Asthma-Related Environmental Practices and Asthma Awareness in California Child Care Centers

Abstract

Asthma prevalence is increasing. Child care centers can play an important role in controlling asthma morbidity in young children. Therefore, we assessed asthma-related environmental practices in licensed centers and asthma awareness among child care staff. Two crosssectional surveys were mailed to 1,250 randomly selected California licensed facility child care centers in 2002. Site directors were asked about the presence of items that can trigger asthma and asthma experience in their centers and were requested to distribute surveys to three child care staff members. Staff surveys assessed asthma knowledge, attitudes, and beliefs using previously validated questions. Univariate and multivariate analyses examined frequencies and relations between responses and asthma-related factors. A total of 284 (24%) site directors and 666 (18%) staff members completed surveys. The median number of children enrolled at the centers was 48 (range, 1-1,356), with a median of 2 children with asthma (range, 0-55). During the preceding year, 55% of site directors treated an asthma episode with medication. Dust was the most commonly reported asthma trigger (84%). Although smoking in California child care centers is illegal, tobacco smoke was reported by 7% of centers. Among staff, the mean percentage of correct responses to knowledge questions was 66% (standard deviation Ϯ 15%). Independent predictors of higher asthma knowledge among staff members were asthma training, older age, longer time working in child care, and personal asthma experience. The findings indicate that asthma-related environmental risk factors are commonly reported in child care centers and asthma knowledge among staff varies. Interventions in both areas could improve management and outcomes of children with asthma. (Pediatr Asthma Allergy Immunol 2005; 18[1]:12-24.)

San Francisco childcare centers' preparedness in the prevention and management of asthma among preschool-aged children

“…A 2002 survey of 950 California childcare managers and staff reported smoke exposure at 7% of childcare centers [5]. Our finding of 47% of managers reporting smoke exposure at least once a month was much higher.…”

Can asthma education improve the treatment of acute asthma exacerbation in young children?

“…Interestingly, administrative staff have been shown to demonstrate higher levels of knowledge than staff directly responsible for child care 17 . Asthma knowledge of staff has been linked with personal asthma or chronic illness experience, 19 length of tenure, 16 time spent as a child care worker and prior asthma education 11 . Therefore, it is not surprising that results from this review demonstrated a significant increase in asthma knowledge following asthma education 24,30–36 .…”

“…Given the high prevalence rates of asthma in children, 10 it can be envisaged that the staff caring for young children will be increasingly required to assist in the management of acute asthma or wheeze. In an American study, 55% of child care staff reported treating an asthma episode with medication in the previous year 11 . Data from the UK suggest that children may experience up to 12 episodes of wheeze per year in primary school 12 .…”

“…Previous studies in primary school and pre‐school settings demonstrate low levels of asthma knowledge 11,16–19 and confidence 17,18,20,21 among staff, in combination with a lack of formalised policies and training in relation to asthma management 12,17,20,22 . This indicates a need for effective health education.…”

Development of a Tool to Evaluate Asthma Preparedness and Management in Child-Care Centers

“…4,5 Previous research has suggested that child-care centers are unprepared to care for children with asthma due to exposure to environmental asthma triggers [6][7][8] and lack of asthma training and asthma policies. 6,[9][10][11][12] Recognizing that the quality of asthma care provided to such children at child-care centers monitored by the San Francisco Department of Public Health (SFDPH) had never been fully evaluated, the SFDPH initiated a partnership with the University of California, San Francisco (UCSF), with the goal of developing an instrument for use by public health workers to quantify and compare child-care center asthma preparedness. This paper describes the development of a comprehensive and evidence-based instrument to measure the preparedness of child-care centers to prevent and manage asthma exacerbations ( Figure 1).…”