Kickin' Asthma: School-Based Asthma Education in an Urban Community
Magzamen, Sheryl, Patel, Bina, Davis, Adam, Edelstein, Joan, Tager, Ira B., Journal of School Health
Asthma is the most common chronic disease of childhood. 1,2 In the United States, approximately 12% of children younger than 18 years have been diagnosed with asthma. (3) Asthma is the leading cause of school absences due to a chronic disease and accounts for 3 times more lost school days than any other cause. (4,5) Asthma also is associated with low academic achievement and high likelihood of grade retention. (6-8)
Asthma has a substantial impact on urban school districts that serve a large proportion of nonwhite and impoverished children. (9) Asthma-related morbidity, as measured by school absences, hospitalizations, and outpatient emergency care, has been found to be disproportionately high among children living in poverty, (10-13) as well as black and Latino children. (2,14-17) Morbidity in nonwhite and impoverished populations has been explained by many factors that include lack of access to primary care, (18) substandard primary care, (19) characteristics of the social environment, (15,20) and physical environment, (21,22) as well as the perception of asthma as an acute rather than chronic disease. (4,23)
Schools in urban communities are logical places to conduct asthma education interventions. Schools are centrally organized locations with broad community access. Previous studies have found that school-based asthma education is cost-effective and garners higher attendance rates compared to clinic-based programs, particularly in urban settings. (4,24,25) School-based asthma education eliminates issues related to transportation, limited access to health care providers, and lack of parental awareness or knowledge of asthma. Since asthma-related absences also impose a burden on school systems due to the relation between average daily attendance and funding, school systems have a stake in minimizing the financial and educational impact of asthma on students.
As part of the Centers for Disease Control and Prevention (CDC)-funded Controlling Asthma in American Cities Project, Oakland Kicks Asthma (OKA) (joint venture between the American Lung Association [ALA] of California, University of California, Berkeley, Children's Hospital Oakland, and Oakland Unified School District [OUSD]) conducted a school-based asthma program for adolescent students enrolled in OUSD middle schools and high schools. Adolescent students (aged 1 I-18 years) have been targeted specifically for services for several reasons. Although hospitalizations and emergency room visits due to asthma are highest at younger ages, (16) adolescents have a higher prevalence of asthma, suffer more frequent exacerbations, and have more near-fatal episodes compared to younger children. (26,27) Increased morbidity may be explained partly by the fact that parents and guardians may have reduced roles in the management of the child's health as the child matures. However, adolescents often may not be prepared to assume the full responsibility for self-management. (28) Further, adolescents face logistical and financial obstacles, such as inadequate transportation, that hinder their capacity to receive care or education independent of parents or guardians. Often, clinical care cannot be provided without parental consent, which, in some cases, may pose a barrier. Despite the added challenges faced by adolescents, relatively few programs and resources have been developed for students with asthma in this age-group. Although programs have specifically been developed for adolescents, (26) there are no interventions that target the unique health and social needs of urban adolescents.
The primary objective of this study is to evaluate the effectiveness of the first 3 years of a school-based asthma education program, entitled Kickin" Asthma, that targeted middle school and high school students with asthma in the OUSD. The specific aims of this analysis are to ascertain if school-based asthma education significantly reduced asthma symptoms, asthma-related acute care utilization, and school absences among children identified with asthma. …