Mid-Atlantic Regional Asthma Network (MARAN) Newsletter: Fall 2008
In This Issue
By Janice Lewis, U.S. EPA, Region 3, Philadelphia, PA
On October 30, 2008, a meeting for the Mid-Atlantic Regional Asthma Initiative (MARAI) Stakeholders was held at the end of the 10th Annual CHEST Conference at the Pennsylvania Convention Center, Philadelphia, PA. This meeting was to discuss the success of MARAI and programs/projects by the Stakeholders and provide feedback on the successful outcomes; highlight newly established Regional collaborations as well as existing coalitions; and finally, closing-out the MARAI as an Initiative and propel its success into other mechanisms.
The Stakeholders came to a consensus that the Initiative has achieved its goals/objectives after nine years of existing and evolving, but should continue to remain as a resource for all who have a vested interest in eradicating asthma in the Mid-Atlantic Region. Instead of an initiative, MARAI will be a network, called the Mid-Atlantic Regional Asthma Network (MARAN). EPA will be the clearing-house and the overseer of the network with the Stakeholders serving as the driving force.
The goal of the network will be to bring Regional partners together and continue to build collaborative relationships and the sharing of best practices by using several multifaceted approaches such as, the Community Friendly Asthma-Network, emails, E-newsletters, webinars, and listservs for the sharing and dissemination of asthma and environmental tobacco smoke (ETS) related announcements, asthma articles, and research activities. These mechanisms will also be used to distribute information about the development of new policies, funding opportunities, upcoming events, conferences, trainings, resource tools. Information concerning tobacco control, children's environmental health, healthy homes, integrated pest management, and other activities throughout the Region and abroad addressing the issues of asthma will also be included.
MARAI's information is available on the U.S. EPA Mid-Atlantic Regional web site for past and present asthma and ETS activities accomplished with the Mid-Atlantic stakeholders throughout the nine years of MARAI's existence.
By Erin McCarville
The Philadelphia Allies Against Asthma (PAAA) Coalition recently celebrated its 8th year as an active coalition dedicated to improving asthma-related morbidity and mortality among children in Philadelphia. PAAA is a citywide collaboration of stakeholders representing health care systems, providers, schools, insurers, community-based organizations, nursing centers, state and local health departments, and parents and caregivers.
PAAA has developed numerous programs and services to address childhood asthma including the Child Asthma Link Line, a telephone-based care coordination system for parents of children with asthma. The Link Line has recently received recognition from three national awards including: the Nemours Vision Award for Excellence in Child Health Promotion and Disease Prevention, the Premiere Cares Award for Improving Healthcare for the Medically Underserved, and the US Environmental Protection Agency's Communities in Action for Asthma-Friendly Environment's National Exemplary Award. Since its inception in 2000, PAAA's programs and services have reached over 17,000 families with asthma through education, care coordination, and outreach services. In recent years, more that 5,000 children have been screened for asthma, 350 educational presentations have been held in the community, and over 1400 children have been enrolled in the Child Asthma Link Line.
After eight years of program and service development, the Philadelphia Allies Against Asthma Coalition is transitioning from a coalition into a resource-sharing network which will allow the group to evolve as it continues to remain engaged in, and informed about, asthma initiatives in Philadelphia.
Currently the major funder of the PAAA and the Child Asthma Link Line is the Merck Company Foundation's Merck Childhood Asthma Network (MCAN) Project. Other MCAN project Partners include the Children's Hospital of Philadelphia's Community Asthma Prevention Program, Thomas Jefferson University, The School District of Philadelphia, and The Philadelphia Department of Public Health.
By Dr. Tyra Bryant-Stephen
Asthma is the most common chronic illness diagnosed in children and it's the number one diagnosis for admission at the Children's Hospital of Philadelphia. In urban Philadelphia approximately 1 out of 5 children have asthma. The Community Asthma Prevention Program of Philadelphia (CAPP) currently provides effective community-based services to children who have asthma and their families. The major objective of CAPP is to provide a comprehensive, community-based program, which through the elimination of many barriers promotes an optimal learning environment for asthma education. The goals of CAPP are: 1) to increase asthma knowledge and improve self-management behavior; 2) to improve quality of life for children with asthma; and 3) to train members of the community to teach their peers about asthma.
