Mid-Atlantic Air Protection

Philadelphia Merck Childhood Asthma Network (MCAN)

by Erin McCarville, Asthma Project Manager, Health Promotion Council

The Philadelphia Merck Childhood Asthma Network (MCAN) has spent the last year addressing gaps in pediatric asthma care across the Philadelphia region. Through family and community asthma education, home environmental assessments, healthcare provider education, and coordination of asthma services, the Philadelphia MCAN project has expanded asthma treatment and management services to more than 269,000 children in Philadelphia.

The Philadelphia MCAN project was established through a grant from the Merck Company Foundation’s Merck Childhood Asthma Network .  In November 2005, the Philadelphia Allies Against Asthma (PAAA) Coalition was one of five sites nation-wide to be awarded this four-year, $2 million grant to combat pediatric asthma.  The Health Promotion Council, the lead agency on this project, has managed the Philadelphia MCAN project on behalf of the PAAA Coalition.

Other key partners for this initiative include: the Children’s Hospital of Philadelphia’s Community Asthma Prevention Program (CAPP) , Thomas Jefferson University, the School District of Philadelphia, the Philadelphia Department of Public Health, the National Nursing Centers Consortium, and the Philadelphia Health Management Corporation.

Over the four-year grant period the Philadelphia MCAN project will provide services in four geographic regions of Philadelphia—West, South, Northwest, and Northeast.  The long-term goals of these services include:

• Improving access to and quality of pediatric asthma health care services
• Educating children and families about asthma
• Making communities and schools more asthma-friendly
• Promoting asthma-safe home environments

In order to achieve these goals, the Philadelphia MCAN Project has developed three programs—asthma screening, asthma care coordination, and asthma education—and targeted three groups—communities, schools, and primary care providers.

Asthma Screening: It is currently estimated that 30 percent of children 5-13 years old in Philadelphia have asthma, but there is very little concrete data on asthma prevalence.  Through community and school asthma screening, the Philadelphia MCAN project aims to identify Philadelphia children with asthma.  This screening allows the project to target asthmatic children for asthma care services. In addition, screening will provide valuable data on asthma prevalence that can be used by policy-makers, researchers, and community groups.

Care Coordination: In the past patients, health care providers, and service providers have found it difficult to manage asthma care and services across agencies, health management organizations, and providers.  In response to these concerns, the Philadelphia Allies Against Asthma Coalition developed the Child Asthma Link Line—a telephonic care coordination hub for Philadelphia residents with asthma. The Link Line’s Asthma Care Coordinators work with families with asthma to ensure that all of their social, health, and educational needs are being addressed.  The Link Line is now a key partner in the Philadelphia MCAN project, accepting referrals from schools, communities, and healthcare providers. 
 
Asthma Education: It is imperative that families of children with asthma, schools, and primary care providers understand how to manage the disease of asthma. Therefore, the Philadelphia MCAN project—in conjunction with the Community Asthma Prevention Program, the Philadelphia Department of Public Health, and the School District of Philadelphia—has developed a number of community asthma education programs.  These programs are offered at community sites and Philadelphia community health centers throughout the target region.  In addition, the MCAN project offers school education programs that target students, teachers, and school staff in order to ensure that schools remain a healthy environment for children with asthma.  Finally, asthma education is also offered to primary care providers to ensure that providers are up-to-date on the latest asthma research and guidelines.

 In its first year of implementation, the Philadelphia MCAN project has made great strides to address pediatric asthma in Philadelphia.  Hundreds of children have been screened for asthma and referred to asthma care coordination and asthma education services.  The program looks forward to three more years of providing integrated pediatric asthma services to the Philadelphia community.

For more information on the Philadelphia MCAN project, the Philadelphia Allies Against Asthma, or the Asthma Link Line, please contact Erin McCarville (emccarville@phmc.org, 215-731-6195).

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Memorandum of Understanding (MOU) to Reduce Health Risks

U.S. EPA Headquarters and the U.S. Department of Health and Human Services (HHS) signed a Memorandum of Understanding (MOU) to improve the quality of life for Head Start and Early Head Start families nationwide.  The MOU establishes a framework between EPA's Indoor Environments Division  (IED) and the HHS' Office of Head Start (OHS).  The agencies intend to work together to conduct nationwide outreach to nearly a million families in an effort to deliver health risk reduction messages related to secondhand smoke and other environmental asthma triggers.

EPA-HHS MOU

Numerous studies have documented the significant health risks to young children from exposure to secondhand tobacco smoke and other indoor asthma triggers. These risks include upper respiratory tract infections and more frequent and more severe asthma attacks among children with asthma. Other indoor asthma triggers include dust mite and cockroach allergen, animal dander, and mold. The National Academy of Sciences has concluded that exposure to secondhand smoke and exposure to house dust mite allergen are also risk factors for the onset of new asthma. Data gathered through the 2004 EPA National Survey on Environmental Management of Asthma and Childhood Exposure to Environmental Tobacco Smoke (PDF, 2pp, 88k, about PDF) indicates that Environmental Tobacco Smoke (ETS) exposure and asthma rates are higher in households at or below poverty level and in those with lower levels of education. These findings suggest a critical need to better educate low-income and low-literacy populations about exposure to ETS and for children with asthma, other indoor asthma triggers as well. Particular focus should be given to the families of the approximately 20 percent of children with asthma who are exposed to ETS in their homes.

According to information contained in the HHS “Action Against Asthma: A Strategic Plan for HHS,” asthma is a growing problem for Head Start, as well as the nation as a whole. It is one of the most common chronic disease of childhood and places a disproportionate burden on minority groups and the poor, the population that Head Start serves. The HHS Office of Inspector General issued the 2002 “Head Start Services for Children with Asthma” report, which found that asthma is the top chronic disease among Head Start children and is one of many health conditions affecting Head Start children and their families.

