Perspective: Strategic approaches to asthma in California schools
By:
Mary Kreger, Gaylen Mohre, Marion Standish and Claire Brindis
Published: November 22, 2010
Mary Kreger is a senior researcher at the Philip R. Lee Institute for Health Policy Studies at the University of California, San Francisco. Gaylen Mohre is a research associate at the institute. Marion Standish is director of community health at The California Endowment. Claire Brindis is director of the Philip R. Lee Institute for Health Policy Studies and a professor of pediatrics at UC San Francisco's Division of Adolescent Medicine.
In the Fresno Unified School District, one of the largest in the state, one out of five students has asthma, according to a recent California Healthy Kids Survey. In 2008, the district began to address one source of environmental asthma triggers: the chemicals commonly found in cleaning products. Like many other school districts across the state, Fresno Unified is now utilizing “green” cleaning products made with less harmful compounds. This important step, started by the Green Schools Initiative, is just one example of an effective way to reduce the burden of asthma on students and schools.
More than one in eight children in California have been diagnosed with asthma as of 2009, according to Meredith Milet at California Breathing, a program of the California Department of Public Health. Asthma is the leading chronic disease among school-age children and is a major cause of school absences, accounting for a reported 14 million missed days of school annually nationwide—including 1.9 million days in California. The high prevalence of asthma in school-age children places an economic and social burden on families, schools and communities. Meanwhile, school absences cost children the opportunity to learn and achieve, and translate into lost revenue for California schools. The good news is that asthma lends itself to relatively rapid remediation when managed clinically and if environmental triggers are removed. As local institutions that bring together families, children and community leaders, schools provide an ideal access point for a collaborative approach to addressing asthma.
The costs in absence and underachievement
While approximately 70 percent of California students with asthma do not miss any school, an estimated 14 percent miss three to 11 or more days of school per year due to their condition, according to California Breathing’s Milet (see chart on page 16). A study by the UCLA Center for Health Policy Research showed that California schoolchildren with frequent asthma symptoms (indicating severe or poorly managed asthma) had higher rates of absence, missing at least one week of school in the past year, than children who had less frequent symptoms.
Absenteeism has an undeniable impact on student achievement. A new study from the American Educational Researcher Journal shows a correlation between good attendance and both higher GPAs and better standardized test scores. A study published in the March 2008 issue of the Journal of School Health shows that an increase in both the presence of asthma and its severity heighten the likelihood of absence from school, and that asthma severity is associated with decreased school performance.
Poorly managed asthma also imposes economic costs on school districts. Schools receive an average of $7,500 of revenues per student per year for Average Daily Attendance. Based on a school year of 175 days, every excess asthma absence results in about $42.80 of lost ADA revenue—that’s per student, per day. Preliminary data analysis from a study by the University of California, San Francisco, indicates that approximately 14 percent of school-age children and youth with asthma statewide account for approximately $40 million of lost ADA revenue to school districts annually, as the chart on page 16 illustrates.
With so much hinging on student wellness, and with asthma playing such a significant role in that, our children and schools can only benefit from a strategic approach to asthma issues, even—or especially—in view of inadequate state and federal fiscal resources.
Environmental triggers: What schools are doing
Improving indoor air quality in schools is an important component of school-based approaches to reducing the burden of asthma. Allergens and airborne toxins are common in classroom air and can exacerbate asthma symptoms. Strategies to improve indoor air quality include assuring adequate ventilation and reducing sources of mold, pesticides and volatile compounds, which are often found in cleaning products and paints. Recently, the San Francisco Unified School District, in conjunction with its local asthma coalition, began participating in the U.S. Environmental Protection Agency’s Tools for Schools program, implementing strategies to improve indoor air quality in local schools. In Richmond, California, a community asthma coalition is working on rerouting truck routes in order to reduce the environmental impact of toxins and particulate matter in diesel exhaust on local schools and neighborhoods. Advocates and policymakers in Long Beach and Los Angeles are working to reduce the pollutants from local ports, which affect nearby schools and communities.
Other strategies to reduce risk
Given that school districts across the state are facing severe budget reductions, and that asthma poses a threat to student achievement and well-being, now is a vital time for school leaders to take steps to address the burden of asthma. The following strategies are culled from successful existing programs:
Educational strategies: Involve school personnel, students and families. Utilize school health staff and community health workers to educate students, parents and teachers about asthma management and emergency response procedures. Integrate asthma education into health and science curricula. Use existing curricula to increase asthma awareness in the school community.
Clinical strategies: Ensure the creation of asthma action plans for students with asthma to coordinate care among the student’s parent or caregiver, health care provider and school health personnel. Allow students to carry self-administered prescribed medication (with a parent and health care provider’s written permission) or allow them to have medication stored at the school and administered under supervision. Sustain involvement of trained health professionals, including a school nurse where available, to screen and track students with asthma. Integrate school health care services with community services, and work with local health care providers.
Environmental strategies: Systematically identify and minimize asthma triggers (respiratory allergens and irritants such as dust mites, furry classroom pets, chalk dust, mold, diesel bus and truck exhaust) in school buildings and on school grounds. Ensuring that ventilation ducts are open and the school heating, ventilation and air conditioning system works properly is a low-cost and effective strategy. Provide the EPA’s Tools for Schools to school administrators, teachers, custodians, and parents. Work with these stakeholders to implement ventilation and indoor air guidelines. Removing indoor and outdoor environmental asthma triggers is critical to reducing the burden of asthma on schools.
Multicomponent strategies: Establish systems for clinical and environmental policies by building collaborative partnerships that weave together school, community and family efforts. Build schools’ capacity to implement strategies through training, technical assistance and pilot programs, and translate this experience into fuller program implementation. Provide adequate program evaluation to document evidence for support of program and policy decisions. Plan strategically while building upon no-cost and low-cost solutions.
The increasing prevalence of asthma among California students in many school districts makes it imperative that schools implement effective policies and programs to reduce the economic impact of this condition. By utilizing broad-based collaborations to implement the types of strategies such as those outlined in this article, schools can help ensure that today’s youth can contribute to California’s future.
Asthma resources
CSBA provides background information on issues that impact California’s children, including the following asthma resources, on its Policy Advisories and Briefs Web page:
Other useful resources:
This research was supported by The California Endowment.