Asthma outcomes at an inner-city school-based health center

Childhood asthma has reached near-epidemic levels in the US cities. Innovative strategies to identify children with asthma and prevent asthma morbidity are needed. This study measured asthma outcomes after initiation of an inner-city elementary school health center with a schoolwide focus on asthma detection and treatment. The site was an inner-city elementary school in Minneapolis, Minn. The study design incorporated a pre and post comparison with a longitudinal cohort of children (n = 67) and a cross-sectional cohort of children before (n = 156) and after (n = 114) the intervention. Hospitalization rates for asthma decreased 75% to 80% over the study period. Outpatient visits for care in the absence of asthma symptoms doubled (p < .01), and the percentage of students seeing a specialist for asthma increased (p < .01). Use of peak flow meters, use of asthma care plans, and use of inhalers also improved (p < .01). While no change occurred in school absenteeism, parents reported that their children had less awakening with asthma and that asthma was less disruptive to family plans. This schoolwide intervention that included identification of children with asthma, education, family support, and clinical care using an elementary school health center was effective in improving asthma outcomes for children.     

National Analysis of State Health Policies on Students' Right to Self‐Carry and Self‐Administer Asthma Inhalers at School

BACKGROUND

Asthma has no known cure, and though manageable, it disrupts the everyday lives of over 6 million US children. Because children spend more than half of their waking hours in school, students must be able to carry and administer their inhaler at school to manage their asthma.

METHODS

This policy paper is a comprehensive review of all 50 states and the District of Columbia's laws and policies for the self‐carry and administration of quick‐relief asthma inhalers among children in prekindergarten through 12th grade.

RESULTS

All states permit students to carry and administer their inhalers at school, although each state differs in their development and implementation of policies for asthma self‐management at school. This review examines how states regulate self‐carry policies by looking at policy development, regulated school systems, relevant stakeholders, required medical records, and school liability.

CONCLUSIONS

Each state's laws have nuances that create gray areas, increasing the potential of misinterpreted or incorrectly implemented policies for asthma self‐management at school. As a result, children may not have immediate access to their inhaler for symptom management or in an emergency. State policymakers should reform current laws to remove barriers for students to carry and use inhalers at school.

     

Asthma inhalers in schools: rights of students with asthma to a free appropriate education

Students who possess and self-administer their asthma medications can prevent or reduce the severity of asthma episodes. In many states, laws or policies allow students to possess and self-administer asthma medications at school. In the absence of a state or local law or policy allowing public school students to possess inhalers and self-medicate to treat asthma, 3 federal statutes may require public schools to permit the carrying of such medications by students: the Individuals With Disabilities Education Act, Section 504 of the Rehabilitation Act of 1973, and Title II of the Americans with Disabilities Act. Local policies and procedures can be based on these federal laws to ensure that students with asthma can take their medicines as needed.     

An investigation of prescribed and nonprescribed medicine use behavior within the household context

The goal of this study was to study empirically individual and household characteristics and their relation to individual medicine use behavior. The study accounted for 40% of the variance in prescribed medicine use and 20% of the variance in nonprescribed medicine use behavior for 545 AFDC households in Northern Mississippi. Perceived morbidity was the primary mediator of medicine use and 57% of the explained variance in nonprescribed medicine use. Age was a significant contributor to the variance explained in prescribed medicine use behavior. The use of nonprescribed medicines by other members of the household also significantly enhanced individual nonprescribed medicine use. Although many of the other individual and household variables were significant predictors of medicine use behavior they contributed little to the total explained variance. Research concerning medicine use in the context of the household is in the initial stage of theory development.     

The effects on prescribing patterns and costs of having a special interest in asthma.

To define the characteristics of general practices with a special clinical interest in asthma and to estimate the resulting extra prescribing costs, we sent a postal questionnaire to all English practices containing members of the General Practitioners in Asthma Group. Item and cost comparisons for 24 PACT (prescribing analysis and cost) aggregates were made between practices who had operated an agreed, written management plan for asthma before 1 April 1990 and all other practices in their respective Family Health Services Authorities. One hundred and sixty-three practices with GPIAG members responded (70%), of which 26 filled the management plan requirement. These 26 practices showed evidence of significantly better asthma care provision than the remainder of the sample. Their prescribing costs were significantly higher for respiratory drugs (median 37% higher) but lower in other drug categories. For respiratory drugs, costs were significantly higher for inhaled adrenoceptor stimulants, steroid inhalers, large spacers, and peak flow meters, but lower for cough medicines and systemic nasal decongestants: the number of items prescribed showed similar patterns. The prescribing costs of practices claiming a special interest in asthma are likely to show higher respiratory drug costs, but overall prescribing costs showed no increase in the practices studied.     

