Detroit Head Start Project: an intervention to improve asthma morbidity Noreen M. Clark Center for Managing Chronic Disease University of Michigan

1. DETROIT HEAD START ASTHMA PROJECT: “ An Intervention to Improve Asthma Morbidity and Asthma Health Care Use Among Low-Income Urban Preschool Children” This study was funded by the Center for Disease Control and Prevention: Community-Based Participatory Prevention Research. #R06/CCR521533-01 Head Start 9 th National Research Conference June 23-25, 2008 Belinda Nelson, PhD Presenter/Project Director

3. Prevalence of Asthma and Asthma Attacks Among Children 0-4 Years (2001-2003) Source: National Surveillance for Asthma—US, 1980-2004, MMWR, October 2007/Vol.56/No.SS-8, DHHS, Centers for Disease Control and Prevention

4. Health Care Utilization for Asthma Source: Morbidity and Mortality Weekly Report, October 2007/Vol.56/No.SS-8, DHHS, Centers for Disease Control and Prevention

7. D ETROIT H EAD S TART S TRUCTURE Grantee Delegate Agency Content Area Coordinators Agency Director Clerical Staff Family Service Workers Center Admin. Teachers Support Staff (cooks, etc.)

8. PURPOSE The primary purpose of the project was to engage Head Start personnel and families in efforts to improve the management of asthma symptoms among children enrolled in Head Start and to develop a program that specifically addresses the needs of this population.

10. Screening and Recruitment Asthma Health Screening (n = 3254) Children identified with asthma symptoms (n = 888) Baseline Interviews (n = 675) Continued on Next Slide

11. Intervention and Follow-Up Physician Led: Comprehensive Asthma Management Training Session Asthma Educators: Continued Training and Support Head Start Educators and Staff n=175 Parents receive assistance with asthma management (Educational handbooks, presentations, help from Head Start staff) Follow Up Interviews (n=487)

12. Criteria Used to Identify Children with Active Asthma Symptoms Source: NAEPP Guidelines Summary Criteria Diagnosis & Symptoms Diagnosis and 1+ symptoms any number of days in past yr. Diagnosis & Prescription Diagnosis and prescription Non-Exercise Symptoms 3+ non-exercise symptoms, each 5+ days in past yr. Exercise Symptoms 2 exercise symptoms, each 5+ days in past yr. Nighttime Symptoms Nighttime symptoms 3+ times per month

13. Asthma Prevalence Among Detroit Head Start Children

14. Characteristics of Children and Caretakers in Detroit Head Start Asthma Project Continued on Next Slide Final Sample (N=487) Child Characteristics: Age 3.9 Female (%) 56.0 Ethnicity % African American 85.0 Hispanic/Latino 6.0 Other 9.0 Diagnosed w/ asthma 67.1 Rx for asthma 74.3 Primary Caretaker % Relationship to child: Mother 88.7 Father/Grandmother 10.2

15. Characteristics of Children and Caretakers in Detroit Head Start Asthma Project Educational Level of Caretaker % <High School 16.6 High School/GED 36.6 Voc/Tech /Some College 37.0 College Degree/Adv Degree 9.8 Annual Household Income % <5,000 15.3 5001 – 20K 40.1 20,001 – 40K 25.5 >40K 19.1

16. Asthma Severity Status

17. Annual Symptom Days

18. Asthma Attacks

19. Asthma Health Care Utilization Continued on Next Slide Intervention Control Baseline Follow-Up Baseline Follow-Up Caretaker ever asked doctor about asthma (%) 73.0 85.2 .000 79.5 84.1 ns Doctor/Clinic Visits # 3.26 2.33 .006 3.05 2.82 ns

20. Asthma Health Care Utilization Intervention Control Baseline % Follow-Up % Baseline % Follow-Up % ≥ 1 ED Visits 43.9 31.3 .000 37.7 24.6 .001 ≥ 1 Hospitalizations 15.2 9.0 .006 11.5 5.7 .031

21. Caretaker Level of Confidence in Head Start