Asthma in Low-Income Minority Children in Head Start Programs and Middle Schools in Detroit
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printed by www.postersession.com ASTHMA IN LOW-INCOME MINORITY CHILDREN IN HEAD START PROGRAMS AND MIDDLE SCHOOLS IN DETROIT N.M. CLARK, J.A. DODGE, B.W. NELSON, L.J. THOMAS, D.F. AWAD, R.H. ROBERTS, C.L.M. JOSEPH UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH, ANN ARBOR, MICHIGAN Asthma is the most common chronic childhood disease. Studies suggest that asthma in children is both under-diagnosed and under-treated, which leads to increased morbidity. While the prevalence of childhood asthma is high in inner city communities, the comparative prevalence in different age groups of low-income minority children has not been well- studied. Further, variations in the patterns of physician diagnosis and symptom experience in these populations are not well understood. The purpose of this study was to explore these patterns in Head Start and middle school Chi-square tests were used to compare characteristics between groups. Statistical analysis was performed using SAS statistical software, version 9.2 (SAS Institute Inc., Cary, NC). Case identification revealed prevalence rates for probable asthma in 27.3% of the Head Start children and 28.1% of the 6th grade students. In the case identification sample (N= 7304), 20% of both Head Start and middle school students have been diagnosed with asthma at some time in their lives. Asthma prevalence was studied in children enrolled in 66 Head Start programs (ages 2.5 to 4) and 6th grade students (ages 10 to 13) attending 19 middle schools within the city of Detroit. Case identification was initiated by distributing asthma symptom questionnaires at school to the target populations. The questionnaires were sent home with the children, completed by the parent/guardian, and returned to the schools. A total of 3841 questionnaires were distributed to parents of Head Start children and 3256 were returned for a return rate of 84.8%. A total of 6827 asthma symptom questionnaires were sent home with 6th grade students and 4186 were returned, for a return rate of 61.3%. With a 10% daily absenteeism rate in Detroit middle schools, the adjusted return rate was 71.3%. National Asthma Education and Prevention Program – Expert Panel Report 2: Guidelines for the Diagnosis and Management of Asthma. National Institutes of Health publication no. 97-4051, Bethesda, MD, 1997. Under-diagnosed and under-treated asthma continues to be a significant problem as evident in this low-income, primarily African-American urban population. Younger and older children appear to be equally vulnerable. Efforts to confirm asthma through clinical assessment are needed for these populations, as is appropriate use of prescribed medications and age- appropriate education of students, their parents, and school The Guidelines of the National Asthma Education and Prevention Program (NAEPP) are the primary reference in the United States for diagnosis and treatment of asthma. The case definition distinguishes prevalence classification from clinical and laboratory classifications. For estimating prevalence, the case statement recommends combining both confirmed and probable cases of asthma. A brief, adapted questionnaire based on the NAEPP Guidelines was designed for this study to encourage completion. It comprised seven items related to asthma symptoms and requested information on the frequency of occurrence of these symptoms in the past 12 months. Additional items included an ever receiving asthma diagnosis from a physician and having received a prescription for asthma medications in the past 12 months. A copy of the questionnaire follows. BACKGROUND CASE IDENTIFICATION METHODS RESULTS CONCLUSIONS REFERENCES Head Start* Middle School** Packets Delivered 3841 6827 Returned 3256 4186 Return Rate 84.8% 61.3% Eligible for Case ID 3256 4048 + Probable Cases 890 (27.3%) 1138 (28.1%) *Head Start : Case identification conducted in one year. Packets were placed in the hands of the parent. **Middle School : Case identification conducted over two years. Packets were carried home by the students. + Reasons a pre-teen was ineligible included: in Special Education classroom or packet returned past due date. CASE IDENTIFICATION STATISTICS Summary Criteria Questions Diagnosis & Symptoms Diagnosis and 1 or more symptoms, any number of days past year 1 – 8, 10 Diagnosis & Prescription Diagnosis and prescription 10, 11 Non-Exercise symptoms 3 or more non-exercise symptoms, each 5+ days in past year 1, 3, 4, 6, 7, 8 Exercise symptoms 2 exercise symptoms, each 5+ days in past year 2, 5 Nighttime symptoms Nighttime symptoms 3+ times per month 9 CASE IDENTIFICATION CRITERIA KEY H ead Start 9.9% 51.3% 36.0% 2.9% 2 years 3 years 4 years Unknow n Head Start Middle School AGE RACE CASE IDENTIFICATION DEMOGRAPHICS N=3256 N=3256 N=4186 N=4186 All probable cases of asthma (N=2018) were classified into intermittent or persistent asthma severity based on the frequency of nighttime symptoms. Nighttime symptoms are especially concerning to clinicians. Yet, as seen in the table that follows, 25.5% of identified Head Start children and 20.5 % of middle school students (p < 0.01) were classified as having persistent nighttime Of the students identified as having probable asthma through case identification (N=2018), 32.4% of Head Start children and 33.8% of middle school students have never received a diagnosis of asthma (p>0.10). Forty percent (40%) of both Head Start and 6th grade students identified with probable disease, report experiencing symptoms despite having a diagnosis of asthma and receiving a prescription for asthma in the past 12 months (p>0.10). Prevalence ofProbable A sthm a Atleastone case identification criteria m et 27.3% 28.1% 0% 10% 20% 30% 40% Head Start Middle School Ever G iven a Diagnosis 19.5% 19.9% 0% 5% 10% 15% 20% 25% 30% Head Start Middle School P robable A sthm a C ases 32.4% 8.1% 40.4% 19.1% 33.8% 12.0% 40.8% 13.4% 0% 10% 20% 30% 40% 50% Undiagnosed Diagnosed & NotTreated Diagnosed,Treated & Symptom atic Diagnosed,Treated & NotSym ptomatic Head Start M iddle School p>0.10 p>0.10 Definitions Treated = Prescription in past 12 months Symptomatic = Symptoms above case identification threshold A sthm a S everity C lassification*and D iagnosis * Based on Nighttim e Sym ptom s 6.4% 34.6% 25.5% 33.3% 12.2% 36.6% 20.5% 28.2% 0% 10% 20% 30% 40% 50% Interm ittent, No Diagnosis Interm ittent, Diagnosis Persistent, No Diagnosis Persistent, Diagnosis Head Start M iddle School Definitions Intermittent Asthma = Nighttime symptoms no more than two times per month Persistent Asthma = Nighttime symptoms more than two times per month
Asthma in Low-Income Minority Children in Head Start Programs and Middle Schools in Detroit
Clark, N.M., Dodge, J.A., Nelson, B.W., Thomas, L.J., et al. "Asthma in Low-Income Minority Children in Head Start Programs and Middle Schools in Detroit," presented at the 61st Annual Meeting of the American Academy of Allergy, Asthma and Immunology in San Antonio, TX, March 18-22, 2005. (Poster)
