Asthma | California School-Based Health Alliance

Too Many Children & Youth Have Uncontrolled Asthma

Asthma is a common chronic condition among children and youth in California. Although asthma can be effectively managed, many children and youth lack access to regular medical services and end up making unnecessary visits to the emergency room. These ER visits are difficult for families and costly for our health care system.

16% of California children aged 5-18 have, at some point in their lives, been diagnosed with asthma.¹
48% of children age 18 and younger who had asthma reported having one or more asthma attacks in the past year.²
Among California children aged 5-18 who currently have asthma, 9% had an asthma-related emergency room or urgent care visit in the past year. Among children living in poverty, this percentage rises to 16%.³

Children of color are disproportionately burdened by asthma. Whereas the prevalence of asthma among white children is estimated at 7.6 percent, these estimates increase to 13.4 percent for African American children and 8.5 percent for Hispanic children.⁴

Blacks have 40% higher asthma prevalence than Whites, four times higher asthma ED visit and hospitalization rates, and two times higher asthma death rates. Asthma hospitalization and ED visit rates are higher in Latinos (all subgroups combined) when compared to whites, especially among children.⁵
In California, the odds of having asthma are 1.7 times higher for African Americans than they are for white children.⁶

In addition, asthma is a common cause of school absence: children with asthma miss 13 million days of school annually.⁷ This impacts individual students’ academic achievement and it impacts overall school funding: students with asthma miss three times more school.⁸

School-Based Health Centers Help Manage Asthma

School-based health centers (SBHCs) help children, youth, and families manage asthma, keeping kids out of the hospital and in school and saving money for our health care system. More specifically, recent research shows that:

SBHC users are less likely to have asthma-related restricted activity days.⁹
SBHC users miss less school as a result of their asthma.¹⁰
SBHC users are less likely to go to the ER or be hospitalized for asthma.^{11, 12}
When children with asthma have access to an SBHC, less is spent on ER visits and hospitalizations.¹³

Citations
(1) California Health Information Survey (CHIS), 2009.
(2) Centers for Disease Control and Prevention. (2018). “Asthma: Most recent asthma data”.
(3) California Health Information Survey (CHIS), 2009.
(4) Asthma and Allergy Foundation of America. (2019). “Asthma facts and figures”.
(5) Let’s Get Healthy California. (2016). “Healthy beginnings: Reducing childhood asthma ED visits”.
(6) Meng, Y., Babey, S.H., Hastert, T.A., & Brown, R.E. (2007). California racial and ethnic minorities more adversely affected by asthma. University of California, Los Angeles. Center for Health Policy Research.
(7) Akinbami, Lara J., Centers for Disease Control and Prevention. (2006). The State of Childhood Asthma, United States, 1980-2005. Advance Data. 381:1-24.
(8) Cicutto, Lisa, et al. “Creating asthma‐friendly schools: A public health approach.” Journal of school health 76.6 (2006): 255-258.
(9) Mansour, Mona E., et al. “Pursuing perfection: An asthma quality improvement initiative in school-based health centers with community partners.” Public health reports 123.6 (2008): 717.
(10) Webber, Mayris P., et al. “Burden of asthma in inner-city elementary schoolchildren: do school-based health centers make a difference?.” Archives of pediatrics & adolescent medicine 157.2 (2003): 125-129.
(11) Mansour et al.
(12) Guo, J. J., et al. “Impact of school-based health centers on children with asthma.” Journal of Adolescent Health 37.4 (2005): 266-274.
(13) Guo et al.

New!: National Asthma Learning Collaborative Case Studies

Asthma affects over 7 million children nationwide and is one of the leading causes of school absenteeism. Even children with the best medically managed asthma will continue to suffer if they face environmental asthma triggers in their home, school, and outdoor environments. School-based health centers (SBHCs) are uniquely positioned to reduce environmental asthma triggers, given their role linking the student, school, and home. For more information on how school-based health centers can address environmental asthma triggers, view the Asthma Environmental Intervention Guide for School-Based Health Centers.

Regional Asthma Management & Prevention (RAMP) and the California School-Based Health Alliance, with a grant from the US Environmental Protection Agency, partnered to increase engagement of SBHCs in the environmental management of asthma. Through this partnership, training on environmental asthma triggers was delivered across the country, and the Asthma Environmental Intervention Guide for School-Based Health Centers was developed to help SBHCs provide more comprehensive asthma care to patients.

Additionally, two year-long learning collaboratives were launched, which supported 14 SBHCs across the country with training, technical assistance, and stipends to implement small-scale environmental interventions. The case studies highlight success stories of six SBHCs that participated in our learning collaboratives, along with four SBHCs that are leaders in asthma management and served as great sources of motivation for our work.

Addressing Asthma and Air Pollution: How the West Oakland Middle School Health Center launched a comprehensive asthma program

2014-12-17 11.03.18 West Oakland is a small neighborhood in Alameda County, California, on the shores of the San Francisco Bay, where residents live near thousands of moving and stationary sources of diesel pollution. Container trucks carry goods to and from the Port of Oakland, U.S. Postal Service trucks carry mail to a major distribution center, and trucks and automobiles move overhead on freeways that surround the community.¹

In 2008, the California Air Resources Board (CARB) conducted a health risk assessment and reported that West Oakland residents are exposed to high concentrations of diesel particulate matter—almost three times higher than the average background levels in the Bay Area.² The population is predominantly African-American and 35% of residents live below the federal poverty line.³

Asthma is a significant public health concern for this community. Rates for Emergency Department visits due to asthma are higher in Alameda County than for the state and West Oakland children go to the Emergency Department with asthma almost twice as often as the county average.

