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This study evaluated whether the Navajo Community Asthma Program reduced asthma exacerbations on the Navajo Nation. After 1 year of community engagement, a 7-year stepped wedge study was implemented across three communities with trained health and school staff, guideline-based care, asthma education, and school inhaler programs. During COVID-19 school and clinic closures, visits occurred via emergency departments, and training in the third community was delayed.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/outcomes-of-the-navajo-community-asthma-program-during-the-covid-19-pandemic/409544/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/outcomes-of-the-navajo-community-asthma-program-during-the-covid-19-pandemic/409544.png","ImageObject",300,407,{"name":92,"@type":93},"Oliver","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-28",true,{"@type":102,"interactionType":103,"userInteractionCount":24},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What was the main objective of the Navajo Community Asthma Program study?","Question",{"text":112,"@type":113},"To test whether the Community Asthma Program reduced the number of asthma exacerbations on the Navajo Nation.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How was the study designed and implemented across communities?",{"text":117,"@type":113},"After 1 year of community engagement, a 7-year stepped wedge study began sequentially in three communities, each with its own Indian Health Service medical center and school system.",{"name":119,"@type":110,"acceptedAnswer":120},"What effects were observed during the COVID-19 pandemic period?",{"text":121,"@type":113},"Reflecting national trends, asthma exacerbation numbers fell dramatically during the pandemic; after controlling for the pandemic effect, asthma exacerbation visits increased by 53% and routine visits increased by 56%.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},409544,1790792580,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":24,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":39,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":46,"preview_page_count":4},8796095461610,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","Outcomes of the Navajo Community Asthma   \nProgram during the COVID-19 pandemic  \nBruce G. Bender, PhD,a Elvira Begay,b James Crooks, PhD,a Joe K. Gerald, MD, PhD,b Bryan Hudson, PhD, MSPH,a Diane K. King, PhD,c Aaron Kobernick, MD,d Andrew H. Liu, MD,e,f Ashley A. Lowe, PhD, MSPH,b Wayne Morgan, MD,b Peter Nez, MS,a Hanna Phan, PharmD,g Buffy Tso,b Patrick Wightman, PhD,b and Lynn B. Gerald, PhD, MSPHh Denver and Aurora, Colo; Tucson, Ariz; Anchorage, Alaska; Salt Lake City, Utah; Ann Arbor, Mich; Chicago, Ill  \nBackground: Despite elevated rates of asthma among Native American children, few interventions have been tested on tribal lands.  \nObjective: Our aim was to test whether the Community Asthma Program reduced the number of asthma exacerbations on the Navajo Nation.  \nMethods: Following 1 year of community engagement meetingson the 27,000–square mile Navajo Nation, a 7-year, stepped wedge study was commenced sequentially in 3 communities, each with its own Indian Health Service medical center and school system. Health care staff were trained in evidence-based guidelines for the management of childhood asthma. School staff were trained in the American Lung Association Asthma 101 and Open Airways for Schools programs. Stock inhaler programs were implemented in schools. The primary outcome, asthma exacerbations, was defined as emergency room visits, hospitalizations, or oral corticosteroid requirement. With the arrival of the coronavirus disease 2019 (COVID-19) pandemic in the second year of the program, schools and medical clinics were closed. All medical visits were conducted through emergency departments. Training in the third community was delayed by 1 year.  \nResults: A total of 439 health care and school staff were trained either in person or virtually. Reflecting national trends, the numbers of asthma exacerbations fell dramatically during the pandemic. After control for the effect of the pandemic, asthma exacerbation visits increased by 53% and routine visits increased by 56% .  \nConclusions: Although the impacts of the pandemic and the program on asthma exacerbations are difficult to disentangle, the collective evidence indicates that that the program led to increased community awareness of asthma and increased  \nFrom aNational Jewish Health, Denver; bthe College of Nursing, University of Arizona, Tucson; cthe University of Alaska Anchorage; dthe University of Utah, Salt Lake City; eChildren’s Hospital Colorado, Aurora; fthe University of Colorado, Denver; gthe College of Pharmacy, University of Michigan, Ann Arbor; and hthe University of Illinois, Chicago.  \nReceived for publication March 26, 2025; revised August 11, 2025; accepted for publication August 13, 2025.  \nAvailable online October 31, 2025.  \nCorresponding author: Bruce G. Bender, PhD, National Jewish Health, 1400 Jackson St, Denver, CO 80206. E-mail: [benderb@njhealth.org](benderb@njhealth.org).  \n The CrossMark symbol notifies online readers when updates have been made to the  \narticle such as errata or minor corrections 2772-8293  \n© 2025 The Author(s) . Published by Elsevier Inc. on behalf of the American Academy of Allergy, Asthma & Immunology. This is an open access article under the CC BY-NCND license ([http://creativecommons.org/licenses/by-nc-nd/4.0/](http://creativecommons.org/licenses/by-nc-nd/4.0/)) .  \n[https://doi.org/10.1016/j.jacig.2025.100593](https://doi.org/10.1016/j.jacig.2025.100593)  \nasthma care–seeking behavior by families of children with asthma. (J Allergy Clin Immunol Global 2026;5:100593.)  \nKey words: Asthma, Navajo, children  \nThe prevalence of asthma among Native American children is higher than for most other groups of children. The 2018 US Centers for Disease Control and Prevention National Health Information Survey found that 17. 8% of American Indian or Alaska Native (AI/AN) children aged 18 years or younger had ever been diagnosed with asthma, which is higher than the rate for either White children (9 .4%) 1 or Black c","cbCaipUpt7hZuVsW","https://ap.wps.com/l/cbCaipUpt7hZuVsW","pdf",994402,"English","# Background\n# Objective\n# Methods\n## Study setting\n## Intervention training and implementation\n## Outcomes\n# Results\n# Conclusions\n# Key words","[{\"question\":\"What was the main objective of the Navajo Community Asthma Program study?\",\"answer\":\"To test whether the Community Asthma Program reduced the number of asthma exacerbations on the Navajo Nation.\"},{\"question\":\"How was the study designed and implemented across communities?\",\"answer\":\"After 1 year of community engagement, a 7-year stepped wedge study began sequentially in three communities, each with its own Indian Health Service medical center and school system.\"},{\"question\":\"What effects were observed during the COVID-19 pandemic period?\",\"answer\":\"Reflecting national trends, asthma exacerbation numbers fell dramatically during the pandemic; after controlling for the pandemic effect, asthma exacerbation visits increased by 53% and routine visits increased by 56%.\"}]","Outcomes of the Navajo Community Asthma Program during the COVID-19 pandemic | PDF",1790582546]