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Wrona J, Hardy P, Youssef C, Adeleke S, Martin MA, Gerald LB, Pappalardo AA. Stock Inhalers: A Qualitative Data Analysis of Illinois Health Policy Trials and Triumphs. THE JOURNAL OF SCHOOL HEALTH 2024. [PMID: 39098995 DOI: 10.1111/josh.13500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 05/31/2024] [Accepted: 07/13/2024] [Indexed: 08/06/2024]
Abstract
BACKGROUND Asthma reliever medication access is critical, especially in schools. Policies that "stock" reliever inhalers in schools provide failsafe medication access. This research aims to understand barriers and facilitators to Illinois stock inhaler policy implementation. METHODS We conducted 18 semi-structured interviews in 2021-2022 with key school-based and non-school-based partners (school administrators, nurses, governmental agencies, and advocacy leaders). Through Atlas.ti, code frequencies compared (Fisher's exact test), and a thematic analysis performed. RESULTS Four themes emerged: facilitators, barriers, program rationale, and process considerations. The common facilitators were "Finding a provider," having a "Champion," and "Funding". Barriers included "Not enough school nurses," "Pharmacy refusal to fill prescriptions," and "Feeling overwhelmed." All were supportive of the rationale for stock inhalers. Non-school-based informants (p < .01) were more likely to mention medication donations, while school staff reported having enough nurses as a facilitator (p < .01). School staff reported concerns about children with asthma not having their medication significantly more than other partners (p = .02). IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY Our analysis revealed that school partners recognize the value of stock inhalers. Barrier mitigation to support the funding, prescription access and processing, and training are essential to success of stock inhaler programming. Multilevel collaborative efforts through coalitions could be a potential solution.
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Affiliation(s)
- Jessica Wrona
- School of Public Health, University of Illinois Chicago, Chicago, IL, USA
| | - Paige Hardy
- School of Public Health, University of Illinois Chicago, Chicago, IL
- Department of Pediatrics, University of Illinois at Chicago, Chicago, IL, USA
| | - Caroline Youssef
- Department of Pediatrics, University of Illinois Chicago, Chicago, IL, USA
| | - Semmy Adeleke
- Department of Pediatrics, University of Illinois Chicago, Chicago, IL
- Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Molly A Martin
- Department of Pediatrics, University of Illinois Chicago, Chicago, IL, USA
| | - Lynn B Gerald
- Department of Medicine, University of Illinois Chicago, at Chicago, Chicago, IL
- Office of Population Health Sciences, University of Illinois, Chicago, IL, USA
| | - Andrea A Pappalardo
- Department of Pediatrics, University of Illinois Chicago, Chicago, IL
- Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
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Nanda A, Siles R, Park H, Louisias M, Ariue B, Castillo M, Anand MP, Nguyen AP, Jean T, Lopez M, Altisheh R, Pappalardo AA. Ensuring equitable access to guideline-based asthma care across the lifespan: Tips and future directions to the successful implementation of the new NAEPP 2020 guidelines, a Work Group Report of the AAAAI Asthma, Cough, Diagnosis, and Treatment Committee. J Allergy Clin Immunol 2023; 151:869-880. [PMID: 36720288 DOI: 10.1016/j.jaci.2023.01.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 01/08/2023] [Accepted: 01/19/2023] [Indexed: 01/29/2023]
Abstract
The most recent recommendations from the 2020 National Asthma Education and Prevention Program Update and Global Initiative for Asthma 2021 guide evidence-based clinical decision making. However, given the present state of health disparities by age, income, and race, the equitable implementation and dissemination of these guidelines will be unlikely without further guidance. This work group report reviews the current state of the new asthma guideline implementation; presents updated evidence-based therapeutic options with attention to specific patient populations; and addresses barriers to the implementation of these guidelines in minoritized, historically marginalized, and underresourced communities. Allergists and immunologists can use practical ways to accomplish the goals of improved asthma care access and advanced asthma care across the life span, with specific considerations to historically marginalized populations. Modifiable barriers to guideline implementation include financial barriers, environmental factors, and allergy subspecialty access and care coordination. Various programs to improve access to guideline-based asthma care include community programs, school-based asthma programs, and digital health solutions, with an emphasis on reducing disparities by race.