Kickin’ Asthma: School‐Based Asthma Education in an Urban Community

BACKGROUND: In urban communities with high prevalence of childhood asthma, school‐based educational programs may be the most appropriate approach to deliver interventions to improve asthma morbidity and asthma‐related outcomes. The purpose of this study was to evaluate the implementation of Kickin’ Asthma, a school‐based asthma curriculum designed by health educators and local students, which teaches asthma physiology and asthma self‐management techniques to middle and high school students in Oakland, CA. METHODS: Eligible students were identified through an in‐class asthma case identification survey. Approximately 10‐15 students identified as asthmatic were recruited for each series of the Kickin’ Asthma intervention. The curriculum was delivered by an asthma nurse in a series of four 50‐minute sessions. Students completed a baseline and a 3‐month follow‐up survey that compared symptom frequency, health care utilization, activity limitations, and medication use. RESULTS: Of the 8488 students surveyed during the first 3 years of the intervention (2003‐2006), 15.4% (n = 1309) were identified as asthmatic; approximately 76% of eligible students (n = 990) from 15 middle schools and 3 high schools participated in the program. Comparison of baseline to follow‐up data indicated that students experienced significantly fewer days with activity limitations and significantly fewer nights of sleep disturbance after participation in the intervention. For health care utilization, students reported significantly less frequent emergency department visits or hospitalizations between the baseline and follow‐up surveys. CONCLUSIONS: A school‐based asthma curriculum designed specifically for urban students has been shown to reduce symptoms, activity limitations, and health care utilization for intervention participants.     

Retrospective cohort study of an outbreak of cryptosporidiosis caused by a rare Cryptosporidium parvum subgenotype

The occurrence of a gastrointestinal illness among a class of 96 undergraduate veterinary students in New Zealand prompted laboratory and questionnaire-based investigations. Cryptosporidium parvum was the only enteropathogen identified in 4/7 faecal specimens analysed. The C. parvum isolates carried a rare IIa GP60 allele, indicating a point-source outbreak. The infection source could not be microbiologically traced, but the investigation suggested contact with calves during a practical class as the most likely exposure. A total of 25/80 respondents to a questionnaire were defined as cases using a clinical case definition (31% attack rate). The inferred median incubation period was 5 days (range 0-11 days), and the median illness duration was 5-6 days (range 2-23 days), corroborating previous observations in experimental cryptosporidiosis. Disease was self-limiting, characterized by abdominal discomfort, diarrhoea, and in some cases, vomiting. Originating from a rural area and having had previously handled ruminants were associated with a significant risk reduction in males. All the three students who reported chronic use of steroid inhalers for treatment of asthma were cases. This case highlighted, once again, the potential hazard for explosive outbreaks of cryptosporidiosis.     

Medication Use Patterns among Urban Youth Participating in School-Based Asthma Education

Although pharmaceutical management is an integral part of asthma control, few community-based analyses have focused on this aspect of disease management. The primary goal of this analysis was to assess whether participation in the school-based Kickin’ Asthma program improved appropriate asthma medication use among middle school students. A secondary goal was to determine whether improvements in medication use were associated with subsequent improvements in asthma-related symptoms among participating students. Students completed an in-class case-identification questionnaire to determine asthma status. Eligible students were invited to enroll in a school-based asthma curriculum delivered over four sessions by an asthma health educator. Students completed a pre-survey and a 3-month follow-up post-survey that compared symptom frequency and medication use. From 2004 to 2007, 579 participating students completed pre- and post-surveys. Program participation resulted in improvements in appropriate use across all three medication use categories: 20.0% of students initiated appropriate reliever use when “feeling symptoms” (p?<?0.001), 41.6% of students reporting inappropriate medication use “before exercise” initiated reliever use (p?<?0.001), and 26.5% of students reporting inappropriate medication use when “feeling fine” initiated controller use (p?<?0.02). More than half (61.6%) of participants reported fewer symptoms at post-survey. Symptom reduction was not positively associated with improvements in medication use in unadjusted and adjusted analysis, controlling for sex, asthma symptom classification, class attendance, season, and length of follow-up. Participation in a school-based asthma education program significantly improved reliever medication use for symptom relief and prior-to-exercise and controller medication use for maintenance. However, given that symptom reduction was not positively associated with improvement in medication use, pharmaceutical education must be just one part of a comprehensive asthma management agenda that addresses the multifactorial nature of asthma-related morbidity.     

