The effect of family routines on care for inner city children with asthma.

This article provides the results of a study utilizing baseline data from the School-Based Asthma Therapy Trial, an ongoing comprehensive school-based intervention for urban children. We examined the effect of family routines as measured by the Asthma Routines Questionnaire on asthma care measures of trigger control and medication adherence, as well as on parental quality of life. We found that families with more asthma routines had better adherence with preventive medications (r = .

Pearls and pitfalls of community-based group interventions for adolescents: lessons learned from an adolescent asthma cAMP study.

This paper explores specific challenges in implementing community-based group interventions with adolescents and makes practical suggestions to researchers who contemplate the group approach. Group interventions have important implications for adolescent research and program development in the area of chronic illness. They have a capacity to address participants' psychosocial needs as well as to offer a cost and time-effective opportunity for disease-specific education.

Don't ask, don't tell: parental nondisclosure of complementary and alternative medicine and over-the-counter medication use in children's asthma management.

Introduction: Parent-health care provider (HCP) communication is an important component of pediatric asthma management. Given the high prevalence of complementary and alternative medicine (CAM) and over-the-counter (OTC) medication use among this population, it is important to examine parental nondisclosure of these asthma management strategies.

Method: One-time interview and 1-year retrospective medical record review with 228 parents of 5- to 12-year-old children with asthma enrolled from six pediatric primary care practices examining parental nondisclosure of CAM and OTC medication use, reasons for nondisclosure, medical record documentation of CAM usage, and association between parent-HCP relationship and nondisclosure.

The impact of the parental illness representation on disease management in childhood asthma.

Background: Despite significant advances in treatment modalities, morbidity due to childhood asthma has continued to increase, particularly for poor and minority children.

Objectives: To describe the parental illness representation of asthma in juxtaposition to the professional model of asthma and to evaluate the impact of that illness representation on the adequacy of the child's medication regimen.

Methods: Parents (n = 228) of children with asthma were interviewed regarding illness beliefs using a semistructured interview.

Complementary and alternative medicine use in children with asthma: prevalence and sociodemographic profile of users.

Research on complementary and alternative medicine use in children with asthma is in its infancy. This study examined the prevalence, types of CAM used and sociodemographic differences in CAM use among children 5-12 years with asthma. 65% of parents reported using CAM.

Asthma care of children in clinical practice: do parents report receiving appropriate education?

Unlabelled: This paper describes asthma education received from the health care provider as reported by parents of children with asthma and evaluates differences in their report based on socio-demographic and disease characteristics.

Methods: Parents of 228 children with asthma were recruited from diverse clinical practice sites and asked to report on the level of education received in key content areas the National Asthma Education and Prevention Program identified as critical.

Results: The overall proportion of education content fully discussed was 66%.

Impact of asthma education received from health care providers on parental illness representation in childhood asthma.

The burden of asthma has increased dramatically despite increased understanding of asthma and new medication regimens. Data reported here are part of a larger study investigating factors that influence parental asthma illness representation and the impact of this representation on treatment outcomes, including the parent/health care provider relationship. We investigated the influence of asthma related education provided by health care providers on these outcomes.

Inadequate therapy and poor symptom control among children with asthma: findings from a multistate sample.

Objectives: Asthma continues to cause significant morbidity in children. We hypothesized that many children still do not use recommended preventive medications, or they have ineffective symptom control despite preventive medication use. The aim of this study was 1) to describe the use of preventive medications among children with persistent asthma, 2) to determine whether children using preventive medications have adequate asthma control, and 3) to identify factors associated with poor control.

Quantifying preventive asthma care delivered at office visits: the Preventive Asthma Care-Composite Index (PAC-CI).

Our objective was to develop a composite index to measure and quantify preventive asthma care delivered in the primary care office. We documented preventive actions used for children with asthma at the time of an office visit and weighted actions based on their intensity to create a composite index. The usefulness of the index was supported by significant correlations with several measures of symptom severity.

Treatment regimens and health care utilization in children with persistent asthma symptoms.

This study evaluated the anti-inflammatory medication regimens in children with persistent asthma, determined their health care utilization patterns, and evaluated factors associated with failure to seek and/or receive appropriate treatment. Parents of 68% of children who qualified for anti-inflammatory medications by National Asthma Education and Prevention Program (NAEPP) guidelines reported their use. However, only 14% received an optimal regimen (mild intermittent symptoms), while 55% were still symptomatic despite reported medications (suboptimal regimen).

Symptom reporting in childhood asthma: a comparison of assessment methods.

Background: One barrier to receiving adequate asthma care is inaccurate estimations of symptom severity.

Aims: To interview parents of children with asthma in order to: (1) describe the range of reported illness severity using three unstructured methods of assessment; (2) determine which assessment method is least likely to result in a "critical error" that could adversely influence the child's care; and (3) determine whether the likelihood of making a "critical error" varies by sociodemographic characteristics.

Methods: A total of 228 parents of children with asthma participated.

Improved asthma care after enrollment in the State Children's Health Insurance Program in New York.

Background: Uninsured children with asthma are known to face barriers to asthma care, but little is known about the impact of health insurance on asthma care.

Objectives: We sought to assess the impact of New York's State Children's Health Insurance Program (SCHIP) on health care for children with asthma.

