Community Organization to Reduce the Need for Acute Care for Asthma Among African American Children in Low-Income Neighborhoods: The Neighborhood Asthma Coalition

Background. Low-income African Amer- icans exhibit disproportionate prevalences, morbidity rates, and mortality rates for asthma. Objective. To determine whether a community-based intervention, the Neighborhood Asthma Coalition (NAC), conducted through a well-established neighbor- hood organization in St. Louis could improve awareness of asthma, change attitudes about its care, improve asthma management practices, and reduce the need for acute care for asthma. Methods. The NAC included educational programs for parents and children, promotional activities, and in- dividualized support provided by trained neighborhood residents. African American children, 5 to 14 years of age, with at least 1 incident of acute care (emergency depart- ment visit or hospitalization) within the previous year were enrolled from 8 zip code areas with low-income residents and high proportions of Medicaid-eligible chil- dren, ie, 4 NAC neighborhoods and 4 comparable control neighborhoods. Evaluations included quarterly tele- phone interviews to assess asthma attitudes and manage- ment and sites of care. Audits of acute care sites covered 12 months before initiation of the NAC through 3 years of the program. Results. A total of 371 patients were contacted and determined to be eligible for the study, and 345 agreed to participate, representing a recruitment rate of 93%. Of those, 15 withdrew and 24 were lost to follow-up moni- toring after the initial contact. In addition, 57 were ex- cluded from analysis because of relocation or for other reasons. Utilization data to determine rates of acute care (emergency department visits and hospitalizations) were collected for 249 patients (100 NAC subjects and 149 control subjects). Acute care rates decreased for both the NAC and control groups from the year before interven- tion to the last year of intervention, with no significant differences between the NAC and control groups. Partic- ipation in NAC programming affected the acute care outcome; the NAC-low participation and control groups did not differ but the NAC-high participation group differed significantly from the pooled control and NAC- low participation groups in reductions in acute care rates. Both contacts with NAC staff members and attendance at educational events were associated with changes toward stronger views that asthma can be managed (partial cor- relation .27 and partial correlation .24, respectively). Structural equation modeling demonstrated that partici- pation in the NAC was associated with positive changes on the Index of Asthma Attitudes scale and lower rates of acute care. Social isolation was associated with greater participation in the program and thus reduced care rates. Conclusions. The NAC reached its intended audi- ence, including those who were socially isolated, brought about changes in management practices, and was associ- ated with promising reductions in acute care rates among active participants in the program. Pediatrics 2004;114: 116 -123; childhood asthma, acute care, community-based intervention, asthma attitudes, social isolation, participa- tion in programming.