摘要：Objectives. We determined the prevalence of asthma and estimated baseline asthma symptoms and asthma management strategies among children aged 0–12 years in Central Harlem. Methods . The Harlem Children’s Zone Asthma Initiative is a longitudinal, community-based intervention designed for poor children with asthma. Children aged 0–12 years who live or go to school in the Harlem Children’s Zone Project or who participate in any Harlem Children’s Zone, Inc, program were screened for asthma. Children with asthma or asthma-like symptoms were invited to participate in an intensive intervention. Results. Of the 1982 children currently screened, 28.5% have been told by a doctor or nurse that they have asthma, and 30.3% have asthma or asthma-like symptoms. To date, 229 children are enrolled in the Harlem Children’s Zone Asthma Initiative; at baseline, 24.0% had missed school in the last 14 days because of asthma. Conclusion. The high prevalence of asthma among children in the Harlem Children’s Zone Project is consistent with reports from other poor urban communities. Intensive efforts are under way to reduce children’s asthma symptoms and improve their asthma management strategies. The current prevalence of doctor-diagnosed childhood asthma in the United States is estimated as 7%, 1, 2 with African American children having a slightly higher national prevalence of 8%. 2 However, in New York City 17% of children have experienced asthma-like symptoms at some point in their lives. 3 Children living in poor neighborhoods bear the highest burden of disease and are 4 times more likely to be hospitalized for asthma as children who live in wealthy neighborhoods. 4 In Central Harlem, a community with a devastating overall child health profile, 5 pediatric asthma hospitalizations increased 62% from 1988 to 1997. In 2002 Central Harlem had the third highest rate of pediatric asthma hospitalizations among New York City’s 42 neighborhoods. 3 Asthma remains the leading cause for emergency room evaluations and pediatric hospitalizations at Harlem Hospital Center, the primary source of health care in Central Harlem. 6 Although the determinants of asthma remain speculative, effective management through appropriate interventions is achievable. 7 The Harlem Children’s Zone Project is a community-building strategy of Harlem Children’s Zone, Inc, 8 that is intended to improve the health and well-being of the approximately 13000 residents living within a 24-block area of Central Harlem. 9 The geographic boundaries of the Harlem Children’s Zone Project run north to south from 123rd Street to 116th Street, and east to west from 5th Avenue to 8th Avenue, although expansion of the zone to 60 blocks is currently underway. Concern over elevated school absenteeism resulting from asthma and over the limitations of existing hospital-based interventions led to a partnership between Harlem Children’s Zone, Inc, and the Department of Pediatrics at Harlem Hospital Center, forming the Harlem Children’s Zone Asthma Initiative. 10 What distinguishes this effort from previous community-based health interventions in Harlem is that it was incorporated into an existing community-building initiative designed to improve children’s education (e.g., through Harlem Peacemakers 8 ), provide families with safe and affordable housing (as per the activities of Community Pride 8 ), and improve residents’ parenting skills (through ongoing classes at Baby College 8 ); thus, connections to needed technical, public, and legal services were facilitated, as detailed in the Methods section of this article. To be successful in reaching and screening all children aged 0–12 years in the community who might benefit from the services being offered, we devised an integrated strategy that built on the existing infrastructure at the involved organizations (Figure 1 ▶ ). In addition, we partnered with local institutions and agencies for expert advice and needed services, notably the Mailman School of Public Health and the Urban Planning Program at Columbia University, the New York City Department of Health and Mental Hygiene; the New York City Board of Education; the Brazelton Touchpoints Center, a child and family development training program; the law firm LaBoeuf, Lamb, Greene & MacRae; and Volunteers of Legal Services. Finally, we modeled our integrated approach after the Seattle–King County Health Homes Project 11 and likewise followed an iterative approach of developing initial protocols on the basis of existing scientific evidence and revising protocols as involved team members gained additional experience during the implementation of the intervention components. Open in a separate window FIGURE 1— The Harlem Children’s Zone Asthma Initiative integrates new services and community-based collaborations with existing organizational infrastructures. Notwithstanding previous evidence that asthma disproportionately affects children who are poor, of color, and live in certain geographic areas, 1– 7, 11– 18 we were unprepared for the burden of asthma suffered by children in the Harlem Children’s Zone Project, which necessitated scaling up our initial estimates of personnel and services needed for this intervention. Indeed, our screening initiative yielded twice the prevalence of asthma initially expected, which required seeking additional resources in terms of personnel and supplies. Additional funding was secured, and further augmentation of funds is being sought to expand our initiative to address the childhood asthma crisis in Harlem more effectively over the next several years. We report the screening results and preliminary estimates of asthma symptoms and management strategies for enrolled children.