In June 2006, HHS released "The Health Consequences of Involuntary Exposure to Tobacco Smoke, A Report of the Surgeon General" (PDF, 727pp, 19.83 MB, about PDF). This report summarizes an extensive body of literature that documents the very serious negative health effects of exposure to secondhand smoke for adults and children; among its conclusions are that there is no risk-free level of exposure to second hand smoke.

The mission of HHS is to protect the health of all Americans and provide essential human services, especially for those who are least able to help themselves. Programs funded under the Head Start Act provide comprehensive child development services to low-income children from birth to age five, pregnant women, and their families. They are child-focused programs and have the overall goal of increasing the school readiness of young children in low-income families. Currently, over 950,000 low-income children from birth to age five, including American Indian, Alaska Native and migrant populations, are enrolled in the program.

Head Start health services focus on prevention and early intervention. Head Start and Early Head Start programs work closely with parents to ensure that children are up-to-date on a schedule of age appropriate preventive and primary health care, as well as help parents obtain the necessary medical services for children who have reoccurring health conditions. A review of the 2002-2005 Head Start Program Information Report (PIR) shows asthma as the most frequently reported chronic health condition by Head Start programs nationwide.

The mission of EPA is to protect human health and the environment. Two of the goals of EPA's Office of Radiation and Indoor Air are to reduce the health risks from childhood exposure to secondhand smoke, as well as to reduce the health risks for people with asthma through comprehensive asthma management practices, including reducing exposure to environmental asthma triggers. EPA has developed a number of effective outreach and communication strategies and programs to encourage voluntary behavior change among parents and other caregivers of children with asthma and those exposed to secondhand smoke.

In partnership, EPA and HHS can make significant progress in fulfilling their respective and complementary missions through a joint and concerted effort to educate staff and parents of Head Start and Early Head Start programs on the importance of reducing children’s exposure to environmental asthma triggers and the harmful effects of secondhand smoke. Increasing awareness of secondhand smoke’s health effects will also benefit nonsmoking parents and other adults in the household who are at significant risk for heart disease and lung cancer from secondhand smoke exposure. Education of Head Start staff and parents is will be accomplished through the promotion and distribution of EPA’s Asthma and Smoke-Free Homes Program messages and educational materials to Head Start and Early Head Start programs.

MOU Key Activities

EPA, Office of Radiation and Indoor Air:

• Intends to work with the Office of Head Start to identify and develop cooperative activities to promote awareness of the health effects of secondhand smoke and other asthma trigger exposures on young children and effective strategies for motivating families to take effective exposure reduction actions.
• Plans to work with the Office of Head Start to identify EPA outreach materials that are appropriate for Head Start families and facilitate appropriate dissemination mechanisms, including use of various electronic and print media, as well as EPA-sponsored toll-free telephone hotlines.
• Intends to provide technical assistance to the Office of Head Start in the development and implementation of activities under this MOU.
• Intends to share with the Office of Head Start information on knowledge and asthma management actions taken by caregivers of children with asthma, obtained through the National Survey on Environmental Management of Asthma (NSEMA).
• Plans to help promote the partnership initiative at national, State, and local conferences and support recognition opportunities for Head Start and Early Head Start programs, as appropriate.

U.S. Department of Health and Human Services, Office of Head Start:

• Intends to work with the Office of Radiation and Indoor Air to identify and develop activities to increase awareness of effective interventions to reduce children’s exposure to environmental asthma triggers, including but not limited to secondhand smoke, and encourage parents to take action to reduce exposures.
• Intends to facilitate outreach to Head Start and Early Head Start families by promoting and distributing messages and materials through its network and infrastructure.
• Intends to support EPA's Office of Radiation and Indoor Air’s efforts in creating, developing, and evaluating outreach materials and products for use in Head Start and Early Head Start programs.
• Plans to inform and train the Head Start community about the partnership and opportunities for developing comprehensive asthma management and secondhand smoke programs and activities at the State and local program levels by working with the Head Start State Collaboration Offices.
• Plans to promote the partnership initiative at national, State, and local conferences and support recognition opportunities for Head Start and Early Head Start programs, as appropriate.

To learn more about Head Start Asthma and Second-hand smoke outreach check out "Care for Their Air: Promoting Smoke-free Homes for Head Start Families."

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Children's Health Month

In honor of Children's Health Month, EPA releases its publication, Children's Environmental Health: 2007 Highlights. (PDF, 20pp, 2.54 MB, about PDF)

This publication, seventh in an annual series, highlights EPA's work to protect children from environmental risks.

This year makes the tenth year of explicit attention to the health of children following the Executive Order of 1997, Protection of Children from Environmental Health Risks and Safety Risks (PDF, 4 pp, 114KB). EPA has funded research on how the environment affects children's health, promoted the education of health care providers, assembled data to quantify the extent of the issues, and been an international leader of children's health issues. The 2007 report captures all this and more.

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Other Asthma Information

Asthma In The News:

• Low vitamin E intake during pregnancy can lead to childhood asthma
• Fish Oil Reduces Airway Inflammation Caused by Exercise-Induced Asthma
• Back-to-school Season Can be Tough on Kids with Asthma, University of Michigan expert says
  
• New Campaign Has Asthma Patients Asking — What’s My IgE?
  
• Vitamin C -- a Nutritional Approach to Managing Exercise-induced Asthma
  
• Atlanta Named Top Asthma Capital for 2007
  

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