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Long-term effects of asthma management education for latino families
J ALLERGY CLIN IMMUNOL VOLUME 109, NUMBER 1
Abstracts
32 Families Long-Term Effects of Asthma Management Education for Latino AP Martinez-Donate*, DR Wahlgren*, SB Meltzer*, Eli 0 Meltzer§, CR Hofstetter* GE Matt*, MF Hovell* *Graduate School of Public Health, San Diego State University, San Diego, CA §Allergy & Asthma Medical Group & Research Center, San Diego, CA Asthma education programs have proven successful for reducing asthma morbidity, but different methods may be required for specific population subgroups because of varying cultures, ethnicities, and incomes. Latino families are among the demographic groups most affected by asthma, with high prevalence levels. Latinos may encounter barriers to appropriate asthma management, such as low socioeconomic status, less education, lack of health insurance and language difficulties. Studies have shown that Latino families are both in need of and very responsive to asthma education programs adapted to fit their special needs. However, little is known about the long-term maintenance of the results of these programs. This study addresses the long-term effects of an in-home educational intervention on asthma knowledge and environment-related management practices of 193 Latino low-income families with asthmatic children. Families participated into a 90-minute asthma education program, delivered in their homes by bicultural/bilingual educators. The program reviewed the etiology, prevention, and management of asthma symptoms. Asthma knowledge and the presence of asthma environmental triggers and environmental controllers were assessed at baseline prior to the program, and one week, and three months after the program. A last measure of asthma knowledge was collected one year after the intervention. Generalized Estimating Equation (GEE) approach was used to estimate associations between asthma management education and sustained improvement of asthma knowledge and environmental control practices. Simple correlations were used to analyze the relationship between education content and asthma knowledge changes. Analysis indicated that the intervention resulted in a significant improvement of asthma knowledge (p<0.001) and environment-related management practices (p<0.001, p<0.01) that were maintained over a 3-month and a 12-month follow-up period. Changes in asthma knowledge were closely related to the specific content emphasized in the program (p<0.05).These data have important implications for promoting asthma control among Latino families. Asthma Knowledge, Environmental Triggers and Controllers
Baseline Post-test 3-month F/U 12-mo. F/U Mean (SD) Mean (SD) Mean (SD) Mean (SD) Asthma Knowledge Quiz: % Correct NumberEnvironmental Triggers NumberEnvironmental Controllers
38.7 (15.8)
50.1 (17.1)**
52.6 (17.8)
55.4 (19.3)
2.35 (0.74) 2.15(0.80)**
2.14 (0.85)
Not collected
0.86 (0.64)
1.11 (0.67)
Not collected
1.04 (0.62)*
**p<0.001 (Baseline vs. Post-test). *p<0.01 (Baseline vs. Post-test).
633
Disparities in Asthma Morbidity Between Two Pediatric Populations: Children With Asthma Specialty Care Versus Minimal Asthma Care
SB Meltzer*, Eli 0 Meltzer§, MF Hovell*, DR Wahlgren*, CR Hofstetter* *Graduate School of Public Health, San Diego State University, San Diego, CA §Allergy & Asthma Medical Group & Research Center, San Diego, CA Major scientific advances in the past decade and the 1991 NAEPPdeveloped Guidelines have provided the methods to effectively manage asthma. Nonetheless, asthma morbidity and mortality are increasing, principally among minority populations. Effective preventive therapy is less often provided to minority children, and cultural and economic barriers place Latinos at greater risk. Two consecutive studies of asthmatic children exposed to environmental tobacco smoke (ETS) in contrasting socio-economic populations illustrate the importance of this difference on household
$211
demographics and childhood asthma. Project Zephyr (TRDRP, 1990-95) enrolled 9l families, 78% white, with an asthmatic child aged 6-17 years exposed to parental smoking, with assistance from asthma specialists at Kaiser Permanente, U.S. Navy and two private allergy centers. Subsequently, Project Hijos Sanos (NHLBI, 1995-01) targeted 193 low-income, 100% Latino families to deliver a similar ETS reduction design. In this latter study, families with an asthmatic child aged 3 to 17 years, living with a smoker and exposed to ETS, were recruited through both medical and nonmedical community-based resources. Sites included community clinics, Head Start and Spanish-language newspapers. Randomized groups in both studies received counseling to reduce ETS exposure in the home. Even though the Zephyr children had greater exposure to ETS (the primary entrance criterion) and indoor fur-bearing pets, and their disease management took place when the NAEPP guidelines were less widely disseminated, their asthma morbidity was substantially less. These studies demonstrate that there continue to be significant barriers to adequate asthma therapy in an under-served Latino population.