In its tenth year of service, CAPP has offered free asthma education classes in community-based locations since its inception and has since extended its services to include Home Visiting, Primary Care Education, Education for School Professionals, and Student Asthma classes in Public and Charter Schools. CAPP has earned recognition for its success in community asthma education and prevention from national organizations. Administrator Christie Whitman, of the US Environmental Protection Agency, visited Children's Hospital of Philadelphia in April 2002 for the purpose of recognizing CAPP. In addition, the Environmental Protection Agency has published the home visitor program as a case study in community-based interventions. In 2006 CAPP was awarded the Children's Environmental Health Excellence Award. Also in 2006, CAPP was recognized as one of six model community asthma programs in the country by the University Of Michigan's Asthma Health Outcomes Study.
CAPP Classes: CAPP Community Classes are conducted for adult caregivers and children simultaneously in separate classrooms. Adult classes are taught by parent educators and children's classes are taught by teen peer educators. Since its inception, over 3000 caregivers and children have participated in CAPP community asthma classes in English and Spanish in Philadelphia. Approximately 89 community sites have hosted these classes, including 20 Spanish series held in the Latino community. These sites include schools, daycares, churches, and community centers. We have demonstrated that these classes are effective in increasing knowledge, improving asthma control and improving asthma quality of life. (Bryant-Stephens, T., Li, Y. Community asthma education program for parents of urban asthmatic children. JNMA. July 2004; 96 (7): 954-960.)
The impact of these community classes has been felt across Philadelphia. Over 75 parent educators, including 20 bilingual educators, are now equipped to teach on their own. We have recently been able to establish eleven sustainable community sites. This means that the sites are now able to schedule, run and teach community asthma classes on their own without CAPP staff.
CAPP Home Visit Program: The CAPP Home Visitor Program began in 1998. The goal of this program is to teach parents how to reduce asthma triggers in their home, specifically the child's bedroom, in order to control asthma symptoms and to reduce emergency room and hospital visits. Children are identified when they are either admitted to the hospital or the emergency room for asthma. Additionally, primary care physicians may refer patients to the home visitor program.
Since beginning this program over 1300 families across Philadelphia have enrolled. The home visits have been effective in reducing hospitalizations from 51% to 5%, emergency room visits from 32% to 7%, and asthma nighttime and daytime symptoms by 50%. In addition, CAPP has partnered with agencies across the city that have lay educators and trained them to incorporate various pieces of the home visit program into their case management programs.
CAPP for Schools program: As CAPP expanded into North Philadelphia, there was a request by the school nurses to conduct classes for students with asthma during the school day. In 2005, CAPP began the CAPP for Schools program. The program teaches children with asthma how to self manage their disease in an interactive fashion. This includes teaching them about the triggers of asthma and prevention techniques, asthma medications and devices and how to properly use them. Designed for students in grades 1-12, to date 901 children have participated in this program. Highly coveted by the school personnel, the classes are scheduled months in advance. As a result of the classes, 82.3% of students in the schools have had an increase in asthma knowledge from participating in the CAPP for Schools program.
Furthermore, CAPP conducts training of school professionals, including teachers, school nurses, coaches and physical education teachers across North Philadelphia. The results show that over 80% of school professionals have a significant increase in knowledge and skills after attending CAPP trainings.
