Allies Against Asthma
According to the Centers for Disease Control, asthma affects some 20 million Americans and is the most common chronic disease of childhood, affecting an estimated 6 million children. Asthma prevalence rates have been increasing for all age groups. Children, however, continue to have the highest rates. Childhood asthma prevalence in the U.S. has nearly doubled from 3.6% in 1980 to 7.1% in 2002-2004. Although in the general population of schoolchildren asthma prevalence ranges from 6-8%, in asthma hotspots-- low-income, minority neighborhoods-- prevalence two to three times this number has been reported. In the past decade there have been significant advances in asthma management that allow most people with asthma to live active and healthy lives. Yet, many children continue to suffer with asthma due to a complex set of factors.
Despite the use of practice guidelines, large variations in recommendations and practices exist among many health care providers and in treatment adherence by patients and their families. Furthermore, children living in poverty often lack access to quality health services and are exposed to high levels of environmental allergens and irritants. Schools and childcare providers may limit access to medications, and families may lack the resources to purchase medications and necessary equipment for effective self-monitoring of symptoms. Families may also lack the social support to manage the disease on a long-term basis. In communities across the country, diverse groups are joining forces to develop innovative approaches to manage asthma among children and adolescents. Health care providers, caregivers, patients and their families are working together in coalitions to manage the disease through quality medical care, effective management of symptoms by children and parents, and a reduction in exposure to allergens such as house dust mites, cockroaches, animal dander, tobacco smoke, and mold. Members of such coalitions may include:
- schools
- parents and caregivers of children with asthma
- medical providers
- public health and environmental agencies
- housing professionals
- community organizations
- local officials
- grassroots advocacy groups
- insurers
These coalitions and partnerships hold promise because they bring together diverse groups in a community to address issues of mutual interest, widen spheres of influence, facilitate creativity and innovation in programs and services, and pool resources to address issues system-wide.
In 1999 the Robert Wood Johnson Foundation founded Allies Against Asthma, a national effort to support community-based coalitions that are implementing comprehensive pediatric asthma management programs. Coalition efforts include improved access to and quality of medical services, education, family and community support, and environmental and policy initiatives.
The primary aims of the program are to:
- reduce hospital admissions, emergency room visits, and missed school days
- enhance the quality of life of children with asthma
- develop a sustainable strategy for asthma management in the community
The Allies program awarded $12.5 million to these seven community-based coalitions:
Funds supported the coalition, its targeted activities and evaluation between 2000 and 2006. The National Program Office (NPO) at the Center for Managing Chronic Disease administered the program, provided direction and technical assistance to the funded communities, and continues to coordinate a national cross-site evaluation. Additional support for the evaluation and dissemination activities has been provided by the W.K. Kellogg Foundation. Initial results are promising and demonstrate that coalitions are able to improve policies and practices in their communities (see the April 2006 supplement to the journal Health Promotion Practice found here). Final analysis of evaluation data and dissemination activities are underway.
Project-related Publications:
Clark, N.M., Doctor, L.J., Friedman, A.R., Lachance, L.L., Houle, C.R., Geng, X., Grisso, J.A. Community coalitions to control chronic disease: Allies Against Asthma as a model and case study. Health Promotion Practice, Suppl. to 7(2): 14S-22S, April, 2006.
Lachance, L.L., Houle, C.R., Cassidy, E.F., Bourcier, E., Cohn, J.H., Orians, C.E., Coughey, K., Geng, X. Joseph, C.L.M., Lyde, M.D., Doctor, L.J., Clark, N.M. Collaborative design and implementation of a multi-site community coalition evaluation. Health Promotion Practice, Suppl. to 7(2): 44S-55S, April, 2006.
Clark, N.M., Friedman, A.R., Lachance, L.L. Summing it up: Collective lessons from the experience of seven coalitions. Health Promotion Practice, Suppl. to 7(2): 149S-152S, April, 2006.
Project-related Presentations:
Clark, N.M. and Doctor, L.J. Engaging, involving, and linking key stakeholders in community coalitions. Annual Meeting of the American Public Health Association, San Francisco, November 2003.
Clark, N.M., Doctor, L., Lachance, L., Geng, X., Houle, C., and Friedman, A. Allies Against Asthma experience: Next steps. APHA Annual Meeting, Washington, D.C., November 2004.
Clark, N.M., Lachance, L., Friedman, A.R., Wilkin, M., Wang, S., Doctor, L.J. for Allies Against Asthma. The effect of community coalitions on health and health care of children with asthma. CHEST, Chicago, IL, October 2007.
Clark, N.M., Lachance, L., Friedman, A.R., Butterfoss, F., Meurer, J., and Rosenthal, M. Allies Against Asthma. American College of Chest Physicians Ninth Annual Community Asthma and COPD Coalitions Symposium. CHEST, Chicago, IL, October 2007.
Clark, N.M., Friedman, A, and Lachance, L. Policy change as a result of community coalitions. APHA Annual Meeting, Washington, D.C., November 2007.
For more information, visit the Allies Against Asthma site or contact Laurie Lachance at lauriel@umich.edu
