Impact of Asthma Intervention in Two Elementary School-Based Health Centers in the Bronx, New York City

Abstract

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.

Childhood Asthma and Extreme Values of Body Mass Index: The Harlem Children’s Zone Asthma Initiative

“…Nonetheless, the proportion of Black and Hispanic children in our study reflects the racial and ethnic profile of Central Harlem from the 2000 U.S. Census, and the high rates of current asthma and overweight observed in our dataset are similar to those in published reports of other less affluent, urban communities in New York City. 4,37,38 In short, our results are consistent with findings from other cross-sectional and prospective studies in children and adults 18,[27][28][29][30][31] and address the unresolved issue of whether gender modifies the putative association between obesity and asthma. 39 On the basis of our findings, we are in the process of implementing an intervention for overweight and at risk for overweight children with asthma enrolled in the HCZAI, which will include physical activity and nutrition sessions and an asthma educational intervention.…”

School-based asthma programs

“…School-based health clinics can provide health care for children living in areas that are underserved. 18,19 However, there are only about 1500 such clinics in the United States. These clinics see children for well-child care as well as deal with acute health issues including asthma.…”

The Role of School Health Services in Addressing the Needs of Students With Chronic Health Conditions

“…A follow-up study found improvements in medication management, reduced number of community provider visits, and halving of ED use for students enrolled in SBHCs compared to non-SBHC control schools (Webber et al, 2005). …”