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Release: April 4, 2000

NOTE TO EDITORS: April is Public Health Month in Iowa

UI asthma study will help children and families in rural communities

IOWA CITY, Iowa -- When rural Iowa resident Linda Harris saw her youngest daughter suffering from asthma symptoms more than 20 years ago, she felt there was not much information about the condition and the asthma-causing triggers that are especially prevalent in farm communities.

However, a new University of Iowa College of Public Health study aims to deliver customized information to doctors and families to help manage children’s asthma in rural communities. Harris hopes the selected rural areas will benefit and serve as an example for rural communities everywhere.

The Rural Childhood Asthma Study currently is screening children in Sigourney, Iowa, for the first of three phases over the five-year study period. The project is an offshoot of the ongoing Keokuk County Rural Health Study. The researchers hope to educate families about environmental triggers for asthma symptoms and effective approaches to managing the symptoms.

The asthma project was developed after initial data from the Keokuk County study last year revealed surprisingly high rates of childhood asthma, said Elizabeth Chrischilles, Ph. D., associate professor of epidemiology in the UI College of Public Health and primary investigator for the asthma project.

"The data showed 16 to 17 percent of the children in the sample had evidence of asthma, which rivals the highest rates among inner cities," she said. "We are currently midway through screening the first group of participants for our study, and we are finding the rates from the Keokuk study are true. Also, we have found even more children who have not yet been diagnosed."

To respond to these high rates, UI researchers will use a two-part approach to help collect information on children with asthma and their families in three Keokuk County communities, Chrischilles said. Once appropriate participants have been found through authorized screening in school districts, researchers will appraise each child’s physical environment. Using this information and other medical knowledge about asthma, the staff will recommend personalized asthma management approaches for the families and their doctors.

"The combination of medical management and environmental intervention in this study is unique," Chrischilles said. "We are focusing on control and ways families and the community can control asthma. Often when children have asthma, most families respond by restricting their child’s activities. Kids should not have to do this. Families should be able to manage it in other ways. We now have a huge amount of tools and information on asthma, and people, especially in rural areas, need education about what to do."

The study includes visits by researchers, health care professionals and asthma counselors into participants’ homes to identify the environmental issues that can be changed. According to Chrischilles, many environmental components specific to farming communities can encourage or aggravate asthma symptoms and may account for the high rates of asthma in these areas. Some of these factors are: endotoxins from microorganisms, pesticides and other chemical substances in grain dusts and livestock; second-hand smoke from an increased number of smokers in rural areas; pet dander; and problems associated with older houses common in the areas, like inefficient ventilation, house dust mite exposure and, in some cases, mold.

Harris, who resides in Sigourney and will serve as an asthma counselor for the study, said knowing about these environmental triggers can help the communities. Her personal experience will help, as well.

"We want to promote a greater understanding of the respiratory health of children and the community and this means in large part a general awareness of the environmental issues affecting them," she said. "When we do the testing and evaluation, we will visit with the family and look at what physical things they can improve. I think that having gone through this myself, with a daughter with asthma, I might have a better understanding of the fears and concerns of parents. This will help me to really help the families."

"We are striving for individual, meaningful intervention," Chrischilles added. "We will not talk about pets to a family where that is not an issue. We will identify particular problems for each family and customize our advice. That is a strength of this project."

The other component of the study is to develop and recommend medical approaches to managing asthma symptoms for each family. This will involve health care providers in the surrounding areas to help create or maintain a partnership between the doctors and the families. Making these connections in rural areas can be a problem, Chrischilles said.

"Area physicians know it can be difficult to easily see people as often as the doctors and patients want," she said. "Many rural residents have to travel long distances to see physicians. So we want to boost the resources families have on hand between the times that they see their doctors. We hope that what we develop here in this study can eventually be used by other rural communities with similar problems."

If the study is shown to be effective in the selected communities, Harris sees the ability to transfer what is being done to other communities.

"What we will be doing here is extremely interesting and can provide a real benefit to the community by offering greater awareness and effective approaches to managing asthma," she said.

"Then other areas will have the chance to access our information. We do hope to be a good example of how intervention helps families and their respiratory health care."