ASTHMA IN LOW-INCOME MINORITY CHILDREN IN HEAD START PROGRAMS AND MIDDLE SCHOOLS IN DETROIT

N.M. CLARK, J.A. DODGE, B.W. NELSON, L.J. THOMAS, D.F. AWAD, R.H. ROBERTS, C.L.M. JOSEPH
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH, ANN ARBOR, MICHIGAN

BACKGROUND METHODS RESULTS

Asthma is the most common chronic childhood disease. Studies suggest that asthma in
children is both under-diagnosed and under-treated, which leads to increased morbidity.
While the prevalence of childhood asthma is high in inner city communities, the
comparative prevalence in different age groups of low-income minority children has not
been well-studied. Further, variations in the patterns of physician diagnosis and symptom
experience in these populations are not well understood. The purpose of this study was to
Asthma prevalence was studied in children enrolled in 66 Head Start programs (ages 2.5 to 4) and 6th grade students (ages 10
to 13) attending 19 middle schools within the city of Detroit. Case identification was initiated by distributing asthma symptom
questionnaires at school to the target populations. The questionnaires were sent home with the children, completed by the
parent/guardian, and returned to the schools. A total of 3841 questionnaires were distributed to parents of Head Start children
and 3256 were returned for a return rate of 84.8%. A total of 6827 asthma symptom questionnaires were sent home with 6th
Chi-square tests were used to compare characteristics between groups. Statistical analysis was performed using
SAS statistical software, version 9.2 (SAS Institute Inc., Cary, NC). Case identification revealed prevalence
rates for probable asthma in 27.3% of the Head Start children and 28.1% of the 6th grade students. In the case
identification sample (N= 7304), 20% of both Head Start and middle school students have been diagnosed with
asthma at some time in their lives.
Prevalence of Probable Asthm a
At least one case identification criteria met
Ever Given a Diagnosis

explore these patterns in Head Start and middle school students residing in Detroit, grade students and 4186 were returned, for a return rate of 61.3%. With a 10% daily absenteeism rate in Detroit middle 40%
30%
25%
Michigan. schools, the adjusted return rate was 71.3%. 30%
27.3% 28.1%
20%
19.5% 19.9%

15%
20%
10%
10% 5%

CASE IDENTIFICATION
0% 0%

CASE IDENTIFICATION CRITERIA KEY p>0.10

Head Start Middle School
p>0.10
Head Start Middle School

Summary Criteria Questions

The Guidelines of the National Asthma Education and Prevention Program (NAEPP) are Of the students identified as having probable asthma All probable cases of asthma (N=2018) were
Diagnosis & Symptoms Diagnosis and 1 or more symptoms, any number of days past year 1 – 8, 10 through case identification (N=2018), 32.4% of Head classified into intermittent or persistent asthma
the primary reference in the United States for diagnosis and treatment of asthma. The severity based on the frequency of nighttime
Diagnosis & Prescription Diagnosis and prescription 10, 11 Start children and 33.8% of middle school students
case definition distinguishes prevalence classification from clinical and laboratory symptoms. Nighttime symptoms are especially
have never received a diagnosis of asthma (p>0.10).
classifications. For estimating prevalence, the case statement recommends combining Non-Exercise symptoms 3 or more non-exercise symptoms, each 5+ days in past year 1, 3, 4, 6, 7, 8 Forty percent (40%) of both Head Start and 6th grade concerning to clinicians. Yet, as seen in the table
both confirmed and probable cases of asthma. A brief, adapted questionnaire based on students identified with probable disease, report that follows, 25.5% of identified Head Start
Exercise symptoms 2 exercise symptoms, each 5+ days in past year 2, 5 children and 20.5 % of middle school students (p <
the NAEPP Guidelines was designed for this study to encourage completion. It comprised experiencing symptoms despite having a diagnosis of
Nighttime symptoms Nighttime symptoms 3+ times per month 9 asthma and receiving a prescription for asthma in the 0.01) were classified as having persistent
seven items related to asthma symptoms and requested information on the frequency of nighttime symptoms yet did not report a diagnosis
past 12 months (p>0.10).
occurrence of these symptoms in the past 12 months. Additional items included an ever of asthma.
receiving asthma diagnosis from a physician and having received a prescription for Probable Asthma Cases
asthma medications in the past 12 months. A copy of the questionnaire follows. CASE IDENTIFICATION Asthma Severity Classification* and Diagnosis
CASE IDENTIFICATION
Head Start Middle School
50% *Based on Nighttime Symptoms
40.4% 40.8%

STATISTICS DEMOGRAPHICS 40%

30%
32.4% 33.8%
50%
Head Start

34.6% 36.6%
Middle School

40% 33.3%
19.1% 25.5% 28.2%

AGE 20% 30% 20.5%

12.0% 13.4%
8.1% 20% 12.2%
10% 6.4%
Head Start* Middle School** Head Start 10%
0% 0%
Undiagnosed Diagnosed Diagnosed, Treated Diagnosed, Treated Intermittent, Intermittent, Persistent, Persistent,
Definitions No Diagnosis Diagnosis No Diagnosis Diagnosis
& Not Treated & Symptomatic & Not Symptomatic
Packets Delivered 3841 6827
2.9% 9.9% Definitions Intermittent Asthma = Nighttime symptoms no more than two times per month
Treated = Prescription in past 12 months Persistent Asthma = Nighttime symptoms more than two times per month
Symptomatic = Symptoms above case identification threshold

Returned 3256 4186 36.0%

2 years

3 years

CONCLUSIONS
4 years
Return Rate 84.8% 61.3% Unknown

51.3%

Eligible for Case ID 3256 4048+

N=3256 N=4186 Under-diagnosed and under-treated asthma continues to be a significant problem as evident
Probable Cases 890 (27.3%) 1138 (28.1%) in this low-income, primarily African-American urban population. Younger and older
RACE
children appear to be equally vulnerable. Efforts to confirm asthma through clinical
Head Start Middle School assessment are needed for these populations, as is appropriate use of prescribed medications
*Head Start: Case identification conducted in one year.
Packets were placed in the hands of the parent.
and age-appropriate education of students, their parents, and school staff..

**Middle School: Case identification conducted over two

years. Packets were carried home by the students. REFERENCES
+
Reasons a pre-teen was ineligible included: in Special National Asthma Education and Prevention Program – Expert Panel Report 2: Guidelines for the Diagnosis and
Education classroom or packet returned past due date. Management of Asthma. National Institutes of Health publication no. 97-4051, Bethesda, MD, 1997.
printed by N=3256 N=4186

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