Utilizing the San Diego Unified School District as an access point, we have examined the prevalence and severity of asthma in schools selected for a preponderance of ethnic minority and socioeconomically disadvantaged youth. A high overall current prevalence of asthma was found in a cohort of 9-12 year old students at 14.7%, with an additional 12.5% with possible asthma related symptoms. particularly in the Hispanic community, there was a frequent absence of physician diagnosis, regular access to care and/or health care coverage. We developed a school based child centered asthma education program to assist these students and were able to demonstrate it's efficacy in increasing asthma knowledge, and improving skills for inhaler and peak flow meter technique. Scores for functional asthma severity were reduced in the education vs control students at 180 days of prospective follow-up. Environmental control programs were initiated in selected students and reduction in relevant allergen exposure demonstrated. We now propose to modify our education program for utilization in an asthma counseling intervention in school associated clinic settings. We will assess the program's effectiveness among predominantly ethnic minority socioeconomically disadvantaged fourth through sixth grade students from Southeast San Diego, an """"""""inner city"""""""" environment. Severity matched asthmatic volunteers will be randomized and enrolled in intervention or control groups at the same clinic. Outcomes will include parameters of asthma severity (validated questions for functional severity, spirometry, medication use, absence, hospitalization, ER and urgent visits), tests of asthma knowledge, use of a peak flow meter, and inhaler technique along with quality of care assessment by scoring of treatment/action plans for care. Comparison of baseline assessment vs one year of prospective follow up at 2 month intervals in the intervention (asthma counselor) vs control (usual care) groups will be reviewed for outcome. A nursing algorithm will be developed and validated in the course of the study to assist school nurses in identifying asthmatic children within groups of students presenting with respiratory symptoms. We further will examine the impact on the cost of care of the educational/counseling intervention with attention to direct and indirect expenditures related to the asthmatic student.
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