CAPP Primary Care Provider and Practice Training Program: In trying to understand the gaps in asthma care, CAPP conducted several focus groups of caregivers, nurses and physicians in 2001-2003. In the caregiver and nurse focus groups, the primary care providers were often named as being uninformed of current asthma guidelines. In order to address the gaps between communication and practice, CAPP initiated and implemented the Primary Care Provider Education and Training program in 2003. In this program twenty inner city practices, representing 60 providers, who take care of approximately 95,000 children, have voluntarily enrolled for a site-specific education and training program. The four best practices targeted are: severity classification, prescription of controller medications, use of asthma care plan and use of spirometry. Three levels of intensity are offered to practices: general continuing education, continuing education combined with on-site staff training, and continuing education combined with on-site staff training and systems support. CAPP requires each practice to appoint a physician and nurse asthma champion who receive extensive training. The asthma champions are responsible for leading the interventions in their offices. To date, preliminary analysis shows significant improvement in all four best practices including improved severity classification, improved controller medication use, improved use of asthma action plans and improved use of spirometry in the office as compared to baseline.
Overall impact in the community
Since 2003 CAPP has conducted yearly Juniper Quality of Life surveys to determine if its programs improved the quality of life for sixth graders in North Philadelphia. After screening over 3,300 6th grade students, we have demonstrated that from baseline the sixth graders have in general experienced an improvement in quality of life. We believe that this is a result of the combined efforts of the CAPP programs in reaching out to all aspects of the community.
Visions for the future
Given CAPP's 10 year history and success with educating all aspects of the community, CAPP is in the phenomenal position of being a national resource for other communities and cities who struggle with the asthma epidemic. In the past, CAPP has hosted visitors from Texas, Chicago, New York City and Richmond, VA, all who were seeking to learn from CAPP's expertise in conducting community-based programs. CAPP staff is experienced at learning from the community, getting involvement from the community in developing the program, getting buy-in from the community once starting programs, and helping other agencies to incorporate various aspects of the programs as necessary. All of this experience can and should be shared with others so that others will not have to recreate the wheel.
CAPP is also committed to continue to serve the needs of urban Philadelphia. CAPP's partners and others can continue to benefit from the "one-of-a-kind" broad community service and experience. In addition, without the presence of CAPP in Philadelphia, newly diagnosed children with asthma and children who are not familiar with CAPP will not have any other route to obtain such comprehensive services.
George Washington University's Department of Environmental and Occupational Health Receives $50,000 Grant from EPA to Support the Healthy Asthma Homes Project
Source: George Washington University Medical Center, "What's New at GWUMC"
Asthma is an epidemic affecting more than one in ten children in the District of Columbia. These numbers rank them among the highest, nationally, in the rate of emergency room visits due to asthma, with over 7,000 visits a year to DC hospitals. This is why the US Environmental Protection Agency (EPA), Region 3 has given the Mid-Atlantic Center for Children's Health and the Environment (MACCHE), a joint effort between GW and Children's National Medical Center, a collaborative grant of $50,000 to address this problem through the Healthy Asthma Homes Project.
The goal of the Healthy Asthma Homes Project is to improve the quality of life of asthmatic children in the District through in-home asthma intervention. Through this cooperative agreement, homes with asthmatic children are targeted for in-home asthma intervention, which consist of a healthy home visit and an asthma management plan component. Experts work with these families to identify and reduce/eliminate in-door environmental asthma triggers and educate families on how to better manage their condition.
"This grant allows us to continue and expand the important work we do here in Washington, DC. We know that by taking an integrated approach at addressing all environmental health hazards in the homes of DC residents, we are having a significant impact on the health of many children here. This support helps families lower the effects of asthma in both children and adults," said David Michaels, PhD, MPH, research professor and interim chair of the Department of Environmental and Occupational Health.
Work on the Healthy Asthma Homes Project began in July 2008. In the District, Wards 6, 7 and 8 are the initial target of this project because these areas show the highest asthma prevalence and have a population that has limited access to primary health care services. When asthma is properly managed the problems associated with the disease are greatly reduced.
"For more than 30 years, EPA has been working for a cleaner, healthier environment for the American people. This grant enables our partners to help address this prominent health issue at the local level, where in-home improvements can make a real difference," said Donald S. Welsh, regional administrator for EPA's mid-Atlantic region.
The project builds on the Healthy Lead Homes project currently being implemented by MACCHE.
Experts from GW and the EPA, Region 3 will leverage resources to implement this project.
