Community-based Research to Address Asthma Management and Prevention


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Research poster: Community-based Research to Address Asthma Management and Prevention. Read the full story:

View the booklet now "What you can do about your child's asthma" -

This SC CTSI-supported study was developed by: Marisela Robles, MS; Katrina Kubicek, MA; Michele D. Kipke, PhD - SC Clinical and Translational Science Institute and Children’s Hospital Los Angeles; Neal Richman, PhD; Saba Firoozi, MPH - BREATHE California of Los Angeles County; Charlene Chen, MHS; Hannah Valino, MPH - COPE Health Solutions.

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Community-based Research to Address Asthma Management and Prevention

  1. 1. Community-based Research to Address AsthmaManagement and PreventionKatrina Kubicek, MA, Marisela Robles, MS, Michele D. Kipke, PhDNeal Richman, PhD, Saba Firoozi , MPH, Charlene Chen, MHS, Hannah Valino, MPHSouthern California Clinical and Translational Science Institute, Children’s Hospital Los Angeles,BREATHE California of Los Angeles County, COPE Health SolutionsABSTRACT• This project represents a partnership between the Community Engagementprogram from the Southern California Clinical and Translational Science Institute(SC CTSI), BREATHE California of Los Angeles County (BREATHE LA) - a non-profitorganization committed to improving lung health and air quality througheducation and practice - and COPE Health Solutions, a healthcare managementgroup which facilitates a consortium of community clinics to improvecommunication and coordination of services.• This group formed to address the high rates of childhood asthma in thecommunity of Long Beach within Los Angeles County.• Long Beach is particularly burdened with higher rates of childhood asthma,where asthma affects 21.9% of children ages 5-17, compared with 15.6%, 18%, and14.2% in LA County, CA and the US respectively.6• This project provides guidelines on how to apply community-based participatoryresearch (CBPR) methods to inform the adaptation of an asthma educationcurriculum designed for after-school settings.• Asthma is the most common chronic childhood disease in the United States,particularly within minority populations and it is the leading cause of schoolabsence due to chronic disease and accounts for three times more lost schooldays than any other cause. 1-3, 5-8• In urban Los Angeles, children living along congested freeways and ports andother industrial areas are at similarly increased risk.2Interventions for Asthma Management• Over the last several years, we have seen an increase in the provision of asthmaeducation in school –based settings. 3-4 Providing health-related education inschool settings may be an effective method given that children are accustomedto receiving instruction and that the emphasis is typically teaching the child howto manage his/her asthma rather than relying on the parent to do so. 4• In general, school-based programs were found to be effective in increasingknowledge about asthma.Afterschool Settings for Health Promotion• Afterschool programs offer a unique opportunity to provide health-related orother educational materials. With most school districts facing drastic budgetcuts and limited time to provide the required coursework, it can be challengingto integrate new information into the school curriculum.BACKGROUNDMETHODSDATA ANALYSIS ANDCONCEPTUAL MODEL• The conceptual framework for this study was influenced primarily by our research goals andby reviewing other asthma prevention and management curricula. In addition, based ondiscussions with our CABs, we identified topics that are important for effective asthmamanagement. Using the conceptual model below as a guide, code reports were reviewed andpresented to the research team and CAB for further discussion on how to best interpret andintegrate the data into the asthma curriculum.Based on Empowerment Theory and Social Support -both of which have been linked to improved health outcomesRESULTSCURRICULUM ADAPTATIONThe Photovoice sessions helped inform the adaptation of the BREATHE LA asthma curriculum. The Photovoicesessions helped to highlight relevant changes to the curriculum to make it more grounded in the knowledge andexperiences of the target population.Buddy SystemOne of the unique features of this asthma curriculum is that it is provided to children with and without asthma.Therefore, it is important to identify how those without asthma can use the information provided to them. Datafrom the Photovoice sessions indicate that children with asthma often feel left out of certain activities. Thus, theresulting curriculum includes a new section in which students are matched with a “buddy”. This buddy systemensures that students with asthma have a friend who can assist them in the event of an asthma attack as well assomeone that they can play with in less strenuous activities when they are not feeling well.Physical ActivityIn addition, the Photovoice sessions highlighted the need to educate youth on how children with asthma canengage in physical activities. The resulting curriculum includes a new emphasis on this area and provides someguidance on how children with asthma can be physically active without exacerbating their asthma condition. Thisis an important inclusion as there is currently a body of research investigating the relationship between asthmaand obesity.AdvocacyMany of the students and parents discussed ways that can change the environments in which they live to makethem healthier for people with asthma. Parents recognized the potential risks from the refineries, ports andfreeways in their community. While they said they often felt “powerless” to stop them, many of the parents leftthe Photovoice sessions inspired to try to enact change in their communities. Given the interest trying to evokechange, a new section on advocacy has been introduced into the curriculum. Students are encouraged to take ona project in their homes, school or community to make it safer for them and their friends and family. Activitiessuch as letter writing, poster making and other simple activities have been introduced to encourage students to bemore assertive in identifying issues that may be hazardous to their well-being.CONCLUSION AND NEXT STEPS• This study provides guidelines for how to conduct a CBPR project with the goal of creating a community-drivenand scientifically-grounded asthma curriculum. For example, this is the first asthma curriculum that we haveidentified that integrates social support as a way to mediate positive health outcomes.