Denver health and education officials now know which public schools have the worst student asthma rates. Most are concentrated along the I-70 corridor and in neighborhoods challenged by lower incomes, higher numbers of uninsured residents and other troubling health indicators.
Yet there is no coordination of student protection policies—keeping kids inside during recess when needed, for example—across Denver Public Schools (DPS) on bad air-quality days, with decisions left up to individual school leaders.
Air quality officials estimate it costs $3,100 a year to treat a DPS student with asthma, totaling $30 million in costs for the 9,700 students diagnosed with the respiratory affliction.
As the Denver metro area sees an increasing threat to air quality from car traffic, spiking ground ozone concentration on hot days, and new oil, gas and construction projects that can worsen particulate pollution, a cross-institutional team is attacking the school dilemma with a new sensor network and health analytics.
The City of Denver’s environmental health division has teamed with National Jewish Health, a respiratory medicine leader, and other partners to begin installing particulate sensors at 40 schools with the highest asthma rates by the end of 2021. DPS health officials will run a parallel effort to correlate student sick days and use of asthma inhalers—which requires a visit to the school health office and an incident record—with daily air-quality data.
Results could inform policymakers about how pollution spikes directly affect children, as well as families or school leaders looking for day-to-day direction. (Preliminary National Jewish research has found increased inhaler use among children two to three days after air pollution increases.)
The local research will add knowledge to consistent national and international studies showing that air pollution tends to affect some populations much more than others.
“On average, non-Hispanic whites experience a ‘pollution advantage’: They experience ∼17% less air pollution exposure than is caused by their consumption,” wrote a group of scientists from the National Academy of Sciences in a March 2019 study. Conversely, “Blacks and Hispanics on average bear a ‘pollution burden’ of 56% and 63% excess exposure, respectively, relative to the exposure caused by their consumption.”
“The burden of air pollution is not evenly shared. Poorer people and some racial and ethnic groups are among those who often face higher exposure to pollutants and who may experience greater responses to such pollution,” according to the American Lung Association. “Low socioeconomic status consistently increased the risk of premature death from fine particle pollution among 13.2 million Medicare recipients studied in the largest examination of particle pollution-related mortality nationwide.”
The association said scientists attribute the disparities to possible factors such as housing discrimination that place people of color closer to pollution sources; exposure to dirtier workplaces or higher automobile traffic volume; and health factors like diabetes, which disproportionately affects some populations, increasing the impact risk from air pollutants.
Denver schools receiving the first wave of air quality monitors include Bruce Randolph, Fairview, Garden Place, Gust, High Tech Early Learning College, Sabin, South, Swansea and University Prep-Steele.
The consortium is also working through neighborhood focus groups and other study methods to find more effective ways to illustrate available air-quality data so that school officials and families can make more informed health decisions.
“Asthma in Denver is a big deal,” said Michael Ogletree, air program manager in Denver’s Department of Public Health & Environment, which is overseeing the new sensor installations under a $1 million grant from Bloomberg Mayors Challenge. “The lifelong health and economic cost of asthma is significant, and something that will impact your quality of life, for your entire life, and we really want to address that within our population.”
DPS central administration officials said they do not have a uniform policy for shutting down outdoor recess or other breath-saving changes on high air-pollution days.
“I don’t have a perfect answer for this question for you. I think that in years past, it hasn’t come to the forefront that this was so much of an issue,” said Kathrine Hale, DPS manager of nursing and student health services.
DPS officials are hoping to learn more about the extent of the problem from the new Bloomberg-funded monitoring system; they say schools are given a menu of options on how to handle air quality.
Kirsten Frassanito, principal of Sabin World Elementary in southwest Denver, where a monitor will be hooked up and displaying information by fall, said principals are engaged but don’t have resources to make big changes.
“We just don’t have a lot of alternatives to sending kids outside to play,” said Frassanito, whose gym feels packed with 25 kids tossing balls around. “We don’t have the infrastructure in the building to have the kids do anything other than watching something in the auditorium.”
Some Denver students have taken the air quality questions into their own hands. Gina Ridgeway is a 5th grader at Sabin and president of the student council, and has launched a campaign to get more students riding bikes or walking, or for their parents to stop idling cars for long periods at the school entrances.
“You’re hurting your child’s breath!” said Ridgeway, whose brother was diagnosed with asthma, and who has classmates with breathing issues. “I don’t know if today is a bad air day—where would I even get that information?”
Ridgeway thinks parents will listen to posters made by their children, even if they ignore the more bureaucratic “no idling” signs already hung around school grounds. She is also pushing for more “bike pools” and “walking pools” where kids and parents feel safest in numbers.
