Reducing childhood asthma through community-based service delivery—New York City, 2001-2004

Morbidity and Mortality Weekly Report, Jan 14, 2005 by S.W. Nicholas, V.E. Hutchinson, B. Ortiz, S. Klihr-Beall, B. Shoemaker Jean-Louis, K., C. Singleton, J. Credell, R. Swaner, R.D. Vaughan, M.E. Northridge, L.F. Cushman, E. Polley, C. Golembeski

TABLE 1. Percentage of parents/guardians of enrolled children who
reported selected asthma symptoms and management strategies at
3-month follow-up time points--Harlem Children's Zone Asthma
Initiative, NewYork City, 2001-2004

                                      Time 1 *     Time 2      Time 3
Symptoms and strategies               (n = 314)   (n = 186)   (n = 145)

Asthma symptoms reported during
    preceding 14 days
  Child experienced wheezing or         61.5%       43.0%       40.7%
    tightness in chest
  Child had to slow down or stop        48.7%       40.3%       36.5%
    play or activities because of
    asthma
  Child woke up because of asthma,      49.0%       36.6%       32.4%
    wheezing, cough, or tightness
    in chest
  Child missed school for any           34.4%       22.6%        9.7%
    reason
  Child missed school because of        23.3%       15.0%        9.7%
    asthma

Asthma symptoms reported during
    preceding 3 months
  Child visited the emergency           35.0%       20.9%       15.8%
    department or made an unsche-
    duled visit to a physician's
    office for treatment of asthma
  Child was admitted to a hospital       8.6%        4.8%        2.7%
    and stayed overnight for asthma
  Child took any medications for        81.2%       88.2%       84.8%
    asthma

Reported use of asthma management
    strategies
  Child took any medications pres-      32.2%       37.1%       42.8%
    cribed for asthma every day,
    even when well, to prevent
    asthma symptoms
  Child has a spacer device such as     48.1%       87.6%       95.2%
    AeroChamber[R], Optichamber[R],
    or InspirEase[R]
  Child uses a spacer device with       41.4%       74.7%       87.6%
    any  inhaled medications
  Child has a peak flow meter           21.9%       72.6%       82.1%
  Child has an asthma plan              19.7%       32.8%       35.2%

                                       Time 4      Time 5
Symptoms and strategies               (n = 111)   (n = 70)

Asthma symptoms reported during
    preceding 14 days
  Child experienced wheezing or         42.3%       42.8%
    tightness in chest
  Child had to slow down or stop        39.6%       42.8%
    play or activities because of
    asthma
  Child woke up because of asthma,      36.9%       40.0%
    wheezing, cough, or tightness
    in chest
  Child missed school for any           13.5%        8.6%
    reason
  Child missed school because of         7.2%        7.1%
    asthma

Asthma symptoms reported during
    preceding 3 months
  Child visited the emergency           11.7%       14.3%
    department or made an unsche-
    duled visit to a physician's
    office for treatment of asthma
  Child was admitted to a hospital       2.7%        2.8%
    and stayed overnight for asthma
  Child took any medications for        83.8%       84.3%
    asthma

Reported use of asthma management
    strategies
  Child took any medications pres-      43.2%       47.1%
    cribed for asthma every day,
    even when well, to prevent
    asthma symptoms
  Child has a spacer device such as     97.3%       98.6%
    AeroChamber[R], Optichamber[R],
    or InspirEase[R]
  Child uses a spacer device with       91.9%       95.7%
    any  inhaled medications
  Child has a peak flow meter           85.6%       91.4%
  Child has an asthma plan              44.1%       41.4%

                                       Time 6      p values
Symptoms and strategies               (n = 50)    ([dagger])

Asthma symptoms reported during
    preceding 14 days
  Child experienced wheezing or         48.0%       <0.001
    tightness in chest
  Child had to slow down or stop        48.0%        0.14
    play or activities because of
    asthma
  Child woke up because of asthma,      42.0%       <0.01
    wheezing, cough, or tightness
    in chest
  Child missed school for any           16.0%       <0.001
    reason
  Child missed school because of         8.0%       <0.001
    asthma

