School Health

The Title V legislation requires the state, as part of its Application, to carry out a statewide Needs Assessment every five years that identifies the need for preventive and primary care services for pregnant women, mothers and infants up to age one; children and adolescents; and children with special health care needs up to age 26. The University of Arizona College of Public Health is collaborating with Arizona Department of Health Services (ADHS) to contribute the qualitative components of the Title V needs assessment, including focus groups, community forums and dissemination of results to community partners. Our approach involves (i) participation at state-wide meetings; (ii) conduct of focus groups with selected communities not traditionally heard including African American, Hispanic, Refugees, LGBTQ, Farm Workers, Families with Children with Special Health Care Needs and Youth; (iii) facilitation of community forums with community members and providers to get feedback on preliminary findings; and (iv) dissemination of results to community partners. Results will feed into priority setting for Title V programming for the next five years 2020 – 2025.  This project is funded by the Arizona Department of Health Services (ADHS).

This a pilot clinical trial that seeks to determine the feasibility of dispensing inhaled corticosteroids in the emergency department and supervising their use in the school setting among children with asthma. The trial will be conducted at three clinical sites of the Pediatric Emergency Care Applied Research Network (PECARN). If this trial is successful, we plan to conduct a larger multi center trial to determine whether the intervention cost-effectively reduces exacerbation risk among elementary-age children with mild-to-moderate asthma. This project was funded by the National Heart, Lung, and Blood Institute of the National Institutes of Health. 

This is a clinical trial pilot study to examine the feasibility of conducting a large multicenter trial of dispensing inhaled corticosteroids in the emergency department (ED) and supervising their use in the school setting in children with asthma. Kurt Denninghoff is co-principal investigator for this project. 

More than four million people with asthma live outside of urban areas, and most are seen in primary care settings where their asthma is often inadequately managed, representing a significant gap in care. Rural health disparities for children with asthma include poverty, limited access to care, and environmental challenges including high levels of outdoor and indoor particulate exposure. The Asthma Toolkit program has translated evidence-based asthma care into both rural and urban primary care practices. Although this program has produced evidence of increased guidelines-concordant care, much room exists for improvement. We believe that by deploying Asthma Toolkit training in a larger program that includes community, school, and family engagement, quality of care and health outcomes can be improved for rural children with asthma. This project will bring together investigators from the University of Arizona and National Jewish Health to 1) engage three communities on the Navajo Nation to build a successful collaboration (U34); and 2) conduct a randomized pragmatic trial of a community rural pediatric asthma program (U01). During the initial empowerment phase, we will solidify relationships with community stakeholders including patients, parents, community leaders, hospital administrators, schools, and providers. A group of stakeholder advisors will be created to inform and guide the subsequent study.  In the second (U01) phase, we will employ a step wedge, randomized trial design to test the capacity of the Community Asthma Toolkit program to improve care and outcomes.  The provider component will include comprehensive training in evidence-based pediatric asthma care. The school component will work to improve capacity to identify pediatric asthma and facilitate communication between school, family, and provider. The hospital component will help provide structured communication between hospital clinicians and primary care providers to improve outpatient management and prevent unnecessary urgent care utilization. Finally, the air quality component will assess community and provider concerns about indoor and outdoor air quality and determine potential methods to measure and reduce environmental risks to children with asthma. The final trial will be modified in accord with stakeholder input during the engagement phase. We believe that the intervention could serve as a model for implementation of strategies to improve asthma care in rural children.

Asthma is a common chronic condition among children that is associated with significant morbidity. Because medication non-adherence is an important cause of excess morbidity, the National Asthma Education and Prevention Program guidelines have called for the development of more effective adherence programs.  Schools represent a logical setting where adherence programs could reach the inner-city, low-income, and ethnically diverse populations that have the highest morbidity and lowest adherence.  A recent clinical trial demonstrated that supervised therapy of daily controller medication at school increased medication adherence and asthma control among primarily African-American students in urban, low-income elementary schools.  This study aims to evaluate:  (1) the effectiveness of supervised therapy when administered by the community under real world conditions via a randomized controlled trial of 500 children with asthma in a large urban, predominantly Hispanic school system;  (2) the cost-effectiveness of supervised therapy from the societal perspective using dollars per quality-adjusted life year (QALY) gained; and 3) the program’s implementation fidelity, optimal delivery mechanisms, and construct validity via a comprehensive process evaluation.  Supervised therapy is hypothesized to be both an effective and cost-effective mechanism to improve population-level asthma control among students with asthma.  This project will provide critical information regarding the program’s value, feasibility, and sustainability within communities with large asthma burden.  In addition, it will provide important recommendations to accelerate the adoption of guideline-based care for students with asthma in urban, low-income, and ethnically diverse populations.  With this information, policymakers can optimize the use of scarce public health resources by adopting programs that efficiently maximize child health. Funding for this study came from the National Heart, Lung, and Blood Institute. Also, this study is supported in part by a research grant from the Investigator Initiated Studies Program of Merck Sharp & Dohme Corp and product donation from Thayer Medical Corporation.

The goal of this project is to examine the association between stress and asthma morbidity, using our preliminary work from the Children’s Respiratory Study, and within the context of an ongoing school-base randomized clinical trial, to determine to what degree variations in asthma control and morbidity are associated with chronic school stressors. Eyal Oren was a contributor on this project but has since left the University of Arizona. 

This project involved holding open forums at high exemption rate schools to discuss and clarify vaccination information. This was part of a contract with the Arizona Department of Health Services. 

The goal of this project was to understand the part school nurses play in improving the health of students within Maricopa County. This project was done through a contract with the Maricopa County Health Department. 

This study is an NIH/NHLBI funded project that is examining the effectiveness of a school based hand sanitizer program on asthma exacerbations in elementary school children.