Hospitalizations and deaths from asthma are highest among inner-city African-American and Latino children. These children may be at greatest risk because they have disproportionately worse access to health care and to quality asthma care, poor self-management skills, and increased exposure to environmental allergens and irritants, particularly ETS and cockroach allergens. The applicants propose to implement a culturally sensitive, cost-effective six-site intervention for inner-city poor children with asthma aged 4 to 12 years of age called Targeting the Environment and Asthma Management (TEAM). This is a three-pronged intervention which includes the following: (1) the delivery of high-quality asthma care by primary care physicians trained in quality asthma management and behavioral strategies to enhance patient satisfaction; (2) a self- management component by a bilingual Asthma Counselor, who will reinforce the physicians' teaching, review the medication plan, and teach culturally-appropriate self-management skills; and (3) an environmental component in which all TEAM families will be taught environmental control, and TEAM patients who are skin-test positive to cockroach allergens will be offered cockroach eradication services. At each site, three cohorts of 60 subjects each will undergo a baseline interview and be randomly assigned to the TEAM intervention group or the control group. Data will be collected at baseline, at 3, 6, 9, and 12 months during the intervention, and at 3, 6, 9, and 12 months following the intervention period. The intervention will be evaluated for its short- and long-term effectiveness. Primary outcomes include days of cough and wheeze, sleep and play disruption, school days missed, and disruption of caretaker plans. Health utilization outcomes include emergency room (ER) visits, unscheduled and scheduled visits, and hospitalizations. Costs of care for the intervention and control groups will also be monitored. It is hypothesized that functional morbidity and utilization will be significantly less for children in the TEAM intervention group compared with the control group.
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