Risk assessment and community participation model for environmental asthma management in an elementary public school: a case study in Puerto Rico

Abstract

Asthma is a rapidly growing chronic disease in the general population of the world, mostly in children. Puerto Ricans have the highest prevalence of children with asthma among the Hispanic community in the US and its territories. Asthma and air quality are becoming a significant and potentially costly public health issue in Puerto Rico. The CDC has reported that in Puerto Rico, 320,350 adults have asthma and this number represents 11.5% of the island adult population. The north east municipality of Carolina, Puerto Rico, has the highest asthma prevalence in the 0 to 17 year old range (2001 data). In this study, we address the potential relationship between anthropogenic and naturally occurring environmental factors, and asthma prevalence in an urban elementary public school in Carolina in an effort to empower and engage communities to work on their environmental health issues. We integrated geographic information systems (GIS) data of anthropogenic activities near the school as well as the natural resources and geomorphology of the region. We found that as Carolina is close by to Caribbean National Forest (El Yunque), this together with the temperature and precipitation cycles in the zone creates the ideal environmental conditions for increased humidity and pollen, mold and fungi development through out the year. We also collected health and socio economic data to generate an asthma profile of the students, employees and parents from the school community, and through a survey we identified perceptions on environmental asthma triggers, and indoor air quality in the school and homes of the students and employees. Finally, we implemented a workshop on indoor air quality designed to engage the school community in managing asthma triggers and the school environment. Our results showed that nearly 30 % of its student's population has asthma, and from this group 58% are males and 42% are female students. Of all asthmatic children, only 43% receive treatment for the disease. The study also showed that most asthmatic children are between 7 and 9 year old, and live in households with an annual income below 10,000 dollars. It also showed that 25 % of the student's parents have the condition, and that 25% of the employees are also affected by this chronic condition. All these numbers are significantly higher than those reported by the CDC for Puerto Rico. The perception component had a response of 83% of school employees, and a 39% response from parents. It showed that people know asthma as a disease but many can't identify most environmental asthma triggers. Pre and post tests of the workshop protocol showed that before the activity only 21% of participants can identify asthma triggers. At the end of the workshop nearly 80% were able to identify and manage environmental asthma triggers. This work validates the fact that Puerto Rico continues to have a significant number of people with asthma, particularly children asthma, and that schools are an important settings to create community based action plans to manage environmental asthma triggers through outreach and training.

Figure 1:

Map illustrating the geographic location of the school that participated in this study. School was located in Carolina, Puerto Rico, a municipality that has the Atlantic Ocean on the north, the Caribbean National Forest on the east, the Sierra de Luquillo mountains on the South and the capital of Puerto Rico, San Juan, on the west.

Figure 2:

Temperature (A) and precipitation (B) profile for the municipality of Carolina, Puerto Rico. Data was kindly provided by the National Weather Service and the National Oceanic and Atmospheric Agency (NOAA) through the website.

Figure 3:

Aerial photos and maps illustrating the geographical and spatial relationship between the school setting and the location of anthropogenic and natural resources in the region in A. In B, the main industrial area is highlighted (in purple).

Figure 4:

Profile of asthmatic students per gender and in treatment.

Figure 5:

Profile of school’s administrative personnel (including teachers) with asthma per gender.

Figure 6:

Profile of parents that self reported as asthmatic per gender (A) and those that have at least one (1) child with asthma (B).

Figure 7:

Profile of school’s administrative staff (including teachers) perceptions of asthma triggers in general (A) and in the classroom (B).

Figure 8:

Results of the indoor air quality tool for schools (IAQTFS) training workshop pre and post tests. School’s administrative personnel (including teachers) responses to premises I know the method to control asthma triggers (A), I know what to do to avoid asthma attacks in the classroom (B); I know the impact of asthma on the students health and academic performance (C); and I know where to get information about indoor air quality (D).

Figure 8:

Results of the indoor air quality tool for schools (IAQTFS) training workshop pre and post tests. School’s administrative personnel (including teachers) responses to premises I know the method to control asthma triggers (A), I know what to do to avoid asthma attacks in the classroom (B); I know the impact of asthma on the students health and academic performance (C); and I know where to get information about indoor air quality (D).