Asthma Action. Contra Costa Asthma Coalition

Transcription

1 Blueprint Asthma Action for A Report for Awareness and Advocacy in Contra Costa County Contra Costa Asthma Coalition

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3 Mission of the Contra Costa Asthma Coalition The Contra Costa Asthma Coalition is an inclusive, broad-based partnership of organizations and individuals whose mission is to strengthen Contra Costa County s ability to prevent asthma and improve the lives of people affected by asthma. It does this by: Helping asthma-related organizations to learn from each other, coordinate their services, and enhance the level of care, Promoting public education and programs that reduce health disparities and are responsive to the needs of the community, and Advocating for improved local, state, and federal asthma-related programs, policies and legislation. Coalition Members American Lung Association of California Asthma Community Advocates Communities for a Better Environment Community Action To Fight Asthma Initiative Community Clinic Consortium of Contra Costa Community Focus Community Health Initiative Concerned residents of Contra Costa County Contra Costa Child Care Council Contra Costa Community Services Contra Costa Council Contra Costa Health Plan Contra Costa Health Services John Muir Community Health Alliance Kaiser Permanente La Clinica de La Raza Martinez Unified School District Mt.Diablo Unified School District Neighborhood House of North Richmond Parents for a Safer Environment Regional Asthma Management and Prevention Initiative Shields-Reid Community Center West County Toxics Coalition Blueprint for Asthma Action: A Report for Awareness and Advocacy in Contra Costa County 1

4 Acknowledgements The Blueprint for Asthma Action: A Report for Awareness and Advocacy in Contra Costa County was prepared by the Contra Costa Asthma Coalition with the support and assistance of the Blueprint sub-committee designed to provide technical advice. Special thanks go to Kaiser Permanente for supporting revisions to the Blueprint in early We thank the sub-committee and the entire membership for their support. More information about the Coalition can be obtained at To obtain a full copy of the Blueprint, or to find out more about the Contra Costa Asthma Coalition, please contact Carol Shenon at ccac-admin@hotmail.com. This publication was supported by Cooperative Agreement Number U50/CCU from the Centers for Disease Control and Prevention (CDC) as part of the National Environmental Public Health Tracking Program. Its contents do not necessarily represent the official views of CDC. The design and printing of this publication was provided by funding from The California Endowment, Contra Costa Health Services, and Kaiser Permanente. 2 Blueprint for Asthma Action: A Report for Awareness and Advocacy in Contra Costa County

5 Blueprint for Asthma Action: A Report for Awareness and Advocacy in Contra Costa County I. Overview of the Problem Asthma is a disease in which inflammation of the airways causes airflow into and out of the lungs to be restricted. are hospitalized for asthma at higher rates than for other children. Contributing factors to these disparities include poor air quality outdoors and indoors that children from low-income families are often exposed to in their daily lives. Limited access to health care and lack of appropriate asthma education programs and social support in these communities are contributing factors that further exacerbate the problem. When an asthma attack occurs, the muscles of the bronchial tree become tight and the lining of the air passages swells, reducing airflow and producing the characteristic wheezing sound. Mucus production is increased. Asthma is the most common chronic childhood disease, affecting 4.8 million children nationwide and accounts for one-third of all pediatric emergency visits. It is widely recognized that environmental factors play a major role in contributing to asthma. Over the last two decades, the nationwide prevalence of childhood asthma has risen substantially. The reason for this rise in prevalence is not known. Although children and adults suffer from asthma, the recent nationwide increase provides an impetus for this report to focus on the effects of asthma on children. Hospitalization rates, a commonly used indicator of this burden in a population, tell us that in California, African American and Latino children Blueprint for Asthma Action: A Report for Awareness and Advocacy in Contra Costa County 3

