Identification and Education of Adolescents with Asthma in an Urban School District: Results from a Large-scale Asthma Intervention

Abstract

Asthma is a leading cause of hospitalizations, acute care utilization, health care costs, and school absences in children. Asthma morbidity is disproportionately high in inner city populations. In general, community-based public health interventions to reduce asthma morbidity have had modest success due in part to their limited reach and low participation by the targeted population. Adolescents have been especially difficult to reach. A coalition of community organizations developed a school-based, population-level system to identify, prioritize, and provide interventions for middle school children with asthma in a large urban school district in Oakland, CA. Nearly 92% (n = 8,326) of students in the targeted schools took an asthma case identification survey. Of those students who took the survey, 17.5% (n = 1,458) had active asthma and were eligible for services. Among those identified with active asthma, 83% (n = 1,217) voluntarily attended asthma self-management classes at school. The 4-week curriculum previously has been shown to significantly improve several indicators of asthma control in this population. Retention was high-72% of students who enrolled attended at least three of the four curriculum sessions. Many higher-risk students were subsequently referred to and enrolled in off-site asthma services. Large school districts with incomplete or inadequate health records, high asthma prevalence, and internal or external services available for students with asthma may benefit from a similar model. A system such as the one described may be an effective public health strategy for school districts, health departments, and community coalitions addressing asthma or other conditions with high childhood prevalence.

The management of the allergic child at school: EAACI/GA2LEN Task Force on the allergic child at school

“…Each child should then be individually managed to ensure that their specific needs are addressed, through a partnership between the child's doctor, parents and school staff (9). A model for 'asthma friendly schools' has been described (28).…”

“…Encourage full participation in physical activities when students are well, offer reduced/modified activities if experiencing symptoms. There are many examples of successful education programmes for school children with asthma which incorporate some of the above-mentioned principles (28)(29)(30)(31).…”

School-Centered Asthma Programs

“…Most school-based educational programs have focussed on building skills for elementary school-aged children and have demonstrated improvements in asthma knowledge, confidence/self-efficacy, asthma management skills and associated asthma morbidity outcomes, such as improved quality of life, and reduced symptoms, emergency department visits, urgent care visits, hospitalizations and school absenteeism. [46][47][48][49][50] Studies in adolescents, an identified difficult-to-reach group, have demonstrated acceptance, involvement and retention by this age group: over 75% of those eligible participated and over 70% were retained. 37,38,44,45 Recently, school-centered asthma education efforts have targeted adolescents of low income living in urban settings.…”

Medication Use Patterns among Urban Youth Participating in School-Based Asthma Education

“…To address the specific asthma-related needs of the middle school population, Oakland Kicks Asthma, a large community-based intervention in Oakland, California, developed an asthma management education program for students in the Oakland Unified School District (OUSD), a diverse, predominantly low-income urban school district with high asthma prevalence 7,19. Known as Kickin’ Asthma , this curriculum for sixth-grade students with asthma teaches management strategies with an emphasis on appropriate medication use.…”