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Background: The composition of the gut microbiome has been associated with development of atopic conditions such as food allergy (FA) and asthma. African American or Black children with FA have higher rate of asthma compared to their White counterparts., Objective: We sought to investigate whether the diversity and relative abundance (RA) of gut microbiota is different between children with FA from different racial backgrounds living in the same cities. Furthermore, we aimed to understand whether the difference in the gut microbiota is associated with asthma in children with FA., Methods: We analyzed and compared the stool microbiome of a cohort of Black and White children with FA by shotgun genomic sequencing., Results: A total of 152 children with IgE-mediated FA enrolled onto FORWARD (Food Allergy Outcomes Related to White and African American Racial Differences); 30 Black and 122 White children were included. The RA of several bacteria was associated with race and asthma. Most notably the RA of Bacteroides thetaiotaomicron, Chlamydia thrachomatis, Parabacteroides goldsteinii, and Bacteroides eggerthii were significantly higher, while the RA of Bifidobacterium sp CAG:754, Parabacterium johnsonii, Bacteroides intestinalis, and Bifidobacterium breve were significantly lower in stool samples of Black children compared to White children. Asthma was associated with lower RA of B breve, Bifidobacterium catenulatum, Prevotella copri, Veilloella sp CAG:933, and Bacteroides plebius, and higher RA of 3 Bacteroides species., Conclusions: The observed variations in the gut microbiota of Black and White children such as differences in the Bacteroides and Bifidobacterium species along with their association to history of asthma in our cohort is indicative of their potential role in the higher rate of asthma observed among Black children with FA., (Copyright © 2023 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

Background: Previous studies have reported that Black children with food allergy (FA) have higher risk of atopic comorbidities than White children., Objective: Our study sought to understand if disparities in the prevalence of atopic comorbidities among children with FA are driven by individual and community-level socioeconomic status (SES)., Methods: We analyzed data from a prospective, multicenter cohort investigating the natural history of pediatric atopy: the Food Allergy Outcomes Related to White and African American Racial Differences (FORWARD) study. A validated, multicomponent area deprivation index (ADI) percentile score was tabulated by the census block group for each subject's home address. The association of ADI with atopic comorbidities in FA was assessed via multivariable regression analysis., Results: Of the 700 children in this study, the mean ADI was 37.7 (95% confidence interval: 35.6-39.7). The mean ADI was higher in children with asthma (43.3) compared with those without asthma (31.8), which remained significant after adjusting for race (P < .0001). Children with allergic rhinitis (AR) had a higher mean ADI (39.1) compared with those without (33.4) (P = .008). ADI was associated with secondhand smoking, parents' education, and household income. Black children had a higher risk for asthma after adjusting for ADI and SES-related factors., Conclusion: The independent association of ADI with asthma and AR, regardless of race, suggests a role of neighborhood-level socioeconomic deprivation in the development of these conditions among children with FA. Black children with FA remained at higher risk for asthma after adjusting for SES-related variables, which can indicate an independent risk for asthma in these children., (Copyright © 2023 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

Background: Whether children and people with asthma and allergic diseases are at increased risk for severe acute respiratory syndrome virus 2 (SARS-CoV-2) infection is unknown., Objective: Our aims were to determine the incidence of SARS-CoV-2 infection in households with children and to also determine whether self-reported asthma and/or other allergic diseases are associated with infection and household transmission., Methods: For 6 months, biweekly nasal swabs and weekly surveys were conducted within 1394 households (N = 4142 participants) to identify incident SARS-CoV-2 infections from May 2020 to February 2021, which was the pandemic period largely before a vaccine and before the emergence of SARS-CoV-2 variants. Participant and household infection and household transmission probabilities were calculated by using time-to-event analyses, and factors associated with infection and transmission risk were determined by using regression analyses., Results: In all, 147 households (261 participants) tested positive for SARS-CoV-2. The household SARS-CoV-2 infection probability was 25.8%; the participant infection probability was similar for children (14.0% [95% CI = 8.0%-19.6%]), teenagers (12.1% [95% CI = 8.2%-15.9%]), and adults (14.0% [95% CI = 9.5%-18.4%]). Infections were symptomatic in 24.5% of children, 41.2% of teenagers, and 62.5% of adults. Self-reported doctor-diagnosed asthma was not a risk factor for infection (adjusted hazard ratio [aHR] = 1.04 [95% CI = 0.73-1.46]), nor was upper respiratory allergy or eczema. Self-reported doctor-diagnosed food allergy was associated with lower infection risk (aHR = 0.50 [95% CI = 0.32-0.81]); higher body mass index was associated with increased infection risk (aHR per 10-point increase = 1.09 [95% CI = 1.03-1.15]). The household secondary attack rate was 57.7%. Asthma was not associated with household transmission, but transmission was lower in households with food allergy (adjusted odds ratio = 0.43 [95% CI = 0.19-0.96]; P = .04)., Conclusion: Asthma does not increase the risk of SARS-CoV-2 infection. Food allergy is associated with lower infection risk, whereas body mass index is associated with increased infection risk. Understanding how these factors modify infection risk may offer new avenues for preventing infection., (Copyright © 2022. Published by Elsevier Inc.)

