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Abstract
The school is a complex microenvironment of indoor allergens, pollutants, and other exposures. The school represents an occupational model for children and exposures in this environment have a significant health effect. Current research establishes an association between school exposure and asthma morbidity in children. This review will focus on common school environmental exposures (cockroach, rodents, cat, dog, classroom pets, dust mite, fungus, and pollution) and their impact on children with allergies and asthma. Understanding and evaluation of school-based environments is needed to help guide school-based interventions. School-based interventions have the potential for substantial benefit to the individual, school, community, and public health. However, there is a paucity data on school-based environmental interventions and health outcomes. The studies performed to date are small and cross-sectional with no control for home exposures. Randomized controlled school-based environmental intervention trials are needed to assess health outcomes and the cost-effectiveness of these interventions. The School Inner-City Asthma Intervention Study (SICAS 2), a NIH/NIAID randomized controlled clinical trial using environmental interventions modeled from successful home-based interventions, is currently underway with health outcome results pending. If efficacious, these interventions could potentially help further guide school-based interventions potentially with policy implications. In the meanwhile, the allergist/immunologist can continue to play a vital role in improving the quality of life in children with allergies and asthma at school through the use of the ADA policy and Section 504 of the Rehabilitation Act as well as encouraging adoption of toolkits to build successful school-based asthma programs and asthma-friendly schools.
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Phipatanakul W, Koutrakis P, Coull BA, Kang CM, Wolfson JM, Ferguson ST, Petty CR, Samnaliev M, Cunningham A, Sheehan WJ, Gaffin JM, Baxi SN, Lai PS, Permaul P, Liang L, Thorne PS, Adamkiewicz G, Brennan KJ, Baccarelli AA, Gold DR. The School Inner-City Asthma Intervention Study: Design, rationale, methods, and lessons learned. Contemp Clin Trials 2017; 60:14-23. [PMID: 28619649 DOI: 10.1016/j.cct.2017.06.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 05/31/2017] [Accepted: 06/10/2017] [Indexed: 02/08/2023]
Abstract
Asthma is the most common chronic disease of childhood in the United States, causes significant morbidity, particularly in the inner-city, and accounts for billions of dollars in health care utilization. Home environments are established sources of exposure that exacerbate symptoms and home-based interventions are effective. However, elementary school children spend 7 to 12h a day in school, primarily in one classroom. From the observational School Inner-City Asthma Study we learned that student classroom-specific exposures are associated with worsening asthma symptoms and decline in lung function. We now embark on a randomized, blinded, sham-controlled school environmental intervention trial, built on our extensively established school/community partnerships, to determine the efficacy of a school-based intervention to improve asthma control. This factorial school/classroom based environmental intervention will plan to enroll 300 students with asthma from multiple classrooms in 40 northeastern inner-city elementary schools. Schools will be randomized to receive either integrated pest management versus control and classrooms within these schools to receive either air purifiers or sham control. The primary outcome is asthma symptoms during the school year. This study is an unprecedented opportunity to test whether a community of children can benefit from school or classroom environmental interventions. If effective, this will have great impact as an efficient, cost-effective intervention for inner city children with asthma and may have broad public policy implications.
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Affiliation(s)
- Wanda Phipatanakul
- Boston Children's Hospital, Division of Allergy and Immunology, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.
