A review of potential state and local policies to reduce asthma disparities.

Although policies promoting asthma-friendly communities should reduce asthma disparities, not much is known about the status of policy implementation or effectiveness. We review the efforts of state and local agencies to identify and target asthma disparities for reduction, as evidenced by written laws and policy documents and use of funding. Policies targeting health care, homes, schools, and workplaces hold promise for creating asthma-friendly communities; however, the scope and reach of these activities must be increased to have statewide or national impact. In addition, there is a general lack of systematic review of evidence about the institutionalization of successful demonstration programs into policy.

A preliminary investigation of asthma mortality in schools.

Although asthma deaths in children are rare, most asthma deaths should be preventable. No information has been identified in the professional literature addressing the occurrence of asthma deaths in schools. This investigation identified asthma deaths that occurred in US schools between 1990 and 2003 and the circumstances surrounding those deaths. Data were obtained through newspaper articles in the LexisNexis database and death certificates. Between 1990 and 2003, 38 asthma school deaths were reported. Eighteen (47%) identified deaths occurred among black children and 12 (31%) among white. Twenty-seven (72%) of the deaths occurred among teens. Of the fatal asthma attacks, 16 (42%) occurred while the children were participating in a physically active event. Twelve (31%) children died while waiting for medical assistance. Due to the nature of these data, inferences may be subject to source bias. For the identified asthma deaths, key findings include the following: (1) most deaths occurred in teens and high school students; (2) frequently, the precipitating event was related in time to exercise; and (3) a delayed response or hesitancy of school staff to provide medical assistance may have contributed to some of the deaths. Although few school-related asthma deaths are reported each year, the true number is unknown. Key factors in managing the disease and preventing asthma deaths and exacerbations in schools include identification of students with diagnosed asthma, communication with parents and health care providers, removal of triggers in the immediate school environment, and maximizing access to needed medications.

Ensuring a scientific basis for community interventions for asthma.

Community based interventions are an important part of public health management of many diseases, including asthma. However, there are few scientifically proven and readily available community interventions for asthma. In an effort to increase the number of available interventions, we have identified ongoing asthma intervention research, identified potentially effective asthma interventions based on completed research, and prepared several of the effective interventions for widespread implementation through a process called "translation." We provide an example of one of these effective interventions now available for widespread implementation, "Creating a medical home for asthma." This intervention grew out of need for an intervention in New York City Department of Health (NYCDOH) clinics. The intervention includes training all clinic staff in a comprehensive, preventive approach to asthma care. All of the materials needed to implement the intervention are available to all through the NYCDOH web site (www.nyc.gov/ html/doh/html/cmha/index.html). This example points to the importance of making the tools needed to implement effective interventions available across the country and the role of public/private partnerships to assure the availability of science-based interventions for asthma control.

Population-based screening or case detection for asthma: are we ready?

Asthma is a prevalent health problem for which there are effective treatments. By identifying people with asthma and treating them effectively, the burden of asthma in the United States should be reduced. Detecting people with asthma through screening programs seems a logical approach to the problem. This article assesses our readiness for population-based screening and case detection programs for asthma and examines these activities in relation to World Health Organization criteria for determining the appropriateness of screening programs. Given that, at this time, a number of the criteria have not been met, we conclude that population-based approaches to screening and case detection of asthma are of unproven benefit and need further research. A more appropriate focus may be to ensure that all people who are diagnosed with asthma receive appropriate medical care.