asthma disparities

Addressing Asthma Disparities: Helping Children Breathe Easier

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Blog-Authorby Brenda Doroski, Director, Center for Asthma and Schools

As we approach the one-year anniversary of the release of The Coordinated Federal Action Plan to Reduce Racial and Ethnic Asthma Disparities, I am excited to be part of this effort to improve the lives of children with asthma

The Action Plan was released on May 31, 2012 by CEQ Chair Nancy Sutley, HUD Secretary Shaun Donovan, HHS Secretary Kathleen Sebelius and former EPA Administrator Lisa Jackson.  They were joined by other federal representatives and national leaders who helped to unveil the Action Plan to the 100 participants at the event and the 400 participants joining by live broadcast.

The Action Plan outlines strategies to reduce barriers to implementation of guidelines-based asthma care; enhance local capacity to deliver integrated, comprehensive asthma care; improve capacity to identify the children most in need; and accelerate efforts to prevent the onset of asthma.  EPA is leading efforts to equip parents to effectively manage environmental asthma triggers as part of their child’s asthma care.

While the Action Plan is focused on coordinated federal action, this alone is not enough to fully address racial and ethnic disparities in asthma. We are actively engaging non-federal stakeholders to take action at the local community level through interactive webinars, meetings and conferences.

We are creating pathways for community programs and non-governmental organizations to engage with us on this important work.  Headlining this effort is www.AsthmaCommunityNetwork.org–an online peer to peer network that provides access to valuable tools and resources.  This Network, supported by EPA in collaboration with the Merck Childhood Asthma Network and the Robert Wood Johnson Foundation Allies Against Asthma at the University of Michigan, serves as the communication hub for stakeholders to explore the Action Plan and share the strategies and best practices they are deploying in the field.  Today, the Network has more than 2,000 members representing and supporting nearly 700 asthma programs across the country.

Asthma Awareness Month provides another excellent opportunity to further engage with our stakeholders to promote and adopt best practices and effective strategies for successfully managing asthma.  To learn more, visit www.epa.gov/asthma/childrenstaskforce.

About the author:  Brenda Doroski serves as the Director of the Center for Asthma and Schools in EPA’s Indoor Environments Division.  She leads efforts to improve indoor air quality in homes and schools.  Brenda has twenty-five years experience developing and leading domestic and international environmental health programs with the EPA and the Peace Corps in Latin America.

Editor's Note: The opinions expressed here are those of the author. They do not reflect EPA policy, endorsement, or action, and EPA does not verify the accuracy or science of the contents of the blog.

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Asthma Disparities: Making an Impact in Chicago’s Public Housing

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By Melissa Gutierrez Kapheim

It’s Asthma Awareness Month! For hundreds of asthma community programs across the country, raising asthma awareness is a year-round reality as we work to improve the lives of people living with asthma every day.

As a 2010 winner of EPA’s National Environmental Leadership Award in Asthma Management, my organization, Sinai Urban Health Institute (SUHI), is always excited to partner with EPA. We strive to share successful strategies that will help programs across the nation deliver environmental asthma management as part of their asthma care services to underserved communities.

Later this month, on May 16th, I will co-present an EPA webinar with Andy Teitelman from the Chicago Housing Authority (CHA) on our collaboration efforts for a program called Helping Children Breathe and Thrive in Chicago Public Housing (HCBT).

With funding from the U.S. Department of Housing and Urban Development, SUHI partners with the CHA to implement HCBT in a community where asthma affects 25–30 percent of children, a rate twice the national average. Through community engagement and partnerships, we provide asthma education, assistance navigating the healthcare system, and environmental home assessments.

HCBT uses a Community Health Worker (CHW) model to deliver its services. We hire and train people who live in the same building to educate residents about asthma management. This approach is effective in accelerating honest communications in which people with asthma and their families feel comfortable discussing their home environment.

The visits include a home assessment to identify asthma triggers. HCBT refers triggers to CHA’s case management service, which works with property management to resolve the issue. This referral system was developed so participants can report their housing concerns to CHWs, who shepherd them through the process of getting the problem fixed.  As a result, a variety of housing issues that exacerbate asthma, such as mold, roaches, carpet, and mice, are referred to property management. To date, 80 percent of those referrals have been resolved.

Through our partnerships with CHA and residents of the housing developments, we have achieved results indicative of improved asthma symptoms and control. Specifically, preliminary six-month outcomes of the HCBT program indicate a 56 percent reduction in asthma symptoms, significant reductions in health resource utilization, and statistically significant and clinically associated improvements in quality of life. The project is slated to end in the fall of 2013.

Please join us for our webinar on May 16th. For more information and to register, visit

About the author: Melissa Gutierrez Kapheim, MS, is an epidemiologist at the Sinai Urban Health Institute (SUHI) in Chicago, IL. She has worked in the field of health disparities and community-based health interventions for more than eight years. Since joining SUHI in 2006, she has worked on three consecutive asthma interventions that utilize the community health worker model to improve the health and well-being of children and adults with asthma living in Chicago’s most vulnerable communities.

