Asthma Surveillance and the Environment

Investigators: John Balmes, Jennifer Mann, Ira Tager

Asthma is a priority condition. We are using our experience in conducting research regarding the impact of environmental factors on asthma to provide improved surveillance of asthma. We sponsored a workshop in October 2004 that concluded: 1) a focus on asthma among children has the greatest potential public health impact; 2) school-based approaches are efficient for surveillance of asthma among children; 3) some state programs have had success with surveillance conducted by school nurses; 4) in school districts that do not have many nurses, the use of a brief, self-administered student questionnaire [specifically, the survey instrument developed for the CDC-funded "Oakland Kicks Asthma" (OKA) program] may be an alternative approach.
Advantages of the OKA survey instrument is that it can provide information on severity as well as prevalence of asthma and on children with probable, but undiagnosed asthma. Potential disadvantages are that limited school resources might be impacted and Family Education Rights and Privacy Act (FERPA) restrictions might be invoked in certain school districts. Because of its potential advantages to school districts with low numbers of school nurses, this survey approach to asthma surveillance in schools should be validated through comparison with other methods, such as school nurse reporting. Because school surveys may be difficult to implement in some districts, feasibility and costs need to be carefully evaluated.
To develop capacity to obtain ongoing local-level asthma prevalence and severity data, we will "beta-test" this school-based, survey approach in Fresno, CA; compare prevalence estimates from the school survey instrument with prevalence estimates from school nurse-based surveillance programs in CT and MA; and collaborate with the CA EPHT program to determine whether any indicators used in that program's managed care-based surveillance pilot project can estimate asthma prevalence and/or severity in Oakland and to study the relationship of exposure to pesticides (and other environmental factors) and asthma outcomes in Fresno.