Journal of Urban Health

, Volume 88, Supplement 1, pp 85–99 | Cite as

A Community-Based Strategy for Improving Asthma Management and Outcomes for Preschoolers

  • Sally E. Findley
  • Gloria Thomas
  • Rosa Madera-Reese
  • Natasha McLeod
  • Sreelata Kintala
  • Raquel Andres Martinez
  • Benjamin Ortiz
  • Elizabeth Herman


Although almost one in ten (8.6%) preschool children has been diagnosed with asthma, few asthma management programs are designed for parents of preschool children. The Asthma Basics for Children program addressed this need in 2003–2008 by implementing a multi-layered approach that offered educational activities to center staff, parents, and children and PACE training to physicians in 31 Northern Manhattan daycare centers. Following program participation, 85% of parents reported reducing their child's triggers, 89% said it was easier to talk to their child's physician, and 80% were confident in their ability to manage their child's asthma. Children's any daytime symptoms dropped from 78% to 42%, any nighttime symptoms from 81% to 49%, any daycare absences from 56% to 38%, any asthma-related emergency department (ED) visits from 74% to 47%, and any asthma-related hospitalizations from 24% to 11% (p < .001 for all differences). Outcomes varied by level of exposure. In the Center-Only group (no parent participation), the only reduction was from 19% to 10% (McNemar = 3.77, p = .052) in hospitalizations. Children whose parents participated in the program had significant reductions in daycare absences (62% to 38%, McNemar = 11.1, p < .001), ED visits (72% to 43%, McNemar = 19.2, p < .001), and hospitalizations (24% to 11%, McNemar = 5.54, p = .018). Children whose parents and healthcare provider participated had the greatest improvements with asthma-related daycare absences dropping from 62% to 32% (McNemar = 9.8, p = .001), ED visits from 72% to 37% (McNemar = 14.4, p < .001), and hospitalizations from 35% to 15% (McNemar = 8.33, p = .003). This study demonstrates that a multi-layered approach can improve asthma outcomes among preschoolers with a combination of parent and provider education having the greatest impact.


Early childhood centers Asthma Self-management training Indoor trigger reduction Community-based interventions 


