Pediatric asthma is a well documented public health issue in the United States. The impact of pediatric asthma can be measured by both health care costs and morbidity. Asthma morbidity is seasonal with the greatest number of exacerbations occurring in autumn and the fewest in mid-summer. There is a strong age-related seasonal variability with grade school children being the most vulnerable to seasonal changes. Furthermore, the annual peak asthma morbidity for children has been shown to be associated with the start of the school year. Recent research suggests that this seasonality in children is primarily related to viral respiratory tract infections. Regular handwashing has been widely recognized as the most effective means to combat the spread of infectious illness, including viruses. However, effective handwashing among school-age children is inconsistent at best. The school setting provides multiple barriers to effective handwashing such as time constraints, and frequent lack of soap, towels, and strategically located sinks. Spring loaded faucets which serve to prevent overuse of water inadvertently pose an additional barrier to thorough hand cleansing. Hand sanitization in such settings may be effectively accomplished by antimicrobial rinse-free hand sanitizers. Therefore, we propose to collaborate with a single school district to achieve the following specific aims: 1. Develop a simple school based intervention using hand sanitizers to decrease asthma exacerbations in children with asthma. 2. Implement a school based internet monitoring system within both the active and placebo groups to record asthma symptoms, peak flow meter readings, school absences, and use of rescue medications at school. 3. Randomize 26 schools to either active or placebo hand sanitizer. 4. Use a cross-over design to compare the active and placebo groups with regard to time-averaged proportion of children with asthma who have at least one exacerbation per month. Improving hand hygiene in the school environment may be a relatively simple, yet effective way to reduce the risk of asthma exacerbations. By achieving these specific aims, this study will provide valuable information on the effectiveness of hand sanitizers in the school setting.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Research Project (R01)
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Behavioral Medicine, Interventions and Outcomes Study Section (BMIO)
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Smith, Robert A
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University of Alabama Birmingham
Internal Medicine/Medicine
Schools of Medicine
United States
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Gerald, Lynn B; Gerald, Joe K; Zhang, Bin et al. (2012) Can a school-based hand hygiene program reduce asthma exacerbations among elementary school children? J Allergy Clin Immunol 130:1317-24
Gerald, Lynn B; Gerald, Joe K; McClure, Leslie A et al. (2011) Redesigning a large school-based clinical trial in response to changes in community practice. Clin Trials 8:311-9