Getting SMART About Asthma Education
Ruchi S. Gupta, MD, MPH, is an alumna of the Robert Wood Johnson Foundation Physician Faculty Scholars program. She is an associate professor of pediatrics and director of the maternal and child healthcare program at the Northwestern University Feinberg School of Medicine, and an attending physician at the Ann & Robert H. Lurie Children's Hospital of Chicago. Learn more at www.ruchigupta.com.
This past spring, 12 students with asthma at James Hedges Elementary in Chicago’s Back of the Yards neighborhood took hundreds of pictures, filmed video Public Serve Announcements (PSAs), created a website, and rolled out a community intervention to improve asthma conditions. These activities were part of the Student Media-Based Asthma Research Team, or SMART program. We developed this program from a previous pilot program in Chicago’s Uptown neighborhood that empowered students to learn about their asthma and challenged them to create change in their own communities.
As the most common chronic condition in children and the most common cause of school absenteeism, asthma is responsible for 13 million days of school missed each year. Asthma disproportionately affects racial and ethnic minorities, as African Americans and Hispanics/Latino children have significantly higher asthma-related morbidity and mortality rates compared to White children. While evidence-based guidelines for asthma care have been available for 20 years, ethnic minorities have a lower likelihood of receiving or following proper asthma treatment. Across and within racial/ethnic groups, asthma care has been shown to be more effective when it is tailored to the individual community instead of one-size-fits-all intervention.
At James Hedges Elementary, a predominantly Hispanic/Latino school, more than one in four kids have been diagnosed with asthma. While the students found factors associated with increased asthma exacerbations such as a lack of access to health care, air contamination from car exhaust and second hand smoke, roach waste, pet dander, and industrial pollution are all factors that affect asthma, we found another alarming disparity by neighborhood in our research. A lack of education and knowledge about asthma in many communities leads to poor avoidance of triggers and untreated asthma, which only grows worse. Our team led discussions and helped the students develop multimedia projects in hour-long group sessions three days a week to improve community asthma knowledge. The kids also developed objectives and interventions specific to their own community to dispel common misconceptions about asthma.
To help collect information, we provided SMART program participants with smart phone devices and asked them to complete different photo-voice assignments where they took pictures and videos related to their asthma each week. The students also used the devices to create asthma diaries that could geospatially plot locations where they experienced different asthma triggers. During the classroom sessions, we also discussed asthma-related topics as a group and helped the students develop community-specific video PSAs.
The students shared their video PSAs with their peers at school assemblies and with community members and parents at events before and after school. In addition, the students helped develop a website (hedgessmart.blogspot.com) to distribute information, pictures, and PSAs after the program ended.
The students also examined one individual trigger that they saw as a major problem in their community: exhaust from idling vehicles. Students understood that exhaust from idling vehicles affects their asthma by making their airways inflamed and narrow. In order to create community awareness around this issue, the students handed out material in English and Spanish about idling vehicle exhaust and had drivers sign no-idling contracts. In addition to education, the students also installed custom “no-idling” signs on school grounds and were interviewed by local news outlets about the work they have been doing on this campaign.
We watched the kids grow over the course of the program as they became more comfortable talking about living with asthma and began using their voices to make a positive change in the Back of the Yards community. The hope is that even after we move on to work with a different school, these students stay empowered to continue to use what they have learned to improve asthma knowledge and outcomes for years to come.
We have recently received funding from the American Lung Association to bring the SMART program to another school in a Chicago neighborhood with high asthma rates. Our goal is to eventually roll out a similar program across all Chicago Public Schools to empower kids to control and change outcomes related to chronic conditions in their community.