北京市顺义区初中学生哮喘知识知晓状况

目的 了解北京市顺义区初中学生哮喘防治知识现状,为开展以学校为基础的哮喘患儿健康教育提供参考依据.方法 采用自填式家长问卷,对顺义区整群抽取的初一、初二10780名学生患哮喘状况进行筛查.根据家长报告,有56名学生曾被医生诊断哮喘,341名学生近12个月有喘息史但没有患哮喘诊断(疑似哮喘).对哮喘学生、疑似哮喘学生及以班级为单位抽取的非哮喘学生(474名)进行有关哮喘知识自填式问卷调查.结果 在被调查的10780名初中生中,哮喘报告率为0.52％,可疑哮喘报告率为3.16％.在被调查的患哮喘初中生中,只有7.1％能比较全面地正确地回答哮喘的早期症状,有55.4％知道远离过敏原可避免或减少哮喘的发作.哮喘、疑似哮喘和非哮喘学生之间有关哮喘干预知识得分差异无统计学意义.结论 患哮喘的学生缺乏哮喘干预相关知识,应重视在初中生中开展哮喘干预教育.     

Use of birth control pills, condoms, and withdrawal among U.S. high school students.

PURPOSE: To examine the use of contraception at last sexual intercourse among currently sexually active adolescents. METHODS: We analyzed data from national school-based Youth Risk Behavior Surveys (YRBS) conducted in 1991, 1993, 1995, and 1997. The YRBS is a self-administered, anonymous survey which uses a national probability sample of U.S. students in public and private schools from grades 9 through 12. RESULTS: From 1991 to 1997, condom use significantly increased (from 46% to 57%), birth control pill use decreased (from 21% to 17%), and use of withdrawal significantly decreased (from 18% to 13%). In 1997, although more students were using condoms, 13% reported using withdrawal and 15% reported using no method to prevent pregnancy at last sexual intercourse. In 1997, condom use among females was significantly lower in the 9th grade than in the 12th grade (p <.001), whereas birth control pill use was higher (p <.001) and use of withdrawal remained stable. Among males, condom use and withdrawal use remained stable from 9th to 12th grade, whereas birth control pill use by their partner increased (p <.001). CONCLUSIONS: Inadequate contraceptive use among sexually active adolescents continues to be a major public health problem in the United States. For young people who will not remain sexually abstinent, families, health care providers, schools, and other influential societal institutions should promote the correct and continued use of condoms as essential protection against sexually transmitted diseases and human immunodeficiency virus infection.     

Asthma education for school staff in Riyadh city: effectiveness of pamphlets as an educational tool

Teachers and support staff are often called upon to manage asthma at school but may have little knowledge and understanding of the condition. The objectives of this study were to develop educational package (pamphlets) about asthma, and assess its effectiveness as an educational tool for schools' staff through evaluation of its impact on the staff's asthma-related knowledge, attitudes and management practices on their pupils. A pre-post experimental research design was used in Riyadh city with distribution of self-administered questionnaires and asthma package to 4 randomly selected girls schools compounds. Participants were school staff (n = 297) of primary, intermediate and secondary schools. Results showed that only 5.7% of the staff had received previous training in asthma education. Lack of knowledge and misconceptions about asthma medication were evident among a considerable proportion of the staff specifically for use of antibiotics, steroids, side effect of ventolin, and addicting effect of inhalers. At pretest, only 35% and 40.1% of the staff had good level of knowledge and management practices. At posttest, the corresponding percentages increased significantly to be 83.9% and 68.6% respectively. The mean total score of staff's asthma related-attitudes became more favorable towards asthma education after intervention, it increased significantly from 53.5 to be 55.0. Total posttest knowledge score was the only predictor of both staff attitudes and management practices constituting 9.1% and 10.2% of their variance. The great majority cited lack of training (92%), unavailability school policy (86.8%), and shortage of educational resources (88.3%) as barriers against asthma education and management in their schools. Conclusions: Most of school staff had poor to fair level of asthma knowledge and management practices. Such simple educational intervention using pamphlets and demonstration of inhaler use and peaked flow meter was significantly successful in enhancing staff's asthma-related knowledge, attitudes and management practices among their pupils. It is very important that training is directed to all staff as pre-service and in-service programs.     