Objective: Little is known about the implementation challenges health providers might face with the use of digital health in outpatient asthma care. To qualitatively explore the experience of health providers with electronic medication monitoring (EMM) using an implementation science framework., Methods: Using the Consolidated Framework of Implementation Research (CFIR), we conducted interviews ( n  = 10) exploring health providers' experience with EMM with asthma patients from 5 primary care or specialty clinics. The EMM tracked albuterol and inhaled corticosteroid (ICS) use, and health providers called parents whenever ICS adherence waned, or albuterol use increased. Interviews were audio-recorded, transcribed, and deductively analyzed using directed content analysis., Results: Health providers reported the intervention's primary advantage, compared with current asthma care, was the ability to monitor medication use at-home. Most felt the intervention improved care delivery. Nurses and medical assistants described a process of phone calls and checking alerts, that had varying levels of administrative burden and complexity. Health providers felt that sustained implementation of the intervention model would require additional employees to handle the administrative and clinical workload. Half of the interviewed providers were unsure if patient needs were met by the intervention, while some cited technology syncing issues, others liked the enhanced interactions for asthma education., Conclusion: Health providers reported positive experiences supporting parents and children with asthma using EMM but also highlighted intervention components that needed improvement or refinement to yield successful implementation in outpatient pediatric clinics. Recommendations for enhancing the intervention for a scaled-up implementation were discussed.

Objective: Self-efficacy is the personal belief that a behavior can produce a desired result; and in asthma, self-efficacy in asthma care has been related to improvements in asthma outcomes and children's quality of life. To appreciate the full burden of asthma on families, the relationship between parental self-efficacy and quality of life also needs further study. We aim to characterize this relationship. Methods: Secondary analysis of measurements of parents of children with persistent asthma ( n  = 252; ages 4-17 years) from a large urban area were identified from a randomized trial; the association between baseline assessments of parental quality of life, measured by the Pediatric Asthma Caregiver's Quality of Life Questionnaire (PACQLQ), and parental self-efficacy, measured through the Parental Asthma Management Self-Efficacy Scale (PAMSES), were examined through multivariable linear regression. Results: Parental self-efficacy in asthma was positively associated with quality of life among parents of racially and ethnically diverse children ( p  = 0.01). Confidence in using medications correctly ( p  = 0.03), having inhalers during a child's serious breathing problem ( p  = 0.02), and knowing which medications to use during a child's serious breathing problem ( p  = 0.04) were associated with a clinically meaningful difference in parental quality of life. Other significant factors associated with parental quality of life included Hispanic/Latino ethnicity ( p  < 0.01) of the child and Asthma Control Test scores ( p  < 0.01). Conclusion: The findings suggest that improving parental confidence on when and how to use their child's asthma medications, particularly during an asthma attack, might be clinically meaningful in enhancing parent's quality of life.

