Denver is expanding its air quality monitoring and education program to combat high rates of asthma in lower-income neighborhoods and communities of color, focusing on school-age children.
The city’s Department of Public Health and Environment is on schedule with a multiyear grant to install air monitors at 40 public schools and tie them together with a consumer-friendly “dashboard” that families can use to assess danger and alter their activity. Denver will replicate the dashboard and the accompanying clean-air curriculum for the Tri-County Health Department, serving Adams, Arapahoe and Douglas counties, after Tri-County received a state grant.
Urgency for attacking inequitable asthma rates increased through a summer and fall of lung-straining wildfires, and a viral pandemic that has underscored threats to respiratory health, Denver officials said. Metro Denver has this year recorded the highest number of particulate warning days—the form of pollution exacerbated by wildfire smoke—in at least 10 years. Respiratory physicians report a spike in asthma and other complaints among regular patients.
“Certainly, more people are thinking about the air they breathe and how it affects their health,” said Michael Ogletree, air quality program manager for the city health department.
Boosting the efforts is a growing consensus that poor air quality affects lower-income neighborhoods and people of color more deeply than other groups in the metro area. Previous studies in Denver have shown children in industry-adjacent neighborhoods like Globeville and Elyria-Swansea suffer from asthma at much higher rates than wealthier blocks free of highways or smokestacks. Collaboration between the city, Denver Public Schools and National Jewish Health has shown clear correlations between bad air days and spikes in use of asthma inhalers at school-based health clinics.
The state’s Greenhouse Gas Pollution Reduction Roadmap released this fall, the official guidance for setting new policies, addressed inequities directly: “In communities that face disparate impacts from pollution—often including the confluence of industrial facilities, highways, and other sources of air pollution—there is greater frequency of more intense exposure to pollution, and a correlation to higher frequency of upper respiratory and other dangerous health impacts,” the report states.
“Studies show that lower-income individuals and people of color experience increased health impacts and premature death due to exposure to particulate matter in the air. Individuals and families who may already be dealing with chronic health conditions, inadequate healthcare [sic] or insurance, or a lack of access to trustworthy information may also be more vulnerable to the impacts from air pollution and climate change.”
Denver now has real-time air quality “dashboards” available online for 19 schools, on its way to 40, though installation of monitors and smoothing out the technology at the remaining schools on the list were paused by the pandemic.
The Denver health department developed science and health curricula to go along with the dashboards, with the aim that local teachers would help spread word to families about the available air quality information by talking about it in classes. With many elementary students away from classrooms for months because of the pandemic, the health department pivoted to creating instructional videos and worksheets accessible from home, Ogletree said.
Other health departments and school districts can install their own low-cost air quality monitors and replicate the online dashboards and curriculum, he added, with Tri-County Health being the first to work with Denver. Denver trademarked the “Love My Air” program name, and offers free licensing agreements and toolkits for those who want to use it.
The next step, Ogletree said, is working with app developers to turn the Love My Air program into a smartphone tool showing real-time sensors, and also using GPS to automatically detect and display data from the closest monitor. Schools could use the app to push out campaigns like anti-idling at dropoffs and pickups, a common environmental pollution cause at many schools.
In choosing the initial round of schools for the monitors and dashboards, Ogletree said, Denver compared neighborhood health equity indexes, school asthma rates and proportions of free- and reduced-price lunch programs.
Denver Public Schools does not have a citywide policy on what to do about recess and outdoor sports on potentially dangerous air quality days, Ogletree noted. The district leaves those decisions up to the principals. Denver’s health department now regularly fields calls from individual principals seeking guidance for conditions in their areas, and what respiratory experts might recommend.
“The thing is, we really don’t know what to recommend,” admitted Lisa Cicutto, PhD, RN, director of community research at National Jewish Health’s Department of Medicine. “And even before COVID-19, we didn’t know.”
Researchers don’t yet have enough information about how higher exposure to particulate matter over longer periods of time affects pediatric health, Cicutto said. Moreover, the asthma versus inactivity question remains a dilemma in public health. Students need exercise, for physical health and to sharpen their minds for classroom work, educators say.
“Leaving kids inside all day and not able to burn off their energy has a negative effect, also,” Cicutto said. “So what’s the balance?”
National Jewish Health works with Ogletree and Denver’s health department to incorporate into school curricula the results from the hospital’s personal air-monitoring project in 2018 and 2019. Volunteers from Globeville, Elyria-Swansea and other neighborhoods wore particulate matter monitors around their neck that measure indoor levels of pollution from such sources as gas cooking stoves, vacuuming, highway dust and more.
Two of the most effective lessons learned for the families using the personal monitors, Cicutto said, were in cooking and driving in heavy traffic. Installing a ventilator above the stove, or just using the one already there, makes a big reduction in inhaled particulate matter, she said: “And sitting in traffic with the windows down, they learned that when they put the windows up and used the air filtering built into the car, they reduced their exposure as well.”
Addition of the coronavirus into the mix of factors for school-age children has complicated optimal detection and treatment of respiratory problems, Cicutto added. Families are supposed to self-screen (and schools are supposed to be on the lookout) for kids with runny noses and coughs that come with the virus.
But the heavy smoke from wildfires pouring down onto the Front Range since summer causes the same symptoms, as do normal seasonal allergies. And when individual kids are held out for symptoms, or entire schools are sent home during outbreaks, kids lose access to the school clinics many families have come to rely on.
“The school health systems are so stressed by handling on-site students, those who are remote learners are really relying on teachers to do the follow-up on why they haven’t been present,” Cicutto said. “That is playing out.”
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