Factors Related to Undiagnosed Asthma in Urban Adolescents: A Multilevel Approach

PurposeWe report the results of a school-based asthma case-identification survey to determine the prevalence and predictors of possible undiagnosed asthma in a population of urban adolescents.MethodsDuring school years 2006–2008, middle school students in Oakland, California, completed a brief survey adapted from the International Study of Asthma and Allergy in Children. Students were classified into one of three categories: no asthma, current asthma, or possible undiagnosed asthma. Students reported demographic information and residential address, which was geocoded and matched tract-level data from the US Census 2000, Oakland land use designations, public and assisted housing locations, and distance from closed-access roadways. Logistic regression was used to examine factors associated with possible undiagnosed asthma.ResultsOf the 4,017 students who completed the survey, 4.8% (95% confidence interval [CI]: 4.1, 5.5) were classified as possible undiagnosed asthma. Female students (odds ratio: 1.53, 95% CI: 1.07, 2.19) and students who resided in an urban residential area (odds ratio: 2.05, 95% CI: 1.05, 4.05) had significantly increased odds of classification as “possible undiagnosed asthma” compared to current asthma. Percentage of noncitizen recent immigrants in a census tract was related to increased odds of possible undiagnosed asthma. Residence in a census tract with older residential units was significantly associated with decreased odds of undiagnosed asthma.ConclusionsIn urban settings, school-based asthma surveillance can aid in the identification of children with possible undiagnosed asthma. Implementation of a geographic information systems framework can enhance the identification of demographic and physical environmental factors associated with possible undiagnosed asthma.     

Identifying Students with Self-Report of Asthma and Respiratory Symptoms in an Urban,High School Setting

Strategies for identifying urban youth with asthma have not been described for high school settings. African-American high school students are rarely included in asthma studies, despite a high risk of asthma mortality when compared to other age and race groups. Identification and follow-up of children with uncontrolled respiratory symptoms are necessary to reduce the burden of asthma morbidity and mortality, especially in underserved areas. We describe a process used to identify high school students who could benefit from intervention based on self-report of asthma and/or respiratory symptoms, and the costs associated with symptom-identification. Letters announcing a survey were mailed to parents of 9th-11th graders by an authorized vendor managing student data for the school district. Scan sheets with student identifiers were distributed to English teachers at participating schools who administered the survey during a scheduled class. Forms were completed by 5,967 of the 7,446 students assigned an English class (80% response). Although prevalence of lifetime asthma was 15.8%, about 11% of students met program criteria for enrollment through report of an asthma diagnosis and recent symptoms, medication use, or health care utilization. Another 9.2% met criteria by reported symptoms only. Cost of symptom-identification was $5.23/student or $32.29/program-eligible student. There is a need for school-based asthma programs targeting urban adolescents, and program initiation will likely require identification of students with uncontrolled symptoms. The approach described was successfully implemented with a relatively high response rate. Itemized expenses are presented to facilitate modifications to reduce costs. This information may benefit providers, researchers, or administrators targeting similar populations.     

Differences in asthma prevalence between samples of American Indian and Alaska Native children

OBJECTIVES: To better understand the prevalence of asthma among American Indian and Alaska Native (AI/AN) children and to explore the contribution of locale to asthma symptoms and diagnostic assignment, the authors surveyed AI/AN middle school students, comparing responses from metropolitan Tacoma, Washington (metro WA) and a non-metropolitan area of Alaska (non-metro AK). METHODS: Students in grades 6-9 completed an asthma screening survey. The authors compared self-reported rates of asthma symptoms, asthma diagnoses, and health care utilization for 147 children ages 11-16 self-reporting as AI/AN in metro WA and 365 in non-metro AK. RESULTS: The prevalences of self-reported asthma symptoms were similar for the metro WA and non-metro AK populations, but a significantly higher percentage of metro WA than of non-metro AK respondents reported having received a physician diagnosis of asthma (OR 2.33; 95% CI 1.23, 4.39). The percentages of respondents who reported having visited a medical provider for asthma-like symptoms in the previous year did not differ. CONCLUSIONS: The difference in rates of asthma diagnosis despite similar rates of asthma symptoms and respiratory-related medical visits may reflect differences in respiratory disease patterns, diagnostic labeling practices, or environmental factors. Future attempts to describe asthma prevalence should consider the potential contribution of non-biologic factors such as diagnostic practices.     