About the Mid-Atlantic Center for Children's Health and the Environment (MACCHE)
The Mid-Atlantic Center for Children's Health is one of the eleven pediatric environmental health specialty units in the Nation. Its mandate is to create awareness and educate health care providers and the general public on environmental issues that affect children in EPA Region 3 (Delaware, District of Columbia, Virginia, Maryland, Pennsylvania, and West Virginia). It is a joint effort of the George Washington University (GWU) and the Children's National Medical Center (CNMC), and is based within the Department of Environmental and Occupational Health of the GW School of Public Health and Health Services. MACCHE is funded by the Association of Occupational and Environmental Clinics (AOEC) through a cooperative agreement with the Agency for Toxic Substances and Disease Registry (ATSDR) and the U.S. Environmental Protection Agency (EPA), Region 3.
About The George Washington University Medical Center
The George Washington University Medical Center is an internationally recognized interdisciplinary academic health center that has consistently provided high-quality medical care in the Washington, DC metropolitan area for 176 years. The Medical Center comprises the School of Medicine and Health Sciences, the 11th oldest medical school in the country; the School of Public Health and Health Services, the only such school in the nation's capital; GW Hospital, jointly owned and operated by a partnership between The George Washington University and a subsidiary of Universal Health Services, Inc.; and the GW Medical Faculty Associates, an independent faculty practice plan. For more information visit the GWUMC web site .
By Pennsylvania Integrated Pest Management Program (Source: PA IPM News, volume 11, No. 4, Fall 2008)
Suppression of asthma triggers such as rodents and cockroaches and the pesticides used to treat them is the focus of a new integrated pest management (IPM) training program to be offered in public housing au¬thorities across the country. The Northeastern IPM Center project, funded by the Department of Housing and Urban Develop¬ment through the U.S. Department of Agriculture, will promote IPM to public housing authorities as a low-risk, effective way to reduce pests and pesticide use. IPM is a common sense approach to managing pests that uses knowledge of pests' habits and needs to help residents implement pest prevention tactics for long-term control. Sealing off cracks and crevices where pests can enter and removing food and water are all examples of preventative tactics. In IPM, pesticides are used only as a last resort and they are selected based on their safety to humans and the environment.
Project coordinator Allison Taisey says that one public housing study showed that at least six pesticide products were found in the majority of homes studied—including banned and restricted use products. "Unfortunately, not everyone practices IPM, and many institutions don't have a written pest management policy. That leaves unaware residents thinking they have to deal with their own pest problems."
Many people are also unaware that pests and pesticide use can increase the risk of asthma and even cause it in some cases. "A 2006 study points out that asthma affects over 12 percent of children nationwide, but that number increases to 17 percent of the children in New York City, and 30 percent of the children in Harlem," says Taisey. "There is a correlation between public housing and asthma. In addition to the health consequences, asthma episodes in children result in missed school, medical expenses, and lost time at work for the caregiver. There is a way to take these burdens off already struggling families."
Project partners consulted with the USDA-formed advisory committee to review and refine existing IPM training materials pertinent to public housing. "Educational packets are being developed and will be used during one-day trainings for maintenance staff, managers, and resident leaders in each of the four USDA regions," Taisey explains. "The trainings will emphasize a team-based approach, meaning that project partners, trainers, residents, maintenance staff, supervisors, and pest control companies will share in supporting a successful IPM program."
In addition, Taisey says that IPM information will be conveyed to these audiences in a variety of ways, not only as concepts on paper but as demonstrations in real-world situa¬tions. "The on-site, hands-on training will also be practical. For example, we will show where to use sticky traps and steel wool, how to seal cracks and crevices and when to contact a pest control professional." Other topics include how to write a pest management policy, performance-based contracts and standard contract specifications for IPM services, and the basic biology and behavior of pests such as cockroaches, rodents, and bed bugs.
The one-day training course is being made available through the NE IPM Center and the National Healthy Homes Training Center. To review course materials and get more background on the course, see the National Center for Healthy Housing web site .