6 Families with asthmatic children face economic burdens with each hospitalization and must cope with the emotional challenge of controlling a lung disease that can be life threatening whenever improperly managed by the patient, family or health care provider. When children repeatedly experience mild to severe episodes, they cannot engage in normal physical activities and are absent from school for more days than children without asthma. Asthma is the #1 cause of school absenteeism due to a chronic illness in children in the U.S., which also leads to missed workdays for parents. While experts continue to debate the causes of asthma, which include genetic and environmental factors, there is strong consensus that asthma episodes are triggered by colds, exercise, flu and bad outdoor and indoor environmental conditions. Vehicle exhaust, industrial plant emissions, woodstoves and secondhand smoke from cigarettes can trigger asthma episodes. Mold, dust, and cockroaches and other allergens commonly found in substandard housing and poorly maintained schools can also trigger episodes. The relative importance of a particular asthma trigger varies from person to person, and it is often the complex interaction of exposure to a number of environmental triggers and other factors that causes an asthma episode for an individual. As a result, strategies to decrease exposure to all of these environmental triggers and manage their impact need to be implemented by local communities through campaigns that increase awareness, promote asthma self-management skills, improve social support and address policies to reduce these triggers in the environment. II. Asthma Rates According to the California Department of Health Services, hospitalizations for asthma are a significant burden in Contra Costa County. Data collected by the Office of Statewide Health Planning and Development show that certain zip code areas in the County, namely those in Richmond and San Pablo, have child hospitalization rates higher than the state average and higher than other communities in the County. Please see Table 1. Table 1 California Walnut Creek Antioch/Martinez Pittsburg/Bay Point Concord Richmond/San Pablo Child Hospitalization Rate by Contra Costa Communities Source: Community Action to Fight Asthma Zip Code Data, According to the 2003 California Health Interview Survey (CHIS), the prevalence of asthma among children 0-14 years in Contra Costa County is 15.3%. According to the 2001 and 2003 CHIS, the Rate per 10,000 among children Blueprint for Asthma Action: A Report for Awareness and Advocacy in Contra Costa County

7 percentage of African Americans (all ages) who reported being diagnosed with asthma nearly doubled, increasing from 14% to 26%, in contrast to 14.9% to 15.1% among Whites (Table 2). In addition, the hospitalization rate for African American children with asthma is more than four times that of Latino children, and almost five times that of white children. (Table 3). Table 2 Table 3 Rate per 10, Rate of Childhood Asthma Hospitalization by Ethnic Group Contra Costa Source: California County Asthma Hospitalization Chart Book African American Latino White Asian/PI County-wide Percent (%) Diagnosed with Asthma by Ethnic Group Contra Costa County Source: CHIS 2001 and 2003 African American children in Contra Costa County are almost five times more likely to be hospitalized for asthma than White children In the 2003 CHIS report, 38% of African Americans Percent diagnosed with asthma reported visiting an emergency room while 12.5% Latinos and 8% of 5 White community members reported using the ER 0 Latino Asian African American White because of their asthma. A higher percentage of African Americans reported experiencing symptoms every day (19%) and every week (14%), compared to Whites (11%, 5%, respectively). Please see Table 4. Blueprint for Asthma Action: A Report for Awareness and Advocacy in Contra Costa County 5

8 Table 4 2. Area sources include diverse, un-permitted Percent (%) who Reported going to ER/Urgent Care for Asthma in Past 12 Months by Ethnic Group Source: CHIS 2003 Contra Costa County small sources that individually do not emit significant amounts of pollutants but which Latino African American White together emit an appreciable amount of pollution. Examples of area sources are residential heating and use of paints, varnishes, consumer products and wood stoves. 3. Mobile sources include cars, buses, and trucks that run on gasoline or diesel fuel; and trains, ships and construction equipment that run on diesel fuel. Response to the 2003 CHIS survey question: During the past 12 months, have you had to visit a hospital emergency room or urgent care clinic because of your asthma III. Environmental Factors that Affect Asthma Outdoor Air Pollution Outdoor air pollutants have been studied, measured and regulated for many years, and health-based standards have been set for many of these pollutants because historically, outdoor air pollution has had major impacts on people s health. Outdoor air pollution that triggers asthma episodes originates from three source categories: 1) stationary; 2) area; and 3) mobile. 1. Stationary sources in Contra Costa County Sources in all of these categories emit sulfur dioxide (SO2), particulate matter (PM), and nitrogen dioxide (NO2). Reactive Organic Gases (ROG) are also emitted from source in all these categories. These Reactive Organic Gases react with nitrogen dioxide in the presence of sunlight to form photochemical ozone, which is a major component of smog. Studies have shown that there are strong relationships between the levels of NO2, SO2, particulate matter (PM), and photochemical ozone in the air, and the occurrence of asthma episodes in children and decreases in lung function and growth. These are commonly called criteria pollutants because the U.S. Environmental Protection Agency has set ambient air quality standards for these pollutants based on health-protective criteria. The state of California has set more stringent health-based criteria standards for these pollutants. 1 include power plants, refineries, and other industrial facilities. 1 It is important to differentiate between stratospheric ozone and photochemical ozone. Most of the atmospheric ozone (about 90%) is found in the stratosphere, which is located approximately from 12 to 15 miles above the earth s surface. The stratospheric ozone is beneficial ozone since it absorbs hazardous ultraviolet radiation emitted by the sun, whereas photochemical ozone is an asthma trigger. 6 Blueprint for Asthma Action: A Report for Awareness and Advocacy in Contra Costa County

