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Asthma affects 7.1 million children in the United States, disproportionately burdening African American and Latino children. Barriers to asthma control include insufficient patient education and fragmented care. Care coordination represents a compelling approach to improve quality of care and address disparities in asthma. The sites of The Merck Childhood Asthma Network Care Coordination Programs implemented different models of care coordination to suit specific settings—school district, clinic or health care system, and community—and organizational structures. A variety of qualitative data sources were analyzed to determine the role setting played in the manifestation of care coordination at each site. There were inherent strengths and challenges of implementing care coordination in each of the settings, and each site used unique strategies to deliver their programs. The relationship between the lead implementing unit and entities that provided (1) access to the priority population and (2) clinical services to program participants played a critical role in the structure of the programs. The level of support and infrastructure provided by these entities to the lead implementing unit influenced how participants were identified and how asthma care coordinators were integrated into the clinical care team. [ABSTRACT FROM AUTHOR]

Individuals with asthma living in the inner city experience increased asthma morbidity and mortality compared to the US average. The Controlling Asthma in America's Cities Project's Chicago site used a multifaceted approach to improve asthma care. The diverse scope of this project's interventions necessitated the use of novel methods to assess the effect of these interventions on the entire study area. Asthma-related medication-dispensing data were obtained from a large pharmacy chain for prescriptions filled in calendar years 2004-2006 for all individuals aged 5-17 years living in Chicago who filled at least four asthma-related medications within a 12-month period. Inhaled corticosteroid (ICS) use was considered inadequate if an individual had four or more dispensings of a short-acting beta-agonist without at least four dispensings of an ICS agent. Logistic regression was used to compare adequate ICS use in individuals within the intervention area with ICS use in the remainder of the city, after controlling for gender, insurance status, race, and poverty. A significant difference in adequate ICS use was found in years 2 (2005) and 3 (2006) of the project for individuals aged 5-9 in the intervention area (odds ratios for adequate ICS use-year 2, 1.26; CI, 1.04-1.53, p = 0.04; year 3, 1.30; CI, 1.08-1.55, p = 0.008) compared to individuals aged 5-9 in the remainder of the city. There was no similar significant difference in the 10-17 age group. These findings suggest an effect of a large multifaceted asthma intervention in improving medication use in the targeted age group. This methodology might also prove useful in the future for assessing the effect of similar interventions. [ABSTRACT FROM AUTHOR]

Objectives. We analyzed the response of the Chicago Department of Public Health with respect to its effectiveness in providing health care to Hurricane Katrina evacuees arriving in the city. Methods. Between September 12 and October 21, 2005, we conducted a real-time qualitative assessment of a medical unit in Chicago's Hurricane Victim Welcome and Relief Center. A semistructured guide was used to interview 33 emergency responders in an effort to identify key operational successes and failures. Results. The medical unit functioned at a relatively high level, primarily as a result of the flexibility, creativity, and dedication of its staff and the presence of strong leadership. Chronic health care services and prescription refills were the most commonly mentioned services provided, and collaboration with a national pharmacy proved instrumental in reconstructing medication histories. The lack of a comprehensive and well-communicated emergency response plan resulted in several preventable inefficiencies. Conclusions. Our findings highlight the need for improved planning for care of evacuee populations after a major emergency event and the importance of ensuring continuity of care for the most vulnerable. We provide an emergency response preparedness checklist for local public health departments. (Am J Public Health. 2009;99:1496-1504. doi: 10.2105/AJPH.2007.126680) [ABSTRACT FROM AUTHOR]

Recent studies suggest that psychosocial factors may contribute to asthma. We examined associations of stressful life events with asthma prevalence and morbidity among Chicago adolescents. Self-reported asthma, measures of asthma morbidity, and 15 life events were collected from 2026 seventh to ninth grade students from 34 Chicago Catholic schools as part of the International Study of Allergies and Asthma in Childhood in 1994–95. Life events were reported by 77% of adolescents and overall asthma prevalence was 15.5%. Stressful life events in adolescents were significantly related to both asthma and asthma morbidity. Odds of asthma was 1.44 (95% confidence interval [CI] = 1.07, 1.95) for those reporting two to three stressful events and 1.92 (95% CI = 1.41, 2.62) for subjects endorsing more than three stressful events. In adolescents with asthma, number of asthma symptoms (odds ratio [OR] for increase in one event = 1.16, 95% CI = 1.07, 1.27), asthma-related school absenteeism (OR = 1.17, 95% CI = 1.04, 1.32), physician visits for asthma (OR = 1.16, 95% CI = 1.04, 1.29), and hospitalization for asthma (OR = 1.20, 95% CI = 1.001, 1.44) were significantly associated with the number of stressful events, independent of home exposure to cigarette smoke and dampness, use of inhaled substances, and sociodemographic factors. While these results are not sufficient to assign causality in the relationship between stress and asthma, they are supported by a number of other studies and by plausible biologic mechanisms. Assessing and addressing the effects of stressful life events may be helpful in managing asthma in inner city adolescents. [ABSTRACT FROM AUTHOR]

Death certificate data were used to examine asthma mortality among African Americans and Whites aged 5 through 34 years in Chicago from 1968 through 1991. African Americans experienced consistently higher asthma mortality throughout the period. Asthma mortality remained stable among Whites from 1968 through 1991 but increased by 337% among African Americans from 1976 through 1991 (P< .001). The increase was greatest among 20-through 34-year-olds. Between 1979 and 1991, outpatient and emergency department deaths increased significantly, while the proportion of dead-on-arrival cases remained stable at 51%. This shift to non-inpatient deaths suggests that lack of access to health care may play a role in increasing asthma mortality. [ABSTRACT FROM AUTHOR]