Design: Parents of a stratified random sample of new enrollees in New York's SCHIP were interviewed by telephone shortly after enrollment (baseline, n = 2644 [74% of eligible children]) and 1 year later (follow-up, n = 2310 [87%]).

Parental beliefs about medications and medication adherence among urban children with asthma.

Background: Although national guidelines recommend controller medications for children with persistent asthma, adherence is poor. Prior studies have begun to explore parental beliefs regarding controller asthma medications and their effect on adherence.

Objective: To describe parental beliefs about controller medications among a community-based sample of urban children with persistent asthma and to examine the relationship between parental beliefs and adherence.

The language of breathlessness: do families and health care providers speak the same language when describing asthma symptoms?

Introduction: Effective communication about symptoms is a critical prerequisite to appropriate treatment. Study aims were to: (a) document the symptoms that children with asthma and their parents associate with asthma, (b) identify differences between the "professional model "of asthma symptoms and the "lay model," (c) describe the family's proposed action in response to symptoms, and (d) investigate the congruence between parental assessment of "good control" and severity obtained using National Asthma Education and Prevention Program criteria.

Method: Children with asthma and their parents (N = 228) were recruited from diverse clinical practice sites.

A randomized trial of primary care provider prompting to enhance preventive asthma therapy.

Background: Guidelines recommend preventive medications for all children with persistent asthma, yet young urban children often receive inadequate therapy. This may occur in part because primary care providers are unaware of the severity of their patients' symptoms.

Objective: To determine whether systematic school-based asthma screening, coupled with primary care provider notification of asthma severity, will prompt providers to take preventive medication action (prescribe a new preventive medication or change a current dose).

The impact of childhood asthma on parental quality of life.

Measuring the quality of life of caregivers is important for interventions designed for young children with asthma. However, little is known about the impact of childhood asthma on parental quality of life for certain subgroups. This study included the families of young urban children with mild persistent to severe persistent asthma.

Benefits of a school-based asthma treatment program in the absence of secondhand smoke exposure: results of a randomized clinical trial.

Background: Daily maintenance medications are recommended for all children with mild persistent to severe persistent asthma; however, poor adherence to these medications is common.

Objective: To evaluate the impact of school-based provision of inhaled corticosteroids on asthma severity among urban children with mild persistent to severe persistent asthma.

Design: Children aged 3 to 7 years with mild persistent to severe persistent asthma were identified at the start of the 2000-2001 and 2001-2002 school years in Rochester.

Asthma management across the life span: the child with asthma.

Childhood asthma has an adverse impact on children, families, and society. Treatment of asthma presents special challenges related to diagnosis, ongoing symptom monitoring, and treatment when the patient is a child. To be effective, treatment needs to be medically sound and developmentally appropriate.

Barriers to anti-inflammatory medication use in childhood asthma.

Objectives: To identify parental barriers to anti-inflammatory medication use and to develop an instrument for use in research and health care settings to identify at-risk populations.

Methods: Instrument development consisted of 4 phases: 1) gaining the professional perspective (N = 8 experts in asthma management), 2) gaining the perspective of parents of children with asthma (qualitative interviews with 21 parents), 3) instrument pretesting and refinement (N = 133 parents), and 4) determining the instrument's psychometric properties. Study participants were diverse in race, socioeconomic status, and the child's illness severity.

Parental perceptions of their child's asthma: management and medication use.

Introduction: Adequate treatment for asthma depends on accurate assessment and intervention by the parent and child and timely communication with the provider. These actions by the parent may be affected by their understanding of asthma management and their concerns about medications being prescribed. This research reports parental experiences with their children with asthma, specifically their beliefs, knowledge, and attitudes about asthma management, including medication use.

Symptom perception in childhood asthma: how accurate are children and their parents?

Accurate symptom perception on the part of the patient is a critical component of asthma management. Limited data are available about how accurate children and their parents are in evaluating asthma symptoms. This study was designed to determine the symptom perceptual accuracy of families and to identify risk factors associated with inaccurate symptom perception.

A potential pitfall in provider assessments of the quality of asthma control.

Background: Pediatricians elicit information about asthma control from parents to help formulate management plans. If parents of children with significant asthma symptoms inappropriately indicate good control, physician recommendations may not be optimal. We examined whether a single general question about asthma control might lead to inaccurate assessment of severity.

Symptom monitoring in childhood asthma: a randomized clinical trial comparing peak expiratory flow rate with symptom monitoring.

Background: Accurate symptom evaluation is a critical component of asthma management. Limited data are available about the accuracy of symptom evaluation by children with asthma and their parents, or the impact of various symptom-monitoring strategies on asthma morbidity outcomes.

Objective: The purpose of this randomized clinical trial was to evaluate the effect of three different intensities of symptom monitoring on asthma morbidity outcomes.

Peak flow meters in childhood asthma: parent report of use and perceived usefulness.

Introduction: Peak flow meters (PFMs) in children with moderate to severe asthma have been used to monitor changes in asthma status and inform treatment decisions. However, their usefulness and the likelihood of their long-term use by families remains controversial.

Methods: One hundred sixty-eight children ages 6 to 19 years were enrolled in a longitudinal randomized clinical trial to evaluate the impact of 3 different intensities of symptom monitoring on diverse clinical outcomes: subjective symptom monitoring, symptom-time PFM monitoring, and daily PFM monitoring.