Columbia Public Health Program Reduces Hospital Visits for Local Preschoolers With Asthma
Nearly one in ten preschool children in the U.S. has been diagnosed with asthma, and in New York City, neighborhoods in upper Manhattan including the Bronx, Harlem and Fordham have the highest childhood asthma rates—in some areas, higher than the national average. Yet few asthma management programs are designed for parents of preschool children. A new program established Columbia University’s Mailman School of Public Health is working to address this gap and help families better prevent and treat asthma.
The program, called Asthma Basics for Children (ABC), provided multiple opportunities for parents to learn about asthma signs, triggers and management techniques through activities held at 31 daycare centers in northern Manhattan. Program leaders worked with a coalition of community service organizations, educators, parenting programs and community pediatric providers to offer a multilayered approach that includes educational activities as well as training to community pediatric providers. Following participation in the program, 85 percent of parents reported reducing their child’s asthma triggers. The number of asthma-related visits to emergency departments declined sharply from 74 percent to 47 percent, as did asthma-related hospitalizations, dropping from 24 percent to 11 percent. Full results of the program were published in the February 2011 Journal of Urban Health.
Parent participation was made more convenient through flexible workshop and activity scheduling. The Columbia researchers found that parent participation rates in the study exceeded rates found in most other preschool or school-based asthma programs.
“Although emergency room visits and hospitalization rates for this age group are more than twice that of older children with asthma, until we developed the ABC model, only a handful of programs had been designed to promote better asthma management by their parents of preschoolers,” said Sally E. Findley, professor of clinical population and family health at the Mailman School and lead author of the paper. “Our study suggests that this is an excellent time to engage parents in learning how to control their child’s asthma, which is evidenced in the huge gains that parents made in asthma control.”
Another key element of the ABC strategy was designing asthma education activities for the daycare setting to improve communication between parents and their child’s healthcare provider. Parents in the program said they were often reluctant to share concerns with their physician, especially about possible side effects of their child’s asthma medications. After participating in the program, however, nearly 90 percent of the parents said they found it easier to talk to their doctor, and 80 percent said they were confident in their ability to manage their child’s asthma. The two-pronged strategy of strengthening communication skills of parents and their child’s healthcare provider is likely to have contributed to the changes in asthma management behaviors, improved confidence and improved asthma control, said Dr. Findley.
Asthma control outcomes improved progressively as the child’s exposure to ABC's multilayered interventions increased. “This study shows that you can improve asthma outcomes for preschoolers with an approach that integrates activities for children, parents, teachers and healthcare providers,” noted Dr. Findley. “The greatest impact occurs when you combine education interventions at all of these levels. Our hope is that the asthma control skills that parents learn through this program will continue to help them support asthma control as their children progress in their schooling at community elementary schools. ”
The project was funded by the CDC's Controlling Asthma in American Cities Project.
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