Background: Although sensor-based monitoring of daily inhaled corticosteroids (ICSs) and short-acting β-agonist medications may improve asthma outcomes, the effectiveness of these interventions in diverse pediatric populations remains unclear., Methods: Caregiver and child dyads were randomly assigned to receive inhaler sensors that allowed for caregiver and clinician electronic monitoring of medications. End points included Asthma Control Test scores (≥19 indicated asthma control) and asthma health care use. Caregiver quality of life (QoL) and child ICS adherence were also assessed. Multilevel models were used to estimate adjusted changes from baseline., Results: Dyads were assigned to the control ( n = 127) or intervention ( n = 125) arms. At the end line, the mean Asthma Control Test score increased from 19.1 (SE = 0.3) to 21.8 (SE = 0.4) among the intervention and from 19.4 (SE = 0.3) to 19.9 (SE = 0.4) among the control (Δ intervention-control = 2.2; SE = 0.6; P < .01). Adjusted rates of emergency department visits and hospitalizations among the intervention were significantly greater (incidence rate ratio emergency department = 2.2; SE = 0.5; P < .01; incidence rate ratio hospital = 3.4; SE = 1.4; P < .01) at endline than the control. Caregiver QoL was greater among the intervention at the endline (Δ intervention-control = 0.3; SE = 0.2; P = .1) than the control., Conclusions: Findings suggest that sensor-based inhaler monitoring with clinical feedback may improve asthma control and caregiver QoL within diverse populations. Higher health care use was observed among the intervention participants relative to the control, indicating further refinement is warranted., Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose., (Copyright © 2021 by the American Academy of Pediatrics.)

Objectives: The objective of the study was to determine whether parents who use a low-literacy, pictogram- and photograph-based written asthma action plan (WAAP) have a better understanding of child asthma management compared to parents using a standard plan., Methods: A randomized controlled study was carried out in 2 urban pediatric outpatient clinics. Inclusion criteria were English- and Spanish-speaking parents of 2- to 12-year-old asthmatic children. Parents were randomized to receive a low-literacy or standard asthma action plan (American Academy of Allergy, Asthma and Immunology) for a hypothetical patient on controller and rescue medications. A structured questionnaire was used to assess whether there was an error in knowledge of (1) medications to give everyday and when sick, (2) need for spacer use, and (3) appropriate emergency response to give albuterol and seek medical help. Multiple logistic regression analyses were performed, adjusting for parent age, health literacy (Newest Vital Sign); child asthma severity, medications; and site., Results: 217 parents were randomized (109 intervention and 108 control). Parents who received the low-literacy plan were (1) less likely to make an error in knowledge of medications to take everyday and when sick compared to parents who received the standard plan (63.0 vs. 77.3%, p = 0.03; adjusted odds ratio [AOR] = 0.5[95% confidence interval: 0.2-0.9]) and (2) less likely to make an error regarding spacer use (14.0 vs. 51.1%, p < 0.001; AOR = 0.1 [0.06-0.3]). No difference in error in appropriate emergency response was seen (43.1 vs. 48.1%, p = 0.5)., Conclusions: Use of a low-literacy WAAP was associated with better parent understanding of asthma management. Further study is needed to assess whether the use of this action plan improves child asthma outcomes.

Background: Childhood food allergy and asthma rates are increasing. The hygiene hypothesis has been proposed as an explanation for the increased incidence of allergic disease., Objective: To describe the association of childhood food allergy and asthma with hygiene factors, such as the number of siblings, antibiotic use, infection history, pet exposure, child care exposure, and maternalchild factors., Methods: Children ages 021 years old (N = 1359) were recruited for a cross-sectional family-based study, including children with food allergy and children without food allergy, and their siblings. We assessed the associations between childhood food allergy and asthma with hygiene factors., Results: Of the 1359 children, 832 (61.2%) had food allergy, and 406 (30%) had asthma. In the adjusted analysis, the prevalence of food allergy was increased if there was a history of skin infection (prevalence ratio [RRR] 1.12 [95% confidence interval {CI}, 1.011.24]) or eczema (RRR 1.89 [95% CI, 1.702.10]). The prevalence of asthma was increased with a history of respiratory syncytial virus infection (RRR 1.60 [95% CI, 1.341.90]) or eczema (RRR 1.54 [95% CI, 1.271.86]). A greater number of siblings were associated with a decreased prevalence of food allergy (RRR 0.79 [95% CI, 0.750.84]) and asthma (RRR 0.82 [95% CI, 0.740.91])., Conclusion: Our findings supported the accumulating evidence of an association between skin infections and eczema with food allergy. Because these results could be subject to recall bias, additional prospective studies are needed to substantiate these findings.