Editor's Note: The opinions expressed here are those of the author. They do not reflect EPA policy, endorsement, or action, and EPA does not verify the accuracy or science of the contents of the blog.

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Sister Blog: Closing the Asthma Gap – Spanish Translation

EPA’s Spanish blog, Conversado acerca de nuestro media ambiente, posted a translation of our recent blog post, Science Matters: Closing the Asthma Gap.

You can read the translation here – Cerrando la brecha del asma para los niños pobres y minoritarios.

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Conversando acerca de nuestro medio ambiente, el blog de EPA en español, tradujo una entrada reciente de nuestro blog, Science Matters: Closing the Asthma Gap.

Para leer la traducción, haga clic aquí: Cerrando la brecha del asma para los niños pobres y minoritarios.

Editor's Note: The opinions expressed here are those of the author. They do not reflect EPA policy, endorsement, or action.

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Science Matters: Closing the Asthma Gap

To observe October as Children’s Health Month, we will periodically post Science Matters feature articles about EPA’s children’s health research here on the blog. Learn more about EPA’s efforts to protect children’s health by going to www.epa.gov/ochp.

Nearly 26 million Americans, including seven million children, are affected by asthma. But when emergency room doors burst open for someone with an asthma attack, chances are the patient will be a poor, minority child.

According to the Centers for Disease Control and Prevention (CDC), minority children living in poor socioeconomic conditions are at greatest risk. For instance, 16% of African American children had asthma in 2010 compared to 8.2% of white children, and they are twice as likely to be hospitalized with an asthma attack and four times more likely to die than white children. The asthma rate among children living in poverty was 12.2% in 2010, compared to 8.2% among children living above the poverty line.

“Across America we see low-income and minority children and families at a disproportionately higher risk for asthma and respiratory illnesses. Air pollution and other challenges are having serious health effects, which compound economic challenges through medical bills and missed school and work days,” said EPA Administrator Lisa P. Jackson. “As the mother of a child with asthma, I know what it means for our children to have clean and healthy air to breathe.”

Administrator Jackson made those remarks during the unveiling of the Coordinated Federal Action Plan to Reduce Racial and Ethnic Asthma Disparities, a blueprint for how EPA and other federal agencies can team up to reduce asthma disparities.

A major part of that effort is the work conducted by EPA scientists and their partners exploring environmental causes and triggers of asthma, including how socioeconomic factors contribute to childhood asthma. The overall goal is to illuminate the underlying factors of asthma to support work on prevention and intervention strategies.

What increases the risk of developing asthma? While part of the answer certainly lies with genetics, as more than half of all children with asthma also have close relatives with the illness, the environment also plays a key role. Air pollutants, allergens, mold, and other environmental agents trigger asthma attacks.

EPA researchers and their partners are leading the effort to develop new scientific methods, models, and data for assessing how such triggers increase the risk for asthma and asthma attacks. The impact of this research has already contributed to current regulatory standards for two priority air pollutants regulated under the National Ambient Air Quality Standards (NAAQS): ozone and particulate matter. EPA’s asthma research has also been factored into health assessments for diesel emissions.

The next step is to learn ways to better protect those most at risk.

“Now we’re digging into the disparities side of the asthma problem,” said Martha Carraway, MD, a researcher at EPA. “Kids with poorly controlled asthma are more likely to be treated in the emergency room than kids with controlled asthma. So for public health reasons we need to understand how environmental factors, including air pollution, affect asthma control in vulnerable populations.”

To advance that work, EPA researchers and their partners took advantage of a 2008 lightning strike that occurred in Pocosin Lakes National Wildlife Refuge in North Carolina. The 40,000-acre (16,000-hectare), smoldering peat fire sparked by the lightning sent thick, billowing clouds of smoke wafting into the air.

In collaboration with scientists at the University of North Carolina Center for Environmental Medicine, Asthma, and Lung Biology, a team of EPA researchers led by David Diaz-Sanchez, PhD compared emergency room visits for asthma with air quality reports. Looking at the results geographically, they found that low income counties had significantly more visits than more affluent counties, even though air quality and exposure levels were the same.

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“EPA studies suggest that children and others living in low-income counties could be less resilient to air pollution, possibly because of social factors such as inadequate nutrition. For example, if you’re poor and you’re not eating well, your asthma may be more severe,” said Nsedu Obot Witherspoon, MPH, Executive Director of the Children’s Environmental Health Network, a national multi-disciplinary organization whose mission is to protect developing children from environmental health hazards and promote a healthier environment. “Of course, other factors may also be involved, such as whether kids take medications correctly and whether they have access to good medical care.”

EPA’s research on asthma disparities can help guide newer and better interventions for reducing exposure to asthma triggers and limiting the impacts of the ailment, helping to close the gap for minority and poor children and improving the health of children everywhere.

Editor's Note: The opinions expressed here are those of the author. They do not reflect EPA policy, endorsement, or action.

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