title: San Francisco childcare centers' preparedness in the prevention and management of asthma among preschool-aged children.
abstract: Asthma is a common health condition for children in childcare. National recommendations for asthma in childcare exist. However, no studies have investigated the extent to which childcare centers adhere to these recommendations. We aimed to assess childcare center adherence to National Asthma Education and Prevention Program (NAEPP) recommendations for asthma care and preparedness and to identify characteristics associated with increased adherence to national asthma recommendations.
  
  
  
  We developed a standardized instrument. Each childcare center received a score of 0 through 7 based on number of recommendations met. We conducted t-tests, chi square tests and linear regression to identify childcare center factors associated with increased asthma preparedness.
  
  
  
  36 out of 40 eligible childcare centers (90%) participated. These sites served 1570 children primarily between the ages of 2 to 5 years. On average, centers met 3.8 out of 7 (SD  =  1.3) recommendations. Staff familiarity caring for children with asthma (p < 0.001) and the center's asthma prevalence (p  =  0.01) was positively associated with the center's asthma preparedness. The 3 areas most in need of improvement related to asthma medications, asthma action plans and asthma policies. None of the managers reported being familiar with the NAEPP recommendations.
  
  
  
  There is room for improvement in the asthma care and preparedness of childcare centers. The 3 areas in which centers performed poorly (appropriate asthma medication management, use of asthma action plans, and presence of appropriate asthma policies) suggest that closer collaboration between clinicians and childcare centers may be a key to improving asthma management for young children.
authors.affiliation: a Department of Psychiatry , University of California , San Francisco, San Francisco , California , USA.
authors.forename: Chelsea A
authors.initials: CA
authors.lastname: Young
authors.affiliation: b Maternal, Child and Adolescent Health , San Francisco Department of Public Health , San Francisco , California , USA.
authors.forename: Jodi
authors.initials: J
authors.lastname: Stookey
authors.affiliation: c Department of Pediatrics , University of California , San Francisco, San Francisco , California , USA.|d Philip R. Lee Institute of Health Policy Studies, University of California , San Francisco , California , USA.
authors.forename: Anisha I
authors.initials: AI
authors.lastname: Patel
authors.affiliation: b Maternal, Child and Adolescent Health , San Francisco Department of Public Health , San Francisco , California , USA.
authors.forename: Curtis
authors.initials: C
authors.lastname: Chan
authors.affiliation: b Maternal, Child and Adolescent Health , San Francisco Department of Public Health , San Francisco , California , USA.
authors.forename: Jane
authors.initials: J
authors.lastname: Evans
authors.affiliation: e Children's Environmental Health , San Francisco Department of Public Health , San Francisco , California , USA.
authors.forename: Karen
authors.initials: K
authors.lastname: Cohn
authors.affiliation: e Children's Environmental Health , San Francisco Department of Public Health , San Francisco , California , USA.
authors.forename: Luz
authors.initials: L
authors.lastname: Agana
authors.affiliation: f Internal Medicine, University of California , San Francisco , California , USA.
authors.forename: Irene H
authors.initials: IH
authors.lastname: Yen
authors.affiliation: f Internal Medicine, University of California , San Francisco , California , USA.
authors.forename: Alicia
authors.initials: A
authors.lastname: Fernandez
authors.affiliation: c Department of Pediatrics , University of California , San Francisco, San Francisco , California , USA.|d Philip R. Lee Institute of Health Policy Studies, University of California , San Francisco , California , USA.|g Department of Epidemiology and Biostatistics , University of California , San Francisco , California , USA.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Cabana
mesh_terms: D018927:Anti-Asthmatic Agents / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy / Q000517:prevention & control* / Q000628:therapy*; D002656:Child Day Care Centers / Q000458:organization & administration*; D002675:Child, Preschool; D019468:Disease Management; D004777:Environment; D015444:Exercise; D005260:Female; D019983:Guideline Adherence; D017408:Guidelines as Topic; D006801:Humans; D007318:Inservice Training; D008297:Male; D057766:Policy; D015995:Prevalence; D012495:San Francisco; D014028:Tobacco Smoke Pollution / Q000517:prevention & control; D014691:Ventilation / Q000379:methods
chemical_list: D018927:Anti-Asthmatic Agents; D014028:Tobacco Smoke Pollution
keywords: Pediatrics; asthma action plan; controller medication; daycare; prevention; provider education