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Affiliation(s)
- Anil Nanda
- Asthma and Allergy Center, Lewisville-Flower Mound; Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas
| | - Roxana Siles
- Department of Allergy and Clinical Immunology, Respiratory Institute, Cleveland Clinic Foundation, Cleveland
| | - Henna Park
- Department of Pediatrics, University of Illinois Hospital, Chicago
| | - Margee Louisias
- Department of Medicine, Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Cleveland; Department of Immunology, Boston Children's Hospital, Boston; Harvard Medical School, Boston
| | - Barbara Ariue
- Department of Pediatrics, Division of Allergy/Immunology, Loma Linda Children's Hospital, Loma Linda
| | - Maria Castillo
- Department of Medical Education at Driscoll Children's Hospital, Corpus Christi
| | - Mahesh Padukudru Anand
- Department of Respiratory Medicine, JSS Medical College, JSS Academy of Higher Education and Research, Mysore
| | - Anh P Nguyen
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, School of Medicine, University of California Davis, Sacramento
| | - Tiffany Jean
- Division of Basic and Clinical Immunology, Department of Medicine, University of California Irvine, Orange
| | - Michael Lopez
- Division of Basic and Clinical Immunology, Department of Medicine, University of California Irvine, Orange
| | - Roula Altisheh
- Department of Allergy and Clinical Immunology, Respiratory Institute, Cleveland Clinic Foundation, Cleveland
| | - Andrea A Pappalardo
- Department of Pediatrics, Department of Medicine, University of Illinois at Chicago, Chicago
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Pappalardo AA, Martin MA, Weinstein S, Pugach O, Mosnaim GS. Improving Adherence in Urban Youth With Asthma: Role of Community Health Workers. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:3186-3193. [PMID: 36058514 PMCID: PMC10091238 DOI: 10.1016/j.jaip.2022.08.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 08/15/2022] [Accepted: 08/16/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND The Asthma Action at Erie Trial is a comparative effectiveness trial comparing a community health worker (CHW) versus certified asthma educator (AE-C) intervention in low-income minority children. OBJECTIVES Determine whether asthma medication possession, adherence, technique, and triggers differ in children receiving an asthma CHW compared with an AE-C intervention. METHODS Children with uncontrolled asthma were randomized to receive 10 CHW home visits or 2 AE-C sessions in a clinic over 1 year. Asthma medication possession and inhaler technique were observed; adherence was measured using self-report, dose counters, and electronic monitors. Environmental triggers were captured by self-report, observation, and objective measurement. Mixed effects linear and logistic regression models were estimated for continuous and binary outcomes. RESULTS Children (n = 223) were mainly Hispanic (85%) and ages 5 to 16 years. Quick-relievers (82%), spacers (72%), and inhaled corticosteroid (ICS)-containing medications (44%) were tracked. Of those with uncontrolled asthma, 35% lacked an ICS prescription (n = 201). Children in the CHW arm were more likely to have an ICS prescription at 12 months (odds ratio 2.39; 95% CI 0.99-5.79). Inhaler technique improved 9.8% in the CHW arm at 6 months (95% CI 4.20-15.32). The ICS adherence improved in the CHW arm at 12 months, with a 16.0% (95% CI 2.3-29.7; P = .02) difference between arms. Differences in trigger exposure over time were not observed between arms. CONCLUSIONS The CHW services were associated with improved ICS adherence and inhaler technique, compared with AE-C services. More information is needed to determine the necessary dosage of intervention to sustain adherence.
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Affiliation(s)
- Andrea A Pappalardo
- Department of Medicine and Pediatrics, University of Illinois at Chicago of Medicine, Chicago, Ill.
| | - Molly A Martin
- Department of Pediatrics, University of Illinois at Chicago College of Medicine, Chicago, Ill
| | - Sally Weinstein
- Department of Psychiatry, University of Illinois at Chicago College of Medicine, Chicago, Ill
| | - Oksana Pugach
- Department of Biostatistics, Corevitas, LLC, Waltham, Mass
| | - Giselle S Mosnaim
- Division of Allergy and Immunology, Department of Medicine, NorthShore University Health System, Evanston, Ill
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Pappalardo AA, Wang T, Martin MA. CHECK: Multi-level Real-World Pediatric Asthma Care Coordination: Results and Lessons Learned. J Asthma 2022; 60:1061-1071. [PMID: 36151882 DOI: 10.1080/02770903.2022.2129063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Because asthma health disparities in children remain common, innovative approaches to obtain asthma health equity are essential. Comprehensive care coordination programs may address the social determinants of health that influence these disparities. This analysis aims to ascertain if receipt of Coordination of Healthcare for Complex Kids (CHECK) program services was associated with changes in school absence, cost, healthcare utilization, and controller prescription in children with asthma. METHODS The CHECK program ran from December 1st, 2014 through August 31st, 2017. Engagement with Community Health Workers (CHW) was rolling and targeted based on risk level (low, medium or high determined by healthcare utilization). This analysis included school-aged children with asthma (n = 2,629) and sufficient Chicago Public Schools attendance data (n = 430). RESULTS Children engaged in CHECK were more likely to be female (p = 0.046) and to identify as Black and/or Hispanic/Latino than enrolled-only children. School absence was not different between the groups. Average total cost for engaged children was 21.3% more than enrolled-only children the first year (p = 0.027) but did not differ by the second year (p = 0.948). At baseline, 68.1% of the cohort had at least one ED visit 12-months prior to CHECK, this reduced to 49.5% post-1 and 41.9% post-2. Engaged children were 21% more likely to visit an ED (p = 0.010) and 40% more likely to have a controller. CONCLUSIONS CHECK program receipt was associated with reduced costs and improved healthcare utilization, and controller prescriptions. School attendance did not change. The CHECK model offers potential pathways to support low-income children with asthma.
