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Querdibitty CD, Williams B, Wetherill MS, Sisson SB, Campbell J, Gowin M, Stephens L, Salvatore AL. Environmental Health-Related Policies and Practices of Oklahoma Licensed Early Care and Education Programs: Implications for Childhood Asthma. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168491. [PMID: 34444242 PMCID: PMC8391589 DOI: 10.3390/ijerph18168491] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/02/2021] [Accepted: 08/06/2021] [Indexed: 11/16/2022]
Abstract
Little is known about the environmental health-related policies and practices of early care and education (ECE) programs that contribute to childhood asthma, particularly in Oklahoma where child asthma rates (9.8%) and rates of uncontrolled asthma among children with asthma (60.0%) surpass national rates (8.1% and 50.3%, respectively). We conducted a cross-sectional survey with directors of Oklahoma-licensed ECE programs to assess policies and practices related to asthma control and to evaluate potential differences between Centers and Family Childcare Homes (FCCHs). Surveyed ECEs (n = 476) included Centers (56.7%), FCCHs (40.6%), and other program types (2.7%). Almost half (47.2%) of directors reported never receiving any asthma training. More Center directors were asthma-trained than FCCH directors (61.0% versus 42.0%, p < 0.0001). Most ECEs used asthma triggers, including bleach (88.5%) and air fresheners (73.6%). Centers were more likely to use bleach daily than were FCCHs (75.6% versus 66.8%, p = 0.04). FCCHs used air fresheners more than did Centers (79.0% versus 61.0%, p < 0.0001). The majority of ECEs (74.8%) used pesticides indoors. Centers applied indoor pesticides more frequently (i.e., monthly or more often) than did FCCHs (86.0% versus 58.0%, p < 0.0001). Policy, educational, and technical assistance interventions are needed to reduce asthma triggers and improve asthma control in Oklahoma ECEs.
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Affiliation(s)
- Cassandra D. Querdibitty
- Department of Health Promotion Sciences, Hudson College of Public Health, University of Oklahoma Health Sciences Center, 801 N.E. 13th Street, Oklahoma City, OK 73104, USA; (C.D.Q.); (M.S.W.); (L.S.)
| | - Bethany Williams
- Department of Nutrition and Exercise Physiology, Elson S. Floyd College of Medicine, Washington State University Health Sciences Spokane, 412 E. Spokane Falls Blvd., Spokane, WA 99202, USA;
- Department of Nutritional Sciences, College of Allied Health, University of Oklahoma Health Sciences Center, 1200 N. Stonewall Ave., Oklahoma City, OK 73114, USA;
| | - Marianna S. Wetherill
- Department of Health Promotion Sciences, Hudson College of Public Health, University of Oklahoma Health Sciences Center, 801 N.E. 13th Street, Oklahoma City, OK 73104, USA; (C.D.Q.); (M.S.W.); (L.S.)
| | - Susan B. Sisson
- Department of Nutritional Sciences, College of Allied Health, University of Oklahoma Health Sciences Center, 1200 N. Stonewall Ave., Oklahoma City, OK 73114, USA;
| | - Janis Campbell
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, 801 N.E. 13th Street, Oklahoma City, OK 73104, USA;
| | - Mary Gowin
- Department of Family & Preventive Medicine, College of Medicine, University of Oklahoma, 900 N.E. 10th Street, Oklahoma City, OK 73104, USA;
| | - Lancer Stephens
- Department of Health Promotion Sciences, Hudson College of Public Health, University of Oklahoma Health Sciences Center, 801 N.E. 13th Street, Oklahoma City, OK 73104, USA; (C.D.Q.); (M.S.W.); (L.S.)
| | - Alicia L. Salvatore
- Department of Health Promotion Sciences, Hudson College of Public Health, University of Oklahoma Health Sciences Center, 801 N.E. 13th Street, Oklahoma City, OK 73104, USA; (C.D.Q.); (M.S.W.); (L.S.)
