While increased asthma morbidity and mortality have been observed across all ethnicities, results from several studies have found that asthma morbidity has increased disproportionately in low-income African American children. Elementary school-based asthma education programs have shown promise in improving asthma management, and reducing asthma morbidity in this high-risk population, however, the fastest growing asthma risk is associated with children young than six. By elementary age many parents and children with asthma have well-established patterns of inappropriate asthma management that may be difficult to change. To date, no research has examined the impact of early intervention for asthma management in low-income, high-risk children. This project will evaluate the effectiveness of a Head Start-based early intervention for designed to improve asthma management skill and practices of parents, pre-school children and Head Start staff. The proposed intervention study will be conducted in Head Start sites in Baltimore City (N=61). We will recruit 448 parents with preschool age (3-4 years) children with asthma enrolled in these Head Start sites over 32 months. Head Start sites will be randomized to either a minimal intervention control group of the A+ Asthma early intervention program for asthma management. This social-behavioral intervention is designed to educate and assist Head Start teachers and family service coordinators to: 1) optimize classroom management of asthma, 2) educate, facilitate and reinforce appropriate parental medical and behavioral management of asthma, and 3) instruct, model and reinforce early asthma knowledge and age-appropriate skills for preschool age children. At each intervention Head Start site an A+ asthma educator will train teachers and family service coordinators to work with children and their families to achieve optimal school and home asthma management. The primary outcome study measure will be Head Start absences/days enrolled, determined by review of Head Start attendance records. Secondary outcomes include other school absences, health care utilization, asthma symptoms, asthma medications, parents' asthma-related quality of life, and parent, child and teacher asthma knowledge and management practice. Additionally, we will assess program implementation and adoption. Phone- base interviews will be conducted with parents at baseline, 6, 12, 18, and 24 months. Teachers, family service coordinator, and child measures will be collected at the beginning and end of each school year. We hypothesize that a Head Start-based early intervention for asthma management will significantly reduce school absences and emergency care for asthma, increase primary care for asthma, improve parent's asthma related quality of life, and improve asthma management practices of parents, children and Head Start staff.
| Snyder, E L; O'Donnell, L; Dengler, T J et al. (2001) Ex vivo evaluation of PBMNCs collected with a new cell separator. Transfusion 41:940-9 |
