Asthma prevalence and school-related hazardous air pollutants in the US-México border area.

BACKGROUND: Asthma is the most common chronic disease in children and has been linked to high levels of ambient air pollution and certain hazardous air pollutants (HAPs). Outdoor pollutants such as benzene, released by car emissions, and organic chemicals found in diesel exhaust, as well as particles and irritant gases, including nitrogen dioxide (NO2), sulfur dioxide (SO2), and ozone (O3), contribute to an increased prevalence of respiratory diseases such as asthma. OBJECTIVES: The objectives of this study were to: 1) conduct a screening survey to identify high risk for asthma among school-age children in Hidalgo County, and, 2) study the potential health impact of school-related exposure to HAPs pertaining to asthma risk. METHODS: We carried out a quantitative cross-sectional study combining a school-based asthma screening survey across 198 schools in Hidalgo County, Texas, with information on school neighborhood environments, including census tract-level information on hazardous air pollutants (HAPs) and socioeconomic status (SES) in the respective school neighborhoods. HAPs levels were assessed based on the EPA 2011 National-Scale Air Toxics Assessment (NATA) while SES information was assessed using data from the 2010-2014 American Community Survey. RESULTS: 2930 students completed the asthma screening survey and results showed an overall asthma prevalence of 9.4%, slightly higher than the national and state prevalence. Participants in the 14-18 years old age group showed a much higher asthma prevalence of 16.7%. When assessing school-neighborhood characteristics, our results revealed no significant differences in asthma prevalence across census tracts with different SES levels. For HAPs, in the single-pollutant model, chlorine levels showed a significant linear trend for prevalence of asthma (p=0.03) while hydrochloric acid had a marginally significant linear trend (p=0.08). The association with chlorine remained significant in the multi-pollutant model. CONCLUSIONS: Asthma prevalence among school-age children in Hidalgo County, Texas, is 9.4%, which is slightly higher than the state rate, especially among young adults, ages 14-18 years who had an asthma rate of 16.7%. Results support an association between exposures to school-neighborhood HAPs and risk for pediatric asthma, especially as related to chlorine. No significant effects of school-level SES on asthma risk were observed.

The United States-Mexico border environmental public health: the challenges of working with two systems.

This report shares the challenges and opportunities encountered by a binational project that examined the availability of environmental and public health information for the United States-Mexico border area. The researchers interviewed numerous national and binational agencies on both sides of the border, endeavoring to develop a framework to advance the knowledge of academic and public health professionals in the area of environmental border health. However, the lack of standardized indicators and metrics in both countries validates the emergent need to establish a viable framework for the collection, analysis, and dissemination of environmental information. Recommendations for next steps are included.

Does injury prevention education initiate household changes in a Spanish-speaking minority population?

Young children from low income families are among the most affected population of unintentional injury. This non-randomized longitudinal study examined knowledge for home and child safety with an injury prevention training offered to parents of children who reside in the Rio Grande Valley of Texas. Eighty eight parents received the training and pre-and post-test surveys were used to measure knowledge outcomes. A follow-up survey was conducted 2 months after the educational intervention to identify how many parents reported household and safety behavior changes as a result of the training. The most significant change in behavior, as it pertains to the household, was related to locking and storage of dangerous cleaning chemicals. Other significant changes in behavior were in areas that directly related to the child such as learning how to swim, use of sun block and fire safety in the home. This study suggests that tailored trainings can improve parent knowledge and change in behaviors for the promotion of safety activities to avoid risks for unintentional injuries. Further, the study identified certain at-risk areas that need to be addressed from an educational perspective. These areas include bicycle and water safety; specifically, the use of protective gear when bicycling; understanding and adhering to traffic rules when bicycling; and, the dangers of drowning in small quantities of water.

Incorporating what promotoras learn: becoming role models to effect positive change.

Promotoras (community health workers) play an important health promotion role and must be continuously trained, but little is known about how much of their learning they actually put into practice. This non-randomized, longitudinal study examined knowledge and home environmental outcomes of an asthma and healthy homes training offered to promotoras using a train-the-trainer model. Eighty-five promotoras received the training and pre- and post-test surveys were used to measure training outcomes. Results showed a statistically significant increase in asthma and healthy home-related knowledge (P < .001). At 12-months post-intervention, a majority of the promotoras (69%) reported they made household changes to improve their indoor environment as a result of the training. This study suggests that effective trainings can improve promotoras knowledge and behaviors for the promotion of healthy homes in the community. Further evaluation is needed to investigate whether these trainings allow promotoras to serve as role models within their communities "by educating through example" and thereby enhance their credibility as health educators.

The impact of asthma health education for parents of children attending head start centers.

Parents of children who attend Head Start Centers are key participants in the health promotion and care of their own children. This non-randomized, longitudinal study aimed to test the effectiveness of an educational intervention based on the asthma and healthy homes curriculum targeting parents of Head Start children with or without an asthma diagnosis. One hundred and fifteen parents of children in Head Start Centers received an educational intervention at their corresponding sites, additionally pre- and post-test surveys were administered to measure educational intervention outcomes. A follow-up survey was conducted 6 months after the educational intervention was offered. Results showed a statistically significant increase in asthma and healthy home-knowledge (p < 0.001) in several areas. At 6 months post-intervention (54.4 %) (61 participants) were contacted and 98.4 % of made changes in their households as a result of their training. This study suggests that education can improve knowledge and change behaviors for the well-being of the residents of that household.