The Impact of Student-Directed Videos on Community Asthma Knowledge

The Student Asthma Research Team (START) program was designed to enable students to explore socio-ecological factors contributing to asthma through the use of Photovoice, a technique that gathers both photographs and personal experiences from participants. The photographs taken by and commentary from student participants were integrated into public service announcements (PSAs) intended to increase community asthma awareness and catalyze behavior change. This article evaluates the effectiveness of these student-directed PSAs at improving asthma awareness among peers and community members. Pre-PSA, immediate post-PSA, and 4 month post-PSA follow-up assessments were conducted to evaluate changes in community members’ asthma knowledge and behavior. The student-directed PSAs were found to significantly increase asthma knowledge among community members, irrespective of age, gender, or race. Increased knowledge persisted through the 4-month post-PSA follow-up. Of the thirty-six participants who were successfully contacted for the follow-up survey, nearly 40 % reported meaningful behavior-change in response to the PSAs. Photovoice and media production techniques were effective in engaging adolescent students—an under-served and often disenfranchised population—in asthma health education through the development and dissemination of PSAs. The extension of participatory techniques such as Photovoice to include the creation of student-directed PSAs holds promise for engaging adolescents in public health initiatives within their communities.     

Substance use and weight loss tactics among middle school youth

OBJECTIVE: Diet pills (DP) and vomiting or laxative (VL) use as weight loss tactics are associated with substance use in older adolescent populations. This study examined the association of weight loss tactics and substance use among middle school students. METHODS: A Youth Risk Behavior Survey was administered to 6,957 middle school students in eastern North Carolina. Multiple logistic regression examined substance use as predictors of DP and VL use. RESULTS: DP and VL use was reported by 6.0% and 7.1% of students, respectively, with each reported more frequently by females and White students. Regression analysis demonstrated alcohol, cigarette, or marijuana use as predictors for individual race/gender groups whereas steroid use was a predictor for all race/gender groups. We found a clustering effect of alcohol and cigarette use with both DP and VL use. DISCUSSION: Substance use is associated with weight loss tactics as early as middle school. More research in the areas of clustering of behaviors and age at onset is needed.     

中国6省市2508名大学生儿童期性虐待经历回顾性调查

目的 了解大学生中儿童期性虐待发生情况,探讨性虐待经历与大学生心理健康的关联.方法 采用自填式问卷,于2003年11月至2004年3月对北京、河北、山西、江苏、陕西、安徽6省市6所普通高校中2508名大学生(女生1360人,男生1148人)童年期性虐待经历进行不记名回顾性调查.结果 2508名大学生中,有24.8%的女生和17.6%的男生报告16岁前曾经历过1项或1项以上的性虐待,其中包括非身体接触的性虐待(女生20.0%,男生14.6%)和包括触摸在内的身体接触的性虐待(女生14.1%,男生7.8%).儿童期性虐待经历与是否为独生子女、家庭居住地是农村还是非农村、父母亲文化程度等没有明显的关联.与没有童年期性虐待经历的学生比较,有童年期性虐待经历的学生躯体化症状、强迫症状、人际关系敏感、抑郁、焦虑、敌对、恐怖、偏执、精神病性症状等因子均分偏高.结论 童年期性虐待经历与大学生心理健康问题相关.     

Effects of a School-Based Drug Abuse Prevention Program for Adolescents on HIV Risk Behavior in Young Adulthood

Early onset of substance use among adolescents has been found to be associated with later risky sexual behaviors. This study examined long-term follow-up data from a large randomized school-based drug prevention trial to (1) investigate the long-term impact of the prevention program on drug use and sexual behaviors that put one at elevated risk for HIV infection; and (2) use growth modeling procedures to examine potential mechanisms of intervention effects. Self-report survey data were collected from students in the 7th grade, prior to the intervention in 1985, and in grades 8, 9, 10, and 12. Participants in the intervention condition received a 30-session drug prevention program in 7th through 9th grades. Follow-up surveys were completed by 2042 young adults (mean age = 24) in 1998. As young adults, participants were considered to be engaging in high-risk behavior for HIV infection if they reported having multiple sex partners, having intercourse when drunk or very high, and recent high-risk substance use. The intervention had a direct protective effect on HIV risk behavior in the overall sample in young adulthood. Furthermore, among participants receiving 60% or more of the prevention program, analyses showed that the intervention significantly reduced growth in alcohol and marijuana intoxication over the course of adolescence, which in turn was associated with a reduction in later HIV risk behavior. The behavioral effects of competence-enhancement drug prevention programs can extend to risk behaviors including those that put one at risk for HIV infection.