Download a PDF of this case study.

The West Oakland Middle School has 220 students enrolled and over 50 have been diagnosed with asthma and many more report undiagnosed respiratory concerns. The West Oakland Middle School (WOMS) Health Center recognized the disproportionate burden of asthma in their community and chose to prioritize asthma as one of the key health issues they address at their clinic. Run by Lifelong Medical, the WOMS Health Center developed an asthma management program based on national clinical guidelines. Components of their asthma management program include:

an assessment and health history with the nurse practitioner,
assessment of asthma control,
medication management,
provision of an asthma action plan, and
spirometry—a tool recommended in the national clinical guidelines but greatly underutilized in clinical practice.

“Although spirometry is only used by 52% of providers, we know that it is an essential tool in the diagnosis and management of asthma and are committed to providing the highest standard of care,” says Kristine Carter, Nurse Practitioner.

They also conduct asthma education in a group setting at their clinic. They work with an AmeriCorps: Community Health Corp volunteer to conduct the foursession training which covers: what asthma is; recognizing symptoms; understanding medications; and identifying and reducing exposure to environmental triggers at home, school, and in the community.

“Students are hesitant about coming to class, but are always excited to share what they have learned and used,” shares Aaron Steinfeld, the Community Health Corp Volunteer.

Forty students were able to complete the educational program in the 2014–2015 school year. The staff at the WOMS Health Center are eager to strengthen their asthma program in the fall by adding a component that directly addresses the air pollution in West Oakland through implementing the EPA’s Flag Program. The Flag Program uses different colored flags to inform students, school staff, and the community of daily air quality conditions. The flag colors correspond to the colors used in EPA’s Air Quality Index (AQI), which tells how clean or polluted the air is for that day. Sharing the daily air quality through these highly visible flags increases awareness about air pollution. In addition to raising awareness, the flag program also serves as important guidance for modifying physical activity in order to protect the health and well-being of students.

In addition to expanding the breadth of their asthma program, the staff have plans to expand their reach. They will be expanding their own clinic services to include students from a nearby Charter Middle School. Additionally, they plan to replicate their comprehensive asthma program in another school-based health center run by Lifelong Medical in East Oakland, CA.

Hana Shirriel-Dia, Health Center Supervisor, shares: “We know that our program is working and we’re excited to expand it to other locations to help children all across Oakland breathe easier.”

Contact

West Oakland Middle School Health Center

For more information on how school-based health centers can address environmental asthma triggers, view the Asthma Environmental Intervention Guide for School-Based Health Centers.

Citations
1 “Clearing the Air: Reducing Diesel Pollution in West Oakland” A West Oakland Environmental Indicators Project Report by the Pacific Institute in conjunction with the Coalition for West Oakland Revitalization November 2003. http://www.pacinst.org/wp-content/uploads/ sites/21/2013/02/clearing_the_air_final3.pdf
2 Bay Area Air Quality Management District. “West Oakland Truck Survey Final Report” 2009. http://woeip.org/wp-content/uploads/2010/12/West-Oakland-Truck-Survey-Final-ReportDec-2009.ashx_.pdf
3 Douglas, R. “A Brief History of West Oakland” adapted from Olmsted and Olmsted (1994)

Regional Asthma Management and Prevention Initiative (RAMP)

RAMP is a regional coalition committed to addressing asthma morbidity and mortality. It is composed of health departments, health plans, community-based organizations, hospitals, government agencies, providers, and community members in Alameda, Contra Costa, San Francisco, and Solano counties. Visit RAMP’s website to sign up for email updates, view past RAMP newsletters, and access a wide array of RAMP tools.

The California School-Based Health Alliance has partnered with RAMP to develop a comprehensive guide to support school-based health center staff in leading or supporting evidence-based strategies and promising practices to reduce exposure to environmental asthma triggers. An updated tips for success guide is based on experiences SBHCs had in implementing strategies and provides six key practices to reduce asthma triggers.

American Lung Association’s Asthma-Friendly Schools Initiative

This toolkit was developed by the American Lung Association‘s Asthma-Friendly Schools Initiative. It is a planning tool that helps community organizations collaborate with schools to create comprehensive asthma management systems. The toolkit can be used to ensure that children with asthma are healthy, in school, and ready to learn.

Get more information on the American Lung Association’s educational programs, including the Open Airways for Schools curriculum for children aged 8-11.

National Heart, Lung, and Blood Institute’s Resources

This National Heart, Lung, and Blood Institute has resources including a guide for schools.

California Breathing Resources

California Breathing is a program of the California Department of Public Health charged with implementing components of the Strategic Plan for Asthma in California. California Breathing has also put together Asthma QuickTakes, a series of three brief training videos, and accompanying resources, specifically for schools. These training videos address Emergency Response, Indoor Asthma Triggers, and Outdoor Asthma Triggers.

Asthma and the Achievement Gap Among Urban Minority Youth

This article, by Charles E. Basch, includes a chapter on asthma. It describes how disproportionate rates of asthma among urban minority youth contribute to the achievement gap and outlines ways schools can help.

CDPH Cleaning for Asthma-Safe Schools

The Cleaning for Asthma-Safe Schools project helps school districts transition to healthier and asthma-safer cleaning products and practices.