Additional project activities include "train-the-trainers" sessions so that a network of professionals across the country who are supporting IPM efforts in public housing can be established. In addition, portions of the trainings will be taped to develop DVDs that will be used by housing authorities to educate their residents. "Our ultimate goal is to demonstrate that through a team approach to IPM, public housing staff and residents can work together to reduce pest problems and contribute positively to healthy homes," says Taisey.
Other partners in the project include the four Regional IPM Centers, the Environmental Protection Agency, Centers for Disease Control and Prevention, the state-based cooperative extension system, private consultants, pest control operators, and nonprofit organizations, such as the National Center for Healthy Housing.
The Northeastern Integrated Pest Management Center fosters the development and adoption of IPM, a science-based approach to managing pests in ways that generate economic, environmental, and human health benefits.
Cockroach and Mouse Proteins Associated with Greater Risk for Asthma and Allergies in Preschool Children
A study released by researchers at the Columbia Center for Childrenís Environmental Health (CCCEH) (PDF, 7 pp, 260KB) at Columbia Universityís Mailman School of Public Health shows that developing antibodies to cockroach and mouse proteins is associated with a greater risk for wheeze, hay fever, and eczema in preschool urban children as young as three years of age. The study, published in the November 2008 issue of the Journal of Allergy and Clinical Immunology, is the first to focus on the links between antibody responses to cockroach and mouse proteins and respiratory and allergic symptoms in such a young age group.
This study is part of a broader multi-year research project launched in 1998 by CCCEH that examines the health effects of exposure of pregnant women and babies to indoor and outdoor air pollutants, pesticides, and allergens. The Centerís prior research findings have shown that exposure to multiple environmental pollutants is associated with an increase in risk for asthma symptoms among children. These latest findings contribute to a further understanding of how the environment impacts child health.
To learn more about the CCCEH, visit their web site .
CONGRATULATIONS to the Communities in Action for Asthma-Friendly Environments National Exemplary Award Winners in the Mid-Atlantic Region!
- Child Asthma Link Line
- Children's Hospital of Philadelphia Community Asthma Prevention Program
- Controlling Asthma in the Richmond Metropolitan Area (CARMA)
The National Exemplary Award recognizes community-based asthma programs that have:
- Committed program champions
- Strong community ties
- High performing collaborations and partnerships
- Integrated health care services
- Tailored environmental interventions
- Achieved positive health outcomes
Award recipients are featured on the Communities in Action for Asthma-Friendly Environments website and also receive:
- National recognition
- Personalized program mini-Web pages
- Invitation to serve as mentors for other programs
For more information on the awards or to apply visit the Communities in Action for Asthma-Friendly Environments web site .
Two New Programs in the Region Have Joined the Communities in Action Online Network:
West Virginia Asthma Education and Prevention Program (Charleston, WV)
The mission of the WV-AEPP is to develop, implement, and evaluate a statewide strategic asthma plan in the ultimate interest of reducing the health and economic consequences attributed to asthma in West Virginia. The WV-AEPP aspires to highlight asthma as a priority health concern and to reduce suffering, disability, death, and economic costs related to asthma from several fundamental approaches as outlined in The Burden of Asthma in West Virginia and in the Strategic Plan for Addressing Asthma in West Virginia. The AEPP's main goal is to improve the lives of over 150,000 West Virginians who have asthma. Contact: Cynthia Keely at firstname.lastname@example.org or (304) 558-0644. Visit the Communities in Action for Asthma-Friendly Environments web site for more information.
Asthma Institute (Pittsburgh, PA)
The Asthma Institute provides clinical services through University of Pittsburgh Medical Center and Children's Hospital of Pittsburgh as well as do research on asthma in both settings. They also do community health screenings and education.Contact: Catherine Vitari at email@example.com or (866) 804-5278. Visit the Communities in Action for Asthma-Friendly Environments web site for more information.
Communities in Action for Asthma-Friendly Environments Launches New Resource Bank
WHAT: Communities in Action for Asthma-Friendly Environments has launched a new Resource Bank that provides access to hundreds of up-to-date asthma-related tools and materials. You can now also share resources with programs across the nation by becoming a member of the online Network.
