Childhood Incident Asthma and Traffic-Related Air Pollution at Home and School

Background

Traffic-related air pollution has been associated with adverse cardiorespiratory effects, including increased asthma prevalence. However, there has been little study of effects of traffic exposure at school on new-onset asthma.

Objectives

We evaluated the relationship of new-onset asthma with traffic-related pollution near homes and schools.

Methods

Parent-reported physician diagnosis of new-onset asthma (n = 120) was identified during 3 years of follow-up of a cohort of 2,497 kindergarten and first-grade children who were asthma- and wheezing-free at study entry into the Southern California Children’s Health Study. We assessed traffic-related pollution exposure based on a line source dispersion model of traffic volume, distance from home and school, and local meteorology. Regional ambient ozone, nitrogen dioxide (NO₂), and particulate matter were measured continuously at one central site monitor in each of 13 study communities. Hazard ratios (HRs) for new-onset asthma were scaled to the range of ambient central site pollutants and to the residential interquartile range for each traffic exposure metric.

Results

Asthma risk increased with modeled traffic-related pollution exposure from roadways near homes [HR 1.51; 95% confidence interval (CI), 1.25–1.82] and near schools (HR 1.45; 95% CI, 1.06–1.98). Ambient NO₂ measured at a central site in each community was also associated with increased risk (HR 2.18; 95% CI, 1.18–4.01). In models with both NO₂ and modeled traffic exposures, there were independent associations of asthma with traffic-related pollution at school and home, whereas the estimate for NO₂ was attenuated (HR 1.37; 95% CI, 0.69–2.71).

Conclusions

Traffic-related pollution exposure at school and homes may both contribute to the development of asthma.     

Identification and Education of Adolescents with Asthma in an Urban School District: Results from a Large-scale Asthma Intervention

Asthma is a leading cause of hospitalizations, acute care utilization, health care costs, and school absences in children. Asthma morbidity is disproportionately high in inner city populations. In general, community-based public health interventions to reduce asthma morbidity have had modest success due in part to their limited reach and low participation by the targeted population. Adolescents have been especially difficult to reach. A coalition of community organizations developed a school-based, population-level system to identify, prioritize, and provide interventions for middle school children with asthma in a large urban school district in Oakland, CA. Nearly 92% (n = 8,326) of students in the targeted schools took an asthma case identification survey. Of those students who took the survey, 17.5% (n = 1,458) had active asthma and were eligible for services. Among those identified with active asthma, 83% (n = 1,217) voluntarily attended asthma self-management classes at school. The 4-week curriculum previously has been shown to significantly improve several indicators of asthma control in this population. Retention was high—72% of students who enrolled attended at least three of the four curriculum sessions. Many higher-risk students were subsequently referred to and enrolled in off-site asthma services. Large school districts with incomplete or inadequate health records, high asthma prevalence, and internal or external services available for students with asthma may benefit from a similar model. A system such as the one described may be an effective public health strategy for school districts, health departments, and community coalitions addressing asthma or other conditions with high childhood prevalence. Electronic supplementary material The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

Asthma Knowledge, Roles, Functions, and Educational Needs of School Nurses

In October 1997, 790 school nurses in Maryland and the District of Columbia were surveyed to determine their attitudes, knowledge, and beliefs about asthma. Results for 550 (70%) nurses indicated school nurses possess a generally appropriate level of knowledge concerning asthma, and most asthma myths have been replaced with knowledge. However, school nurses also have varied responsibilities that affect their ability to provide health education and support services to children with asthma at school. Little time is available for a proactive role. Concerns about the criteria and follow-up for delegating medication administration within the school setting were reported. A lack of communication existed with parents about the child's asthma. Open communication between school nurses and the family is recommended to establish a partnership and improve asthma management outcomes. In addition, school policies and procedures should be updated to meet the demands of children with asthma.     

The awesome Asthma School Days Program: educating children, inspiring a community

Program planners developed an educational program to improve the health of children with asthma in grades three to five in Milwaukee (Wis.) Public Schools. During 1997-1998, 1,400 students from 74 elementary schools participated in the Awesome Asthma School Days education program. In a cross-sectional survey, about 40% of children reported play interrupted and sleep disturbed by asthma, more than 50% of children reported exposure to smoke in their home, most children lacked asthma self-care tools, and most children with persistent symptoms did not use an anti-inflammatory inhaler. The educational program improved students' expectations about normal play and sleep and improved their understanding of asthma. Leaders in Milwaukee used the survey results to develop a community action plan. The educational program, surveys, community partnerships, and strategic plans can be replicated in other schools.     

Development and Evaluation of an Integrated Asthma Awareness Curriculum for the Elementary School Classroom

Asthma is one of the most common causes of school absenteeism, and many children are affected by, or encounter, it in the school setting. An integrated curriculum that presents asthma as a real world example can raise all children’s awareness and understanding of asthma, not just those with the condition. A 15-lesson, asthma-based curriculum was developed to integrate with and enhance the core subjects of math, science, and communication arts. A pilot test was performed in fourth- and fifth-grade classes to assess student asthma knowledge gain, teacher acceptance, and grade appropriateness of the curriculum. During the 2006–2007 school year, 15 teachers were recruited from the St. Louis, MO, USA area to assess the curriculum through teaching and administering pre- and post-unit tests and completing a teacher evaluation for each lesson taught. Four additional classrooms served as comparisons. Paired t tests were used for each lesson taught, to evaluate pre-/post-test and classroom differences, and focus groups were used for qualitative evaluation. There was an increase in asthma knowledge between pre- and post-tests in both grades, individually and combined (p?<?0.001). Intervention post-test scores were higher than comparison classroom scores (p?<?0.001). Teacher feedback indicated that the lessons enhanced previously learned skills and increased students’ overall understanding of asthma. Offering asthma education in the classroom can provide an opportunity for all students to gain asthma knowledge and build health literacy about a leading chronic disease in school-aged children.