• The next steps for this project will be to take the newly adapted curriculum into an efficacy trial to identifywhether the desired outcomes are met.REFERENCES1. Akinbami L. The State of Childhood Asthma, United States, 1980–2005. Hyattsville, MD: National Center for HealthStatistics; December 29, 2006 2006.2. Brim S, Rudd R, Funk R, Callahan D. Asthma Prevalence Among US Children in Underrepresented MinorityPopulations: American Indian/Alaska Native, Chinese, Filipino, and Asian Indian. Pediatrics. July 20082008;122(1):e217-e222.3. Christiansen SC, Zuraw BL. Serving the underserved: School based asthma intervention programs. Journal ofAsthma 2002;39(6):463-472.4. Coffman JM, Cabana MD, Yelin EH. Do school-based asthma education programs improve self-management andhealth outcomes? Pediatrics 2009;124:729-742.5. Lieu TA, Lozano P, Finkelstein JA, et al. Racial/ethnic variation in asthma status and management practicesamong children in managed medicaid. Pediatrics 2002;109(5):857-865.6. McDaniel M, Paxson C, Waldfogel J. Racial Disparities in Childhood Asthma in the United States: Evidence Fromthe National Health Interview Survey, 1997 to 2003. Pediatrics. 2006;117:e868-e877.7. Newacheck P, Halfon N. Prevalence, Impact, and Trends in Childhood Disability Due to Asthma. Archives ofPediatrics & Adolescent Medicine. March 2000 2000;154:287-293.8. Simon P, Zeng Z, Wold C, Haddock W, Fielding J. Prevalence of Childhood Asthma and Associated Morbidity inLos Angeles County: Impacts of Race/Ethnicity and Income. Journal of Asthma. 2003;40(5):535-543.9. Smith L, Hatcher-Ross J, Werthmeimer R, Kahn R. Rethinking Race/Ethnicity, Income, and Childhood Asthma:Racial/Ethnic Disparities Concentrated Among the Very Poor. Public Health Reports. March/April 2005 2005;120:109-120.ACKNOWLEDGMENTSNational Institutes of HealthGrant number UL1RR031986Boys and Girls Club of Long Beach StaffHealthcare Community Advisory Board MembersParent Advisory Board MembersOur project was guided by two community advisory boards (CABS). Onecomprised of healthcare providers and advocates and another comprised ofparents of children with asthma. See Figure 1 for details on methods.Limitations for Children with AsthmaThe majority of the limitations mentioned by participants had to do with not being able to bephysically active. In general, students and parents both felt that participating in physical activity,especially “rough” physical activity, would bring about an asthma attack and therefore limited theactivities in which children with asthma could participate. One student spoke about the competitivenature that he had and how he had to fight against the desire to compete with his friends while stillbeing cognizant of his health: “If other people challenge you and you want to take the challenge, andyou know you can’t but you are competitive so at the end, you’re out of breath and might have anasthma attack.”A less common but still present theme related to limitations was participants identifyingthe inability to play, pet or be around animals and pets such as cats. “If they [children] have asthmathey can’t touch them [pets] or pet them… or get near them… they get asthma.”Social SupportGiven the high rates of asthma in the surrounding community, all of the children and parents involvedin the Photovoice session had someone close to them (friend or family member) who was diagnosedwith asthma. Thus, issues related to what to do if you see a friend having an asthma attack wereoften discussed. One student reported that she would often give her friends advice on what activitiesthey should do: “My friend said let’s go racing, and I said, ‘no you can’t because you have asthma,’and then he started running and he had to stop and use his inhaler.” This is further complicated by thesense of isolation and loneliness that children with asthma may feel if they are unable to play withtheir friends and classmatesAdvocacyA final theme that emerged that was integrated into the resulting curriculum was the idea of advocacyin the home, school and community. Students felt very passionate about people not smoking aroundthem . Parents too reported that smoking was a major trigger of asthma symptoms and that this wassomething that was difficult to control. In addition to this issue of smoking in apartment buildings,some parents also spoke about the conditions of their apartments and the unwillingness of owners toaddress things such as smoking or making improvements to the buildings. Parents also commonlyspoke about their surrounding community and how the ports, refineries, local airport and largefreeways all contribute to the environmental issues in their neighborhoods. One parent brought in apicture of a refinery that is located near the childcare agency in which she works: “I have a picture ofthe refineries. I work close to it in the childcare. There are kids there who already come with asthma,but they have to withdraw because the smoke from the refineries aggravates their asthma.”