Asthma Clinical Trial
To evaluate a community organization approach to promoting asthma management in four neighborhoods in St. Louis with predominantly low income, Black populations.
BACKGROUND:
Asthma prevalence and mortality among Black children exceed levels among whites. Asthma
management programs have reduced symptoms, attacks and emergency room usage. However, in
1990 a pattern of underutilization and neglect of care among Black Americans in cases of
asthma deaths among Black children indicated the importance of promoting ongoing versus
episodic care, reduced exposure to triggers, sensitivity to signs of attacks, attack
management, and communication with caregivers, professionals, and teachers. Research in
Black communities indicated the importance of informal networks and neighborhood influences,
in promoting improved asthma care within low-income Black communities.
The study was part of a demonstration and education initiative "Interventions for Control of
Asthma Among Black and Hispanic Children" which was released by the NHLBI in June 1989.
DESIGN NARRATIVE:
Working with an established community agency, Grace Hill Neighborhood Services and its
Community Wellness Board, the investigators established Neighborhood Steering Committees to
oversee development and implementation of a Neighborhood Asthma Collaboration (NAC) in each
neighborhood. The 36-month NAC included (a) promotional campaigns to increase awareness of
asthma and its care; (b) Neighborhood Volunteers disseminating leaflets encouraging
identification of and continuing care for asthma, and recruiting participants into NAC
programs; (c) Neighborhood Volunteers trained as Asthma Advocates to work with asthmatic
children and their care-givers to encourage asthma co-management and to conduct management
programs in local institutions; (d) an Asthma Management Course offered through community
health centers, churches, and other local institutions; and, (e) local school programs
including in-service teacher education on asthma management, an asthma program for all
students to enhance support for asthmatic children, and school implementation of the Asthma
Management Course.
Prior to implementing the NAC, the investigators (a) reviewed, adopted, piloted and revised
existing asthma management educational and promotional materials, (b) worked with asthma
care providers to gain their involvement in program planning and patient referral to the NAC
and (c) adapted procedures from other worksite/community health promotion programs for
working with Neighborhood Steering Committees and training Neighborhood Volunteers. General
evaluation included (a) surveys of community awareness of and attitudes toward asthma, (b)
dissemination and implementation, and (c) pre-post changes in symptoms, attacks, ER visits,
and hospitalizations among all child participants in the NAC. These measures as well as kept
appointments and serum theophylline levels less than or equal to 5 mg/dl were used in two
controlled studies within the NAC to compare (1) children from study neighborhoods with
children from socioeconomically comparable neighborhoods, all of whom received care through
Children's Hospital of Washington University, and (2) children receiving care through two
Centers serving other, socieoeconomically similar neighborhoods.
The study completion date listed in this record was obtained from the "End Date" entered in
the Protocol Registration and Results System (PRS) record.
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