Asthma in Rural School Children
Asthma is a chronic lung disease that can involve sudden attacks that have been described as gasping, painful and frightening struggles to get air in to and out of the lungs. Immediate treatment with appropriate medication is needed during these episodes to prevent worsening and potentially life-threatening respiratory difficulty. With over 45,000 rural Pennsylvania school children with asthma, understanding the capacity of rural schools to meet their needs is an important health and policy issue.
Marianne Hillemeier
"The prevalence rate of asthma in rural school-aged children in Pennsylvania has increased by over 20 percent in the last five years," states Dr. Marianne Hillemeier, assistant professor of health policy and administration, who is leading a research effort to examine whether or not rural children in the state are at a disadvantage when it comes to getting the medical care they need to treat asthma.
Hillemeier continues, "Asthma is the single most prevalent cause of childhood disability. Nationally, it is responsible for an estimated 14 million missed school days each year, and is one of the most common causes of childhood hospitalization. The monetary costs of childhood asthma are staggering, totaling $6.6 billion annually in medical care expenditures, lost school days and lost productivity."
Limited empirical evidence suggests that rural children with asthma often face unique disadvantages in achieving adequate management of their disease. For example, while in school, rural elementary-aged children are less likely to be allowed to carry needed medication as compared to urban children. Additionally, significantly fewer rural schools have personnel who know what to do for a severe asthma attack before help arrives. Moreover, young rural children are more frequently hospitalized for asthma symptoms then corresponding urban children.
"Since children spend a large portion of their time in school, it is important that school staff members are knowledgeable about asthma, and that appropriate treatment is provided when a child experiences an asthma attack," states Hillemeier. "We want to understand differences between rural and urban schools with respect to asthma management, and learn more about barriers to optimal asthma care that rural schools face."
Dr. Maryellen Gusic, a pediatrician at Hershey Medical Center, and Yu Bai, a doctoral student in health policy and administration, are collaborating with Hillemeier on this project which is funded by The Center for Rural Pennsylvania. The project includes a school nurse survey to assess the prevalence of asthma and asthma-related morbidity, school policies and procedures related to asthma, the preparedness of school staff to manage asthma, and perceived needs for continued education and improvements in current asthma policies.
Additionally, the team will conduct an analysis of children's hospitalization data to determine the incidence of hospitalization by geographic area, quantify the monetary costs of the hospitalizations and sources of insurance coverage, analyze the association of various individual, school and community characteristics with increased risk for hospitalization, and determine the extent to which socioeconomic and rural-urban disparities in asthma burden exist.
"We hope that our findings will help to develop policy interventions at state and local levels to promote optimal health for rural Pennsylvania children with asthma," concludes Hillemeier.