Section 1. The Problem
Asthma is a chronic airway condition affecting 6.3 million children or 8.6% of the population younger than 18 years (CDC, 2016). School-age children spend 6-7 hours of each day in school for 171-182 days per year (NCES, 2011). As such, the school is a suitable environment for asthma prevention and management. For instance, there are schools which have implemented asthma programs to educate students about asthma and self-management, develop asthma action plans, and create safe environments for learning (CDC, 2015).
The chosen setting is a school district in a county in a northcentral U.S. state. It is composed of 12 elementary schools with a combined student population of 4,881. The schools cater to multicultural students with significant populations of Hispanics, African Americans, and Asians. There are 3 school nurses in the entire district with a ratio of 1 nurse for every 1,627 elementary students. There are no asthma programs at the school or district levels. The air quality index for the county is categorized as “good” for 78% of all days in 2015 based on annual monitoring data (US EPA, 2016). However, the monitoring of indoor air quality (IAQ) and indoor environmental quality (IEQ) inside school buildings has been irregular and there is no policy, funding, and designated persons for coordinated initiatives to address these issues.
The chosen population health problem is childhood asthma in elementary school children from grade 1 through 8. An epidemiological assessment is necessary in order to create a district wide asthma program tailored to the needs of school children with the disease and which also addresses school-specific environmental risk factors that contribute to asthma. In terms of person, the assessment will ascertain how many elementary school children have asthma and the distribution by age, grade, race/ethnicity, gender, and zip code of residence. Of those who have asthma, the number of school days missed and number of children with asthma action plans will also be determined. In terms of place, the assessment will also look into asthma prevalence and level of absenteeism by school. In terms of time, the distribution of asthma absenteeism by month of the school year will be ascertained.
Around 3 in every 30 students, both children and adolescents, have asthma (CDC, 2015). It is a common reason for school absenteeism with approximately 10.5 million days of school missed because of illness (EPA, 2011). This significantly affects the academic performance of young sufferers. Children from low-income and minority families or from inner-city neighborhoods are at a higher risk of poorly controlled asthma manifested by more emergency department visits and hospitalizations and a higher mortality rate (CDC, 2015). There are asthma triggers in the school environment because of poor IAQ and IEQ (US EPA, 2015). A survey by the Department of Education showed that 24% of school buildings were reported to be in either fair or poor condition (Everett, Doroski & Glick, 2015). Only 51.4% of schools were noted to have a formal program for managing IAQ (Everett et al., 2011).
The research questions are: What is the prevalence of asthma among grade 1 through 8 students in the school district? What are the demographic characteristics of the students with asthma? How many students with asthma have asthma action plans? Among the students with asthma, what is the trend of asthma-related missed school days per school year? What is the monthly trend of asthma-related absenteeism during the school year? These questions will help build a description of asthma in the target population which will guide program design and implementation.
Section 2. Research Methods
An observational retrospective cohort study will be conducted to answer the research questions. This design pertains to analyzing previously collected student data on the basis of exposure status (Song & Chung, 2010). At the end of the school year, records of students from grades 1 through 8 will be analyzed to identify students with asthma and obtain demographic, asthma action plan, and absenteeism information. Data will be sourced from student records, health folders, student attendance records, school attendance monitoring documents, and records of communications from and to parents regarding absences. Pertinent records that are already in the district central repository will also be accessed.
The documents are in electronic or paper format. There are laws and policies regarding record-keeping to maintain the privacy and confidentiality of students and their parents (US Department of Education, 2012). The purpose of the study relates to district-wide quality improvement in the areas of IAQ, IEQ, and the management of asthma in the school setting. For this reason, it is exempted from obtaining informed consent from the students and parents (US Department of Education, 2012). However, communication about the study and requests to access school records will be sent to the school principals. Notes enumerating what data were extracted from the records, by whom, when, and what purpose will also be included in the student records (US Department of Education, 2012). Care will be done to de-identify the data collected and keep them in a secure location in accordance with policies.
Data extraction tools will be created to ensure the efficiency and completeness of data collection (Song & Chung, 2010) given that there are likely differences in the forms and record-keeping practices of the different schools. At the school level, for instance, a tally sheet will be created per grade level to record the demographic characteristics and asthma action plan status of students with asthma who are assigned a code name. Another tally sheet for each grade will be created to record the number of asthma-related absences per student per month. Data from the tally sheets will be consolidated for analysis at the school and district levels and to ascertain monthly trends in asthma-related absenteeism. Asthma prevalence will be calculated by dividing the number of students with asthma by the student population per grade, per school or the entire district (CDC, 2012). The data will be presented in charts, tables, and graphs.
References
Center for Disease Control and Prevention (CDC) (2012). Lesson 6: Descriptive epidemiology. Retrieved from http://www.cdc.gov/ophss/csels/dsepd/ss1978/lesson1/section6.html
Center for Disease Control and Prevention (CDC) (2015). Asthma and schools. Retrieved from http://www.cdc.gov/healthyschools/asthma/index.htm
Center for Disease Control and Prevention (CDC) (2016). Asthma. Retrieved from http://www.cdc.gov/nchs/fastats/asthma.htm
Everett, J.S., Smith, A.M., Wheeler, L.S., & McManus, T. (2011). School policies and practices that improve indoor air quality. Journal of School Health, 80(6), 280-286. doi: 10.1111/j.1746-1561.2010.00502.x.
Everett, J.S., Doroski, B., & Glick, S. (2011). Association between state assistance on the topic of indoor air quality and school district-level policies that promote indoor air quality in schools. The Journal of School Nursing, 31(6), 422-429. doi: 10.1177/1059840515579082
National Center for Education Statistics (NCES) (2011). Schools and staffing survey (SASS). Retrieved from https://nces.ed.gov/surveys/sass/tables/sass0708_035_s1s.asp
Song, J. W., & Chung, K. C. (2010). Observational studies: Cohort and case-control studies. Plastic and Reconstructive Surgery, 126(6), 2234–2242. doi: http://doi.org/10.1097/PRS.0b013e3181f44abc
United States (US) Department of Education (2012). Safeguarding student privacy. Retrieved from https://www2.ed.gov/policy/gen/guid/fpco/ferpa/safeguarding-student- privacy.pdf
United States Environmental Protection Agency (US EPA) (2011). Managing asthma in the school environment. Retrieved from https://www.epa.gov/iaq-schools/managing- asthma-school-environment
United States Environmental Protection Agency (US EPA) (2015). Take action to improve indoor air quality in schools. Retrieved from https://www.epa.gov/iaq-schools/take- action-improve-indoor-air-quality-schools
United States Environmental Protection Agency (US EPA) (2016). Air quality index report. Retrieved from https://www3.epa.gov/airdata/ad_rep_aqi.html
