Asthmatic children in 20 Baltimore elementary schools are expected to take part next fall in a federally funded study to find the best ways to teach children how to reduce the frequency and severity of asthma attacks.
When it's all over, whichever approach proves most effective will be made available to all schools in this city, as well as in Washington, where 20 more schools are to participate in the study.
"Asthma is the leading health cause of absences in schools," said Dr. Cynthia Rand, an assistant professor at the Johns Hopkins School of Medicine and a principal investigator in the study. It contributes to poor performance on standardized tests and behavior problems.
In Baltimore, about 10 percent of all children entering school are identified by the parents as having asthma.
Previous studies have found that inner city minority children are three times more likely than whites to suffer from asthma, and asthma rates are increasing disproportionately among minorities nationwide. Asthma death rates are now 4.5 to 6 times higher among minorities than whites.
No one knows for sure why, Rand said. Environmental factors, from higher smoking rates in black households to a higher rate of cockroach infestations, have been suggested as contributing causes.
But disproportionate suffering from other chronic diseases, such diabetes and high blood pressure, suggests that inner city blacks are not receiving the health care education and continuous monitoring they need to cope with chronic illness.
"Asthma is a chronic disease that needs continuous monitoring," Rand said. Treating it only when crises arise may even make it worse.
But the existing health care system is frequently inaccessible or underused, Rand said. Inner city minorities tend to go to emergency rooms when they have problems,instead of making regular appointments with physicians in order to stay healthy.
The researchers also believe that educational materials designed to teach asthmatics how to deal with their illness on a daily basis are either unavailable, or "culturally insensitive."
In designing their own educational materials, Rand said, members of her team found they had to discard the term !B "trigger," which medical people commonly use to refer to the "cause" of an asthma attack. In the inner city, she said, the word is associated only with guns, and lends a strongly negative connotation to educational material.
Likewise, the team's materials will be more sensitive to low reading levels among inner city children. And they will avoid pictures showing families with both a mother and father, a setting unfamiliar to many children.
The 20 Baltimore schools to take part in the study have not yet been selected, Rand said. When they are, they'll be divided into four groups.
Children in the first group will receive no new assistance in coping with their asthma. Those in the second group will take part in a program of eight 90-minute educational sessions designed to teach them more about their asthma, its causes and how to cope with it effectively.
The researchers will take a community-based approach with children in the third group of schools. Community health workers will work directly with the students' parents and teach them how they can reduce the frequency and severity of their child's asthmatic attacks.
Children in the fourth group of schools will benefit from both the school-based and community-based approaches.
The effectiveness of each approach will be evaluated on the basis of its impact on the children's health, the family's health care use and the child's school performance. The first results are expected in about a year, Rand said.
The study is being paid for through a grant from the National Institutes of Health.