1998 OPEN FORUM Abstracts
Managing Pediatric Asthma in the Inner City: Results of the National Cooperative Inner-City Asthma Study
Shari L. Wade, Ph.D. Children's Hospital Medical Center, Cincinnati, Ohio
Morbidity and mortality from asthma disproportionately affect children living within the inner-city. The National Cooperative Inner-City Asthma Study (NCICAS) was developed: 1) to identify factors contributing to asthma morbidity among inner-city children and 2) to test an empirically-based intervention to reduce asthma morbidity in this population.
During Phase I of NCICAS, caregivers of 1528 children with asthma, aged 4 to 9, were interviewed regarding asthma morbidity, the asthma management regimen, access to care, adherence, psychosocial characteristics, and the home environment. The children were 6.2 years of age on average and predominantly African-American (73.5%).
Findings from Phase I indicated that caregivers had high levels of asthma knowledge and positive expectations regarding their ability to manage the child's asthma. However, caregivers had difficulty generating effective solutions to problem-solving scenarios and most children had three or more individuals involved in the management of their asthma. Children had high levels of behavior problems with 35% exceeding the clinical cutoff on the Child Behavior Checklist. Caregivers also reported high levels of psychological symptoms with 50% of the caregivers exceeding the clinical cutoff on the Brief Symptom Inventory. Poor problem solving, and caregiver and child adjustment were all found to be related to asthma morbidity.
Based on these findings, we developed a comprehensive intervention focusing on reducing individual barriers to effective asthma management through education and training in problem-solving skills. The core intervention consisted of two caregiver and two child group education sessions focusing on effective asthma management, problem-solving strategies, and caregiver-physician communication. Following the group sessions, the Asthma Counselor scheduled bi-weekly contacts with the caregiver to address individual barriers to asthma management identified via the Asthma Risk Assessment Tool.
A total of 964 participants (475 intervention and 489 control) completed the intervention Phase of NCICAS. Across follow-up, children in the intervention group had .7 fewer days of asthma symptoms during a 2 week period than those in the control group. Caregivers in the intervention group also reported more positive attitudes about their ability to manage the child's asthma following the intervention than caregivers in the control group.
These findings suggest that an asthma intervention designed to improve problem-solving skills and reduce individual barriers to asthma management can effectively reduce asthma symptoms in population of children at elevated risk.
The 44th International Respiratory Congress Abstracts-On-Disk®, November 7 - 10, 1998, Atlanta, Georgia.