Asthma symptoms reported during
    preceding 3 months
  Child visited the emergency            8.0%       <0.001
    department or made an unsche-
    duled visit to a physician's
    office for treatment of asthma
  Child was admitted to a hospital       0.0%        <0.01
    and stayed overnight for asthma
  Child took any medications for        90.0%         0.34
    asthma

Reported use of asthma management
    strategies
  Child took any medications pres-      52.0%       <0.05
    cribed for asthma every day,
    even when well, to prevent
    asthma symptoms
  Child has a spacer device such as     98.0%       <0.001
    AeroChamber[R], Optichamber[R],
    or InspirEase[R]
  Child uses a spacer device with       96.0%       <0.001
    any  inhaled medications
  Child has a peak flow meter           92.0%       <0.001
  Child has an asthma plan              60.0%       <0.001

* Time 1 = baseline; each subsequent time point represents
a 3-month follow-up. (Exact follow-up lengths might differ
because of variations in family schedules.) Decreasing number
of participants does not necessarily reflect permanent loss to
follow up. Families are invited back when their resources
allow them to continue or if they return to New York City
to live.

([dagger]) P-values are from chi-squared tests on five degrees
of freedom. Significance levels were replicated by using
repeated measures models in statistical software.

TABLE 2. Percentage of children screened for asthma or asthma-like
signs *, by program enrollment status and selected demographic and
health characteristics--Harlem Children's Zone Asthma Initiative,
New York City, 2001-2004

                            Children with asthma
                               or asthma-like      Children with asthma
                              signs, enrolled         or asthma-like
                                 (n = 314)         signs, not enrolled
Characteristic                   ([dagger])             (n = 668)

Age group (yrs)
    0-5                            39.2%                  29.1%
   6-10                            41.9%                  54.1%
  11-15                            18.9%                  16.8%
Sex
  Female                           45.2%                  44.2%
  Male                             54.8%                  55.8%
Race/Ethnicity
  Black, non-Hispanic              75.8%                  83.2%
  Black/Hispanic                    9.7%                   7.3%
  White/Hispanic                    3.8%                   3.0%
  Other                            10.6%                   6.5%
Child has a regular
    source of health care
  Yes                              85.4%                  86.7%
  No                               14.6%                  13.3%
Child has health
    insurance
  Yes                              87.0%                  67.8%
  No                               13.0%                  32.2%
Household member smokes
    cigarettes
  Yes                              32.3%                  20.8%
  No                               67.7%                  79.2%

                            Children without
                                asthma or            Total
                            asthma-like signs   children screened
Characteristic                 (n = 2,150)         (N = 3,132)

Age group (yrs)
  0-5                             34.5%               33.8%
  6-10                            53.9%               52.7%
  11-15                           11.6%               13.5%
Sex
  Female                          51.8%               49.4%
  Male                            48.2%               50.6%
Race/Ethnicity
  Black, non-Hispanic             85.6%               84.2%
  Black/Hispanic                   6.2%                6.8%
  White/Hispanic                   1.8%                2.3%
  Other                            6.4%                6.7%
Child has a regular
    source of health care
  Yes                             83.1%               84.0%
  No                              16.9%               16.0%
Child has health
    insurance
  Yes                             68.0%               69.9%
  No                              32.0%               30.1%
Household member smokes
    cigarettes
  Yes                             16.4%               18.9%
  No                              83.6%               81.1%

* For children with asthma, a parent/guardian indicated that the
child had ever been told by a doctor or nurse that the child had
asthma. For children with asthma-like signs, a health-care provider
indicated that the child's chest radiograph was not clear, or peak
expiratory flow rate for children aged [greater than or equal to] 6
years was correctly performed and abnormal. Thus, 314   668 = 982
and 982/3132 = 31.4% of children surveyed have asthma or asthma-like
signs.

([dagger]) Percentages might not total 100% because of missing values.