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Effectiveness of a Home- and School-Based Asthma Educational Program for Head Start Children With Asthma: A
Michelle N Eakin1, Sandra Zaeh1, Thomas Eckmann1
1Division of Pulmonary and Critical Care Medicine, The Johns Hopkins University, Baltimore, Maryland.
Insights
A combined asthma education program improved children's asthma control, reduced steroid use, and lowered hospitalizations. This multilevel intervention in community settings is key to reducing health disparities for at-risk families.
Area of Science:
- Pediatric Asthma Research
- Public Health Interventions
- Health Disparities in Minority Children
Background:
- Asthma is a leading chronic illness in children, disproportionately affecting Black children with higher morbidity and mortality rates.
- Effective community-based interventions are crucial for reaching at-risk families and mitigating asthma's impact.
Purpose of the Study:
- To assess the effectiveness of a combined home and school (Head Start) asthma education program.
- To compare this multilevel intervention against a Head Start-only program for improving pediatric asthma outcomes.
Main Methods:
- A randomized clinical trial involving 398 children with asthma in Head Start programs.
- Interventions included Asthma Basic Care (ABC) family education plus Head Start education versus Head Start education alone.
- Asthma control was measured using the Test for Respiratory and Asthma Control in Kids (TRACK) score over a 12-month period.
Main Results:
- The combined ABC and Head Start program significantly improved asthma control (TRACK score).
- This intervention also led to a reduction in oral corticosteroid use and asthma-related hospitalizations.
- Statistical significance was observed for all primary outcomes (P < .001 for control and hospitalizations, P = .02 for corticosteroids).
Conclusions:
- Multilevel asthma educational interventions combining family and preschool components enhance asthma control in children.
- These programs effectively reduce oral corticosteroid use and hospitalizations, addressing critical pediatric asthma outcomes.
- Implementing such interventions in community settings serving low-income minority families is vital for reducing asthma-related health disparities.
Importance:
Asthma is the most common chronic childhood disease, with Black children experiencing worse morbidity and mortality. It is important to evaluate the effectiveness of efficacious interventions in community settings that have the greatest likelihood of serving at-risk families.
Objective:
To evaluate the effectiveness of a multilevel home- and school (Head Start)-based asthma educational program compared with a Head Start-based asthma educational program alone in improving asthma outcomes in children.
Design, Setting, And Participant:
This randomized clinical trial included 398 children with asthma enrolled in Head Start preschool programs in Baltimore, Maryland, and their primary caregivers. Participants were recruited from April 1, 2011, to November 31, 2016, with final data collection ending December 31, 2017. Data were analyzed from March 18 to August 30, 2018.
Interventions:
Asthma Basic Care (ABC) family education combined with Head Start asthma education compared with Head Start asthma education alone.
Main Outcomes And Measures:
Asthma control as measured by the Test for Respiratory and Asthma Control in Kids (TRACK) score.
Results:
Among the 398 children included in the analysis (247 boys [62.1%]; mean [SD] age, 4.2 [0.7] years), the ABC plus Head Start program improved asthma control (β = 6.26; 95% CI, 1.77 to 10.75; P < .001), reduced courses of oral corticosteroids (β = -0.61; 95% CI, -1.13 to -0.09; P = .02), and reduced hospitalizations (odds ratio, 0.36; 95% CI, 0.21-0.61; P < .001) during a 12-month period.
Conclusion And Relevance:
In this randomized clinical trial, combined family and preschool asthma educational interventions improved asthma control and reduced courses of oral corticosteroids and hospitalizations. Multilevel interventions implemented in community settings that serve low-income minority families may be key to reducing disparities in asthma outcomes.
Trial Registration:
ClinicalTrials.gov Identifier: NCT01519453.
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