When Clinical Management Isn’t Enough: School-Based Health Centers as Leaders in Reducing Environmental Asthma Triggers Anne Kelsey Lamb, MPH, Director Regional Asthma Management & Prevention (RAMP)
Asthma in children • 7 million children under the age of 18 in the U.S. have asthma • Most common cause of disability among children in the U.S. • Leading cause of school absences due to chronic disease.
10 12 14 16 18 20 Percent 0 2 4 6 8 8.3 Children 7.0 Adults Race and Ethnicity, and Poverty Status (2013) 7.7 White Non-Hispanic Current Asthma Prevalence by Age Group, Asthma disparities 11.2 Black Non-Hispanic 9.4 Other Non-Hispanic 5.9 Total Hispanic 14.6 Puerto Rican 4.7 Mexican 10.9 <100% poverty 7.0 100-<250% poverty 6.2 250-<450% poverty 6.6 ≥ 450% poverty
The important role of SBHCs SBHC users are: • Less likely to go to the ED or be hospitalized for asthma • Less likely to have asthma-related restricted activity days • Less likely to miss school as a result of their asthma
Underlying premise of our project: SBHCs provide an ideal setting in which to incorporate environmental components into chronic disease management programs, leveraging their role as a strong link between the student, school, and home.
Environmental asthma triggers • Two categories: allergens and irritants • Difference between exacerbation and causation • Asthma triggers vary from one person to the next
Allergens dust mites mold
Allergens cockroaches rodents
Allergens pets pollen
Irritants/ pollutants chemical irritants from environmental tobacco smoke personal products
Irritants/ pollutants cleaning products pesticides
Irritants/ pollutants gas stoves and space heaters wood smoke
Irritants/ pollutants outdoor air pollution
Irritants/ pollutants outdoor air pollution
Strategy 1: Education Conduct one-on-one education about environmental asthma triggers during patient visits. Conduct, organize, or support school-based group education for students. Provide education for school staff. Print/order and distribute materials, tools and curricula for educating students, families and school staff.
Conduct one-on-one education • During patient visits – Teach how environmental asthma triggers can make asthma worse as well as how to recognize immediate and delayed reaction. – Teach patients strategies for reducing exposure to things that make their asthma worse. – Use an Asthma Action Plan that includes trigger information
Conduct, organize, or support school-based group education for students Elementary schools Middle and high schools • Asthma Awareness Curriculum for • Adolescent Asthma Action the Elementary Classroom • Fight Asthma Now for Teens • Fight Asthma Now for Youth • Kickin ’ Asthma • Open Airways for Schools • Power Breathing • Roaring Adventures of Puff • You Can Control Asthma
Provide education for school staff
The West Oakland Middle School SBHC used the results of trigger assessments to shape education • Students completed at start of education program • Triggers incorporated into asthma action plan, group health education and one-on-one education with the provider.
Strategy 2: Case Management Incorporate strategies to reduce exposure to environmental asthma triggers into your case management approach to students with asthma. Facilitate connections to resources that exist, communicate with and educate other partners critical to effective asthma management (parents, school staff, etc.) and identify when direct advocacy is needed.
Incorporate strategies to reduce exposure to environmental asthma triggers into case management approach • Communicate/ Educate • Identify / Facilitate Services • Advocate
Strategy 3: Improving Indoor Air Quality in Schools Increase awareness. Conduct or facilitate an assessment. Support or lead a comprehensive approach to improving indoor air quality. Support or lead an intervention to address specific triggers or other factors (such as mold and moisture, chemical irritants from schools and personal products, and ventilation.)
Increase awareness
A SBHC in Cincinnati will assess classroom triggers and educate teachers about simple ways to reduce triggers
Support or lead a comprehensive intervention
Implement interventions targeting specific environmental asthma triggers • Cockroaches and rodents
Implement interventions targeting specific environmental asthma triggers • Cleaning products
Strategy 4: Improving the Students’ Home Environments Establish referral systems for in-home asthma education and environmental remediation programs in the community. Educate students and families. Provide supplies to students and families. Utilize case management strategies to connect families with resources.
Establish referral systems for in-home asthma education and environmental remediation programs
SBHC staff provide home visits themselves
Educate students and families
Provide supplies to students and families
A SBHC in Hempstead, NY is working with high school students to identify triggers in their homes • The program empowers youth to engage in their own health • The program provides students with supplies (pillow cases, asthma-friendly cleaning supplies, IPM supplies) to address the triggers they identify.
Strategy 5: Improving Outdoor Air Quality around the School and Community Conduct an assessment of local air quality. Partner with the school to implement programs and policies to reduce exposure to outdoor triggers near the school. Increase awareness and protect students on high pollution days. Develop anti-idling education and policies. Develop approaches to reduce pollen exposure. Partner with others in the community on clean air advocacy.
Conduct an assessment of local air quality
Partner with the school to implement programs and policies
The Carson Wellness Center chose to address bus idling • Staff in the clinic reported smell of exhaust fumes • Mostly in the afternoon • Some days stronger than others • Patterns included really hot days and really cold days • Realized the smell was coming from the school buses parked outside our clinic – right next to the“fresh air vent”
Conducted trigger assessment with students
Their project • Created survey for bus drivers to understand behavior • Conducted a presentation, based on survey results, about idling effects on people with asthma • Found an informal leader among bus drivers, who helped increase attendance “All the women were very pleasant, the information was very helpful and • Bus drivers attended training something I can use everyday not just at work as a bus driver” and were very engaged
The SBHC at Fremont High School chose to implement the EPA’s Flag Program
The Flag Program at the Fremont SBHC
Partner with others in the community on clean air advocacy
Q & A
What can your SBHC do to reduce environmental asthma triggers? Take out your worksheet Team up with a neighbor Address the questions Share your selected activity and your first step
Apply for your SBHC to receive a stipend to conduct one of these interventions Applications due October 14 th
Contact information Anne Kelsey Lamb anne@rampasthma.org (510) 285-5712
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