- Institute for Research on Equity and Community Health (iREACH), ChristianaCare, Avenue North, 4000 Nexus Drive, CEI-300, Wilmington, DE 19803, USA
- Correspondence:
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Young CA, Stookey J, Patel AI, Chan C, Evans J, Cohn K, Agana L, Yen IH, Fernandez A, Cabana MD. San Francisco childcare centers' preparedness in the prevention and management of asthma among preschool-aged children. J Asthma 2016; 53:691-8. [PMID: 27164036 PMCID: PMC5814296 DOI: 10.3109/02770903.2015.1135944] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 11/21/2015] [Accepted: 12/21/2015] [Indexed: 01/22/2023]
Abstract
INTRODUCTION 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. METHODS 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. RESULTS 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. DISCUSSION 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.
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Affiliation(s)
- Chelsea A. Young
- University of California, San Francisco, Department of Psychiatry, San Francisco, California
| | - Jodi Stookey
- Maternal, Child and Adolescent Health, San Francisco Department of Public Health, San Francisco, California
| | - Anisha I. Patel
- University of California, San Francisco, Department of Pediatrics, San Francisco, California
- Philip R Lee Institute of Health Policy Studies, University of California, San Francisco, California
| | - Curtis Chan
- Maternal, Child and Adolescent Health, San Francisco Department of Public Health, San Francisco, California
| | - Jane Evans
- Maternal, Child and Adolescent Health, San Francisco Department of Public Health, San Francisco, California
| | - Karen Cohn
- Children's Environmental Health, San Francisco Department of Public Health, San Francisco, California
| | - Luz Agana
- Children's Environmental Health, San Francisco Department of Public Health, San Francisco, California
| | - Irene H. Yen
- Internal Medicine, University of California, San Francisco
| | | | - Michael D. Cabana
- University of California, San Francisco, Department of Pediatrics, San Francisco, California
- Philip R Lee Institute of Health Policy Studies, University of California, San Francisco, California
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California
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Nowakowski ACH, Carretta HJ, Pineda N, Dudley JK, Forrest JR. Developing Asthma-Friendly Childcare Centers with Online Training and Evaluation. Front Public Health 2016; 4:39. [PMID: 27014676 PMCID: PMC4792866 DOI: 10.3389/fpubh.2016.00039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 02/28/2016] [Indexed: 11/13/2022] Open
Abstract
In 2011, the Florida Asthma Coalition (FAC) began offering its Asthma-Friendly Childcare Center (AFCC) training online. This course teaches childcare center employees the fundamentals of effective asthma management. It covers basic asthma physiology, ways to recognize asthma attacks, techniques to help children experiencing attacks, and strategies to create healthy environments for asthmatics. A team of health services researchers evaluated both years of the online training. Evaluators used a quasi-experimental design with pretest, posttest, and follow-up assessment. Questions measured knowledge gain and retention, user satisfaction, and implementation of management strategies. Over 650 people from nearly all 67 Florida counties took AFCC training online between 2011 and 2013. Test scores improved by a minimum of 11% points in all program years evaluated. Gains in both knowledge and confidence were substantial and highly significant across years. While individual trainees did forget some content on follow-up, they seemed to retain the specific messages most relevant for their own workplaces. Most trainees also planned to implement multiple management strategies recommended by the training. A large majority of participants rated the training as excellent on all quality metrics, including relevance of content and time efficiency of the online format. Nearly all respondents perceived the training as useful for both providing improved care and fulfilling licensure or certification requirements. Many participants also indicated that their centers would pursue formal certification as AFCCs via the program offered by FAC. The online AFCC course performed strongly in its first years, yielding both high participant satisfaction and substantial improvement in workplace asthma management activity. This training holds promise for introducing and improving multidimensional asthma management strategies at childcare facilities nationwide.
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Affiliation(s)
| | - Henry Joseph Carretta
- Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee, FL, USA
| | - Nicole Pineda
- Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee, FL, USA
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