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ABSTRACT: Asthma is among the most common chronic childhood diseases, affecting 6.8 million children nationwide. The highest rates of morbidity and mortality associated with the disease occur among those living in the inner city. Because asthma is a complex disease affected by physiological, social, environmental, and behavioral factors, interventions to reduce its morbidity burden need to address multiple determinants of health. In response to this need, the Centers for Disease Control and Prevention developed a multisite cooperative agreement for the Controlling Asthma in American Cities Project (CAAC), with the primary goal of developing innovative, effective community-based interventions. All CAAC sites found a need for family and home asthma services (FHAS) and developed multicomponent (e.g., asthma self-management, social services, coordinated care) and multitrigger environmental interventions. This paper presents a synthesis of key program variables and process indicators for six CAAC FHAS interventions for consideration by communities, coalitions, or programs planning to implement similar activities.
Journal of Urban Health 02/2011; 88 Suppl 1:100-12. · 2.13 Impact Factor
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ABSTRACT: Asthma is a leading cause of hospitalizations, acute care utilization, health care costs, and school absences in children. Asthma morbidity is disproportionately high in inner city populations. In general, community-based public health interventions to reduce asthma morbidity have had modest success due in part to their limited reach and low participation by the targeted population. Adolescents have been especially difficult to reach. A coalition of community organizations developed a school-based, population-level system to identify, prioritize, and provide interventions for middle school children with asthma in a large urban school district in Oakland, CA. Nearly 92% (n = 8,326) of students in the targeted schools took an asthma case identification survey. Of those students who took the survey, 17.5% (n = 1,458) had active asthma and were eligible for services. Among those identified with active asthma, 83% (n = 1,217) voluntarily attended asthma self-management classes at school. The 4-week curriculum previously has been shown to significantly improve several indicators of asthma control in this population. Retention was high-72% of students who enrolled attended at least three of the four curriculum sessions. Many higher-risk students were subsequently referred to and enrolled in off-site asthma services. Large school districts with incomplete or inadequate health records, high asthma prevalence, and internal or external services available for students with asthma may benefit from a similar model. A system such as the one described may be an effective public health strategy for school districts, health departments, and community coalitions addressing asthma or other conditions with high childhood prevalence.
Journal of Urban Health 06/2008; 85(3):361-74. · 2.13 Impact Factor
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ABSTRACT: To examine a nationally representative sample of US children aged 6 to 16 years old and determine whether there are differences in risk factors and measures of severity between children with different asthma phenotypes.
We analyzed data from the Third National Health and Nutrition Examination Survey. We used questionnaire and skin-prick testing data to separate children into the following mutually exclusive categories: atopic asthma, nonatopic asthma, resolved asthma, frequent respiratory symptoms with no asthma diagnosis, and normal. We used multivariate regression to determine whether demographic or potential risk factors varied between phenotypes and whether measures of severity varied by phenotype.
We found that 4.8% of children had atopic asthma, 1.9% had nonatopic asthma, 3.4% had resolved asthma, and 4.3% had frequent respiratory symptoms. Risk factors varied by phenotype, for example, the mean BMI was higher among children with nonatopic asthma, prenatal maternal smoking was a risk factor for resolved asthma, and child care attendance was a risk factor for frequent respiratory symptoms with no asthma diagnosis. Patients with atopic and nonatopic asthma were similar for most measures of asthma severity (medication use, health status, and lung function impairment). In contrast, patients with resolved asthma had fewer symptoms but a similar level of lung function impairment to that seen in patients with current asthma, whereas children with frequent respiratory symptoms but no asthma diagnosis had normal lung function.
Asthma risk factors and measures of severity vary between children with different asthma phenotypes.
PEDIATRICS 04/2005; 115(3):726-31. · 4.47 Impact Factor
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Amanda Savage Brown,
Paul M Fernhoff,
Susan E Waisbren,
Dianne M Frazier,
Rani Singh,
Fran Rohr,
Jill M Morris,
Aileen Kenneson,
Pia MacDonald,
Marta Gwinn,
Margaret Honein,
Sonja A Rasmussen
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ABSTRACT: The teratogenic effects of maternal PKU are preventable, yet affected babies continue to be born. This study's purpose was to identify barriers to successful dietary control among pregnant women with PKU.
An interview-based study was conducted of women with PKU who were known to metabolic disease clinics in three states and pregnant during 1998 to 2000. Medical records were used to document timing of metabolic control.
Of 24 women in the study, only 8 (33%) initiated the diet before pregnancy. Of 22 medical records received, only 12 (55%) indicated control of blood phenylalanine levels before 10 weeks' gestation. Risk factors for late dietary control included young age and belief that treatment costs complicated the diet. Although all of the women expressed confidence in the metabolic clinic staff, few perceived their obstetricians were knowledgeable about the maternal PKU diet. Of 13 women enrolled in state-based assistance programs, 9 (69%) reported proof of pregnancy was required for eligibility. Many women using private insurance reported their insurers were unwilling to pay for medical foods. When the data were stratified according to state of residence, differences were observed in the rate of live-born infants, prepregnancy medical food use, average travel time to the metabolic clinic, and gestational week when metabolic control was achieved.
Our study's findings may be used to target educational messages to women with PKU and to direct future research directions. For example, obstetric knowledge of maternal PKU needs further evaluation. Discrepancies should be resolved between maternal PKU medical recommendations and the policies of third party-payers. The disparities in financial assistance and services available to pregnant women with PKU residing in different states should be examined further.
Genetics in Medicine 4(2):84-9. · 4.76 Impact Factor
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ABSTRACT: Risk factors for obstructive or restrictive lung disease among persons with asthma are not well defined. Data from the Third National Health and Nutrition Examination Survey were used to determine predictors of poor lung function among 1063 adults, aged 20 years and older, who self-report physician-diagnosed asthma any time during their life regardless of current asthma status. Obstructive lung disease and restrictive lung disease were defined by using spirometry and modified Global Initiative for Chronic Obstructive Lung Disease criteria. Reported symptoms were used to grade asthma severity. Logistic regression models were used to examine associations between lung disease, respiratory symptom severity, and adults who ever had asthma. Risk factors for spirometry-defined obstructive lung disease included increasing age, body mass index < 18.5, current asthma, and non-white race (p < 0.05). Risk factors for spirometry-defined restrictive lung disease included older age at asthma diagnosis, low socioeconomic status, current asthma, and being female (p < 0.05). Risk factors for moderate or severe respiratory symptoms included older age at diagnosis and current smoking status (p < 0.05). Asthma is a known risk factor for chronic obstructive lung disease; these data also suggest that adults, particularly females, who are older at the time of asthma diagnosis, may be at risk to develop spirometry-defined restrictive lung disease as well. These data also suggest that a significant proportion of people with lifetime asthma have impaired lung function; however, it is unclear if more aggressive therapy for asthma would prevent these complications. To further examine the role of these factors in predicting poor lung function among adults with asthma, additional information is needed on these patients' asthma therapy, natural history, and environmental exposures.
Journal of Asthma 42(6):519-23. · 1.52 Impact Factor