9 Table 5 displays how much each source category contributes to the total amount of these pollutants emitted in Contra Costa County. Table Contra Costa Air Contaminant Sources 100% 80% 60% 40% 20% 0% ROG NO2 SO2 PM 2.5 Contaminant Stationary Areawide Mobile Compliance with Health-Based Air Quality Standards (1) Stationary sources include power plants, refineries, and other industrial facilities (2) Area sources are residential heating and use of paints, varnishes, consumer products and wood stoves. (3) Mobile sources include cars, buses, and trucks that run on gasoline or diesel fuel, and trains, ships and construction equipment that run on diesel fuel. ROG = Reactive Organic Gases NO2 = nitrogen dioxide SO2 = sulfur dioxide PM = particulate matter Source: California Air Resources Board web site The Bay Area Air Quality Management District (BAAQMD) maintains 26 monitoring stations throughout the Bay Area that measure the concentration of ozone, NO2, SO2, and PM in the ambient air. Seven of these stations are in Contra Costa County. Although the levels of these pollutants have generally come down over the last 50 years, the Bay Area Air Basin is still out of attainment for the state standards for ozone and particulate matter. The American Lung Association s State of the Air 2005 Blueprint for Asthma Action: A Report for Awareness and Advocacy in Contra Costa County 7

10 examines the two most pervasive air pollutants: ozone and PM 2.5 or particle pollution. While these are not the only outdoor air pollutants, they are the two most dangerous because of their toxicity and their prevalence. This report deliberately limits the grading to counties that have air quality monitors. groups of people. For those days, the particle pollution ranged between 40.5 and 65.4 µg/m3. In addition, there were 4 days when the particle levels are considered unhealthy for all people; the particle pollution ranges from 65.5 to µg/m3 Table 6 American Lung Association State of the Air Report 2005 HIGH OZONE DAYS Report As a result of the Bay Area being out of attainment for the State standard for ozone and particulate matter, the Bay Area Air Quality Management District was required to develop plans identifying additional emission control measures to be taken to reduce pollutant concentrations to acceptable levels. The Bay Area has not had any recent violations of NO2 or SO2 air quality standards. Below are the 2005 data reported from these monitors for Contra Costa County. In 2005, the American Lung Association reported that the ozone grade for Contra Costa County was a D, and that there were 8 days in the year when the ozone levels are considered unhealthy for sensitive groups of people, such as those with asthma. Ozone Grade:... D Weighted Average: Orange Ozone Days:... 8 Red Ozone Days:...0 Purple Ozone Days:...0 PARTICLE POLLUTION 24 Hour Report Grade:...F Weighted Average: Orange Particle Days:...21 Red Particle Days:... 4 Purple Particle Days:...0 PARTICLE POLLUTION Annual Report Grade:...P Design Value: High Ozone Grades Notes The 2005 particle pollution grade for Contra Costa (1) Orange: Unhealthy For Sensitive Groups ( ppm ozone), Red: Unhealthy ( ppm ozone), and Purple: County was an F ; there were 21 days when the Very Unhealthy ( ppm ozone). particle levels are considered unhealthy for sensitive (2) The weighted average was derived by adding the three years of individual level data ( ), multiplying the sums of each 8 Blueprint for Asthma Action: A Report for Awareness and Advocacy in Contra Costa County

