Asthma is a leading cause of childhood illness that disproportionately affects minority children. The causes of higher hospitalization and death rates among minority children with asthma are not understood. It is commonly assumed that barriers related to poverty underlie this public health issue. Two proposed causes of this increased morbidity and mortality are problems associated with effective asthma self-management and difficulties in establishing and maintaining continuity of medical care. In this study we will examine the separate and combined impact of asthma interventions designed to address these two specific problem areas. A school-based asthma self-management program will be developed to promote children's self-management skills within predominately minority schools. A community-based asthma health worker program will be developed to assist minority families in establishing and maintaining asthma health care within the community. It is hypothesized that the most effective control of asthma will be achieved with the combination of these two interventions. Twenty elementary schools each in inner-city Baltimore, Maryland and inner- city Washington D.C. will serve as our study sites. Asthmatic children grades 1-5 will be identified by school records and parent surveys. After obtaining consent schools will be randomly assigned to one of four intervention groups: 1) a control/minimal intervention, 2) a school-based asthma education program, 3) a community-based asthma health worker program, and 4) a combined intervention that includes both the school-based education program and the community-based health worker program. The duration of both the school program and the Community health worker program will be twelve months. Baseline measures will be collected after obtaining consent and prior to school randomization. Followup measures will be collected from children and families at 6, 12, 18, and 24 months. Data will be collected on hospitalization, emergency or urgent care, acute episodes, health care utilization, medications, school absences, academic performance, self-esteem, self and family asthma management, and family coping.
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