Background and Objectives: The use of written asthma action plans (WAAPs) has been associated with reduced asthma-related morbidity, but there are concerns about their complexity. We developed a health literacy-informed, pictogram- and photograph-based WAAP and examined whether providers who used it, with no training, would have better asthma counseling quality compared with those who used a standard plan., Methods: Physicians at 2 academic centers randomized to use a low-literacy or standard action plan (American Academy of Allergy, Asthma and Immunology) to counsel the hypothetical parent of child with moderate persistent asthma (regimen: Flovent 110 μg 2 puffs twice daily, Singulair 5 mg daily, Albuterol 2 puffs every 4 hours as needed). Two blinded raters independently reviewed counseling transcriptions., Primary Outcome Measures: medication instructions presented with times of day (eg, morning and night vs number of times per day) and inhaler color; spacer use recommended; need for everyday medications, even when sick, addressed; and explicit symptoms used., Results: 119 providers were randomly assigned (61 low literacy, 58 standard). Providers who used the low-literacy plan were more likely to use times of day (eg, Flovent morning and night, 96.7% vs 51.7%, P < .001; odds ratio [OR] = 27.5; 95% confidence interval [CI], 6.1-123.4), recommend spacer use (eg, Albuterol, 83.6% vs 43.1%, P < .001; OR = 6.7; 95% CI, 2.9-15.8), address need for daily medications when sick (93.4% vs 34.5%, P < .001; OR = 27.1; 95% CI, 8.6-85.4), use explicit symptoms (eg, "ribs show when breathing," 54.1% vs 3.4%, P < .001; OR = 33.0; 95% CI, 7.4-147.5). Few mentioned inhaler color. Mean (SD) counseling time was similar (3.9 [2.5] vs 3.8 [2.6] minutes, P = .8)., Conclusions: Use of a low-literacy WAAP improves the quality of asthma counseling by helping providers target key issues by using recommended clear communication principles., (Copyright © 2016 by the American Academy of Pediatrics.)

Objectives: This study aimed to characterize asthma and food allergy reporting and management in Chicago Public Schools., Methods: Demographic and health data for students who have asthma and food allergy were extracted from the Chicago Public Schools database. Demographic and geographic variability and the existence of school health management plans were analyzed, and multiple logistic regression models were computed. Home addresses were geocoded to create maps of case counts per community area., Results: Approximately 18,000 asthmatic and 4000 food allergic students were identified. Of asthmatic students, 9.3% had a food allergy; of food allergic students, 40.1% had asthma. Asthma odds were significantly higher among black and Hispanic students (odds ratio [OR] = 2.3 and 1.3, respectively), whereas food allergy odds were significantly higher among black students (OR = 1.1; 95% confidence interval [CI], 1.0-1.3) and significantly lower among Hispanic students (OR = 0.8; 95% CI, 0.7-0.9). Only 24.3% of students who had asthma and 50.9% of students who had food allergy had a school health management plan on file. Odds of having a school health management plan were significantly higher among students with both conditions, but the likelihood of having a plan on file was significantly lower among racial/ethnic minority and low-income students, regardless of medical condition., Conclusions: Only 1 in 4 students who have asthma and half of food allergic students have health management plans in schools, with lower numbers among minority and low-income students. Improving chronic disease reporting and access to school health management plans is critical., (Copyright © 2014 by the American Academy of Pediatrics.)

The Student Asthma Research Team (START) program was designed to enable students to explore socio-ecological factors contributing to asthma through the use of Photovoice, a technique that gathers both photographs and personal experiences from participants. The photographs taken by and commentary from student participants were integrated into public service announcements (PSAs) intended to increase community asthma awareness and catalyze behavior change. This article evaluates the effectiveness of these student-directed PSAs at improving asthma awareness among peers and community members. Pre-PSA, immediate post-PSA, and 4 month post-PSA follow-up assessments were conducted to evaluate changes in community members' asthma knowledge and behavior. The student-directed PSAs were found to significantly increase asthma knowledge among community members, irrespective of age, gender, or race. Increased knowledge persisted through the 4-month post-PSA follow-up. Of the thirty-six participants who were successfully contacted for the follow-up survey, nearly 40 % reported meaningful behavior-change in response to the PSAs. Photovoice and media production techniques were effective in engaging adolescent students--an under-served and often disenfranchised population--in asthma health education through the development and dissemination of PSAs. The extension of participatory techniques such as Photovoice to include the creation of student-directed PSAs holds promise for engaging adolescents in public health initiatives within their communities.