11 level by the assigned standard weights, i.e. 1=orange, 1.5=red, 2.0=purple, and calculating the average. (3) Ozone Grades are as follows: A=0.0, B , C= , D= , F=3.3+. Particle Pollution Grades Notes (4) Particle pollution is reported in two ways: 24-hour measurements, which look at short-term exposure and annual averages, which look at year-round exposure. Serious health effects can occur with high levels over either short-term or yearround exposure. (5) Orange, Red, and Purple days are counted from the shortterm (24-hour) particle levels reported on the Air Quality Index. Orange: Unhealthy for Sensitive Groups ( µg/m3); Red: Unhealthy ( µg/m3); and Purple: Very Unhealthy ( µg/m3) (6) Weighted Average: The weighted average was derived by adding the three years of individual county data ( ), multiplying the sums of each level by the assigned standard weights, i.e.1 = orange, 1.5=red, 2.0 = purple, and calculating the average. Grades for the 24-hour or short-term measurements are as follows: A = 0.0, B = , C = , D = , F = (7) Design Value: A calculated concentration of the pollutant based on the form of the national standard. EPA calculates this value and uses it to determine whether or not the county meets the national standard. (8) Grades for the Annual Average are based on EPA s determination of violations of the national ambient air quality standard for annual PM 2.5 of 15 µg/m3 as reported in communications from the EPA Office of Air Quality Planning and Standards in February Grades are reported as follows: P for Pass: Meeting the standard; F for Fail: Not meeting the standard; I for Incomplete: Insufficient data existed to determine. Diesel Particulate Matter: A Pollutant of Special Concern Diesel Particulate Matter (DPM) refers to the particulate matter in the exhaust from trucks, school buses, trains, ships and construction equipment that run on diesel fuel. Diesel Particulate Matter is typically smaller in diameter than exhaust from other combustion sources and is best measured as part of PM 2.5 (particulate matter smaller than 2.5 microns in diameter). DPM is of special concern for four reasons. First, research has shown that diesel exhaust can trigger asthma episodes, and children are particularly vulnerable to the lung health risks of this exposure. Second, DPM is a potent carcinogen and the California Air Resources Board estimates that it accounts for 70 percent of the cancer risk from air pollution in California. Third, DPM has the greatest impact on people living, working or going to school near the source, so there is a greater disproportionate burden associated with it than for pollutants that disperse throughout the air basin. And fourth, DPM has been relatively less regulated than other major outdoor air pollutants, so many more opportunities to reduce DPM emissions exist than do for other major pollutants. For these reasons, the California Air Resources Board has embarked on an ambitious plan to reduce emissions of DPM by 85 percent by But many of these measures rely on voluntary participation by the owners of diesel engines (such as retrofitting diesel engines to make them cleaner), or currently lack adequate enforcement mechanisms (such as idling restrictions). Pollen: A Significant Outdoor Trigger in the County Pollen, which is an allergen that originates from trees and grass, is an outdoor trigger that often intensifies asthma symptoms in children. Similar to the air quality stations that monitor the presence Blueprint for Asthma Action: A Report for Awareness and Advocacy in Contra Costa County 9

