Children in the cohorts have generally been recruited from lists of patients from emergency department and asthma clinic records of St. Louis Children’s Hospital of Washington University Medical Center. Additionally, some members of the cohort representing the study neighborhoods have been identified through Grace Hill referrals. Caregivers (90% mothers, 2% fathers) are contacted by research staff and receive $15 for completing an initial, 30- to 45-min interview. The baseline interview covers asthma knowledge and management, asthma morbidity and treatment patterns, social support for both the child and caregiver, source of asthma and general health care, family history of asthma, household composition, and sociodemographic characteristics of the caregiver and child. Subsequently, 11 quarterly interviews cover morbidity and subsets of topics from the baseline interview and are reimbursed at $10 each.
The baseline interview and appropriate follow-up items will be repeated at the end of the 36-month program with a $15 stipend. In addition to the financial incentive, cooperation with these interviews rests on the establishment of rapport with the interviewers. Caregivers typically report looking forward to the quarterly interviews and often call the interviewers for information or to report developments in their childrens’ asthma read more buy antibiotics. In addition to their rapport with the interviewers, we have noticed a striking appreciation of the study by many of the caregivers. Once they understand the nature and intent of the study, the majority seem to appreciate the fact that some quarters of the “establishment” are trying to improve their circumstances.
In addition to caregivers’ reports of management practices and skills, counts of actual emergency department visits, hospitalizations, and nonurgent, regular care are being gathered through audits of provider records. These audits are individualized according to the providers for each child identified by the childrens’ caregivers.
Table 4 presents baseline data for samples from the study and control neighborhoods. The challenges of asthma in inner cities, minority groups, and those beset by economic poverty are substantial but progress, if not easy solutions, appears at hand. “Open Airways,” now disseminated as a national program by the American Lung Association, yielded benefits when offered through inner-city schools. A current generation of projects funded by the National Heart, Lung, and Blood Institute take a more comprehensive approach to asthma care for minorities, integrating community promotion of understanding asthma and its care, improved access to clinical care, and asthma education.
Table 4—Neighborhood Asthma Coalition Participants
|% Female (of children)||35||40|
|% African American||100||100|
|Mean age, yr (range: 5-16)||8.9
|Mean age of first degree caregiver, yr (range: 21-73)||34
|Type medical insurance, %|
|Highest education of first degree caregiver, %|
|<High school grad||28||31|
|High school grad||39||40|
|Some college/tech school||29||22|
|Work status of first degree caregiver, %|
|Unemployed but seeking employment||31||24|
|Unemployed—not seeking employment||29||36|