WHO: The Network is supported by the U.S. EPA in partnership with Allies Against Asthma, a program of the Robert Wood Johnson Foundation.
WHERE: Visit the Resource Bank , or become a registered member of the Network .
New Indoor Air Quality Lesson Plans Available for Grades K-12
WHAT/WHO/WHERE: Through a cooperative agreement with the U.S. EPA, the National Education Association Health Information Network (NEAHIN) has created a series of grades K-12 lesson plans that supplement the U.S. EPA's Indoor Air Quality Tools for Schools Program and Action Kit. The new lesson plans can be downloaded from the NEAHIN web site , and the Action Kit can be found at EPA's Indoor Air Quality Tools for Schools (IAQ TfS) Action Kit web page.
INFO: Visit the EPA's Indoor Air Quality Tools for Schools Program web site for more information.
EPA Indoor Air Quality Tools for Schools/HealthySEAT National Symposium (Dec. 4-6)
WHAT/WHO/WHERE: The U.S. EPA's Indoor Air Quality Tools for Schools Program is holding a national symposium December 4-6, 2008 in Washington, D.C.
INFO: Register today! Visit EPA's Indoor Air Quality Tools for Schools Program web site for more information.
NIH Summit—The Science of Eliminating Health Disparities (Dec. 16-18)
WHAT/WHO/WHERE: The NIH Institutes, Centers, Offices, and their many partners engaged in research on minority health and health disparities are presenting a summit highlighting the research progress of the NIH on health issues among racial/ethnic minority and medically underserved populations. The summit will be held at the Gaylord National Resort and Convention Center in National Harbor, MD on December 16-18, 2008.
INFO: Register for this conference. To learn more about NIH's National Center on Minority Health and Health Disparities, visit their web site.
Communities in Action for Asthma-Friendly Environments 2009 National Asthma Forum
WHAT/WHO/WHERE: Communities in Action for Asthma-Friendly Environments will hold its National Asthma Forum June 4-5, 2009 in Washington, D.C. The Forum offers opportunities to network with peer programs, problem solve with insights from asthma program leaders, and learn about important new topics, including program evaluation and the business case for comprehensive asthma care.
INFO: To register or for information about last year's National Asthma Forum, visit the National Asthma Forum web site. Registration will open in January 2009. For more information on Communities in Action for Asthma-Friendly Environments, see their web site.
American Lung Association
Several e-newsletters are available, including Breathe Easy®/Asthma Digest and The Weekly Breather. Sign up by visiting the American Lung Association web site and clicking on "E-Newsletters" on the bottom right-hand corner of the page.
CAFA (Community Action to Fight Asthma)
CAFA distributes CalAsthma Update , a semi-monthly e-newsletter. CAFA is a statewide network of asthma coalitions in California working to shape local, regional and state policies to reduce the environmental triggers of asthma for school-aged children where they live, learn, and play. CAFA is funded by The California Endowment and coordinated by the Regional Asthma Management and Prevention (RAMP) Initiative, a project of the Public Health Institute.
National Center for Healthy Housing
This organization works to create healthy and safe homes for children by helping to reduce children's risk of lead poisoning and children's exposure to other hazards in the home including biological, physical, and chemical contaminants in and around the home. Subscribe to their quarterly e-newsletter, Healthy Housing Connections.
Alliance for Healthy Homes
The Alliance for Healthy Homes is a national, nonprofit, public interest organization working to prevent and eliminate hazards in our homes that can harm the health of children, families, and other residents. The Alliance distributes its e-newsletter, Alliance Alert , monthly. The Alliance also facilitates two e-mail listservs– healthyhomesnet and leadnet -- that allow advocates, policy makers, state and local government staff, health providers, and others interested in lead poisoning prevention and healthy homes issues opportunities to share news, information and experiences with one another.
For past issues of the MARAN e-newsletter, see our MARAN Newsletter web page.