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Characteristics of children with asthma who are enrolled in a Head Start program
Perla A Vargas1, Pippa M Simpson, J Gary Wheeler
1Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, AR 72202-3591, USA. VargasPerlaA@uams.edu
Insights
Children in Head Start programs show high rates of asthma symptoms, environmental tobacco smoke exposure, and allergen sensitization. Many with persistent asthma lack appropriate medication, indicating poor control and a need for targeted case management.
Area of Science:
- Pediatric Public Health
- Environmental Health
- Allergy and Immunology
Background:
- Asthma significantly impacts children's health, with preschool-aged children experiencing increasing emergency department visits and hospitalizations.
- Limited research exists characterizing asthma burden in preschool-aged children.
- Head Start programs serve a population of young children who may be at higher risk for asthma.
Purpose of the Study:
- To identify and characterize children at risk for asthma within a local Head Start program.
- To assess asthma prevalence, symptoms, and associated risk factors in preschool-aged children.
- To inform targeted interventions for high-risk pediatric populations.
Main Methods:
- Recruitment of caregivers for 368 children aged 3-5 years using an asthma survey.
- Collection of data on demographics, healthcare utilization, medication use, symptoms, and environmental exposures.
- Measurement of environmental tobacco smoke exposure via urinary cotinine and allergen sensitization through skin prick testing.
Main Results:
- A high percentage of children (64%) had a history of emergency department visits for asthma.
- Significant exposure to environmental tobacco smoke (37% of households) and high rates of allergen sensitization (71% positive for >1 allergen) were observed.
- Most children (79%) exhibited symptoms consistent with persistent asthma, and many (45%) experienced nighttime symptoms weekly, with inadequate medication management (only 32% of persistent asthma cases had both rescue and controller medications).
Conclusions:
- Preschool children with asthma in Head Start programs face substantial environmental tobacco smoke exposure and high allergen sensitization.
- These children often present with persistent asthma symptoms but receive suboptimal medication treatment, leading to poor overall asthma control.
- This high-risk cohort could significantly benefit from tailored case management programs to improve asthma outcomes.
Background:
Asthma is an increasing public health concern that disproportionally affects children. In 1998, the Centers for Disease Control identified children aged 0 to 4 years as the "driving force" behind climbing rates of asthma-related emergency department visits and hospitalizations. Despite the significant asthma burden in preschool children, few studies characterize this population.
Objective:
This study identifies and characterizes children at risk for asthma who are enrolled in a local Head Start program.
Methods:
Caregivers of 368 children aged 3 to 5 years who were identified by using an asthma survey were recruited. Data were collected on demographics, health care use and access, medication use, symptoms, and trigger exposure. Exposure to tobacco smoke was determined by urinary cotinine and allergen sensitization by skin prick test.
Results:
At baseline, 64% of the children had more than 1 emergency department visit for asthma in their lifetime, whereas 31% had more than 1 visit in the previous 6 months. Caretakers reported smoking in 37% of households with cotinine exceeding 20 ng/mg in 27% of the sample. Twenty-one percent reported symptoms consistent with intermittent asthma, and 79% reported symptoms consistent with persistent asthma. Forty-five percent of the children reported nighttime symptoms more than 1 night per week. Seventy-one percent had positive test results for more than 1 allergen, and 42% had positive test results for more than 3 allergens. Only 32% of children with persistent asthma had both rescue and controller medications.
Conclusion:
Children with asthma enrolled in a Head Start program have significant environmental tobacco smoke exposure, are highly atopic and symptomatic, and do not receive appropriate medication treatment. Overall, children in the study had poor asthma control. This high-risk group could benefit from case management programs.
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