Classroom Temperatures and Asthma-Related School-Based Health Care Utilization: An Exploratory Study |
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| Institution: | 1. Johns Hopkins School of Medicine (CF Plott, P Spin, K Connor, B Smith, and SB Johnson), Department of Pediatrics, Baltimore, Md;2. Johns Hopkins Bloomberg School of Public Health (SB Johnson), Department of Population, Family and Reproductive Health, Baltimore, Md;3. Johns Hopkins Bloomberg School of Public Health (SB Johnson), Department of Mental Health, Baltimore, Md;1. Department of Pediatrics, University of Washington School of Medicine and Seattle Children''s Hospital (EK Chung), Seattle, Wash;2. Department of Pediatrics, Johns Hopkins University School of Medicine (BS Solomon and EM Perrin), Baltimore, Md;3. Johns Hopkins University School of Nursing (EM Perrin), Baltimore, Md;4. Department of Pediatrics, Boston Children''s Hospital and Harvard Medical School (A Starmer), Boston, Mass;5. Department of Pediatrics, Baylor College of Medicine and Texas Children''s Hospital (TL Turner), Houston, Tex;6. Departments of Pediatrics and Medical Education, University of Miami Miller School of Medicine (L Chandran), Miami, Fla;1. Department of Medical Education, Bernard J Fogel Endowed Chair in Medical Education, University of Miami Miller School of Medicine (L Chandran), Miami, Fla;2. Renaissance School of Medicine at Stony Brook University (W-H Lu), Stony Brook, NY;3. Department of Pediatrics, Icahn School of Medicine at Mount Sinai (L Mogilner), New York, NY;4. Department of Family Medicine & Public Health, UC San Diego School of Medicine (DT Rana), La Jolla, Calif;5. Department of Pediatrics, University of Texas Health, San Antonio, Joe R. and Teresa Long School of Medicine (J Petershack), San Antonio, Tex;6. Department of Pediatrics, Baylor College of Medicine (TL Turner), Houston, Tex;1. Children''s Mercy Kansas City (JJ Dilts, AE Esparham, ME Boorigie, M Connelly, and J Bickel), Kansas City, Mo;2. University of Missouri-Kansas City School of Medicine (JJ Dilts, AE Esparham, M Connelly, and J Bickel), Kansas City, Mo;1. Division of General and Community Pediatrics, Children''s National Hospital, Washington, DC;2. Children''s National Hospital, George Washington University, Washington, DC;3. Child Health Advocacy Institute, Children''s National Hospital, Silver Spring, MD;4. Department of Pediatrics, The Barbara Bush Children''s Hospital at Maine Medical Center, Portland, Maine;5. Division of General and Community Pediatrics, Pediatric Residency Program, and Child Health Advocacy Institute, Children''s National Hospital, Washington, DC;1. Department of Health Law, Policy, and Management, Boston University School of Public Health (RC Sheldrick), Boston, Mass;2. Department of Counseling, Clinical, and School Psychology, University of California (ML Barnett), Santa Barbara, Calif |
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| Abstract: | ObjectiveSchools with aging infrastructure may expose students to extreme temperatures. Extreme outdoor temperatures have previously been linked to more asthma-related health care utilization. Explore the relationship between classroom temperatures and school-based health care visits for asthma in an urban school building with an outdated heating and cooling system.MethodsParticipants were students in grades K-8 who received health care from a school-based health center (SBHC) (n = 647) or school nurse (n = 1244) in 2 co-located urban public schools between 2016 and 2018. The probability of an asthma visit to the SBHC or school nurse was modeled as a function of indoor temperature exposure using generalized estimating equations with covariates accounting for grade, sex, outdoor temperature, days at risk of asthma visit, nonasthma visits, month, and year fixed effects.ResultsClassroom temperatures ranged from 48.0?F to 100.6°F. Higher mean grade-level indoor temperatures from a baseline of approximately 70?F to 76?F were associated with increased rates of asthma-related visits to the SBHC or school nurse on same day of exposure. Model-generated estimates suggest that an increase of 10?F in indoor temperature relative to a baseline of 75?F was associated with a 53% increase in the rate of asthma-related SBHC visits.ConclusionsElevated classroom temperatures may be associated with more school-based health care utilization for asthma. Low-income and students from racial and ethnic minority groups have disproportionately higher rates of asthma and are also more likely to attend schools with poor infrastructure. The potential benefits of school infrastructure investments for student health, health care costs, and health equity merit further investigation. |
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