12 of pollutants in the atmosphere, the Aeroallergen Monitoring Network of the American Academy of Allergy, Asthma and Immunology, has established a system of pollen counting stations across the United States that collect airborne pollen samples. These stations are able to determine when pollination periods occur, commonly referred to as pollen seasons, which typically occur in Contra Costa County in the spring, summer or fall. Their local office and measuring equipment are ideally located near pollen producing vegetation. They distribute reports via the National Allergy Bureau to media outlets and to the public through various web sites. This information - published in local daily newspapers - allows asthma sufferers and their physicians to relate symptoms to their likely causes during particular times of the year or day, and consider what they can do to reduce their exposure to high levels of pollen or manage their effects. Indoor Environmental Factors Indoor Air Pollution has been much less studied, measured and regulated than outdoor air pollution, even though it is now thought that indoor air pollution causes significant health effects. No comprehensive indoor air pollution standards or monitoring programs currently exist in California. Children spend close to 90% of their time in the home and school environment, which largely explains why a child with asthma is vulnerable to poor indoor air quality (IAQ). Research has shown that indoor pollution can trigger asthma episodes. Triggers that can be found indoors include cold air, tobacco smoke and wood smoke, perfume, paint, hair spray, or any strong odors or fumes, allergens (particles that cause allergies) such as dust and dust mites, pollen, molds, pollution, and animal dander - tiny scales or particles that fall off hair, feathers or skin - and saliva from any pets and common cold, influenza, and other respiratory illnesses. It is important to pay close attention to improperly operating space heaters, and respiratory irritants released into the air when using particular cleaning and teaching products, and building materials and furnishings. The uncontrolled presence of these triggers, such as when ventilation systems do not function properly, triggers asthma symptoms and makes them more difficult to manage. A study on the health benefits of replacing or upgrading school 10 Blueprint for Asthma Action: A Report for Awareness and Advocacy in Contra Costa County

13 ventilation systems showed that fewer children reported asthma symptoms in schools with improved systems than children in schools with inadequate ventilation systems. Dust, which is an allergen, is commonly found on bookcase surfaces, flooring, carpets and rugs, curtains, and furniture. Mold, caused by moisture-related problems linked to unattended leaks under sinks, floors, and behind walls has also been associated with the prevalence of asthma. In both homes and schools, stemming the conditions that contribute to their prolonged existence can reduce exposure to allergens and mold. This includes removing carpets and rugs where dust and pet dander collect, and checking for moisture problems. Because asthma triggers differ for each individual, school nurses (where available) may work with each student to implement their individual Asthma Action Plans. The California Education Code (AB2132, January 2005) states that with the approval of the pupil s authorized health care provider and the approval of the pupil s parent or legal guardian, a local school district may allow a pupil to carry medication and to self-administer the medication. However, not all schools in Contra Costa County have implemented policies permitting children to do so. Numerous outreach programs exist throughout the County to conduct home assessments identifying possible asthma triggers. However, limited funding of these programs does not meet the needs that exist. More school nurses are needed in the schools to help students with their asthma triggers and to assist them in complying with their asthma management plans. Environmental Justice Concerns According the US Environmental Protection Agency (EPA), Environmental Justice means that no group of people, including racial, ethnic, or socioeconomic groups, should bear a disproportionate share of the negative environmental consequences resulting from industrial, municipal, and commercial operations or the execution of federal, state, local, and tribal environmental programs. Some people in Contra Costa County may live or work in areas where they are either Blueprint for Asthma Action: A Report for Awareness and Advocacy in Contra Costa County 11

14 constantly or periodically exposed to more pollution than is generally present in the county as a whole. For example, people living near major freeways and trucking routes can be exposed to more diesel particulate matter than people that live further away. Other major sources of diesel pollution, such as ports, rail yards and distribution centers may also present greater than average risk to those living and working nearby. Residents living near industrial facilities in Contra Costa County have been periodically exposed to accidental fires and releases of chemicals. Finally, the eastern portion of the county typically has higher concentrations of photochemical ozone than the rest of the county because predominant wind patterns blow the reactive organic gases and nitrogen dioxide emitted throughout the county eastward while they react with sunlight to form ozone. These types of disproportionate exposure can be considered Environmental Justice concerns. area also has a higher percentage of low-income and minority residents than the County as a whole. When trying to improve asthma outcomes, special attention should be paid to those communities where Environmental Justice concerns exist. In addition to more potential outdoor triggers, these same communities are often low-income communities and thus may have more indoor triggers due to poorer housing stock, less access to health care, limited social support for asthmatics, and higher asthma prevalence rates. All of these factors, in turn, can lead to more frequent and severe asthma episodes and higher hospitalization rates. A recent study by an environmental advocacy group found that many of the Contra Costa communities that have major freeways running through them also have the largest industrial sources of air pollution. These same communities also had high percentages of low-income and minority residents. According to a study by another environmental advocacy group, there is an estimated 6 times more diesel pollution released per square mile in Inner West Contra Costa County than in the county as a whole, and 40 times more than the average throughout California. This 12 Blueprint for Asthma Action: A Report for Awareness and Advocacy in Contra Costa County

