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.

Agency
National Institute of Health (NIH)
Institute
National Institute of Allergy and Infectious Diseases (NIAID)
Type
Research Project--Cooperative Agreements (U01)
Project #
3U01AI039900-03S1
Application #
6033485
Study Section
Special Emphasis Panel (ZAI1 (31))
Program Officer
Plaut, Marshall
Project Start
1996-08-01
Project End
2001-07-31
Budget Start
1998-08-01
Budget End
1999-07-31
Support Year
3
Fiscal Year
1999
Total Cost
Indirect Cost
Name
Albert Einstein College of Medicine
Department
Pediatrics
Type
Schools of Medicine
DUNS #
009095365
City
Bronx
State
NY
Country
United States
Zip Code
10461
Pongracic, Jacqueline A; O'Connor, George T; Muilenberg, Michael L et al. (2010) Differential effects of outdoor versus indoor fungal spores on asthma morbidity in inner-city children. J Allergy Clin Immunol 125:593-9
Pongracic, Jacqueline A; Visness, Cynthia M; Gruchalla, Rebecca S et al. (2008) Effect of mouse allergen and rodent environmental intervention on asthma in inner-city children. Ann Allergy Asthma Immunol 101:35-41
O'Connor, George T; Neas, Lucas; Vaughn, Benjamin et al. (2008) Acute respiratory health effects of air pollution on children with asthma in US inner cities. J Allergy Clin Immunol 121:1133-1139.e1
Stout, James W; Visness, Cynthia M; Enright, Paul et al. (2006) Classification of asthma severity in children: the contribution of pulmonary function testing. Arch Pediatr Adolesc Med 160:844-50
Kattan, Meyer; Crain, Ellen F; Steinbach, Suzanne et al. (2006) A randomized clinical trial of clinician feedback to improve quality of care for inner-city children with asthma. Pediatrics 117:e1095-103
Gruchalla, Rebecca S; Pongracic, Jacqueline; Plaut, Marshall et al. (2005) Inner City Asthma Study: relationships among sensitivity, allergen exposure, and asthma morbidity. J Allergy Clin Immunol 115:478-85
Kattan, Meyer; Stearns, Sally C; Crain, Ellen F et al. (2005) Cost-effectiveness of a home-based environmental intervention for inner-city children with asthma. J Allergy Clin Immunol 116:1058-63
Wright, Rosalind J; Mitchell, Herman; Visness, Cynthia M et al. (2004) Community violence and asthma morbidity: the Inner-City Asthma Study. Am J Public Health 94:625-32
O'connor, George T; Walter, Michelle; Mitchell, Herman et al. (2004) Airborne fungi in the homes of children with asthma in low-income urban communities: The Inner-City Asthma Study. J Allergy Clin Immunol 114:599-606
Morgan, Wayne J; Crain, Ellen F; Gruchalla, Rebecca S et al. (2004) Results of a home-based environmental intervention among urban children with asthma. N Engl J Med 351:1068-80

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