventions. Clin Trials 15:543-550
Holderness, Heather; Chin, Nancy; Ossip, Deborah J et al. (2017) Physical activity, restrictions in activity, and body mass index among urban children with persistent asthma. Ann Allergy Asthma Immunol 118:433-438
Gundewar, Anisha; David, Rebecca; Frey, Sean M et al. (2017) Underutilization of Preventive Asthma Visits Among Urban Children With Persistent Asthma. Clin Pediatr (Phila) 56:1312-1318
Halterman, Jill S; Tajon, Reynaldo; Tremblay, Paul et al. (2017) Development of School-Based Asthma Management Programs in Rochester, New York: Presented in Honor of Dr Robert Haggerty. Acad Pediatr 17:595-599
Frey, Sean M; Fagnano, Maria; Halterman, Jill (2016) Medication Identification Among Caregivers of Urban Children With Asthma. Acad Pediatr 16:799-805
Wiesenthal, Elise N; Fagnano, Maria; Cook, Stephen et al. (2016) Asthma and overweight/obese: double trouble for urban children. J Asthma 53:485-91
Koehler, Alana D; Fagnano, Maria; Montes, Guillermo et al. (2014) Elevated burden for caregivers of children with persistent asthma and a developmental disability. Matern Child Health J 18:2080-8

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