Burden of asthma in inner-city elementary schoolchildren: do school-based health centers make a difference?
BACKGROUND
About 1400 school-based health centers (SBHCs) provide care to 1.1 million children. However, it is unknown if access to on-site services is associated with a better outcome.


OBJECTIVE
To compare outcomes including hospitalizations, emergency department visits, and school absenteeism in elementary schoolchildren with asthma who were grouped according to their enrollment at schools that have or do not have SBHCs.


METHODS
Six elementary schools in The Bronx, NY (4 schools with and 2 without SBHCs).


METHODS
Nine hundred forty-nine inner-city schoolchildren with asthma.


METHODS
To collect baseline data for a longitudinal study, we surveyed parents to identify children with asthma, and to obtain information about symptoms and the use of health services in the last 12 months. Participating schools provided absenteeism information.


RESULTS
Of 6433 parents surveyed, 74% completed the questionnaires. The prevalence of asthma was 19.9% and the morbidity was high-during the previous year, 46.2% had been treated for asthma in an emergency department; 12.6% had been hospitalized. Emergency department use was not associated with SBHCs. However, in univariate and multivariate analyses, the rate of hospitalization was higher among children enrolled at schools without an SBHC (rate ratio, 1.5; 95% confidence interval, 1.1-1.9). In addition, schoolchildren with asthma enrolled in the schools without an SBHC missed more days of school than those enrolled in schools with an SBHC (mean [SD], 21.3 [15.4] vs 18.2 [13.0], respectively; P =.02).


CONCLUSIONS
Access to SBHCs was associated with a reduction in the rate of hospitalization and a gain of 3 days of school for schoolchildren who have asthma.
Webber
Mayris P
MP
Department of Epidemiology and Social Medicine, Montefiore Medical Center, 111 E 210th St, Bronx, NY 10467, USA. mwebber@montefiore.org
Carpiniello
Kelly E
KE
Oruwariye
Tosan
T
Lo
Yungtai
Y
Burton
William B
WB
Appel
David K
DK
D000041:Absenteeism; D000553:Ambulatory Care / Q000706:statistics & numerical data; D001249:Asthma / Q000453:epidemiology* / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D003151:Community Health Centers / Q000458:organization & administration*; D017281:Cost of Illness; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009519:New York City / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D016012:Poisson Distribution; D012572:School Health Services / Q000458:organization & administration*; D014505:Urban Population