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Affiliation(s)
- A A Pappalardo
- Department of Pediatrics, University of Illinois at Chicago, Chicago, IL.,Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - T Wang
- Institute of Research and Health Policy, University of Illinois at Chicago, Chicago, IL
| | - M A Martin
- Department of Pediatrics, University of Illinois at Chicago, Chicago, IL.,Institute of Research and Health Policy, University of Illinois at Chicago, Chicago, IL
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Trivedi M, Pappalardo AA, Udoko M, Garg A, Phipatanakul W, Szefler SJ, Nyenhuis SM. Social Determinants of Health in Asthma Through the Life Course. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:953-961. [PMID: 35033702 DOI: 10.1016/j.jaip.2021.12.032] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 11/29/2021] [Accepted: 12/30/2021] [Indexed: 10/19/2022]
Abstract
There is strong evidence supporting the influence of social determinants of health (SDOH) on the development and progression of asthma. SDOH are defined as conditions in which people are born, grow up, live, work, and age, which influence their opportunity to be healthy, risk of illness, and life expectancy. The goal of this article was to describe 2 case-based approaches (pediatric and adult) to assessing and addressing SDOH in asthma across the life course and in community settings. As asthma providers and specialists, the role of SDOH is complex in our clinical care; however, it is critical to address social needs identified through clinical care for our patients with asthma. Clinical-community partnerships, through grant and cost-sharing mechanisms with resource agencies, are necessary to ameliorate social needs for patients and their communities and have the potential to improve asthma outcomes. Although this is a unique and exciting time in health care to promote individual and population health, knowledge gaps remain, including best practices to integrate holistic SDOH care into the care of patients with asthma.
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Affiliation(s)
- Michelle Trivedi
- Division of Pediatric Pulmonology, University of Massachusetts Chan Medical School, Worcester, Mass; Department of Pediatrics, University of Massachusetts Chan Medical School, Worcester, Mass; Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Mass
| | - Andrea A Pappalardo
- Department of Pediatrics, University of Illinois at Chicago, Chicago, Ill; Department of Medicine, University of Illinois at Chicago, Chicago, Ill
| | - Mfonobong Udoko
- Department of Pediatrics, Anschutz Medical Campus, Children's Hospital Colorado Breathing Institute, University of Colorado, Denver, Colo
| | - Arvin Garg
- Department of Pediatrics, University of Massachusetts Chan Medical School, Worcester, Mass
| | - Wanda Phipatanakul
- Division of Asthma, Allergy, and Immunology, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Stanley J Szefler
- Department of Pediatrics, Anschutz Medical Campus, Children's Hospital Colorado Breathing Institute, University of Colorado, Denver, Colo; Anschutz Medical Campus, Adult and Child Consortium for Outcomes Research and Delivery Science (ACCORDS), University of Colorado, Denver, Colo
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Martin MA, Pugach O, Mosnaim G, Weinstein S, Rosales G, Roy A, Pappalardo AA, Walton S. Community Health Worker Asthma Interventions for Children: Results From a Clinically Integrated Randomized Comparative Effectiveness Trial (2016‒2019). Am J Public Health 2021; 111:1328-1337. [PMID: 34111359 PMCID: PMC8355214 DOI: 10.2105/ajph.2021.306272] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2021] [Indexed: 11/04/2022]
Abstract
Objectives. To compare asthma control for children receiving either community health worker (CHW) or certified asthma educator (AE-C) services. Methods. The Asthma Action at Erie Trial is a comparative effectiveness trial that ran from 2016 to 2019 in Cook County, Illinois. Participants (aged 5‒16 years with uncontrolled asthma) were randomized to 10 home visits from clinically integrated asthma CHWs or 2 in-clinic sessions from an AE-C. Results. Participants (n = 223) were mainly Hispanic (85%) and low-income. Both intervention groups showed significant improvement in asthma control scores over time. Asthma control was maintained after interventions ended. The CHW group experienced a greater improvement in asthma control scores. One year after intervention cessation, the CHW group had a 42% reduction in days of activity limitation relative to the AE-C group (b = 0.58; 95% confidence interval = 0.35, 0.96). Conclusions. Both interventions were associated with meaningful improvements in asthma control. Improvements continued for 1 year after intervention cessation and were stronger with the CHW intervention. Public Health Implications. Clinically integrated asthma CHW and AE-C services that do not provide home environmental remediation equipment may improve and sustain asthma control.