Ridgeway was adamant that even a new air monitor with a nice visual display is not enough. Students, parents and the schools need to actually do something about pollution, she said: “Don’t just give the problem to others.”
The neighborhoods that Denver and National Jewish are trying to help first have long been a focus of health inequities. Denver put out a 2014 Health Impact Assessment for Globeville and Elyria-Swansea that said children in the neighborhoods went to the emergency room for asthma at significantly higher rates than other Denver communities. The assessment also found that more than half the adults in the area are overweight or obese, higher than the rest of Denver; that adults are only about half as physically active as the rest of Denver; and that local schoolchildren exercised less than recommended.
Health concerns in Globeville and Elyria-Swansea and other lower-income neighborhoods are compounded by a lack of sidewalks and bike lanes or shoulders; low ratios of park space; and heavy industrial and construction traffic.
Activists along the I-70 corridor north of downtown—which is being widened in a massive, multi-year redevelopment project that promises to significantly increase automobile traffic volume through the area—say those health issues layer upon decades of industrial abuse of lower-income neighborhoods through smelting, refining and other high-emission activities.
The new efforts on particulate pollution—made up primarily of auto emissions, road and construction dust, wood burning or forest fires, industrial and power soot and ash—come as Colorado also renews efforts to attack ground-level ozone, another measured pollutant that harms asthma sufferers and other vulnerable populations.
While other federally regulated pollutants have trended downward in recent decades, ozone has been a persistent problem for the Front Range. While annual ozone averages continue to trend downward, hot weather can produce more daily spikes that put Denver over Environmental Protection Agency (EPA) standards. The EPA lowered its acceptable ozone limits in 2015, putting Denver in violation on more days.
The number of days where Colorado officials have called an “air quality action day,” meaning children and vulnerable populations are advised to avoid outdoor exertion, have risen from 18 in 2014 to 55 last year, according to Colorado Department of Public Health and Environment (CDPHE) staff.
Population and car traffic are growing, oil and gas drillers set up more suburban operations, and summer wildfire smoke blows in from across the West. Sunlight cooks the emissions stew over the metro area, while weather patterns wedge the mix up against the foothills of Boulder, Jefferson and Larimer counties.
“That’s not where the ozone is being produced, but that’s where it goes,” said Gordon Pierce, air quality technical services program manager at CDPHE. The state health department monitors air quality and gives technical and policy advice to the Air Quality Control Commission, which makes policy and regulatory decisions about reducing pollutants.
Colorado in May will likely be bumped into the violation category of “serious” when it reports a new year of results to the EPA.
Such a designation would trigger new efforts to restrict industries and other sources of ozone-causing pollutants, doubling down on recent state efforts to reduce methane gas leaks from petroleum drilling, switch to alternative-energy generation and promote zero-emission vehicles. New restrictions could include tightening of permits to hundreds of industrial polluters.
Past policy changes have cut some ozone production, including Colorado’s strict vehicle emissions monitoring, retiring of older, dirtier cars, and closure of coal-fired power plants in the metro area.
“Things do look worse because the standard has dropped over time, not because air quality is getting worse,” Pierce said. “But we do have to meet these requirements.”
Because of natural and out-of-state weather patterns and influences, Colorado’s options on ozone are more limited than Los Angeles and other cities that have made cuts, Pierce said. The newer EPA standard is 70 parts per billion, while Colorado monitors often record 40 to 50 ppb of “background” ozone caused by far-off sources such as wildfires, massive southwestern power plants, or even drifting air pollution from industrialized China.
Thus, “We only have a small amount we can work on controlling in the metro area,” Pierce said. “That’s why our numbers haven’t been able to drop as much as some of the coastal cities.”
On particulates, Pierce said, Colorado does have days where it spikes above recommended levels, but EPA standards are based on longer-term averages and the state is still in “attainment” for particulates.
National Jewish is in the middle of an extensive effort to make the air quality battle more personal.
The respiratory hospital and research center has a Denver Children’s Environmental Health Center, and a community advisory board concerned about pollution questions in Globeville and Elyria-Swansea, said project leader Lisa Cicutto, MD. They got EPA funding for personal PM2.5 monitors that hang around a volunteer’s neck and measure both outdoor and indoor exposures. (PM2.5 refers to airborne particulate matter 2.5 micrometers or less in diameter. That’s about 1/40 the width of a human hair.)
The project also set up outdoor ambient monitors at 12 sites so that “official” outdoor data could be correlated with results from the personal monitors. Twenty neighborhood residents wore the monitors for 72 consecutive hours in each of three seasons, starting last summer, with the winter cohort completed in February.
