October 20, 1997
Volume 50, No. 9
Once viewed as little more than an unusual allergic condition, asthma is now considered an emerging epidemic. In the United States, this sometimes life-threatening condition affects an estimated 14 million people.
An asthma attack results from irritants setting off an immune response that closes the airways. An episode may feel like tightness in the chest or even suffocation.
Those feelings are much too common for the estimated 5 million American children who suffer from asthma. Many of these are impoverished, inner-city children-the group that has the highest rates for asthma prevalence, hospitalization and mortality. Atlanta's inner city, for example, has five times the number of pediatric asthma cases than in the city as a whole.
To fight this increasingly common condition, Emory and 17 other public and private groups have formed a coalition to target 400 low-income, asthmatic children in Atlanta's federally designated economic empowerment zone. The result of their work is the ZAP Asthma project, a community-based asthma prevention model.
Joyce Essien, director of the Center for Public Health Practice at the Rollins School, first envisioned the project about 18 months ago, along with officials from the Centers for Disease Control and Prevention and representatives of managed care organizations. She suggested that the coalition use a participatory research model "so they could share ownership and accountability.
"We were aware that the American Association of Health Plans was interested in a national demonstration project-an opportunity for managed care organizations to gain more knowledge about how to work in the community and how best to serve its needs," Essien said, noting that seven health maintenance organizations are also partners in the project.
"I think it's an important example of a coordination of the public and private sectors," said Emory health economist Kathleen Adams. An associate professor at Rollins, Adams said that because managed care is a rapidly growing form of health care delivery that increasingly covers low-income populations, these companies have been forced to look at what were traditionally considered public health concerns.
ZAP Asthma's activities revolve around 12 community health workers who live in the targeted neighborhoods. This summer they received the training they will need to make monthly visits to the homes of asthmatic children. Children enrolled in the program will be identified by emergency room personnel at Grady Hospital and Southwest Community Hospital and Medical Center.
The community health workers will be conducting environmental home assessments and introducing prevention interventions to reduce dust mites, clean air and heating systems, control cockroaches, educate caretakers and discourage adult smoking in the home.
The model also includes an evaluation component to examine the impact of critical outcome measures such as the number of emergency room visits, avoidable hospitalizations and lost school days.
While the ZAP Asthma project will not actually provide clinical care for children with asthma, it will direct kids who lack appropriate care to the excellent facilities that are already available, said Emory pediatrician Donna Jones, who works at Hughes Spalding Children's Hospital near Grady.
In addition, ZAP Asthma will provide physician education by making sure doctors in the community are aware of the standards of care for asthma stemming from newly published national guidelines. Physicians will also receive patient education materials for distribution.
"It's clear that asthma is a very big problem in this community, and it's clear that it's not being as well managed as it could be," Jones said. "I guess we're hopeful that this will give us insight into the use of home environmental interventions."
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