Effect of a URI-related educational intervention in early head start on ED visits.

OBJECTIVES: To evaluate the effectiveness of an educational intervention to decrease pediatric emergency department (PED) visits and adverse care practices for upper respiratory infections (URI) among predominantly Latino Early Head Start (EHS) families. METHODS: Four EHS sites in New York City were randomized. Families at intervention sites received 3 1.5-hour education modules in their EHS parent-child group focusing on URIs, over-the-counter medications, and medication management. Standard curriculum families received the standard EHS curriculum, which did not include URI education. During weekly telephone calls for 5 months, families reported URI in family members, care sought, and medications given. Pre- and post-intervention knowledge-attitude surveys were also conducted. Outcomes were compared between groups. RESULTS: There were 154 families who participated (76 intervention, 78 standard curriculum) including 197 children <4 years old. Families were primarily Latino and Spanish-speaking. Intervention families were significantly less likely to visit the PED when their young child (age 6 to <48 months) was ill (8.2% vs 15.7%; P = .025). The difference remained significant on the family level (P = .03). These families were also less likely to use an inappropriate over-the-counter medication for their <2-year-old child (odds ratio, 0.29; 95% confidence interval, 0.09-0.95; 12.2% vs 32.4%, P = .034) and/or incorrect dosing tool for their <4-year-old child (odds ratio, 0.24; 95% confidence interval, 0.08-0.74; 9.8% vs 31.1%; P < .01). The mean difference in Knowledge-Attitude scores for intervention families was higher. CONCLUSIONS: A URI health literacy-related educational intervention embedded into EHS decreased PED visits and adverse care practices.

Failure to return: parental, practice, and social factors affecting missed immunization visits for urban children.

OBJECTIVE: To assess parental, practice, and social factors associated with missed immunization visits by young, urban children. STUDY DESIGN: Parents of children ≤ 36 months(n = 705) were surveyed. The primary outcome was missed immunization visit, by parental report. Key parent, practice, and social factors were assessed using hierarchical logistical regression. Results. Families were predominantly Latino and publicly insured. Parents who rescheduled (adjusted odds ratio [AOR] = 3.27; 95% confidence interval [95% CI] = 1.76-6.09) or had problems scheduling appointments (AOR = 4.00; 95% CI = 1.49-10.75) were more likely to miss an immunization visit, as were those with vaccine safety fears (AOR = 3.76; 95% CI = 1.23-11.5) or more limited communication with their provider (AOR = 2.38; 95% CI = 1.05-5.36). Having friends and families with positive immunization views was protective (AOR = 0.030; 95% CI = 0.002-0.41). CONCLUSION: This study highlights factors that may help urban families keep immunization visits: open communication with providers, flexibility in scheduling appointments, and individual and community education.

A community-based strategy for improving asthma management and outcomes for preschoolers.

Although almost one in ten (8.6%) preschool children has been diagnosed with asthma, few asthma management programs are designed for parents of preschool children. The Asthma Basics for Children program addressed this need in 2003-2008 by implementing a multi-layered approach that offered educational activities to center staff, parents, and children and PACE training to physicians in 31 Northern Manhattan daycare centers. Following program participation, 85% of parents reported reducing their child's triggers, 89% said it was easier to talk to their child's physician, and 80% were confident in their ability to manage their child's asthma. Children's any daytime symptoms dropped from 78% to 42%, any nighttime symptoms from 81% to 49%, any daycare absences from 56% to 38%, any asthma-related emergency department (ED) visits from 74% to 47%, and any asthma-related hospitalizations from 24% to 11% (p < .001 for all differences). Outcomes varied by level of exposure. In the Center-Only group (no parent participation), the only reduction was from 19% to 10% (McNemar = 3.77, p = .052) in hospitalizations. Children whose parents participated in the program had significant reductions in daycare absences (62% to 38%, McNemar = 11.1, p < .001), ED visits (72% to 43%, McNemar = 19.2, p < .001), and hospitalizations (24% to 11%, McNemar = 5.54, p = .018). Children whose parents and healthcare provider participated had the greatest improvements with asthma-related daycare absences dropping from 62% to 32% (McNemar = 9.8, p = .001), ED visits from 72% to 37% (McNemar = 14.4, p < .001), and hospitalizations from 35% to 15% (McNemar = 8.33, p = .003). This study demonstrates that a multi-layered approach can improve asthma outcomes among preschoolers with a combination of parent and provider education having the greatest impact.

Effectiveness of a community coalition for improving child vaccination rates in New York City.

We used a retrospective, matching, birth cohort design to evaluate a comprehensive, coalition-led childhood immunization program of outreach, education, and reminders in a Latino, urban community. After we controlled for Latino ethnicity and Medicaid, we found that children enrolled in the program were 53% more likely to be up-to-date (adjusted odds ratio = 1.53; 95% confidence interval = 1.33, 1.75) and to receive timely immunizations than were children in the control group (t = 3.91). The coalition-led, community-based immunization program was effective in improving on-time childhood immunization coverage.