“Our ultimate goal is to have citizens be able to access and make sense of the data for informed choices,” Cicutto said.
Before the monitoring began, researchers convened focus groups to get a baseline of what people understood about air quality information and pollution sources, and what they wanted to know for their family’s health. After the monitoring stage, researchers will work on creating new dashboards and other dissemination methods that make air quality information more useful to residents.
Current air quality information and advice is confusing for everyone, let alone busy families and those using English as a second language. “When you say PM2.5, a lot of people think that means 2:30 in the afternoon,” Cicutto said. “There were a lot of lessons learned. For those who have conditions, they don’t like being called ‘vulnerable’ and ‘sensitive.’”
One purpose of the personal monitors is to show people what indoor sources they can control. It’s usually a big eye-opener for any family, Cicutto said. People are exposed to higher levels of PM2.5 when they cook without venting, vacuum, use candles, use aerosol-based kitchen cleaners, apply makeup, and smoke or vape cannabis or tobacco. An encouraging development, Cicutto said, was how much more engaged the volunteers were in their second season of monitoring after getting coached on the results from their first season.
National Jewish is also sharing the results of its “gold standard” ambient outdoor monitors with state monitors, to better assess the accuracy of Front Range pollutant counts. “We do know that once (pollution) gets into the red, the monitors tend to underestimate it,” Cicutto said. (The state follows the EPA’s color-coded, six-tier rating system for the air quality index, or AQI; red is considered an unhealthy AQI for all groups.) Researchers will work with equipment manufacturers and the state to interpret results, she said.
Finding better ways to engage the public on daily air monitoring is crucial to health, said Joann Strother, director of advocacy in the western division of the American Lung Association. “Especially to children—their lungs have not yet grown to their full potential and they spend a lot of time outdoors,” she said. “We want parents to know air quality can be harmful, and to keep track of those high days.”
Researchers are also learning, though, that policy or health advice solutions are no simpler than the measurements themselves. Some school leaders or neighborhood activists might want the clear, absolutist policy change—keep all kids indoors on poor air-quality days. But that’s not necessarily what families want when they participate in focus groups on air pollution, Cicutto said.
“When they weighed the pros and cons, they felt at the lower levels, going outside to exercise might be better than keeping them indoors,” Cicutto said. “And if you keep inside the kids with asthma? They were afraid of stigmatizing their child. So how we actually roll these recommendations into what we know from science is going to have to be explored more, and it’s going to have to be nuanced.”
Globeville residents say their fears become much more tangible on winter days when the notorious “brown cloud” smog returns. Again, the Front Range geography and weather patterns contribute, with warm convection air on the ground bumping up against a cold-air layer coming across the mountains, creating a meteorological inversion and leaving a visible smear of ozone, smoke, dust and other particles.
“I spent 2015 and ‘16 in Beijing, with its famous smog problem,” said Globeville resident Laura Shunk. “I often quelled my anxieties there with the idea, ‘I won’t be here forever, I’m eventually going back to a place where there’s cleaner air.’ And [in early March] we hit 150 on the [AQI] scale here—and in Beijing at 150 they said you should wear a mask. I thought, I don’t want this to happen to Denver.” (In the EPA air quality index, 150 is the lower border of that infamous “red” zone.)
Colorado’s more volatile winter this season created more of the high-profile brown cloud days, though emissions themselves were not as volatile, said Jonathan Samet, MD, dean of the Colorado School of Public Health and an epidemiologist specializing in inhaled pollutants.
Global concerns about air pollution have been growing even as most U.S. metro areas have reduced most measured pollutants, Samet said. The World Health Organization has called air pollution “the new smoking,” based in part on recent studies that expanded estimates of how much disability and death is due to air pollution over time.
“I wouldn’t want to sound a huge alarm at Denver’s levels,” Samet said. “That said, if I had a child with severe asthma, I would be concerned when levels are high, and the right thing to do is keep them indoors.”
As for ozone, Samet added, researchers are now learning that sensitivity varies greatly and is linked to genetic factors. “I’m not sure we fully understand the data yet,” he said.
Globeville resident Shunk appreciates the renewed emphasis on pollution measurements for her neighborhood, but knows the eventual big-picture solutions will be difficult.
“Giving a school a sensor is nice, but without actually taking steps to really deal with the problem—taking cars off the road—I don’t know that those rates go down,” she said. “As a city, we haven’t thought about it in so long, I do think there’s an education component to this—that this is bad, and it’s headed in a bad direction.”