The Outdoor Air Quality Flag Program in Central California: A School-Based Educational Intervention to Potentially Help Reduce Children's Exposure to Environmental Asthma Triggers
Shendell, Derek G., Rawling, Mary-Michal, Foster, Christine, Bohlke, Alicia, Edwards, Bobbie, Rico, Susie A., Felix, Justina, Eaton, Sandra, Moen, Stephanie, Roberts, Eric M., Love, Mary Beth, Journal of Environmental Health
Many factors influence children's exposure to biological and chemical pollutants, including known environmental asthma triggers, in microenvironments frequently inhabited during daily activities such as school (Shendell, Barnett, & Boese, 2004). Although microenvironments inside, in school classrooms, and outside, on playgrounds, may be quite different, it has been clearly demonstrated in the scientific literature that outdoor air influences indoor air and environmental quality Only outdoor air quality, however, is subject to local, state, and federal regulations. Therefore, community groups may focus more on outdoor air quality.
An American Academy of Pediatrics (AAP) report has emphasized the need to limit children's exposure to outdoor air pollution because of many known and suspected adverse health effects, including asthma (AAP, 2004). Environmental factors influence the prevalence and severity of asthma, and likely help cause asthma (U.S. Department of Health and Human Services, 2006). In addition, numerous federal reports on environmental threats to children's health have called for improved risk communication and environmental education (U.S. Environmental Protection Agency [U.S. EPA], 1996, 2000, 2002). Recommendations for preventing or reducing exposure to such environmental hazards must inherently be based on the best available science (Shendell, Barnett, & Boese, 2004). For example, the most current outdoor air quality data could be clearly summarized and delivered to targeted stakeholders.
This paper describes a novel school-based, visual environmental public health educational intervention intended to help reduce the exposure of children--and adults--to outdoor air pollution, including known environmental asthma triggers like ozone and particles. The overarching goal was to enhance the learning, recreational, and work environments of students and staff. The specific purpose of the intervention, the Asthma-Friendly Outdoor (Ambient) Air Quality Flag Program, was to establish an education and communication tool so that Central California communities could accomplish two things:
1. permanently change local policy with respect to existing operating procedures in school districts and schools to help reduce the exposure of students, teachers, staff, and nearby communities to outdoor environmental asthma triggers and
2. provide education on air quality and potential health effects from exposure to air pollutants.
The San Joaquin Valley agricultural region of Central California comprises urban and rural communities in nine counties: Fresno, Kern, Kings, Madera, Mariposa, Merced, San Joaquin, Stanislaus, and Tulare. Populations living in these communities were potentially exposed to some of the worst outdoor air quality in the nation, particularly to ozone and particles (American Lung Association, 2006). The populations are diverse in terms of socioeconomics, race/ethnicity, culture, immigration status, and primary languages spoken at home.
Community Action to Fight Asthma Initiative
The mission of the first Community Action to Fight Asthma (CAFA) Initiative (2002-2005) was to reduce the prevalence of asthma and the exposure to environmental hazards among California's school-aged children with asthma. CAFA synergized the advocacy, outreach, education, and intervention work of 12 local asthma coalitions (LCs) that had funding for their various activities--and 20 other LCs and environmental health and justice groups--across the state, linking them through four Regional Centers and a State Coordinating Office. CAFA's structure and its technical-assistance partners in policy advocacy, media, and evaluation augmented the capacity of the LCs from a previous focus on improving access to clinical asthma care and management quality to the pursuit of advocacy to affect environmental policy change at local, regional, and state levels. …