Project Zephyr N=91
Hijos Sanos N=193
Demographics 93% 40% Parent in study completed > high school 62% 14% Home included >1 cat/dog 6.6 4.0 Mean # cigarettes exposed daily Asthma Morbidity 0.24 0.72 Mean #days/week asthma interfered with school/play 4% 23% Hospitalized >1 time in past year for respiratory problems 22% 58% Parent ranks child's health fair/poor 42%/24% 12%/10% Inhaled steroid / cromolyn
#~j~[ Asthma Screening in Inner City Pre-School Children Using the
~,w-lr Brief Pediatric Asthma Screen (BPAS) 6Denise Guanzon*, Asif I Khan§, Kathy Garrett§
*Long Island College Hospital, Brooklyn, NY §Long Island College Hospital, Brooklyn, NY Asthma leads to significant morbidity and mortality, particularly in children, and is frequently undiagnosed in pre-school children. Identification of asthma via screening in school-age children had been conducted in Chicago using the BPAS. There is, however, a need to better recognize asthma in pre-school children specifically within inner cities, where they are at a higher risk. "A is for Asthma" is a Community Wellness Project conducted by the American Lung Association of Brooklyn and the Asthma Center of the Long Island College Hospital. The purpose of the project is to screen for asthma in children of pre-school age in order to provide education about asthma prevention treatment and control to caregivers and providers. The survey was conducted using the BPAS in 15 inner city daycare centers in Brooklyn, who had responded the earliest, chosen based on 18 zip codes with the highest pediatric asthma hospitalization rates according to the "Asthma Facts" published by the New York City Department of Health. A total of 2215 questionnaires were distributed, of which 48% (992) were returned. Using the BPAS, 21% (208) were previously diagnosed with asthma and 16% (156) not previously diagnosed screened positive for the disease yielding a total prevalence of 37%. Among the 5 Questions in the BPAS, questions 3 relating to cough and wheezing during or after active play, and 4 relating to dry cough at night were most significant in identifying asthma, 19% and 28% respectively. Date collected reflects a higher prevalence of pre-school children with possible asthma than previously thought based on hospital admission criteria. An unexpected 89% of children had insurance coverage. There was a wide range of compliance with survey returns as well as attendance at educational sessions. Factors involved in this such as brevity of the questionnaire, timing of survey administration and the presence of a moderator in conducting the screen are currently being examined in order to ensure more effective intervention.
Abstracts
32 Families Long-Term Effects of Asthma Management Education for Latino AP Martinez-Donate*, DR Wahlgren*, SB Meltzer*, Eli 0 Meltzer§, CR Hofstetter* GE Matt*, MF Hovell* *Graduate School of Public Health, San Diego State University, San Diego, CA §Allergy & Asthma Medical Group & Research Center, San Diego, CA Asthma education programs have proven successful for reducing asthma morbidity, but different methods may be required for specific population subgroups because of varying cultures, ethnicities, and incomes. Latino families are among the demographic groups most affected by asthma, with high prevalence levels. Latinos may encounter barriers to appropriate asthma management, such as low socioeconomic status, less education, lack of health insurance and language difficulties. Studies have shown that Latino families are both in need of and very responsive to asthma education programs adapted to fit their special needs. However, little is known about the long-term maintenance of the results of these programs. This study addresses the long-term effects of an in-home educational intervention on asthma knowledge and environment-related management practices of 193 Latino low-income families with asthmatic children. Families participated into a 90-minute asthma education program, delivered in their homes by bicultural/bilingual educators. The program reviewed the etiology, prevention, and management of asthma symptoms. Asthma knowledge and the presence of asthma environmental triggers and environmental controllers were assessed at baseline prior to the program, and one week, and three months after the program. A last measure of asthma knowledge was collected one year after the intervention. Generalized Estimating Equation (GEE) approach was used to estimate associations between asthma management education and sustained improvement of asthma knowledge and environmental control practices. Simple correlations were used to analyze the relationship between education content and asthma knowledge changes. Analysis indicated that the intervention resulted in a significant improvement of asthma knowledge (p<0.001) and environment-related management practices (p<0.001, p<0.01) that were maintained over a 3-month and a 12-month follow-up period. Changes in asthma knowledge were closely related to the specific content emphasized in the program (p<0.05).These data have important implications for promoting asthma control among Latino families. Asthma Knowledge, Environmental Triggers and Controllers
Baseline Post-test 3-month F/U 12-mo. F/U Mean (SD) Mean (SD) Mean (SD) Mean (SD) Asthma Knowledge Quiz: % Correct NumberEnvironmental Triggers NumberEnvironmental Controllers
38.7 (15.8)
50.1 (17.1)**
52.6 (17.8)
55.4 (19.3)
2.35 (0.74) 2.15(0.80)**
2.14 (0.85)
Not collected
0.86 (0.64)
1.11 (0.67)