  1. 1.
    Bloom B, Dey AN, Freeman G. Summary Health Statistics for US Children: National Health Interview Survey, 2005. Vital Health Statistics. 2006;(231):1-84.Google Scholar
  2. 2.
    Moorman JE, Rudd RA, Johnson CA, et al. National surveillance for asthma: United States, 1980–2004. MMWR Surveill Summ. 2007; 56(SS08): 1-54.PubMedGoogle Scholar
  3. 3.
    Brown J, Bakeman R, Celano M, Demi A, Kobrynski L, Wilson S. Home-based asthma education of young low-income children and their families. J Pediatr Psychol. 2002; 27(8): 677-688.PubMedCrossRefGoogle Scholar
  4. 4.
    Holzheimer L, Mohay H, Masters I. Educating young children about asthma: comparing the effectiveness of a developmentally appropriate asthma education videotape and picture book. Child Care Health Dev. 1998; 24(1): 85-99.PubMedCrossRefGoogle Scholar
  5. 5.
    Ladebauche P, Nicolosi R, Reece S, Saucedo K, Volicer B, Richards T. Asthma in head start children: prevalence, risk factors and health care utilization. Pediatr Nurs. 2001; 27(4): 396-399.PubMedGoogle Scholar
  6. 6.
    Nelson B, Clark NM, Valerio MA, Houle CR, Brown RW, Brown C. Working with a head start population with asthma: lessons learned. J Sch Health. 2006; 76(6): 273-275.PubMedCrossRefGoogle Scholar
  7. 7.
    Slezak JA, Persky VW, Kviz FJ, Ramakrishnan V, Byers C. Asthma prevalence and risk factors in selected head start sites in Chicago. J Asthma. 1998; 35(2): 203-212.PubMedCrossRefGoogle Scholar
  8. 8.
    Stevens C, Wesseldine L, Couriel J, Dyer A, Osman L, Silverman M. Parental education and guided self-management of asthma and wheezing in the pre-school child: a randomised controlled trial. Thorax. 2002; 57: 39-44.PubMedCrossRefGoogle Scholar
  9. 9.
    Walders N, McQuaid E, Dickstein S. Asthma knowledge, awareness, and training among head start and early head start staff. J Sch Health. 2004; 74(1): 32-34.PubMedCrossRefGoogle Scholar
  10. 10.
    Warschburger P, von Schwerin A-D, Bucholz HT, Petermann F. An educational program for parents of asthmatic preschool children: short and medium-term effects. Patient Educ Couns. 2003; 51(1): 83-91.PubMedCrossRefGoogle Scholar
  11. 11.
    Wilson S, Latini D, Starr N, et al. Education of parents of infants and very young children with asthma: a developmental evaluation of the Wee Wheezers program. J Asthma. 1996; 33: 239-254.PubMedCrossRefGoogle Scholar
  12. 12.
    Shonkoff JP, Phillips DA, eds. From neurons to neighborhoods: the science of early childhood development. Washington: National Academy Press; 2000.Google Scholar
  13. 13.
    Margolis PA, Stevens R, Bordley WC, et al. From concept to application: the impact of a community-wide intervention to improve the delivery of preventive services to children. Pediatrics. 2001; 108(3): e42.PubMedCrossRefGoogle Scholar
  14. 14.
    Rosen C, Rodriguez L. The Inner-City Asthma Intervention asthma counselor program: a collaborative model between physician and social worker to help empower families. Ann Allergy Asthma Immunol. 2006; 97(Supplement): S16-S19.PubMedCrossRefGoogle Scholar
  15. 15.
    Krieger J, Takaro T, Allen C, et al. The Seattle-King County healthy homes project: implementation of a comprehensive approach to improving indoor environmental quality for low-income children with asthma. Environ Health Perspect. 2002; 110(Supp 2): 311-322.PubMedGoogle Scholar
  16. 16.
    Persky V, Coover L, Hernandez E, et al. Chicago community-based asthma intervention trial: feasibility of delivering peer education in an inner-city population. Chest. 1999; 116(4 Suppl 1): 216S-223S.PubMedCrossRefGoogle Scholar
  17. 17.
    New York State Department of Health. New York State Asthma Surveilance Summary Report. Albany: New York State Department of Health; 2005.Google Scholar
  18. 18.
    New York City Department of Health and Mental Hygiene. Community Health Profiles: Manhattan. In: New York City Department of Health and Mental Hygiene, ed. Bureau of Epidemiology, Vol Inwood and Washington Heights; Central Harlem, 2nd edn. New York City: New York City DOHMH; 2006.Google Scholar
  19. 19.
    Bonner S, Matte T, Rubin M, et al. Validating an asthma case detection instrument in a Head Start sample. J Sch Health. 2006; 76(9): 471-478.PubMedCrossRefGoogle Scholar
  20. 20.
    Findley SE, Levitt D, Hanus E, Gokool-Sheikh FA, Lubeck KM, Thomas GE. Asthma Basics for Children: Parent's Handbook. New York: Trustees of Columbia University and Asthma and Allergy Foundation of America; 2004.Google Scholar
  21. 21.
    Findley SE, Levitt D, Hanus E, Gokool-Sheikh FA, Lubeck KM, Thomas GE. Asthma Basics for Children: Early Childhood Educator's Handbook. New York: Trustees of Columbia University and Asthma and Allergy Foundation of America; 2004.Google Scholar
  22. 22.
    Findley SE, Levitt D, Hanus E, Gokool-Sheikh FA, Lubeck KM, Thomas GE. Asthma Basics for Children: Instructor's Guide. New York: Trustees of Columbia University and Asthma and Allergy Foundation of America; 2004.Google Scholar
  23. 23.
    Roxy to the Rescue. New England Research Institute, with funding from National Heart, Blood and Lung Institute and editorial oversight from the National Collaborative Inner City Asthma Study. Timonium, MD: Milner-Fenwick; 1995.Google Scholar
  24. 24.
    A is for Asthma with Dani: A Childhood Asthma Awareness Program in English and Spanish. New York City: Sesame Workshop; 2003.Google Scholar
  25. 25.
    Cabana MD, Slish KK, Evans D, et al. Impact of physician asthma care education on patient outcomes. Pediatrics. 2006; 117(6): 2149-2157.PubMedCrossRefGoogle Scholar
  26. 26.
    Colland VT, Essen-Zandvliet LEMV, Lans C, Denteneer A, Westers P, Brackel HJL. Poor adherence to self-medication instructions in children with asthma and their parents. Patient Educ Couns. 2004; 55(3): 416-421.PubMedCrossRefGoogle Scholar
  27. 27.
    Walders N, Kercsmar C, Schluchter M, Redline S, Kirchner HL, Drotar D. An interdisciplinary intervention for undertreated pediatric asthma. Chest. 2006; 129(2): 292-299.PubMedCrossRefGoogle Scholar
  28. 28.
    Huss K, Rand CS, Butz AM, et al. Home environmental risk factors in urban minority asthmatic children. Ann Allergy. 1994; 72: 173-177.PubMedGoogle Scholar
  29. 29.
    Bartholomew LK, Sockrider MM, Abramson SL, et al. Partners in school asthma management: evaluation of a self-management program for children with asthma. J Sch Health. 2006; 76(6): 283-290.PubMedCrossRefGoogle Scholar
  30. 30.
    Warman KL, Silver EJ, McCourt MP, Stein REK. How does home management of asthma exacerbations by parents of inner-city children differ from NHLBI guideline recommendations? Pediatrics. 1999; 103(2): 422-427.PubMedCrossRefGoogle Scholar

Copyright information

© The New York Academy of Medicine 2010

Authors and Affiliations

  • Sally E. Findley
    • 1
  • Gloria Thomas
    • 1
  • Rosa Madera-Reese
    • 1
  • Natasha McLeod
    • 1
  • Sreelata Kintala
    • 1
  • Raquel Andres Martinez
    • 2
  • Benjamin Ortiz
    • 2
  • Elizabeth Herman
    • 3
  1. 1.Heilbrunn Department of Population and Family Health, Mailman School of Public HealthColumbia UniversityNew YorkUSA
  2. 2.College of Physicians and SurgeonsColumbia UniversityNew YorkUSA
  3. 3.Air Pollution and Respiratory Health Branch, Centers for Disease Control and PreventionAtlantaUSA

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