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Affiliation(s)
- Molly A Martin
- Molly A. Martin is with the Department of Pediatrics and the Institute for Health and Research Policy at the University of Illinois at Chicago. Oksana Pugach and Genesis Rosales are with the Institute for Health and Research Policy at the University of Illinois at Chicago. Giselle Mosnaim is with Northshore University Health System, Evanston, IL. Sally Weinstein is with the Department of Psychiatry at the University of Illinois at Chicago. Angkana Roy is with Erie Family Health Center, Chicago. Andrea A. Pappalardo is with the Department of Pediatrics at the University of Illinois at Chicago. Surrey Walton is with the College of Pharmacy at the University of Illinois at Chicago
| | - Oksana Pugach
- Molly A. Martin is with the Department of Pediatrics and the Institute for Health and Research Policy at the University of Illinois at Chicago. Oksana Pugach and Genesis Rosales are with the Institute for Health and Research Policy at the University of Illinois at Chicago. Giselle Mosnaim is with Northshore University Health System, Evanston, IL. Sally Weinstein is with the Department of Psychiatry at the University of Illinois at Chicago. Angkana Roy is with Erie Family Health Center, Chicago. Andrea A. Pappalardo is with the Department of Pediatrics at the University of Illinois at Chicago. Surrey Walton is with the College of Pharmacy at the University of Illinois at Chicago
| | - Giselle Mosnaim
- Molly A. Martin is with the Department of Pediatrics and the Institute for Health and Research Policy at the University of Illinois at Chicago. Oksana Pugach and Genesis Rosales are with the Institute for Health and Research Policy at the University of Illinois at Chicago. Giselle Mosnaim is with Northshore University Health System, Evanston, IL. Sally Weinstein is with the Department of Psychiatry at the University of Illinois at Chicago. Angkana Roy is with Erie Family Health Center, Chicago. Andrea A. Pappalardo is with the Department of Pediatrics at the University of Illinois at Chicago. Surrey Walton is with the College of Pharmacy at the University of Illinois at Chicago
| | - Sally Weinstein
- Molly A. Martin is with the Department of Pediatrics and the Institute for Health and Research Policy at the University of Illinois at Chicago. Oksana Pugach and Genesis Rosales are with the Institute for Health and Research Policy at the University of Illinois at Chicago. Giselle Mosnaim is with Northshore University Health System, Evanston, IL. Sally Weinstein is with the Department of Psychiatry at the University of Illinois at Chicago. Angkana Roy is with Erie Family Health Center, Chicago. Andrea A. Pappalardo is with the Department of Pediatrics at the University of Illinois at Chicago. Surrey Walton is with the College of Pharmacy at the University of Illinois at Chicago
| | - Genesis Rosales
- Molly A. Martin is with the Department of Pediatrics and the Institute for Health and Research Policy at the University of Illinois at Chicago. Oksana Pugach and Genesis Rosales are with the Institute for Health and Research Policy at the University of Illinois at Chicago. Giselle Mosnaim is with Northshore University Health System, Evanston, IL. Sally Weinstein is with the Department of Psychiatry at the University of Illinois at Chicago. Angkana Roy is with Erie Family Health Center, Chicago. Andrea A. Pappalardo is with the Department of Pediatrics at the University of Illinois at Chicago. Surrey Walton is with the College of Pharmacy at the University of Illinois at Chicago
| | - Angkana Roy
- Molly A. Martin is with the Department of Pediatrics and the Institute for Health and Research Policy at the University of Illinois at Chicago. Oksana Pugach and Genesis Rosales are with the Institute for Health and Research Policy at the University of Illinois at Chicago. Giselle Mosnaim is with Northshore University Health System, Evanston, IL. Sally Weinstein is with the Department of Psychiatry at the University of Illinois at Chicago. Angkana Roy is with Erie Family Health Center, Chicago. Andrea A. Pappalardo is with the Department of Pediatrics at the University of Illinois at Chicago. Surrey Walton is with the College of Pharmacy at the University of Illinois at Chicago
| | - Andrea A Pappalardo
- Molly A. Martin is with the Department of Pediatrics and the Institute for Health and Research Policy at the University of Illinois at Chicago. Oksana Pugach and Genesis Rosales are with the Institute for Health and Research Policy at the University of Illinois at Chicago. Giselle Mosnaim is with Northshore University Health System, Evanston, IL. Sally Weinstein is with the Department of Psychiatry at the University of Illinois at Chicago. Angkana Roy is with Erie Family Health Center, Chicago. Andrea A. Pappalardo is with the Department of Pediatrics at the University of Illinois at Chicago. Surrey Walton is with the College of Pharmacy at the University of Illinois at Chicago