Not collected
1.04 (0.62)*
**p<0.001 (Baseline vs. Post-test). *p<0.01 (Baseline vs. Post-test).
633
Disparities in Asthma Morbidity Between Two Pediatric Populations: Children With Asthma Specialty Care Versus Minimal Asthma Care
SB Meltzer*, Eli 0 Meltzer§, MF Hovell*, DR Wahlgren*, CR Hofstetter* *Graduate School of Public Health, San Diego State University, San Diego, CA §Allergy & Asthma Medical Group & Research Center, San Diego, CA Major scientific advances in the past decade and the 1991 NAEPPdeveloped Guidelines have provided the methods to effectively manage asthma. Nonetheless, asthma morbidity and mortality are increasing, principally among minority populations. Effective preventive therapy is less often provided to minority children, and cultural and economic barriers place Latinos at greater risk. Two consecutive studies of asthmatic children exposed to environmental tobacco smoke (ETS) in contrasting socio-economic populations illustrate the importance of this difference on household
$211
demographics and childhood asthma. Project Zephyr (TRDRP, 1990-95) enrolled 9l families, 78% white, with an asthmatic child aged 6-17 years exposed to parental smoking, with assistance from asthma specialists at Kaiser Permanente, U.S. Navy and two private allergy centers. Subsequently, Project Hijos Sanos (NHLBI, 1995-01) targeted 193 low-income, 100% Latino families to deliver a similar ETS reduction design. In this latter study, families with an asthmatic child aged 3 to 17 years, living with a smoker and exposed to ETS, were recruited through both medical and nonmedical community-based resources. Sites included community clinics, Head Start and Spanish-language newspapers. Randomized groups in both studies received counseling to reduce ETS exposure in the home. Even though the Zephyr children had greater exposure to ETS (the primary entrance criterion) and indoor fur-bearing pets, and their disease management took place when the NAEPP guidelines were less widely disseminated, their asthma morbidity was substantially less. These studies demonstrate that there continue to be significant barriers to adequate asthma therapy in an under-served Latino population.
Project Zephyr N=91
Hijos Sanos N=193
Demographics 93% 40% Parent in study completed > high school 62% 14% Home included >1 cat/dog 6.6 4.0 Mean # cigarettes exposed daily Asthma Morbidity 0.24 0.72 Mean #days/week asthma interfered with school/play 4% 23% Hospitalized >1 time in past year for respiratory problems 22% 58% Parent ranks child's health fair/poor 42%/24% 12%/10% Inhaled steroid / cromolyn
#~j~[ Asthma Screening in Inner City Pre-School Children Using the
~,w-lr Brief Pediatric Asthma Screen (BPAS) 6Denise Guanzon*, Asif I Khan§, Kathy Garrett§
*Long Island College Hospital, Brooklyn, NY §Long Island College Hospital, Brooklyn, NY Asthma leads to significant morbidity and mortality, particularly in children, and is frequently undiagnosed in pre-school children. Identification of asthma via screening in school-age children had been conducted in Chicago using the BPAS. There is, however, a need to better recognize asthma in pre-school children specifically within inner cities, where they are at a higher risk. "A is for Asthma" is a Community Wellness Project conducted by the American Lung Association of Brooklyn and the Asthma Center of the Long Island College Hospital. The purpose of the project is to screen for asthma in children of pre-school age in order to provide education about asthma prevention treatment and control to caregivers and providers. The survey was conducted using the BPAS in 15 inner city daycare centers in Brooklyn, who had responded the earliest, chosen based on 18 zip codes with the highest pediatric asthma hospitalization rates according to the "Asthma Facts" published by the New York City Department of Health. A total of 2215 questionnaires were distributed, of which 48% (992) were returned. Using the BPAS, 21% (208) were previously diagnosed with asthma and 16% (156) not previously diagnosed screened positive for the disease yielding a total prevalence of 37%. Among the 5 Questions in the BPAS, questions 3 relating to cough and wheezing during or after active play, and 4 relating to dry cough at night were most significant in identifying asthma, 19% and 28% respectively. Date collected reflects a higher prevalence of pre-school children with possible asthma than previously thought based on hospital admission criteria. An unexpected 89% of children had insurance coverage. There was a wide range of compliance with survey returns as well as attendance at educational sessions. Factors involved in this such as brevity of the questionnaire, timing of survey administration and the presence of a moderator in conducting the screen are currently being examined in order to ensure more effective intervention.