Objective: Recognition of the complexity of asthma management has led to the development of asthma treatment guidelines that include the recommendation that all pediatric asthma patients receive a written asthma action plan. We assessed the readability, suitability, and characteristics of asthma action plans, elements that contribute to the effectiveness of action plan use, particularly for those with limited literacy., Methods: This was a descriptive study of 30 asthma action plans (27 state Department of Health (DOH)-endorsed, 3 national action plans endorsed by 6 states)., Outcome Measures: (1) readability (as assessed by Flesch Reading Ease, Flesch-Kincaid, Gunning Fog, Simple Measure of Gobbledygook, Forcast), (2) suitability (Suitability Assessment of Materials [SAM], adequate: ≥ 0.4; unsuitable: <0.4), (3) action plan characteristics (peak flow vs symptom-based, symptoms, recommended actions)., Results: Mean (SD) overall readability grade level was 7.2 (1.1) (range = 5.7-9.8); 70.0% were above a sixth-grade level. Mean (SD) suitability score was 0.74 (0.14). Overall, all action plans were found to be adequate, although 40.0% had an unsuitable score in at least 1 factor. The highest percent of unsuitable scores were found in the categories of layout/typography (30.0%), learning stimulation/motivation (26.7%), and graphics (13.3%). There were no statistically significant differences between the average grade level or SAM score of state DOH developed action plans and those from or adapted from national organizations. Plans varied with respect to terms used, symptoms included, and recommended actions., Conclusions: Specific improvements in asthma action plans could maximize patient and parent understanding of appropriate asthma management and could particularly benefit individuals with limited literacy skills.

Background: Pediatric asthma is a serious public health problem in Chicago and has been designated a high priority concern by residents of Chicago's Humboldt Park, a diverse community area with a large number of Puerto Rican, African American, and Mexican American families., Methods: In May 2009, following the principles of community-based participatory research, a cross-sectional asthma screening survey was administered to adult caregivers of children attending two Humboldt Park elementary schools. Data were analyzed to determine the prevalence of diagnosed and probable asthma as well as the degree of asthma control among affected children; associations between asthma outcomes and mutable triggers were evaluated., Results: Surveys from 494 children were evaluated. Physician-diagnosed asthma was reported for 24.9% of children and probable asthma identified in an additional 16.2% of children. Asthma was poorly or moderately controlled in 60.0% of diagnosed children. Smoking occurred inside 25.0% of households and 75.0% of caregivers reported idling of vehicles in their community. Report of general stress among caregivers, stress due to community crime, and/or an inability to cope with everyday life were significantly and positively associated with poor asthma morbidity and control among affected children., Conclusions: Despite high prevalence rates and poor asthma morbidity and control in Humboldt Park, the association of these measures with mutable variables is promising. A community-based asthma intervention to address the issues identified in this study is needed to affect positive change.

Background: Little attention has been given to exposure to crime as a possible socioenvironmental contributor to variability in urban childhood asthma prevalence., Objective: To determine the association of violent crime, property crime, and drug abuse violations with childhood asthma prevalence in Chicago., Methods: In 2003-2005, the Chicago Initiative to Raise Asthma Health Equity conducted an asthma screening survey of children in grades K to 8 attending Chicago public and Catholic schools. Crime data were obtained from the Chicago Police Department. In addition to simple regression analysis, multilevel logistic regression analysis was performed to estimate the effect of criminal activity on neighborhood asthma variance., Results: Of the surveys returned, 45,371 (93%) were geocoded into 247 neighborhoods. Neighborhoods were divided into quartile groups by mean asthma prevalence (9%, 12%, 17%, and 22%). Criminal activity (annual incidence per 100,000 people) was significantly higher (P < .001) in neighborhoods with a high asthma prevalence, especially drug abuse violations, which increased more than 6-fold (461 vs 2,921), and violent crimes, which increased more than 3-fold (448 vs 1,566). After adjusting for community race/ethnicity, only violent crime continued to be significantly associated with the neighborhood asthma prevalence (odds ratio, 1.27; 95% confidence interval, 1.04-1.55, P < .05). When considered alongside sociodemographic and individual characteristics, violence continued to contribute significantly (P < .05), explaining 15% of neighborhood variation in childhood asthma., Conclusions: Evidence suggests an association between violent crime and childhood asthma prevalence in Chicago. A deeper understanding of the mechanisms that underlie this association may lend insight into potential interventions to address urban asthma.

