Abstract
Strategies for identifying urban youth with asthma have not been described for high school settings. African-American high school students are rarely included in asthma studies, despite a high risk of asthma mortality when compared to other age and race groups. Identification and follow-up of children with uncontrolled respiratory symptoms are necessary to reduce the burden of asthma morbidity and mortality, especially in underserved areas. We describe a process used to identify high school students who could benefit from intervention based on self-report of asthma and/or respiratory symptoms, and the costs associated with symptom-identification. Letters announcing a survey were mailed to parents of 9th–11th graders by an authorized vendor managing student data for the school district. Scan sheets with student identifiers were distributed to English teachers at participating schools who administered the survey during a scheduled class. Forms were completed by 5,967 of the 7,446 students assigned an English class (80% response). Although prevalence of lifetime asthma was 15.8%, about 11% of students met program criteria for enrollment through report of an asthma diagnosis and recent symptoms, medication use, or health care utilization. Another 9.2% met criteria by reported symptoms only. Cost of symptom-identification was $5.23/student or $32.29/program-eligible student. There is a need for school-based asthma programs targeting urban adolescents, and program initiation will likely require identification of students with uncontrolled symptoms. The approach described was successfully implemented with a relatively high response rate. Itemized expenses are presented to facilitate modifications to reduce costs. This information may benefit providers, researchers, or administrators targeting similar populations.
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References
Boss LP, Wheeler LSM, WIlliams PV, Bartholomew LK, Taggart VS, Redd SC. Population-based screening or case detection for asthma: are we ready? J Asthma. 2003;40(4):335–342.
Mannino DM, Homa DM, Akinbami LJ, Moorman JE, Gwynn C, Redd SC. Surveillance for asthma—United States, 1980–1999. MMWR Surveill Summ. 2002;51(1):1–13, Mar 29.
Wheeler LS, Boss LP, Williams PV. School-based approaches to identifying students with asthma. [Review] [16 refs]. J Sch Health. 2004;74(9):378–380, Nov.
Joseph CLM, Foxman B, Leickly FE, Peterson E, Ownby DR. Prevalence of possible undiagnosed asthma and associated morbidity among urban schoolchildren. J Pediatr. 1996;129:735–742.
Clark NM, Brown R, Joseph CL, et al. Issues in identifying asthma and estimating prevalence in an urban school population. J Clin Epidemiol. 2002;55(9):870–881, Sep.
Persky VW, Slezak J, Contreras A, et al. Relationships of race and socioeconomic status with prevalence, severity, and symptoms of asthma in Chicago school children. Ann Allergy Asthma & Immun. 1998;81(3):266–271, Sep.
Centers for Disease Control and Prevention (CDC). Self-reported asthma among high school students—United States, 2003. MMWR Morb Mort Wkly Rep. 2005;54(31):765–767, Aug 12.
Centers for Disease Control and Prevention, National Center for Health Statistics. Healthy Women: State Trends in Health and Mortality. http://www.cdc.gov/search.do?action=search&queryText=healthy+women%3A+state+trends+in+health+and+mortality&image.x=8&image.y=8. Accessed March 4, 2005.
National Asthma Education and Prevention Program. Guidelines for the Diagnosis and Management of Asthma. Expert Panel report 2. United States Department of Health and Human Services NIH Publication No 97-4051 1997 Apr.
©2001 Baylor Health Care System. All rights reserved. Rules of Two® is a federally registered service mark of Baylor Health Care System. http://www.baylorhealth.com/medicalspecialties/asthma/asthmaprograms.htm#Rof2.
CDC. Council of State and Territorial Epidemiologists asthma surveillance definition. Atlanta, GA: US Department of Health and Human Services, CDC, National Center for Environmental Health, 2001. Available at http://www.cdc.gov/nceh/asthma/casedef.htm.
Weiland SK, Bjorksten B, Brunekreef B, Cookson WO, von ME, Strachan DP. Phase II of the International Study of Asthma and Allergies in Childhood (ISAAC II): rationale and methods. Eur Respir J. 2004;24(3):406–412, Sep.
Joseph CL, Havstad S, Anderson EW, Brown R, Johnson CC, Clark NM. Effect of asthma intervention on children with undiagnosed asthma. J Pediatr. 2005;146(1):96–104, Jan.
Fleiss J. Statistical methods for rates and proportions. Second ed. New York, New York: Wiley; 1981.
Besculides M, Heffernan R, Mostashari F, Weiss D. Evaluation of school absenteeism data for early outbreak detection, New York City. BMC Public Health. 2005;5:105, Oct 7.
Wirt J, Choy S, Gerald D, et al. The condition of education 2002. National Center for Education Statistics 2002;NCES 2002-025:71.
Yeatts K, Shy C, Wiley J, Music S. Statewide adolescent asthma surveillance. J Asthma. 2000;37(5):425–434, Aug.
Yeatts K, Shy C. Prevalence and consequences of asthma and wheezing in African-American and White adolescents. J Adolesc Health. 2001;29(5):314–319, Nov.
Yeatts K, Shy C, Sotir M, Music S, Hergot C. Health consequences for children with undiagnosed asthma-like symptoms. Arch Pediatr Adolesc Med. 2003;157(6):540–544, Jun.
Fagan JK, Scheff PA, Hryhorczuk D, Ramakrishnan V, Ross M, Persky V. Prevalence of asthma and other allergic diseases in an adolescent population: association with gender and race. Ann Allergy Asthma & Immun. 2001;86(2):177–84, Feb.
Acknowledgements
We appreciate and acknowledge the collaboration of the Detroit Public School System and the principals of the following Detroit Public high schools: Cody, Henry Ford, Mackenzie, Mumford, Northwestern, and Redford. These principals exhibit a deep concern for the health and welfare of their students. We also acknowledge the valuable work of Ms. Kimberly Schalk and Edward “Mickey” Friedrich of Computer Management Technologies, and thank Ms. Anntinette McCain of the Office and Health and Safety and Ms. Sybil St. Clair of the Office of Research, Evaluation, and Assessment for their guidance and advice.
This research was funded by the National Institutes of Health, National Heart, Lung, and Blood Institute. Grant # R01 HL068971-05.
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Joseph, Stringer, Havstad, Johnson, Williams, and Peterson are with the Department of Biostatistics & Research Epidemiology, Detroit, MI, USA; Baptist is with the Allergy—Immunology Section, Division of General Internal Medicine, Wayne State University, Detroit, MI, USA; Ownby is with the Allergy—Immunology Section, Medical College of Georgia, Augusta, GA, USA.
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Joseph, C.L., Baptist, A.P., Stringer, S. et al. Identifying Students with Self-Report of Asthma and Respiratory Symptoms in an Urban, High School Setting. J Urban Health 84, 60–69 (2007). https://doi.org/10.1007/s11524-006-9121-y
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DOI: https://doi.org/10.1007/s11524-006-9121-y