American inner-city children are disproportionately affected by asthma. During the 1999-2000 school year, we conducted a survey of 6 Bronx, New York City elementary schools to assess the prevalence of asthma and asthma-like symptoms as reported by parents. Children with probable asthma had symptoms within the last 12 months and parents who indicated that their child had asthma. Children with possible asthma had symptoms within the last 12 months but lacked a diagnosis.Overall, 74% (4,775/6,433) of parents returned completed surveys, identifying 20% (949/4,775) of children as probable asthmatics, and 12% (589/4,775) as possible asthmatics. In multivariate analyses, probable asthma was associated with: Puerto Rican, Black, and white race/ethnicity, male gender, having health insurance, and registration at the poorest school. Possible asthma was associated with lack of health insurance and female gender, but was not associated with any specific race/ethnicity. Our findings support the effectiveness of school-based surveys to identify children at high risk for asthma. The challenge remains to engage children and families in appropriate follow-up care and to manage their illness, either through the use of school-based health centers or stronger links to community services.

Access to SBHCs was associated with a reduction in the rate of hospitalization and a gain of 3 days of school for schoolchildren who have asthma.

This study examines healthcare utilization over time in Bronx, New York schoolchildren with asthma who were previously identified via parent surveys in six elementary schools. Four of the schools have on-site school-based health centers (SBHCs), and two do not have on-site health services (control schools). At baseline, we reported an asthma prevalence of 20%, and high rates of emergency department (ED) use (46%) in the previous year. To determine if asthma morbidity (specifically, ED use, community provider use, and hospitalizations for asthma) could be reduced by incorporating an aggressive intervention at two schools with SBHCs, we prospectively followed children for up to 3 years. Parents were scheduled for interviews every 6 months, and were queried about their children's use of health services for asthma in the prior 6 months. In multivariate models, children in the two intervention SBHC schools were less likely to have visited a community provider for asthma (relative rate ratio, 0.52; 95% confidence interval (CI), 0.30-0.88) or an emergency department for asthma (odds ratio, 0.44; 95% CI, 0.14-1.38; P = 0.059) in the prior 6 months compared to children attending control schools. There was no difference in community provider use or emergency department use for asthma between children attending nonintervention SBHCs and control schools. However, school type did not affect asthma hospitalization rates, which declined in all groups. Our findings support the effectiveness of aggressive school-based asthma services provided by SBHCs to reduce asthma morbidity and complement community health services.

F orty-three percent of young children live in homes with at least 1 smoker. 1 The exposure of children to environmental tobacco smoke is associated with increased rates of lower respiratory illness, middle ear effusion, asthma, and sudden infant death syndrome. 2 Despite these morbidities, pediatricians do not routinely counsel parents in smoking cessation. 3 Pediatricians have cited lack of time, lack of skills, and hesitancy to counsel or treat a parent as reasons for not counseling. 4 The American Academy of Pediatrics (Elk Grove Village, Ill) has created a workshop to train pediatricians in smoking cessation counseling (SCC). 5 The goal of such training is to change physician behavior; its effectiveness, however, has not been tested. The aim of this study was to assess the effectiveness of physician training in SCC.We invited pediatricians from 2 inner-city pediatric clinics of the same academic medical center to attend the American Academy of Pediatrics' "Clean Air for Children Three Hour Training Workshop." 6 The workshop included a didactic session, the presentation of a model for brief office-based counseling, and roleplay in SCC.To measure change in physician behavior, we reviewed a consecutive series of medical records for all scheduled visits for 3 weeks before and for 3 weeks after the training. We compared the performance of workshop attendees with that of nonattendees. The study was approved by the medical center's institutional review board for human subjects research.We used a standardized data collection tool to abstract the following data: (1) inquiry into parental smoking status, (2) identification of parent smokers, (3) advice about the effects of environmental tobacco smoke, (4) assessment of the stage of behavior change for parents who smoke, (5) assistance in smoking cessation, and (6) arrangement of a follow-up appointment for SCC. We calculated the frequencies for documentation of each of the 5 variables at baseline and postintervention. For each variable, we compared baseline and follow-up data for both groups. Differences in proportions were tested by the 2 test. Using nonattendees as the reference group, we calculated relative risks to assess the posttraining performance of workshop attendees.Four hundred pretraining and 495 posttraining records were reviewed. Overall, 6 physicians attended the training and 9 did not. At baseline, we found no differences in SCC between attendees and nonattendees (inquiry: 5% vs 8%, P=.29; identification: 2% vs 3%, P=.69; advice: 5% vs 1%, P= .15; assess: 0% vs 0%; assist: 29% vs 0%, P=.49; and arrange: 0% vs 0%; all P, not significant). Posttraining, workshop attendees were significantly more likely to inquire about parental smoking status, to identify smokers, and to offer advice about the effects of environmental tobacco smoke exposure (Table). Modest increases for workshop attendees were noted in the other variables. No significant changes were noted for nonattendees.As with any study of workshop effectiveness, interpretation of these findings is...

School-based health centers (SBHCs) are increasingly charged with providing primary care services including asthma care. This study assessed SBHC provider adherence to the National Heart, Lung, and Blood Institute (NHLBI) asthma care guidelines and the association among provider adherence, patient characteristics, and asthma outcomes. A cross-sectional study design was used to assess SBHC chart data from 415 children with asthma attending four inner-city elementary schools (K-5) in the Bronx, NY. Asthma symptoms, peak flow use, follow-up visits, and referrals to asthma specialists were documented in the charts of 60%, 51%, 22%, and 3% of subjects, respectively. Thirty-three percent of charts had SBHC clinician-documented severity classifications, of which 70% had appropriate medications prescribed. Asthma education and an asthma plan were documented in 18% and 10% of charts, respectively. Environmental triggers and tobacco exposures were documented in 71% and 49% of charts, respectively. Older children (> 8 years) were more likely to have documentation of peak flow use for asthma management, asthma education, follow-up visits, and written asthma plans, whereas younger children (< 8 years) were more likely to miss more days of school (all p < .05). Overall, provider adherence to NHLBI guidelines was inadequate, with adherence somewhat better for older children.