Reducing Asthma Morbidity In High Risk Minority Preschool Children
Condition: Asthma
MeSH terms: Asthma
Study type: Interventional

Summary: 
      Low-income, minority children are disproportionately affected by asthma and can experience
      higher rates of asthma attacks, lower lung function, decreased physical activity, increases
      in school absenteeism, and higher rates of death. The National Center for Children in Poverty
      suggests that effective interventions to improve asthma and reduce harm for high risk groups
      (like low-income minority children) must begin in early childhood. Previous research has
      shown that asthma education programs can be effective to improve overall asthma management in
      preschool children, but there has been limited sustainability of these programs in medical,
      educational, and social environments that serve young high risk children. One of the core
      missions of federally-funded Head Start programs is to provide preventive health services and
      screening to their low-income preschool students and would be an ideal setting in the
      community to disseminate an early asthma education program. The purpose of this study is to
      draw on our health and research partnership with Baltimore City Head Start programs to test
      the effectiveness of a home-based asthma education intervention combined with a Head Start
      level asthma education program compared to a Head Start level asthma education program alone.
    

Detailed description: 
      Despite advances in asthma therapies and the wide-spread dissemination of asthma clinical
      guidelines, low-income, minority children have disproportionately high morbidity and
      mortality from asthma. The National Center for Children in Poverty has strongly argued that
      effective interventions to improve asthma health disparities and reduce harm must begin in
      early childhood. Previous efficacy studies have suggested that asthma education programs can
      be effective in improving overall management of asthma for preschool children. However, for
      these promising asthma intervention strategies to have sustainable public health impact for
      low-income, minority children they must be integrated within those medical, educational and
      social structures that serve these young high risk children, such as community clinics,
      schools and day care programs. Because one of the core missions of federally-funded Head
      Start programs is to provide preventive health services and screening to their low-income
      preschool students, Head Start represents an ideal community setting for disseminating early
      asthma education. The investigators propose to draw on our established health and research
      partnership with Head Start programs in Baltimore City to test the effectiveness of this
      home-based asthma education intervention with demonstrated efficacy, when delivered in the
      context of a Head Start-wide asthma education program. The investigators further propose to
      partner with Head Start to support and evaluate adoption, maintenance and dissemination of
      new knowledge gained from this project. Specifically the investigators hypothesize that
      participants receiving the ABC intervention combined with a HS-level asthma education will
      have more symptom free days at the 6-, 9-, and 12-month evaluation when compared with
      participants in the HS-level asthma education alone. The investigators plan to enroll of 406
      children age 2-6 years old enrolled in Head Start with symptomatic asthma. Secondary outcome
      measures include other measures of asthma morbidity (i.e., hospitalizations, Emergency
      Department visits, oral steroid bursts, school absences, and caregiver quality of life). The
      investigators will also evaluate the mediating effects of outcomes expectancies,
      self-efficacy, asthma knowledge, motivation, and asthma management practices, as well as
      moderator effects, such as health literacy, caregiver depression, neighborhood cohesion,
      family management of asthma, and Head Start adoption and dissemination of an asthma education
      curriculum.
    

Intervention name(s): Home Based Asthma Education
Intervention type(s): Behavioral
Intervention description(s): 4 home based and 3 phone based sessions with community asthma outreach worker to provide families with asthma education
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Asthma; Preschool; Health Disparities; Implementation