Background: Over 3000 older homes containing lead-based paint are demolished in Chicago each year. While previous studies investigating large multifamily housing demolitions have shown high levels of lead in dustfall, dispersed single-family housing demolition have yet to be assessed. Presently, no standards exist to regulate the extent of lead dustfall from housing demolition. Objectives: We studied ten residences in Chicago undergoing demolition and debris removal and compared dustfall rates to five standing homes from March to October 2006. Methods: Dustfall was measured using a modification of APHA Method 502; samplers consisted of plastic buckets filled with 1l of deionized water, elevated to breathing zone height and placed around the demolition site perimeter. Laboratory analysis consisted of filtration, acid digestion and analysis by ICP/MS. Results: During demolition, the geometric mean lead dustfall (n=43 at 10 locations) was 64.1μgPb/m2/h (range: 1.3–3902.5), while the geometric mean lead dustfall for areas with no demolition (n=18 at 6 locations) was 12.9μgPb/m2/h (range: 1.8–54.5). This difference was highly statistically significant (p=0.0004). When dust suppression measures were used, dustfall lead levels were lower, although the difference was not statistically significant. The geometric mean lead dustfall with dust suppression (n=25 at five locations) and without (n=22 at six locations) was 48Pbμg/m2/h and 74.6μgPb/m2/h, respectively. Conclusion: Demolition dustfall lead levels are much higher than background levels of lead during demolition of single-family housing and may constitute a yet uncharacterized but important source of lead exposure to nearby residents. Simple dust suppression methods are likely to reduce the contamination considerably. [Copyright &y& Elsevier]

Background: Studies have shown associations of diabetes and endogenous hormones with exposure to a wide variety of organochlorines. We have previously reported positive associations of polychlorinated biphenyls (PCBs) and inverse associations of selected steroid hormones with diabetes in postmenopausal women previously employed in a capacitor manufacturing plant., Methods: This paper examines associations of PCBs with diabetes and endogenous hormones in 63 men previously employed at the same plant who in 1996 underwent surveys of their exposure and medical history and collection of bloods and urine for measurements of PCBs, lipids, liver function, hematologic markers and endogenous hormones., Results: PCB exposure was positively associated with diabetes and age and inversely associated with thyroid stimulating hormone and triiodothyronine-uptake. History of diabetes was significantly related to total PCBs and all PCB functional groupings, but not to quarters worked and job score, after control for potential confounders. None of the exposures were related to insulin resistance (HOMA-IR) in non-diabetic men., Conclusions: Associations of PCBs with specific endogenous hormones differ in some respects from previous findings in postmenopausal women employed at the capacitor plant. Results from this study, however, do confirm previous reports relating PCB exposure to diabetes and suggest that these associations are not mediated by measured endogenous hormones.

A mortality study of workers employed between 1944 and 1977 at an electrical capacitor manufacturing plant where polychlorinated biphenyls (PCBs), chlorinated naphthalenes, and other chemicals were used was undertaken. Age, gender, and calendar year-adjusted standardized mortality ratios (SMRs) were calculated for 2885 white workers. Total mortality and all-cancer mortality were similar to expected in both males and females. Females employed 10 or more years had a significantly elevated SMR of 6.2 for liver/biliary cancer. Intestinal cancer was significantly elevated in females employed 5 or more years after PCBs were introduced (SMR = 2.2). In males, stomach cancer (SMR = 2.2) and thyroid cancer (SMR = 15.2) were significantly elevated. Although individual exposure assessment was limited, PCBs alone or in combination with other chemicals could be associated with increased risks for liver/biliary, stomach, intestinal, and thyroid cancer.

The effect of ambient air pollutants, pollens, and mold spores on respiratory health was studied in an area with low concentrations of chemical pollutants and abundant aeroallergens. A panel of 40 asthmatic subjects living near East Moline, Illinois, recorded peak expiratory flow rates (PEFRs), respiratory symptoms, frequency of asthma attacks, and asthma medication use between April and October 1994. Daily outdoor concentrations of pollutants and aeroallergens were measured, and indoor levels of bioaerosols were measured on several occasions in each participant's home. Ozone was associated with increased morning and evening symptom scores and decreased evening PEFR, and these associations remained significant with adjustment for weather and aeroallergens. The association between ozone and asthma medication use was increased in magnitude and significance with adjustment for weather and aeroallergens; however, the association between ozone and morning PEFR became nonsignificant with weather and aeroallergen adjustment. Significant associations were also found between pollen concentration and decreased evening PEFR, as well as between increased morning and evening symptom scores and asthma medication use. In addition, associations were noted between total spore concentration and increased morning PEFR and decreased morning and evening symptom scores. The inverse associations found with mold spore concentrations were not consistent with the results of other studies; however, the associations between ozone and pollen concentration were consistent with previous studies. When results were stratified by a number of independent risk factors, no differences were noted relative to allergic status or presence of dampness or flooding in the home; however, the associations with outdoor ozone and pollens were seen mainly among participants with low levels of exposure to indoor bioaerosols (< 1,800 spores/m3) or with no environmental tobacco smoke exposure.