title: Uncontrolled asthma and factors related to morbidity in an impoverished, rural environment.
abstract: BACKGROUND
  Asthma disproportionately affects children living in impoverished communities; however, factors related to asthma morbidity among impoverished rural children have not been adequately described.
  
  
  OBJECTIVE
  To examine factors associated with asthma morbidity among rural children living in the Arkansas Delta region.
  
  
  METHODS
  We performed a cross-sectional investigation of 109 rural children with asthma enrolled in public schools in the Arkansas Delta region. A questionnaire format and home inspection were used to examine participant, caregiver, and home characteristics.
  
  
  RESULTS
  The median age of the study participants was 9 years, 83% were African American, and 71% had an annual household income of $20,000 or less. Ninety-eight percent of participants were insured, and most fit the criteria for uncontrolled asthma, yet only 23% reported taking inhaled corticosteroids. Transportation problems were cited by 20%. In the past 4 weeks, more than 50% reported rescue medication use or exercise limitations of 2 or more days per week or nocturnal symptoms of more than 2 nights per month. Emergency department visits in the past 6 months were reported by 28%, and 43% reported an unscheduled physician's visits for asthma in the past 3 months. Sixty-four percent had 1 or more positive allergen skin test results, and allergic sensitization was associated with exposure to dust mite, dog, mouse, and cockroach allergens in the home.
  
  
  CONCLUSIONS
  Asthma morbidity was high among this cohort of atopic asthmatic children in the Arkansas Delta. Overuse of rescue medications and underuse of inhaled corticosteroids were prevalent even though the population was highly insured and had frequent health care use. Future asthma health initiatives should focus on the unique challenges associated with translating national guidelines-based care to rural pediatric populations.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT00590304.
authors.affiliation: Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72202, USA. perrytamarat@uams.edu
authors.forename: Tamara T
authors.initials: TT
authors.lastname: Perry
authors.forename: Mallikarjuna
authors.initials: M
authors.lastname: Rettiganti
authors.forename: Rita H
authors.initials: RH
authors.lastname: Brown
authors.forename: Todd G
authors.initials: TG
authors.lastname: Nick
authors.forename: Stacie M
authors.initials: SM
authors.lastname: Jones
mesh_terms: D001741:Black or African American; D000485:Allergens / Q000276:immunology*; D000818:Animals; D001131:Arkansas / Q000453:epidemiology; D001249:Asthma / Q000175:diagnosis / Q000453:epidemiology* / Q000276:immunology; D017028:Caregivers; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D006792:House Calls; D006801:Humans; D008297:Male; D009017:Morbidity; D011203:Poverty; D012307:Risk Factors; D012424:Rural Population; D012882:Skin Tests; D011795:Surveys and Questionnaires
chemical_list: D000485:Allergens