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January 2002, Vol 92, No. 1 | American Journal of Public Health 45-46
© 2002 American Public Health Association

RESEARCH AND PRACTICE

School-Based Screening for Asthma in Third-Grade Urban Children: The Passaic Asthma Reduction Effort Survey

Natalie C. G. Freeman, PhD, MPH, Dona Schneider, PhD, MPH and Patricia McGarvey, MA, RN

Natalie C. G. Freeman is with the Department of Environmental and Community Medicine, Robert Wood Johnson Medical School, Piscataway, NJ. Dona Schneider is with the Edward J. Bloustein School of Planning and Public Policy, Rutgers University, New Brunswick, NJ. Natalie C. G. Freeman and Dona Schneider are members of the Environmental and Occupational Health Sciences Institute, Piscataway, NJ. Patricia McGarvey is with Health First, Passaic Beth Israel Hospital, Passaic, NJ.

Correspondence: Requests for reprints should be sent to Natalie C.G. Freeman, PhD, MPH, 11 Cleveland Cir, Skillman, NJ 08558 (e-mail: nfreeman{at}eohsi.rutgers.edu).


   INTRODUCTION
TOP
 INTRODUCTION
METHODS
 RESULTS
 DISCUSSION
 References
 
A communitywide asthma reduction health initiative targeted all third graders (n = 1052) in the public and private schools of Passaic, NJ, for the 1998–1999 school year. The objective of the initiative was to screen all third-grade children for asthma or respiratory dysfunction.


   METHODS
TOP
 INTRODUCTION
 METHODS
RESULTS
 DISCUSSION
 References
 
The initiative included an in-class asthma education module, followed by a 3-pronged screening program: child self-report questionnaires, matched parental questionnaires, and matched spirometry readings with physician interpretations. Children at high risk for asthma were referred for medical evaluation. Nearly complete questionnaire data were obtained from 976 children (93% of the target population) in class. Questionnaires were returned by 818 parents (78% of the target population), and 47% of these were completed in Spanish. A respiratory therapist obtained spirometry readings from 615 children (58% of the target population). Because the population was highly mobile and the children had many school absences, completion of all parts of the screening program was difficult. The full complement of matched parent and child questionnaires with valid spirometry test results was obtained for 501 children (48% of the target population). Of those, 455 had race/ethnicity specified on the parental questionnaire.


   RESULTS
TOP
 INTRODUCTION
 METHODS
 RESULTS
DISCUSSION
 References
 
Racial/ethnic characteristics of the participants reflected the population of Passaic. More than 50% of all children reported asthma-related symptoms, but these were not associated with physician interpretation of spirometry tests and forced expiratory volume in 1 second (FEV1) or forced vital capacity measures. Children reported an average of 5 symptoms per child, whereas parents reported an average of 2 symptoms. On the basis of parents' responses, 21% of the children had been given diagnoses of asthma or related respiratory problems, yet only 11% of the children were reported to be taking medications for these medical conditions. Asthma in other members of the family was reported by 38% of the parents.

Almost 19% of the participating children had forced vital capacity values below 75% of the predicted forced vital capacity values, and almost 13% had FEV1 values below 75% of the predicted FEV1 values. Physicians detected abnormal spirometry values in 22% of the children. Significant differences were found in abnormal evaluations by race/ethnicity, with Blacks and Asians showing more abnormal evaluations and Dominicans having more than other Hispanic groups in the community (Table 1Go). Environmental tobacco smoke in the home showed a dose response to impaired spirometry based on physician interpretation. Children from homes with no tobacco smoke had fewer abnormal readings than did those from homes with a little smoking, whereas children from homes with medium amounts of smoking had the greatest percentage of abnormal spirometry readings.