| | - Petros Koutrakis
- Harvard T.H. Chan School of Public Health, Department of Environmental Health, Boston, MA, United States
| | - Brent A Coull
- Harvard T.H. Chan School of Public Health, Department of Biostatistics, Boston, MA, United States
| | - Choong-Min Kang
- Harvard T.H. Chan School of Public Health, Department of Environmental Health, Boston, MA, United States
| | - Jack M Wolfson
- Harvard T.H. Chan School of Public Health, Department of Environmental Health, Boston, MA, United States
| | - Stephen T Ferguson
- Harvard T.H. Chan School of Public Health, Department of Environmental Health, Boston, MA, United States
| | - Carter R Petty
- Boston Children's Hospital, Clinical Research Center, Boston, MA, United States
| | - Mihail Samnaliev
- Boston Children's Hospital, Clinical Research Center, Boston, MA, United States
| | - Amparito Cunningham
- Boston Children's Hospital, Division of Allergy and Immunology, Boston, MA, United States
| | - William J Sheehan
- Boston Children's Hospital, Division of Allergy and Immunology, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Jonathan M Gaffin
- Boston Children's Hospital, Division of Respiratory Diseases, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Sachin N Baxi
- Boston Children's Hospital, Division of Allergy and Immunology, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Peggy S Lai
- Harvard T.H. Chan School of Public Health, Department of Environmental Health, Boston, MA, United States; Massachusetts General Hospital, Division of Pulmonary and Critical Care, Boston, MA, United States
| | - Perdita Permaul
- Massachusetts General Hospital, Division of Pediatric Allergy and Immunology, Boston, MA, United States
| | - Liming Liang
- Harvard T.H. Chan School of Public Health, Department of Biostatistics, Boston, MA, United States
| | - Peter S Thorne
- University of Iowa, Department of Occupational and Environmental Health, Iowa City, United States
| | - Gary Adamkiewicz
- Harvard T.H. Chan School of Public Health, Department of Environmental Health, Boston, MA, United States
| | - Kasey J Brennan
- Columbia University School of Public Health, New York, Department of Environmental Health, New York, United States
| | - Andrea A Baccarelli
- Columbia University School of Public Health, New York, Department of Environmental Health, New York, United States
| | - Diane R Gold
- Harvard Medical School, Boston, MA, United States; Harvard T.H. Chan School of Public Health, Department of Environmental Health, Boston, MA, United States; Channing Laboratory, Brigham and Women's Hospital, Boston, MA, United States
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Recent advances in environmental controls outside the home setting. Curr Opin Allergy Clin Immunol 2016; 16:135-41. [PMID: 26859366 DOI: 10.1097/aci.0000000000000250] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW It has been well studied that aeroallergen, mold, and airborne pollutant exposure in the inner-city home environment is associated with significant childhood asthma morbidity. Although the home environment has been extensively studied, the school environment is less well understood. RECENT FINDINGS In this article, we discuss the relationship between environmental exposures within the school and daycare environment and pediatric asthma morbidity and novel environmental interventions designed to help mitigate pediatric asthma morbidity. SUMMARY Studies assessing environmental exposures outside the home environment and interventions to mitigate these exposures have the potential to reduce pediatric asthma morbidity. Further study in this area should focus on the complex cost benefit analyses of environmental interventions outside the home setting, while controlling for the home environment.
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Hauptman M, Phipatanakul W. The school environment and asthma in childhood. Asthma Res Pract 2015; 1:12. [PMID: 26523228 PMCID: PMC4627718 DOI: 10.1186/s40733-015-0010-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 09/18/2015] [Indexed: 01/25/2023] Open
Abstract
In this article, we discuss the relationship between environmental exposures within the school environment and pediatric asthma morbidity. This article will conclude by reviewing novel school based asthma education and therapeutic programs and environmental interventions designed to help mitigate pediatric asthma morbidity.
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Affiliation(s)
- Marissa Hauptman
- Division of General Pediatrics, Boston Children’s Hospital, Boston, MA USA
- Division of Allergy and Immunology, Boston Children’s Hospital, Boston, MA USA
- Harvard Medical School, Boston, MA USA
- Region 1 New England Pediatric Environmental Health Specialty Unit, Boston, MA USA
- Boston Children’s Hospital, 300 Longwood Ave., Boston, MA 02115 USA
| | - Wanda Phipatanakul
- Division of Allergy and Immunology, Boston Children’s Hospital, Boston, MA USA
- Harvard Medical School, Boston, MA USA
- Boston Children’s Hospital, 300 Longwood Ave., Boston, MA 02115 USA
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Huffaker M, Phipatanakul W. Introducing an environmental assessment and intervention program in inner-city schools. J Allergy Clin Immunol 2014; 134:1232-1237. [PMID: 25441649 DOI: 10.1016/j.jaci.2014.09.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 09/14/2014] [Accepted: 09/15/2014] [Indexed: 10/24/2022]
Abstract
Home-based environmental interventions have demonstrated clinical benefit for children with asthma. Although much is known about school-based exposures, few studies have comprehensively examined the role the school environment plays in asthma and how effectively changing the environment might reduce morbidity when adjusting for exposures in the home. This review summarizes the importance and common challenges of school-based environmental assessment and intervention studies linked to health effects. We focus on the key components of study development and the challenges and benefits to implementation.
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Affiliation(s)
- Michelle Huffaker
- Brigham and Women's Hospital, Boston, Mass; Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
| | - Wanda Phipatanakul
- Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass.
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