15 Key Findings and Action Items: IV. Key Findings and Action Items The prevalence and burden from asthma in Contra Costa County has been increasing and disproportionately affects the African American and Latino communities. While the debate on the multiple causes of asthma continues, there is strong evidence that supports the view that indoor and outdoor environmental pollutants can cause and/or trigger asthma. Public health advocates in Contra Costa County can work to promote educational interventions and policies that address the reduction of these pollutants and the management of their effects. The Contra Costa Asthma Coalition Strategic Plan for includes priorities to reduce the impact of asthma on residents of Contra Costa County. Following are actions that can be taken by Asthma Coalition members, local policy makers and community members to help lessen the burden that all Contra Costa County experiences from asthma. Blueprint for Asthma Action: A Report for Awareness and Advocacy in Contra Costa County 13

16 Hospitalization rates are highest among the school-aged African American children Action: Support interventions at home and in schools that improve self-management skills to reduce hospitalization rates. Parents, teachers, and children who live in areas with the highest hospitalization rates should be taught how to recognize and respond to symptoms of an asthma episode, and how to manage indoor environmental triggers. Action: Create a school district asthma team, similar to the one created by San Francisco Board of Education, which identifies students with asthma and tracks which students have action plans on the school site. Action: Reinforce evidence-based asthma intervention and management of all school-aged children by supporting their ability to self-manage with prescription inhalers. Address the issue of African Americans of all ages in Contra Costa who continue to be disproportionately affected by asthma. Action: Support culturally appropriate interventions and campaigns designed for the African American community to increase awareness of indoor and outdoor air quality issues and how they affect asthma. Train and support asthma advocates so that they participate in local air regulatory meetings, to promote changes that reduce recognized harmful emissions from stationary, area and mobile sources. Special attention needs to be paid to Diesel Particulate Matter due to the harm it causes, its disproportionate impact and weak regulatory control. Action: Support the Board of Supervisors in the enforcement of the Airborne Toxic Control Measure To Limit Diesel Fueled Commercial Motor Vehicle Idling. Action: Develop and foster a working relationship with the Contra Costa Office of Education to encourage the creation of countywide guidelines for schools in relation to California Education Code (AB 2132). 14 Blueprint for Asthma Action: A Report for Awareness and Advocacy in Contra Costa County

17 Action: Work to ensure that housing is free of triggers and the conditions that promote their existence removed. Action: Raise awareness of the effects of second hand smoke exposure in children and support educational campaigns that encourage smokers to smoke outside the home and away from upwind doors and windows. Indoor Air Quality in Homes and Schools in Contra Costa County Needs Improvement Action: Contra Costa Asthma Coalition members can advocate for interventions that improve indoor air quality in homes and schools, such as promoting the use of the U.S. Environmental Protection Agency s Indoor Air Quality Tools for Schools program in Contra Costa schools located in zip code areas with high child hospitalization rates. Action: Encourage community health outreach worker (CHOW) programs to incorporate asthma trigger management education for families affected by asthma. Support these programs by providing CHOW training on asthma and its management, and on community resources that can help families remove or control triggers in the home. Pollen Can Intensify Asthma Symptoms Action: People with asthma must have appropriate access to health care to identify if pollen is one of their triggers. Advocate for access to appropriate health care so that patients and their families have the tools and knowledge to identify, avoid, and reduce the impact of triggers. Action: Educators and healthcare providers should encourage parents in Contra Costa with children with asthma to consult the pollen reports published in the daily newspapers. Parents and adolescents can become aware of when pollen levels increase during the year and during the day, and take precautionary measures to avoid prolonged exposure. Blueprint for Asthma Action: A Report for Awareness and Advocacy in Contra Costa County 15

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