Background: Asthma burden in the US is not evenly distributed. Although asthma prevalence varies widely across urban neighborhoods, little attention has been paid to the community as a key contributor., Objective: To determine the effect of positive socio-environmental community factors on childhood asthma prevalence in Chicago., Methods: From 2003 to 2005, an asthma screening survey was conducted among children attending Chicago Public/Catholic schools from kindergarten through eighth grade. One hundred five schools participated, yielding a stratified representation of 4 race-income groups. Positive community factors, such as social capital, economic potential, and community amenities, were assessed by using the Metro Chicago Information Center's Community Vitality Index., Results: Of the surveys returned, 45,177 (92%) were geocoded into 287 neighborhoods. Neighborhoods were divided into quartile groups by asthma prevalence (mean, 8%, 12%, 17%, 25%). Community vitality (54% vs 44%; P < .0001) and economic potential (64% vs 38%; P < .0001) were significantly higher in neighborhoods with low asthma prevalence. Neighborhood interaction (36% vs 73%; P < .0001) and stability (40% vs 53%; P < .0001) were significantly higher in neighborhoods with high asthma prevalence. Overall, positive factors explained 21% of asthma variation. Childhood asthma increased as the black population increased in a community (P < .0001). Accordingly, race/ethnicity was controlled. In black neighborhoods, these factors remained significantly higher in neighborhoods with low asthma prevalence. When considered alongside socio-demographic/individual characteristics, overall community vitality as well as social capital continued to contribute significantly to asthma variation., Conclusion: Asthma prevalence in Chicago is strongly associated with socio-environmental factors thought to enrich a community. A deeper understanding of this impact may lend insight into interventions to reduce childhood asthma.

Nearly 2 decades have elapsed since the National Center for Health Statistics raised concerns regarding the trends in increasing asthma prevalence. Additional research highlighted the large racial disparities and geographic variations in asthma morbidity and mortality rates. Although there was little national consensus on the care of children with asthma at the time, there were improvements in the understanding of the mechanisms and treatment of asthma. It was in this context that the National Heart, Lung, and Blood Institute launched the National Asthma Education and Prevention Program, which convened its first panel of experts to create the national consensus clinical practice guidelines on the treatment of asthma. More than 15 years have passed since the publication of those first guidelines and, in August 2007, the National Heart, Lung, and Blood Institute released its newest updates, which are the product of the National Asthma Education and Prevention Program third expert panel. The release of the updated guidelines serves as an occasion to examine important issues regarding the dissemination and clinical implementation of National Asthma Education and Prevention Program guidelines. The goals of this report are to examine the adoption of earlier versions of the National Asthma Education and Prevention Program guidelines and to suggest opportunities for rapid adoption of the newly released guidelines.

Purpose of Review: In spite of numerous efforts, asthma rates in the United States remain historically high and disparities persist among low-income and minority populations. This review assesses the current status of asthma inequities from the perspective of disease development, progression, and outcomes., Recent Findings: Recent findings highlight the complex and multifactorial nature of asthma. There is a clear line of emerging evidence suggestive of important hierarchical relationships between the predisposed or affected individual and his or her intrapersonal life, familial relationships, social networks, and broader community., Summary: Approaches in basic, clinical, and translational asthma research must be modified to account for the social construct of race and to detangle complex interactions of contributing factors at and across the individual and community level. However, there are a number of obvious opportunities to dramatically reduce asthma disparities at hand.

The goal of this study was to characterize asthma knowledge in high risk neighborhoods compared to a random sample of residents in the Chicago area. The Chicago Community Asthma Survey-32 (CCAS-32) was administered to 1006 Chicago-area residents and 388 residents in 4 high-risk Chicago inner-city neighborhoods. There was a significant difference in asthma knowledge between groups. The general Chicago-area respondents have an average desirable response rate of 71.6% versus 64.7% for respondents in high-risk communities (p < 0.0001). For some aspects of asthma knowledge, e.g., nocturnal cough, cockroach allergen, and vaporizer use, general knowledge was similarly low. For other aspects, such as the need for asymptomatic asthma visits and chest tightness, there were larger gaps between residents of high risk communities and the general community. High-risk neighborhoods in Chicago had lower asthma knowledge compared to the general Chicago community. This discrepancy may be contributing to the disparities seen in asthma morbidity. Public health efforts to increase asthma knowledge in these high risk minority communities may help reduce these disparities. Important misconceptions exist about asthma triggers, signs and symptoms, especially among lower income African American communities, that should be addressed by physicians.

