In contrast with the widespread beliefs that access to medical care, health insurance, and continuity of care are the major barriers to quality asthma care, the barriers most frequently reported by parents were related to patient and family characteristics, health beliefs, or to their social and physical environment. To improve asthma management and health outcomes for urban, minority children with asthma, it is critical to tailor education about asthma and its treatment, and address quality of life issues for both children and parents.

The prevalence of early-onset OM and repeated OM continued to increase among preschool children in the United States. Further research to investigate this increasing prevalence should explore changes in management practice and an increase in prevalence of allergic conditions among poor children.

Young urban children self-report low HRQOL scores and do so as early as the 2nd grade. These low scores, which reflect children's own perceptions of impaired psychological and physical health, have potential implications for the success of urban children in their learning environments. The association between HRQOL and school connectedness might suggest that health and educational programs that improve a child's attachment to school could result in improved perceptions of health by urban children.

School-based health centers (SBHCs) provide physical and mental health services on school campuses to improve student health status, and thereby potentially facilitate student academic success. With a growing emphasis on school accountability and the simultaneous dwindling of resources at the federal, state, and local levels, SBHCs face increasing pressures from school administrators and funders to document their impact on student academic achievement. This article reviews the methods, findings, and limitations of studies that have examined the relationship between SBHCs and academic performance. It also describes methodological challenges of conducting and interpreting such research, and discusses factors and intermediate variables that influence student academic performance. Recommendations are offered for SBHC researchers, evaluators, and service providers in response to the pressure they are facing to document the effect of SBHC services on academic outcomes.