The Benefits and Challenges of Managing Asthma in Hispanic Families in South Texas: A Mixed-Methods Study.

BACKGROUND: Understanding the experience of Hispanic parents of children diagnosed with asthma can be useful in the delivery of effective and meaningful asthma education. In order to assess the needs of Hispanic families with asthmatic children in South Texas, investigators utilized a combination of qualitative and quantitative research methods. OBJECTIVES: This study aimed (1) to assess the impact of asthma in the quality of life of Hispanic children and their families and (2) to identify barriers and challenges to asthma management as perceived by parents of children diagnosed with asthma. METHODS: A mixed-methods study included a quality-of-life survey and focus group discussions. The Children's Health Survey for Asthma (CHSA) was completed by 90 parents of children with asthma. Three focus groups were conducted with 15 low-income, Hispanic parents of asthmatic children to assess their needs and experience in managing the disease. RESULTS: Results from the CHSA showed that asthma significantly affects the quality of life of children with asthma and their families, particularly the emotional dimensions and the child's physical health. Fifty-three percent of the children had visited the emergency room, and 51% had been hospitalized due to asthma. One out of five parents had missed work, and 27% of children had missed school in the past 2 weeks due to the child's asthma. In the focus group discussions, the key themes emerging included lack of asthma knowledge, the burden of disease for asthmatic children and their families, and the importance of asthma education and self-management behaviors for asthma control. CONCLUSION: One of the main challenges faced by Hispanic families with asthmatic children is the lack of asthma-related knowledge to help understand and control their children's disease. Lack of knowledge and self-management skills lead to significant stress and anxiety among children with asthma and their parents. Results highlight that while asthma has an effect on the quality of life of children and their families, particularly on the emotional health domain, a wide dissemination of asthma management education in different settings might help prevent asthma attacks and improve symptom control among those suffering from this disease along the US-Mexico border.

Impacting Environmental and Public Health through the Use of Dual Targeted and Tailored Asthma Educational Interventions.

Home-based asthma environmental education for parents of asthmatic children is needed since many health professionals lack the time to offer it. However, developing targeted and tailored education is important in order to address the individual needs of participants. This nonrandomized longitudinal study examined knowledge on asthma with an Asthma and Healthy Homes educational intervention training offered to parents of children from low income families who reside in the Rio Grande Valley of Texas. Eighty-nine parents received the training and pre- and posttest surveys were used to measure knowledge outcomes. A standardized assessment on asthma triggers was used to identify the different triggers each child was exposed to, and a follow-up survey was conducted 6 months after the educational intervention to identify how many parents reported household and behavior changes as a result of the training. Results showed significant changes in behavior by participants as a result of the training received. This study suggests that these behavioral changes are attributed to the dual "targeted" and "tailored" educational interventions delivered to parents which resulted in a greater understanding of how to manage asthma by eliminating asthma triggers in their respective homes.

The United States–Mexico border environmental public health: the challenges of working with two systems / La salud pública ambiental en la frontera entre México y los Estados Unidos: los retos que plantea trabajar con dos sistemas / A saúde pública ambiental na fronteira entre o México e os Estados Unidos: os desafios de trabalhar com dois sistemas

This report shares the challenges and opportunities encountered by a binational project that examined the availability of environmental and public health information for the United States–Mexico border area. The researchers interviewed numerous national and binational agencies on both sides of the border, endeavoring to develop a framework to advance the knowledge of academic and public health professionals in the area of environmental border health. However, the lack of standardized indicators and metrics in both countries validates the emergent need to establish a viable framework for the collection, analysis, and dissemination of environmental information. Recommendations for next steps are included.

En este informe se describen los retos y las oportunidades que ha detectado un proyecto binacional que examinó la disponibilidad de información sobre salud ambiental y salud pública en la zona fronteriza entre México y los Estados Unidos. Los investigadores entrevistaron a numerosos organismos nacionales y binacionales a ambos lados de la frontera, a fin de elaborar un marco para la difusión del conocimiento de los profesionales académicos y de la salud pública en el ámbito de la salud ambiental fronteriza. La falta de indicadores y métodos de medición normalizados en ambos países confirma la necesidad emergente de establecer un marco viable para la recopilación, el análisis y la difusión de información ambiental. Se incluyen recomendaciones para los próximos pasos.

Este relatório apresenta os desafios e oportunidades encontrados por um projeto binacional que examinou a disponibilidade de informações ambientais e de saúde pública na região da fronteira entre o México e os Estados Unidos. Os pesquisadores entrevistaram diversas agências nacionais e binacionais em ambos os lados da fronteira, procurando desenvolver um sistema destinado a promover os conhecimentos de profissionais acadêmicos e de saúde pública na área da saúde ambiental em regiões de fronteira. No entanto, a falta de indicadores e métodos de medição padronizados entre os dois países destaca a necessidade emergente de estabelecer um sistema viável para a coleta, análise e difusão de informações ambientais. São feitas recomendações sobre as próximas medidas a serem tomadas.