Childhood asthma in a rural environment - Implications for clinical nurse specialist practice

Purpose: The purpose of this study was to identify factors that impact asthma morbidity in rural school-aged children. Design: Exploratory analysis of baseline data collected in a longitudinal intervention study was performed. Setting: Four rural school districts that served small towns and unincorporated areas participated in this study. Sample: Participants were children in grades 2 to 5 who had current asthma and who spoke English or Spanish. There were 183 children (108 boys, 75 girls) with an average age of 8.78 years and who were Hispanic (46%), white (31%), or African American (22%). Methods: Associations between asthma risk factors (gender, ethnicity/race, socioeconomic status, asthma severity), asthma resources (access to care, health insurance), family asthma management, and asthma morbidity (absenteeism, emergency department visits, hospitalizations) were analyzed. Findings: Children with more severe asthma had higher absenteeism and more hospitalizations, and their parents performed more asthma management behaviors. Families who had difficulty accessing care had more hospitalizations and emergency department visits and were more likely to be poor. More boys, more Hispanic and African American children, and more children from poorer families were hospitalized for asthma than were middle-class and non-Hispanic white children. Conclusions: Asthma is a chronic condition that is fairly easy for some families to manage, whereas other families are having higher asthma morbidity that needs to be addressed through targeted interventions.