“This approach can be taken anywhere,” said Ruchi Gupta, MD, MPH. “This whole idea of empowering students can be used for healthy living or obesity prevention.”
In Chicago, anywhere from 1 to 40 percent of children have asthma, depending on the neighborhood they live in.
Such dramatic differences among neighborhoods had been discovered through research conducted by Ruchi Gupta, MD, MPH, associate professor of pediatrics at Northwestern University School of Medicine. But she wanted to delve more deeply into those findings to identify community factors that play a key role in the prevalence and severity of childhood asthma and asthma disparities.
“Something is going on that is different between these neighborhoods,” Gupta said. “There are dramatic differences. Let’s tease out what’s happening in each of the neighborhoods. The only way to do it is to go into the neighborhood and ask the kids.”
Gupta had already developed the Chicago Initiative to Raise Asthma Health Equity study database that mapped out the childhood asthma rates in each Chicago neighborhood. But she needed help to find out why these neighborhoods had such starkly different rates of childhood asthma.
Gupta found that support in the Robert Wood Johnson Foundation Physician Faculty Scholars program. The three-year career development award, which Gupta received in 2009, gave her the salary support and time she needed to focus her research on the role that community factors play in childhood asthma.
RWJF Physician Faculty Scholars, which ran from 2006 through November 2012, sought to strengthen junior medical faculty’s leadership skills and academic productivity. Scholars received funds for a three-year research project, along with mentoring, networking, and other supports. Read the Program Results Report for more information.
Finding her niche in asthma research. “What was so special about this program is that we learned a lot about how to achieve our potential and how to take our research to the next level,” Gupta said. “[One of my mentors] pointed out the unique database and amazing laboratory of Chicago that I had. He said that I needed to focus on this resource that I already had. He was able to show me the areas that would make my research special and add to the conversation. Now, I do community asthma and neighborhoods. That’s what I want my contribution to be in asthma.”
In the first stage of her research, Gupta found that the odds of having moderate or severe asthma were significantly higher among children whose caregivers reported seeing violence in their community or who were experiencing high levels of stress. She also found that odds were higher among children from communities with a high or moderate incidence of violent crime. After adjusting for factors such as age, gender, family history, and socioeconomic status, only stress and incidence of violent crime remained significant predictors of asthma severity.
While these findings alone provided new insights into the causes of asthma, Gupta wanted to take her research a step further. To do so, she harnessed the power of a group of high school students who had asthma. These students lived in a neighborhood with 25 percent childhood asthma rates and poor asthma morbidity.
Sending high school students to document asthma triggers. Taking an approach more typical for an anthropologist than a physician, Gupta began working with 15 high school students in an after-school program over a period of 10 weeks. She equipped them with cameras, provided instruction from professionals on taking photos and videos, and asked them to fan out into their communities and document the factors they saw as contributing to their asthma. The students also filled out logs about their use of medications and the issues that were helping or hurting their asthma. The students, in short, became researchers.
Through their logs, photos, and videos, the students provided vivid insights into their struggles with asthma as well as their supports. Many photos featured overflowing ashtrays in their homes, the result of their parents and other family members smoking. Students also shot videos depicting drugs and violence in their communities, which they said exacerbated their asthma. Unhealthy lifestyle—such as lack of exercise, poor diet, and lack of sleep—also figured prominently in the students’ work.
Among the highlights of the journal entries and photos students submitted:
- Social support was documented in 22 percent of the students’ journal entries and photos. Two-thirds described good social support while one-third described poor social support. Those that depicted positive social support showed it as a way to decrease stress and improve health and asthma. One entry read: “I went to _____ with my mother and siblings to visit my grandparents and my uncles. We had fun because we spent time with my extended family who we barely spend time with.”
As an example of poor social support, one teen wrote, “Two days ago, my heart stopped in my sleep. I forgot to take my medicine. So I had to stay home. But, the cause of this was smoke. My parents smoke a lot so the smoke was still inside the house and I was inhaling it.”
- Neighborhood environment was documented in 17 percent of the students' journal entries and photos. Half of the entries described a good neighborhood environment and half a poor neighborhood environment. For those that depicted a good environment, the majority of photographs portrayed clean air, greenery, clear skies, and hybrid cars. For poor environments, social issues like crimes, drugs, and alcohol were illustrated through photographs of metal detectors at schools and police surveillance on the streets, among others.
One particularly poignant journal entry read, “I heard a gunshot so I started running extra fast and I started coughing and wheezing.”
The students’ project culminated in the creation of two public service announcements (PSAs). A schoolwide premiere showcased the PSAs, which were posted on YouTube. The first PSA, entitled “What is asthma?” provides information on the chronic disease. The second PSA, “What can my community do to help kids with asthma?” encourages viewers to become active in reducing community asthma triggers.
Follow-up assessments found that the student-directed PSAs significantly increased asthma knowledge among community members. Participants answered significantly more knowledge items correctly after viewing the “What is asthma?” PSA (53.1% correct answers compared to 34.8% correct answers before viewing the PSA).
Surprising findings from student research. “We were able to come up with some of the key community factors that we wanted to learn about,” Gupta said. “We learned a lot about the social support piece and the community environment. There were a lot of pictures of violence and drugs—things that they thought impacted their asthma that we wouldn’t necessarily think of—like a fear of violence.
“It feels like such a big issue—more than pollution, mold, and cockroaches [which are other asthma triggers]. Even the social support was interesting. It got me moving in thinking about stress and coping strategies.”
One of Gupta’s goals is to develop a curriculum based on this initial work that any school can use. Eventually, she hopes to take this work to multiple schools across Chicago and map out risk factors across the city.
“This approach can be taken anywhere,” Gupta said. “This whole idea of empowering students can be used for healthy living or obesity prevention. What in your community allows you to eat healthy or promotes good health or exercise?”
RWJF perspective. Because many scholars are still early in their careers, it may be too soon to judge the real impact of RWJF Physician Faculty Scholars. However, several scholars currently hold leadership positions in academic medical centers and in local, state, and federal government, and conduct innovative research projects with the potential to affect health and health care.
“The Physician Faculty Scholars program developed a cadre of physicians—65 in total—who will or who have become productive, creative, and influential physician-researchers and leaders,” said RWJF Senior Program Officer David M. Krol, MD, MPH. “It also filled a niche for some physicians who wanted to pursue research that would likely not have been funded by other sources.”
“In a number of ways, the program has helped me advance,” Gupta said. “Being an RWJF Faculty Scholar increased my worth in my institution. I went up a year earlier to be an associate professor than is typical. Having my mentors from RWJF helped me move up faster than I might have otherwise. And they helped point me in the right direction with my research.”
Working with #RWJF scholar Chicago teens took to streets to document what made their asthma better or worse