Background: Childhood asthma prevalence has been shown to be higher in urban communities overall without an understanding of differences by neighborhood., Objective: To characterize the geographic variability of childhood asthma prevalence among neighborhoods in Chicago., Methods: Asthma screening was conducted among children attending 105 Chicago schools as part of the Chicago Initiative to Raise Asthma Health Equity. Additional child information included age, sex, race/ethnicity, and household members with asthma. Surveys were geocoded and linked with neighborhoods. Neighborhood information on race, education, and income was based on 2000 census data. Bivariate and multilevel analyses were performed., Results: Of the 48,917 surveys, 41,255 (84.3%) were geocoded into 287 neighborhoods. Asthma prevalence among all children was 12.9%. Asthma rates varied among neighborhoods from 0% to 44% (interquartile range, 8% to 24%). Asthma prevalence (mean, SD, range) in predominantly black neighborhoods (19.9, +/-7, 4% to 44%) was higher than in predominantly white neighborhoods (11.4, +/-4.7, 2% to 30%) and predominantly Hispanic neighborhoods (12.1, +/-6.8, 0% to 29%). Although sex, age, household members with asthma, and neighborhood income significantly affected asthma prevalence, they did not explain the differences seen between neighborhoods. Race explained a significant proportion (about 80%) but not all of this variation., Conclusion: Childhood asthma prevalence varies widely by neighborhood within this urban environment. Adjacent areas in Chicago were identified with significantly different asthma prevalence. A better understanding of the effect of neighborhood characteristics may lend insight into potential interventions to reduce childhood asthma.

Background: Large racial differences in asthma morbidity and mortality have prompted research on new interventions, public awareness, and health policy efforts in the past decade., Objective: We sought to characterize recent trends in US asthma hospitalization and mortality for black and white children and adults during the period from 1980 through 2002., Methods: We conducted a successive representative national cohort study of US residents ages 5 to 34 years using data from the National Hospital Discharge Survey and the US vital statistics system. Outcome measures included black/white (B/W) asthma hospitalization and mortality rates, rate ratios, and rate differences., Results: For asthma hospitalizations from 1980 through 2002, children ages 5 to 18 years had a 50% increase in the B/W rate ratio, and the rate difference increased from 22.8 to 28.3 hospitalizations per 10,000 population. For young adults ages 19 to 34 years, the B/W rate ratio increased from 2.3 to 2.8, and the rate difference decreased from 9.6 to 7.9 hospitalizations per 10,000 population. For asthma mortality from 1980 through 2001, children ages 5 to 19 years had a large increase in the B/W rate ratio from 4.5 to 5.6 and in the rate difference from 5.6 to 8.1 deaths per 1,000,000 population. There did not appear to be a significant change in the B/W differences for adults ages 20 to 34 years., Conclusions: For children, there have been notable increases in asthma B/W differences in hospitalizations and mortality since 1980, whereas for adults the increase has been smaller. National efforts to improve asthma care over the past decade do not appear to have reduced this B/W gap. When treating children with asthma, it is important to consider the racial-ethnic factors that might lead to avoidable hospitalizations and premature mortality.

Objectives: To examine patient and hospital characteristics associated with varying hospital charges for children admitted with asthma., Methods: We conducted a retrospective cohort study of children (1-18 years old) hospitalized with asthma using data from the 2000 Kids' Inpatient Database (KID; n = 54,029). Predictors of interest included hospital type (teaching and children's hospitals) and patient characteristics (insurance type and race)., Results: After adjusting for patient and hospital characteristics, hospital charges were similar at teaching and nonteaching hospitals. Charges at children's hospitals were higher by 440 US dollars or 10% (95% CI, 352-528) compared with nonchildren's hospitals. Children with Medicaid had higher charges by 132 US dollars or 3% (95% CI, 57-264) compared to those with private insurance. Compared to White children, Black children had higher charges by 396 US dollars or 10% (95% CI, 352-484), Hispanic children by 924 US dollars or 21% (95% CI, 880-1,012), and Asian children by 572 US dollars or 13% (572 US dollars; 95% CI, 352-792)., Conclusions: Important differences exist in the charges incurred by children with asthma based on patient and hospital characteristics. Efforts to understand the reasons behind the differences may help eliminate unnecessary variation in costs for asthma care.