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  		TABLE 1— —Population Distribution, by Race/Ethnicity, and Percentage of Each Subgroup With Physician-Interpreted Abnormal Spirometry Readings (n = 455)
 

   DISCUSSION
TOP
 INTRODUCTION
 METHODS
 RESULTS
 DISCUSSION
References
 
Given that parents reported that 21% of the children had been previously diagnosed with asthma and this screening effort identified abnormal spirometry values in an additional 5% of the undiagnosed children, asthma is a significant health problem in this population. The findings from this screening effort most likely underestimated the problem of undiagnosed asthma, because children who were reported on the parental questionnaire to have high daily exposures to environmental tobacco smoke were less likely to have a spirometry test than were children with little exposure. This means that the screening program may not have identified many children at high risk. The spirometry results from this diverse and predominantly Hispanic community suggest that simple classifications as to Hispanic or non-Hispanic may not be adequate for identifying children at risk.1–3

The self-reported child questionnaire about asthma symptoms was not a good predictor of risk for asthma, but several items on the parental questionnaire may be useful for identifying children at risk: (1) daily tobacco smoke exposure (dose response to environmental tobacco smoke), (2) child coughs frequently (for FEV1 < 65% predicted), and (3) child coughs night and morning (for FEV1 < 65% predicted). Our findings suggest that reducing exposure to environmental tobacco smoke could reduce the burden of asthma in this population.

Finally, because only half of all the children with asthma were receiving medical management, placing these children on asthma protocols should help reduce morbidity in this population. Such coordinated efforts by schools offer the promise of reducing morbidity and absenteeism caused by asthma4–7 in this diverse population.


   Acknowledgments
 
This pilot project was funded by the Robert Wood Johnson Foundation–New Jersey Health Initiatives.

The authors would like to thank the Robert Wood Johnson Foundation–New Jersey Health Initiatives and the members of the Passaic Advisory Council, St. Mary's Hospital, the Passaic Board of Education, the Passaic Parochial Schools, Yeshiva K'tana, Children's Day Nursery, Our Lady of Fatima Day Care, Guidance Guild, New Bairn School, Passaic Head Start, Passaic Health Department, Hispanic Information Center, Rutgers University School of Urban Studies and Community Health, Felician College Department of Professional Nursing, and the project interns, Carrie Bogert and Lenora Roth. We especially would like to thank Ellen Ziff, MS, the original director of the Passaic Asthma Reduction Effort, for developing this project.


   Footnotes
 
N. C. G. Freeman and D. Schneider were advisers to the Passaic Asthma Reduction Effort in its development and analysis stages. All of the authors were involved in analyzing the data and in writing the report.

Peer Reviewed

Accepted for publication August 27, 2001.


   References
TOP
 INTRODUCTION
 METHODS
 RESULTS
 DISCUSSION
 References
 
1. Yoos HL, McMullen A, Bezek S, et al. An asthma management program for urban minority children. J Pediatr Health Care. 1995;11:66–74.

2. Kercsmar CM. Issues in inner city asthma: ethnicity, economics and education. Paper presented at: American Thoracic Society's International Conference; May 16–21, 1997; San Francisco, Calif.

3. Weitzman M, Gortmaker S, Sobol A. Racial, social and environmental risks for childhood asthma. Am J Dis Child.1990;122:1189–1193.

4. Bucher L, Dryer C, Hendrix E, Wong N. Statewide assessment of school-age children with asthma in Delaware. J Sch Health.1998;68:276–281.[Medline]

5. Bauer EJ, Lurie N, Yeh C, Grant EN. Screening for asthma in an inner-city elementary school in Minneapolis, Minnesota. J Sch Health.1999;69:12–16.[Medline]

6. Meurer JR, McKenzie S, Mischler E, Subichin S, Malloy M, George V. The Awesome Asthma School Days program: educating children, inspiring a community. J Sch Health.1999;69:63–68.[Medline]

7. Maier WC, Arrighi HM, Morray B, Llewellyn C, Redding GJ. Indoor risk factors for asthma and wheezing among Seattle school children. Environ Health Perspect. 1997;105:208–214.[Medline]




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