Asthma prevalence and its related morbidity is two to three times higher among African-American children compared to white youth. 1 A key method for reducing asthma-related morbidity is quick-relief and controller medications delivered through respiratory inhaler devices. However, few children use inhalers correctly, which results in negative effects on asthma control, quality of life, and morbidity, 2 thus, inhaler education is critical. Inhaler technique education should occur at every opportunity, according to national asthma guidelines; however this education rarely occurs. 3 Many barriers exist in clinical settings, including time-pressured schedules, limited staff training, inadequate knowledge, and lack of demonstration supplies. 4 As a result, healthcare professionals may ask children or parents about technique, utilizing confidence as a proxy to determine if education is needed. Selfassessment has potential for inaccuracies because children and parents overestimate inhaler skills, as evidenced by studies of non-Hispanic white children 5 and parents of African-American children. 6 However, correlation between child and parent confidence has not been examined. Further, because this overestimation of skills can result in poor self-management, it is important to examine inhaler technique relative to both child and parent confidence. This observational study was conducted over one year (2016-2017) in four Chicago public charter schools with a predominately African-American (97%) and low-income (82%) student population. Students with physician-diagnosed asthma identified during schoolbased screening were recruited. 7 Written consent and assent was obtained. University of Chicago's Institutional Review Board approved the study.

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Each state's laws have nuances that create gray areas, increasing the potential of misinterpreted or incorrectly implemented policies for asthma self-management at school. As a result, children may not have immediate access to their inhaler for symptom management or in an emergency. State policymakers should reform current laws to remove barriers for students to carry and use inhalers at school.

Objective-Asthma self-management depends partly on access to inhalers; for children, this includes independent inhaler carry and use at school ("self-carry"). Although laws and policies support self-carry, little is known about practices within schools. This study aimed to identify factors associated with inhaler self-carry among children and examine barriers and facilitators to self-carry.Methods-This mixed-methods observational study included child-parent dyads and nurses from four Chicago schools. Children and parents answered questions about asthma care and morbidity, confidence in self-carry skills, and facilitators and barriers to self-carry. Nurses reported asthma documentation on file and their confidence in children's self-carry skills. Analysis utilized logistic regression. Thematic analysis was performed for open-ended questions.

Asthma self-management is critical to minimize adverse consequences and depends partly on access to inhalers, including independent carry and use of inhalers by children at school ("self-carry").(1) Traditionally, parents decide when children are ready to self-carry. However, parents often overestimate their child's self-management skills.(2) Further, many children have limited asthma knowledge and misuse inhalers.(3) One study concluded 38% of students (kindergarten-10 th grade) have the ability to self-carry.(4) This study aimed to identify factors associated with children's readiness to self-carry inhalers using an objective tool and to determine how this tool aligns with traditionally utilized subjective readiness measures.