| | - Surrey Walton
- Molly A. Martin is with the Department of Pediatrics and the Institute for Health and Research Policy at the University of Illinois at Chicago. Oksana Pugach and Genesis Rosales are with the Institute for Health and Research Policy at the University of Illinois at Chicago. Giselle Mosnaim is with Northshore University Health System, Evanston, IL. Sally Weinstein is with the Department of Psychiatry at the University of Illinois at Chicago. Angkana Roy is with Erie Family Health Center, Chicago. Andrea A. Pappalardo is with the Department of Pediatrics at the University of Illinois at Chicago. Surrey Walton is with the College of Pharmacy at the University of Illinois at Chicago
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Martin MA, Bisarini R, Roy A, Mosnaim G, Rosales G, Weinstein S, Walton SM. Implementation Lessons From a Randomized Trial Integrating Community Asthma Education for Children. J Ambul Care Manage 2020; 43:125-135. [PMID: 32073501 PMCID: PMC8329939 DOI: 10.1097/jac.0000000000000326] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study characterized and compared the implementation of clinically integrated community health workers (CHWs) to a certified asthma educator (AE-C) for low-income children with asthma. In the AE-C arm (N = 115), 51.3% completed at least one in-clinic education session. In the CHW arm (N = 108), 722 home visits were completed. The median number of visits was 7 (range, 0-17). Scheduled in-clinic asthma education may not be the optimal intervention for this patient population. CHW visit completion rates suggest that the schedule, location, and content of CHW asthma services better met patients' needs. Seven to 10 visits seemed to be the preferred CHW dose.
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Affiliation(s)
- Molly A Martin
- University of Illinois at Chicago (Drs Martin, Bisarini, Weinstein, and Walton and Ms Rosales); Erie Family Health Center, Chicago, Illinois (Dr Roy); and Northshore University Health System, Evanston, Illinois (Dr Mosnaim)
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Pappalardo AA, Paulson A, Bruscato R, Thomas L, Minier M, Martin MA. Chicago Public School nurses examine barriers to school asthma care coordination. Public Health Nurs 2018; 36:36-44. [PMID: 30569556 DOI: 10.1111/phn.12574] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 10/19/2018] [Accepted: 11/14/2018] [Indexed: 01/16/2023]
Abstract
OBJECTIVE/DESIGN Well documented asthma disparities in Chicago pose a continual challenge for the Chicago Public Schools (CPS). Coordinated Healthcare for Complex Kids (CHECK) is a health care demonstration project funded by a Centers for Medicare and Medicaid Services Health Care Innovation Award. A collaborative partnership was formed between CHECK and CPS. With CHECK support, CPS administered a survey to 160 nurses to understand the asthma problems nurses perceived and interest in intervention. RESULTS Seventy-five per cent (n = 120) completed the survey. While asthma was the top diagnosis managed by 95%, 72% reported gaps in asthma understanding. Appropriate communication between school nurses and providers occurred 33% of the time; 18% believed they received sufficient support to follow-up on deficient paperwork. The barriers mentioned were lack of medications (73%), time (67%), and communication with providers (61%). When asked their opinions on potential interventions, 78% of nurses supported web-based applications, 66% community health workers (CHW), and 66% stock albuterol in schools. CONCLUSIONS The greatest barriers for CPS nurses with asthma management are time and communication. Potential interventions such as web-based communication applications and CHW in schools were well received.
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Affiliation(s)
- Andrea A Pappalardo
- Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois.,Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Allison Paulson
- School of Public Health, University Chicago Medical Center, Chicago, Illinois
| | - Robin Bruscato
- Chicago Public Schools Nursing Administration, Chicago, Illinois
| | - Leretha Thomas
- Chicago Public Schools Nursing Administration, Chicago, Illinois
| | - Mark Minier
- Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois
| | - Molly A Martin
- Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois
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